Using Existing Drugs in New Ways to Treat & Cure Diseases of Brain & Body | Dr. David Fajgenbaum
David Fajgenbaum: ...
大卫·法根鲍姆：...
my doctor explained to me that we were out of options.
我的医生向我解释说我们别无选择。
He said, "David, we've tried everything.
他说：“大卫，我们已经尝试了一切。
We tried these chemotherapies, we tried this one experimental drug.
我们尝试了这些化疗，我们尝试了这种实验药物。
There's nothing more that we can do." There was a few-minute period where my dad, and my sisters, and my girlfriend were around me, and we were just bawling our eyes out.
我们无能为力。”有几分钟的时间，我的爸爸、我的姐妹们和我的女朋友都在我身边，我们只是痛哭流涕。
This is the world's expert.
这就是世界专家。
And I kept probing him, "Is there any cell type or signaling pathway or is there something we can target?"
我不断地询问他，“是否有任何细胞类型或信号通路，或者有什么我们可以瞄准的东西？”
David Fajgenbaum: And then he said, "David, there's nothing." "Is there anything in early stage of development?" "David, there is nothing." I heard what he was saying, but then I thought to myself, "You just gave me seven chemotherapies that were made for lymphoma and multiple myeloma, and they've saved my life now three times.
David Fajgenbaum：然后他说，“大卫，什么都没有。” “有什么处于早期开发阶段吗？” “大卫，什么都没有。”我听到了他的话，但后来我心里想：“你刚刚给了我七种针对淋巴瘤和多发性骨髓瘤的化疗，它们已经三次救了我的命。
It's not long-term.
这不是长期的。
I know I keep relapsing, but if these seven chemotherapies are working, how do we know there's not an eighth chemotherapy, or a ninth drug for something else?
我知道我的病情一直在复发，但如果这七种化疗有效，我们怎么知道没有第八种化疗或第九种药物用于其他治疗？
You can't tell me...
你不能告诉我...
We haven't tried all 4,000 drugs.
我们还没有尝试过所有 4,000 种药物。
We've just tried the drugs that maybe we thought to try."
我们刚刚尝试了我们可能想尝试的药物。”
David Fajgenbaum: And so, I just locked in right then, and I turned to my family and just sort of wiped away my tears and said, "I'm going to dedicate the rest of my life, however long that's going to be, it might be a couple of days, maybe it'll be a couple of months, but however long I've got to try to find out, is there a drug out there that could help me and other patients with my disease that's made for another condition?" I just believe that the 4,000 drugs we have today should help all the patients who can benefit from them.
David Fajgenbaum：所以，我当时就锁定了目标，然后转向我的家人，擦干眼泪说：“我将奉献我的余生，无论这会持续多久，可能是几天，也许是几个月，但无论我需要花多长时间来找出答案，是否有一种药物可以帮助我和其他患有我的疾病的患者，而这种药物是针对另一种情况而设计的？”我只是相信我们今天拥有的4000种药物应该可以帮助所有能够从中受益的患者。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
David Fajgenbaum: Period.
大卫·法根鲍姆：就是这样。
No one should suffer if there's a drug at your CVS that could help you.
如果您的 CVS 中有一种可以帮助您的药物，那么没有人会受苦。
Andrew Huberman: Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
Andrew Huberman：欢迎来到 Huberman 实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
Andrew Huberman: I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
安德鲁·胡伯曼：我是安德鲁·胡伯曼，我是斯坦福大学医学院的神经生物学和眼科教授。
My guest today is Dr. David Fajgenbaum.
今天我的嘉宾是戴维·法根鲍姆博士。
Dr. David Fajgenbaum is a professor of translational medicine and human genetics at the University of Pennsylvania.
David Fajgenbaum 博士是宾夕法尼亚大学转化医学和人类遗传学教授。
Andrew Huberman: His work focuses on finding novel cures to both rare and common human diseases by using drugs and other treatments that already exist and that are approved for use in humans for other purposes.
Andrew Huberman：他的工作重点是通过使用现有的药物和其他治疗方法来寻找罕见和常见人类疾病的新疗法，这些药物和其他治疗方法已被批准用于人类其他目的。
As it turns out, most approved drugs impact at least 40 different pathways and mechanisms across the human brain and body, but these drugs are generally approved for use in just one or two of those pathways.
事实证明，大多数批准的药物会影响人类大脑和身体中至少 40 种不同的途径和机制，但这些药物通常只批准用于其中的一两个途径。
Andrew Huberman: David shares with us the many commonly unknown yet powerful benefits of drugs that are already approved for things like heart health, combating cancer, neurodegeneration, and more.
Andrew Huberman：David 与我们分享了许多常见的未知但强大的药物益处，这些药物已被批准用于心脏健康、抗癌、神经退行性疾病等。
From his own near-death experience with Castleman's disease, David discovered that the medical profession already has in hand excellent treatments, and perhaps even cures, for many of the childhood and adult diseases that the medical profession deems uncurable or untreatable.
大卫从自己患卡斯尔曼氏病的濒死经历中发现，对于许多医学界认为无法治愈或无法治疗的儿童和成人疾病，医学界已经掌握了极好的治疗方法，甚至可能治愈。
Andrew Huberman: In addition to running his laboratory, where they search for novel treatments and cures using already approved drugs, David has started a not-for-profit called Every Cure, which helps people find treatments and cures to diseases that the medical field has essentially deemed untreatable.
安德鲁·胡伯曼：除了经营他的实验室，使用已经批准的药物寻找新的治疗方法和治愈方法外，大卫还创办了一个名为“Every Cure”的非营利组织，帮助人们找到医学领域基本上认为无法治疗的疾病的治疗方法和治愈方法。
And that work has already saved countless lives.
这项工作已经拯救了无数的生命。
Our discussion today is about how to navigate your health journey and how to approach the treatment of any illness that you or a relative may face.
我们今天的讨论是关于如何引导您的健康之旅以及如何治疗您或亲戚可能面临的任何疾病。
Andrew Huberman: It's also about the fact that while the fields of medicine and science are truly incredible and well-intentioned, they do have a giant blind spot built into them, which is that many effective treatments, and in some cases cures, exist to diseases that we are told are hopeless to treat, and that even the best trained and well-meaning MDs are often unaware of those treatments.
Andrew Huberman：还有一个事实是，虽然医学和科学领域确实令人难以置信且善意，但它们确实存在一个巨大的盲点，即对于我们被告知无望治疗的疾病，存在许多有效的治疗方法，在某些情况下还有治愈方法，而且即使是训练有素、善意的医学博士也常常不知道这些治疗方法。
Not because they are lazy or that they have some other agenda, but simply because of how medications are studied, patented, and categorized.
并不是因为他们懒惰或有其他议程，而仅仅是因为药物的研究、专利和分类方式。
As you'll soon learn, Dr. Fajgenbaum is on a mission to educate doctors, scientists and most importantly, you, the general public, about these facts.
您很快就会了解到，Fajgenbaum 博士的使命是向医生、科学家，最重要的是向您，即公众，宣传这些事实。
He has lived them directly.
他直接经历过它们。
He's an MD who got very sick with what he was told was a terminal disease, and when the existing system left him at a cliff, he went about curing that disease using old medications in new ways, and he is now helping others who need to do the same.
他是一名医学博士，被告知患有绝症，病得很重，当现有的系统把他逼到悬崖边时，他开始用旧的药物以新的方式治愈这种疾病，现在他正在帮助其他需要这样做的人。
Andrew Huberman: Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
Andrew Huberman：在我们开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。
It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public.
然而，我的愿望和努力的一部分是将有关科学和科学相关工具的零成本消费者信息带给公众。
In keeping with that theme, today's episode does include sponsors.
为了与这个主题保持一致，今天的节目确实有赞助商。
And now for my discussion with Dr. David Fajgenbaum.
现在我与 David Fajgenbaum 博士进行了讨论。
Andrew Huberman: Dr. David Fajgenbaum, welcome.
Andrew Huberman：David Fajgenbaum 博士，欢迎光临。
David Fajgenbaum: Thanks so much for having me.
David Fajgenbaum：非常感谢您邀请我。
Andrew Huberman: These days, people are very concerned about their health, even if they're healthy, and I think the reason for that is ever since 2020, I think people have started to realize that they need to do more self-advocacy in terms of their health, whether or not it's behaviors to take care of their health, learning how to explore medical and health information online more effectively.
Andrew Huberman：现在，人们非常关心自己的健康，即使他们很健康，我认为原因是从2020年开始，我认为人们开始意识到他们需要在健康方面做更多的自我宣传，无论是关心自己健康的行为，还是学习如何更有效地在网上探索医疗和健康信息。
Andrew Huberman: No one knows who to trust, and yet people are realizing that they are a critical element in their health, and should they encounter challenges to their health, they realize they can no longer be passive participants and just go to their doctor, that doctors are human too.
安德鲁·胡伯曼：没有人知道该相信谁，但人们正在意识到他们是健康的关键因素，如果他们的健康遇到挑战，他们意识到他们不能再成为被动的参与者而只是去看医生，医生也是人。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: So, you have a very unique health story, and we'll get into that, but maybe we just start off by educating people a little bit about some of the common misperceptions in order to give them more sense of agency about what they can do.
安德鲁·休伯曼：所以，你有一个非常独特的健康故事，我们将对此进行讨论，但也许我们首先要教育人们一些常见的误解，以便让他们对自己能做什么有更多的代理感。
Andrew Huberman: One of the things that you've been very vocal about is that you believe, through experience and observation, that many of the treatments or even potential cures for the things that challenge people may already exist in the form of medicines that are prescribed or available, maybe even over the counter, but that people, including doctors, are not aware of that.
安德鲁·休伯曼：你一直直言不讳的一件事是，你相信，通过经验和观察，许多治疗方法甚至潜在的治愈方法可能已经以处方药或可用药物的形式存在，甚至可能是非处方药，但人们，包括医生，并没有意识到这一点。
David Fajgenbaum: Right.
大卫·法根鲍姆：对。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: Could you just elaborate on that?
Andrew Huberman：您能详细说明一下吗？
What we're basically saying is the answers may already be here.
我们基本上想说的是，答案可能已经在这里了。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
Well, first off, I love that you're talking about agency in health and in medicine, because I think oftentimes we talk about agency, I can get a good night's sleep, or I can exercise and eat well in the sense of wellness, but oftentimes when people get really sick with a horrible disease, whether it's cancer or Castleman's, feel like, "Well, we're just going to do whatever our doctor, our local doctor tells us to do." But you're right.
嗯，首先，我喜欢你谈论健康和医学领域的能动性，因为我认为我们经常谈论能动性，我可以睡个好觉，或者我可以在健康的意义上锻炼身体和吃得好，但通常当人们患上可怕的疾病时，无论是癌症还是卡斯尔曼氏病，都会感觉，“好吧，我们只是要做我们的医生，我们当地的医生告诉我们做的事情。”但你是对的。
I think that there's so much more that we can do, and there's so much agency that we can take.
我认为我们可以做的还有很多，我们可以采取的行动也很多。
And part of it, to your point, is that there are drugs that we have.
就你而言，部分原因是我们拥有毒品。
David Fajgenbaum: There's 4,000 FDA-approved drugs that are approved for about 4,000 diseases, but we know from laboratory work, and also from clinical trials, that many of those drugs can be used in more diseases, but unfortunately the system really isn't set up to find new uses for old medicines.
David Fajgenbaum： FDA 批准了 4,000 种药物，被批准用于大约 4,000 种疾病，但我们从实验室工作和临床试验中知道，其中许多药物可以用于更多疾病，但不幸的是，该系统实际上并不是为寻找旧药物的新用途而建立的。
And so, that's the work that I do, but I also think it gives all of us really a sense of responsibility that if we're diagnosed with a bad disease, that we find out what's the disease organization advocacy group.
所以，这就是我所做的工作，但我也认为这给了我们所有人真正的责任感，如果我们被诊断出患有严重疾病，我们会找出疾病组织倡导小组是什么。
Maybe they're aware of a drug being used in one part of the world that others aren't.
也许他们知道世界上某个地方正在使用一种药物，而其他地方却没有。
David Fajgenbaum: Who's the leading expert?
David Fajgenbaum：谁是首席专家？
Can you go drive to see the leading expert?
你能开车去见首席专家吗？
And can you make sure that once the expert tells you what to take, you ask questions like, "Is there potentially something else?"
你能确保一旦专家告诉你该采取什么措施，你就会提出诸如“是否还有其他可能的事情？”之类的问题。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
I think of aspirin, for instance.
例如，我想到阿司匹林。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Most people think of aspirin as a pain reliever.
安德鲁·休伯曼：大多数人认为阿司匹林是一种止痛药。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: But aspirin is now used as a way to offset heart attacks.
安德鲁·胡伯曼：但阿司匹林现在被用作抵消心脏病发作的一种方法。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: For its blood-thinning effects, among other effects.
Andrew Huberman：除了其他功效外，还因为它的血液稀释作用。
Just off the top of your head, I'm not trying to test you here.
就你的想法而言，我并不是想在这里测试你。
You're the MD, I'm the PhD, as we were talking about before, and I'm not going to test you on medicine, I'm not equipped to.
你是医学博士，我是博士，正如我们之前讨论的那样，我不会对你进行医学测试，我没有能力这样做。
David Fajgenbaum: No.
大卫·法根鲍姆：不。
Andrew Huberman: But are there other uses for aspirin that we perhaps haven't heard of, or similar drugs that might surprise people?
Andrew Huberman：但是阿司匹林还有其他我们可能没有听说过的用途，或者类似的药物可能会让人们感到惊讶吗？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah, aspirin also has been shown to reduce risk of recurrence of colon cancer.
David Fajgenbaum：是的，阿司匹林也被证明可以降低结肠癌复发的风险。
Particularly, individuals with colon cancer who have a mutation actually in the mTOR pathway.
特别是，mTOR 通路实际上发生突变的结肠癌患者。
But because it's aspirin, because it's sort of widely available, and it doesn't have maybe the same sort of system behind its use, it's really not actually utilized by all the patients that have colon cancer to reduce the risk of recurrence of colon cancer.
但因为它是阿司匹林，因为它被广泛使用，而且它的使用背后可能没有相同的系统，所以实际上并没有被所有患有结肠癌的患者用来降低结肠癌复发的风险。
And that's sort of mind-blowing in itself, and there are other great examples.
这本身就令人兴奋，还有其他很好的例子。
David Fajgenbaum: Many folks have probably heard about how Viagra was repurposed from heart disease to its well-known use.
David Fajgenbaum：很多人可能都听说过伟哥如何从心脏病转变为众所周知的用途。
Most people are aware of erectile dysfunction, but most people don't realize that it's also been repurposed for a rare pediatric lung disease.
大多数人都知道勃起功能障碍，但大多数人没有意识到它也被重新用于治疗一种罕见的小儿肺部疾病。
Kids were dying because they weren't getting enough blood flow to their lungs, and if they take Viagra, they can actually get blood flow to their lungs and live full lives on Viagra.
孩子们因为没有足够的血液流向肺部而濒临死亡，如果他们服用伟哥，他们实际上可以让血液流向肺部并靠伟哥过上充实的生活。
And that, fortunately, was discovered early on in the patent life of Viagra, so there was really a way to push it forward.
幸运的是，这一点在伟哥专利寿命的早期就被发现了，所以确实有办法推动它向前发展。
But a lot of times, these happen after drugs are generic.
但很多时候，这些都是在药物成为仿制药之后发生的。
Andrew Huberman: Yeah, isn't it that the cousin of Viagra, Cialis, was initially tadalafil, used to encourage prostate health, circulation to the prostate, and then only later was it discovered to have these other effects related to sexual function?
Andrew Huberman：是的，伟哥的表亲西力士不是最初是他达拉非，用于促进前列腺健康和前列腺循环，后来才发现它具有与性功能相关的其他作用吗？
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: That's right, yeah.
David Fajgenbaum：没错，是的。
And then we talked about the side effect of a drug, it can be bad or can be good.
然后我们讨论了药物的副作用，它可能是坏的，也可能是好的。
We were chatting earlier, the average small molecule, so a drug that's approved for a condition, can bind between 20 and 30 different proteins in the body.
我们之前讨论过，一般的小分子，即被批准用于治疗某种疾病的药物，可以结合体内 20 到 30 种不同的蛋白质。
So, we call a drug...
所以，我们称药物...
We say it does one thing, but actually it's doing a lot of other things in the body, and unless that drug company began working on it early on for that condition, oftentimes those insights and those other roles for the medicine just fall through the cracks.
我们说它做了一件事，但实际上它在体内做了很多其他事情，除非制药公司很早就开始针对这种情况进行研究，否则通常这些见解和药物的其他作用就会被忽视。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
Andrew Huberman: So, the idea that a drug is useful for other things aside from what it's best known for is seldom discussed, whereas side effects are being discussed more and more nowadays.
Andrew Huberman：因此，人们很少讨论药物除了其最著名的用途之外还有其他用途的想法，而如今人们越来越多地讨论副作用。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: Tell us about lidocaine.
安德鲁·休伯曼：给我们介绍一下利多卡因。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
Andrew Huberman: This is fascinating.
安德鲁·休伯曼：这很有趣。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
So, yeah, I couldn't believe it when we came across this.
所以，是的，当我们遇到这个时我简直不敢相信。
So, I run a nonprofit called Every Cure.
因此，我经营着一个名为“Every Cure”的非营利组织。
We scan the world's knowledge of every drug and every disease to find new uses for the medicines we have, and when we came across lidocaine, we were just sort of blown away.
我们扫描了世界上每种药物和每种疾病的知识，以寻找我们现有药物的新用途，当我们遇到利多卡因时，我们有点震惊。
So, lidocaine, of course, the numbing medicine you get if you go to the dentist, and it's used wholly for the body for numbing all kinds of things.
所以，利多卡因，当然，你去看牙医时会得到的麻醉药，它完全用于身体，使各种东西麻木。
David Fajgenbaum: There's interesting data, actually a large trial that was done in India, of 1,600 patients, where women who had localized breast cancer, if they had lidocaine injected around the tumor before surgery, eight to ten minutes before surgery, there was a 29% reduction in mortality at five years, versus those who did not have lidocaine injected.
David Fajgenbaum：有一个有趣的数据，实际上是在印度进行的一项针对 1,600 名患者的大型试验，其中患有局限性乳腺癌的女性，如果在手术前（即手术前 8 到 10 分钟）在肿瘤周围注射利多卡因，与未注射利多卡因的女性相比，五年后死亡率会降低 29%。
Andrew Huberman: Wow.
安德鲁·休伯曼：哇。
David Fajgenbaum: Now, lidocaine is already going to be used during the surgery, it's used at the site of the incision, it's widely used in so many cases.
David Fajgenbaum：现在，利多卡因已经在手术过程中使用，它用在切口部位，它在很多情况下被广泛使用。
And what's so interesting, it was published in a great journal, the "Journal of Clinical Oncology," yet there's still been barely any uptake all around the world.
有趣的是，它发表在一本伟大的期刊《临床肿瘤学杂志》上，但全世界仍然几乎没有任何人接受它。
David Fajgenbaum: And so, this is just sort of another example for us for why you've got to have an entity that's looking for these great opportunities and then actually doing the work to make sure that they get into patients, because there's close to no downside of something like lidocaine, and if the upside's as high as a 30% reduction in mortality, I don't know how it's not being used all over the place.
David Fajgenbaum：所以，这对我们来说只是另一个例子，说明为什么你必须有一个实体来寻找这些巨大的机会，然后实际开展工作以确保它们进入患者体内，因为像利多卡因这样的药物几乎没有任何负面影响，而且如果其好处高达降低死亡率 30%，我不知道为什么它没有被广泛使用。
Andrew Huberman: Is lidocaine an expensive drug?
Andrew Huberman：利多卡因是一种昂贵的药物吗？
David Fajgenbaum: It's a very inexpensive drug.
David Fajgenbaum：这是一种非常便宜的药物。
It's pennies an injection, and that doesn't mean anyone's hiding lidocaine.
注射一次只需几美分，但这并不意味着有人隐藏利多卡因。
I'm of the belief that drug companies do such important work to develop brand new drugs and they're so good at it, they do a great job getting those drugs to be used for the uses that they're intended for, and it's no one's fault, but once that drug becomes generic, like lidocaine's been generic for decades, that means that there's a number of other companies that make the exact same drug, and the profit for each of those doses becomes close to pennies an injection.
我相信制药公司在开发全新药物方面做了如此重要的工作，而且他们非常擅长，他们在让这些药物用于其预期用途方面做得很好，这不是任何人的错，但一旦这种药物成为仿制药，就像利多卡因已经仿制药几十年了，这意味着有许多其他公司生产完全相同的药物，并且每种剂量的利润变得接近一针几便士。
David Fajgenbaum: And so, again, it's not that anyone's hiding it, but it's just that no entity is incentivized to actually go call on doctors and say, "Hey, did you do the lidocaine before your surgery?" Or to really push to get them into guidelines.
David Fajgenbaum：所以，再说一次，并不是有人隐瞒了这一点，而是没有任何实体有动力去拜访医生并说：“嘿，你在手术前服用了利多卡因吗？”或者真正推动将它们纳入指导方针。
And I will say, this was a really major study, this study that was published, or that was done in India, it was published in a great journal.
我想说，这是一项非常重要的研究，这项研究已发表，或者是在印度进行的，发表在一本很棒的期刊上。
There's interesting laboratory data, but we at Every Cure actually feel responsible to better understand the potential mechanism for how it might work, and also to review the evidence wholly before we actually go out and start encouraging everyone to do it.
有一些有趣的实验室数据，但我们 Every Cure 实际上感到有责任更好地了解其工作原理的潜在机制，并在我们真正出去并开始鼓励每个人这样做之前全面审查证据。
David Fajgenbaum: So, there's still steps that have to be taken, but our belief is that when you come across something that looks promising like this, we need to have some group that's actually pushing and pushing to make sure that it actually gets to patients once you feel comfortable with the data.
David Fajgenbaum：所以，仍然需要采取一些步骤，但我们相信，当你遇到像这样看起来有希望的东西时，我们需要有一些团队真正推动并推动，以确保一旦你对数据感到满意，它就会真正到达患者手中。
Andrew Huberman: I'd like to take a quick break and acknowledge our sponsor, Eight Sleep.
Andrew Huberman：我想稍微休息一下，并向我们的赞助商“八睡”表示感谢。
Eight Sleep makes smart mattress covers with cooling, heating, and sleep tracking capacity.
August Sleep 生产具有冷却、加热和睡眠跟踪功能的智能床垫套。
One of the best ways to ensure a great night's sleep is to make sure that the temperature of your sleeping environment is correct, and that's because in order to fall and stay deeply asleep, your body temperature actually has to drop by about one to three degrees.
确保一夜好眠的最佳方法之一是确保睡眠环境的温度正确，这是因为为了入睡并保持深度睡眠，您的体温实际上必须下降约一到三度。
And in order to wake up feeling refreshed and energized, your body temperature actually has to increase by about one to three degrees.
为了醒来时感觉神清气爽、精力充沛，您的体温实际上必须升高约一到三度。
Andrew Huberman: Eight Sleep automatically regulates the temperature of your bed throughout the night according to your unique needs.
Andrew Huberman：Eight Sleep 会根据您的独特需求自动调节整个晚上的床温。
Eight Sleep has just launched their latest model, the Pod 5, and the Pod 5 has several new important features.
八睡眠刚刚推出了他们的最新型号 Pod 5，Pod 5 有几个新的重要功能。
One of these new features is called Auto Pilot.
这些新功能之一称为自动驾驶仪。
Auto Pilot is an AI engine that learns your sleep patterns to adjust the temperature of your sleeping environment across different sleep stages.
Auto Pilot 是一款人工智能引擎，可以学习您的睡眠模式，从而调整不同睡眠阶段的睡眠环境温度。
It also elevates your head if you're snoring, and it makes other shifts to optimize your sleep.
如果您打鼾，它还会抬高您的头部，并进行其他转换以优化您的睡眠。
Andrew Huberman: The base on the Pod 5 also has an integrated speaker that syncs to the Eight Sleep app and can play audio to support relaxation and recovery.
Andrew Huberman：Pod 5 的底座还配有一个集成扬声器，可与八睡眠应用程序同步，并可以播放音频以支持放松和恢复。
I've been sleeping on an Eight Sleep mattress cover for over four years now, and it has completely transformed and improved the quality of my sleep.
我已经睡在八睡眠床垫罩上四年多了，它彻底改变并改善了我的睡眠质量。
If you'd like to try Eight Sleep, go to eightsleep.com/huberman to get up to 350 dollars off the new Pod 5.
如果您想尝试八睡眠，请访问八睡眠.com/huberman，新款 Pod 5 最高可享受 350 美元的优惠。
Eight Sleep ships to many countries worldwide, including Mexico and the UAE.
八号睡眠船运往世界各地的许多国家，包括墨西哥和阿联酋。
Again, that's eightsleep.com/huberman to save up to 350 dollars.
再次强调，访问八sleep.com/huberman 最多可节省 350 美元。
Andrew Huberman: Today's episode is also brought to us by Rorra.
Andrew Huberman：今天的节目也是由 Rorra 为我们带来的。
Rorra makes what I believe are the best water filters on the market.
我认为 Rorra 制造的是市场上最好的滤水器。
It's an unfortunate reality, but tap water often contains contaminants that negatively impact our health.
这是一个不幸的现实，但自来水通常含有对我们的健康产生负面影响的污染物。
In fact, a 2020 study by the Environmental Working Group estimated that more than 200 million Americans are exposed to PFAS chemicals, also known as forever chemicals, through drinking of tap water.
事实上，环境工作组 2020 年的一项研究估计，超过 2 亿美国人通过饮用自来水接触到 PFAS 化学物质（也称为永久化学物质）。
Andrew Huberman: These forever chemicals are linked to serious health issues, such as hormone disruption, gut microbiome disruption, fertility issues, and many other health problems.
Andrew Huberman：这些永久性化学物质与严重的健康问题有关，例如激素紊乱、肠道微生物组破坏、生育问题和许多其他健康问题。
The Environmental Working Group has also shown that over 122 million Americans drink tap water with high levels of chemicals known to cause cancer.
环境工作组还表明，超过 1.22 亿美国人饮用的自来水含有大量已知致癌化学物质。
It's for all these reasons that I'm thrilled to have Rorra as a sponsor of this podcast.
出于所有这些原因，我很高兴 Rorra 作为这个播客的赞助商。
I've been using the Rorra countertop system for almost a year now.
我使用 Rorra 台面系统已经快一年了。
Andrew Huberman: Rorra's filtration technology removes harmful substances, including endocrine disruptors and disinfection byproducts, while preserving beneficial minerals like magnesium and calcium.
Andrew Huberman：Rorra 的过滤技术可以去除有害物质，包括内分泌干扰物和消毒副产物，同时保留镁和钙等有益矿物质。
It requires no installation or plumbing.
它不需要安装或管道。
It's built from medical-grade stainless steel, and its sleek design fits beautifully on your countertop.
它由医用级不锈钢制成，其时尚的设计非常适合您的台面。
In fact, I consider it a welcome addition to my kitchen.
事实上，我认为它对我的厨房来说是一个受欢迎的补充。
It looks great, and the water is delicious.
看起来很棒，水也很美味。
If you'd like to try Rorra, you can go to rorra.com/huberman and get an exclusive discount.
如果您想尝试 Rorra，可以访问 rorra.com/huberman 并获得独家折扣。
Again, that's Rorra, R-O-R-R-A.com/huberman.
再说一次，那是 Rorra，R-O-R-R-A.com/huberman。
Andrew Huberman: There are a couple avenues that we could explore, given what you've said so far, but the one I'd like to drill into a bit is this thing related to drug companies and patents.
Andrew Huberman：鉴于您到目前为止所说的内容，我们可以探索几种途径，但我想深入探讨的是与制药公司和专利相关的事情。
I don't want to set up the idea that everything is conspiratorial, and yet years ago, when my laboratory was working on eye diseases, glaucoma in particular, I spent a lot of time around people working at companies that develop drug treatments for eye diseases.
我不想让人们认为一切都是阴谋，但几年前，当我的实验室研究眼部疾病，特别是青光眼时，我花了很多时间与在开发眼部疾病药物治疗的公司工作的人们在一起。
They've developed great drugs for the treatment of over-vascularization of the eye, for instance, that can cause blindness or it's related to some blinding diseases.
例如，他们开发了治疗眼睛过度血管化的优秀药物，这种血管化可能导致失明或与某些致盲疾病有关。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And I learned that many of these drugs go to market.
Andrew Huberman：我了解到许多这些药物都进入了市场。
They are, quote, unquote, blockbuster drugs.
它们是，引用，不引用，重磅药物。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: People's symptoms improve.
Andrew Huberman：人们的症状有所改善。
These drug companies make a lot of money.
这些制药公司赚了很多钱。
And then the patent is headed toward expiration, and at that point, the cost of the drug drops markedly.
然后专利即将到期，此时药物的成本显着下降。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: So, the drug companies are heavily incentivized, I learned, to find new uses for that drug to renew the patent under this new application to basically keep the generics away.
Andrew Huberman：因此，据我所知，制药公司非常积极地寻找该药物的新用途，以根据该新申请更新专利，以基本上阻止仿制药的出现。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Yep.
是的。
Andrew Huberman: And on the one hand, it makes sense because the research and development for a drug is exceedingly expensive, and so if they can repurpose a drug and maintain the patent for two diseases, essentially, one drug, two diseases, this is kind of the bread and butter of how drug companies get and remain very wealthy.
Andrew Huberman：一方面，这是有道理的，因为一种药物的研发非常昂贵，所以如果他们能够重新利用一种药物并维持两种疾病的专利，本质上是一种药物，两种疾病，这就是制药公司获得并保持非常富有的基础。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: It has two, what I consider, kind of darker sides to it.
Andrew Huberman：我认为它有两个阴暗面。
One is that the generic, cheaper drugs don't arrive on market for a much longer period of time.
一是更便宜的仿制药不会在更长的时间内上市。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: The other side of the coin, however, is that people suffering from a different disease now can take this drug.
Andrew Huberman：然而，硬币的另一面是，患有不同疾病的人现在可以服用这种药物。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: But that second, darker piece is that drug companies are not very incentivized to go look for new molecules to treat new conditions.
安德鲁·胡伯曼：但第二个更黑暗的部分是，制药公司并没有很大的动力去寻找新的分子来治疗新的病症。
They are heavily incentivized to use old molecules to treat new conditions and maintain control.
他们被强烈激励使用旧分子来治疗新病症并保持控制。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: There's a lot in this statement, but my understanding is this is how it works.
Andrew Huberman：这个声明中有很多内容，但我的理解是它是这样运作的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And so, how do you reconcile that?
Andrew Huberman：那么，你如何协调这一点呢？
I mean, how is it that we should be exploring existing drugs for new conditions, but do it in a way that's really driven toward curing a disease, as opposed to just kind of finding a new purpose so we can keep the generics out for a while?
我的意思是，我们为什么应该探索现有的药物来治疗新的病症，但要以真正致力于治愈疾病的方式进行，而不是仅仅寻找新的用途，以便我们可以暂时将仿制药排除在外？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
It such a great question.
这是一个很好的问题。
So, you're absolutely right that, as drugs begin to reach their patent cliff, oftentimes the drug will be...
所以，你是绝对正确的，当药物开始达到专利悬崖时，药物通常会......
The dose might be changed slightly, the formulation might be changed slightly to create new intellectual property so that way this sort of new version can be used in that same initial disease.
剂量可能会略有改变，配方可能会略有改变，以创造新的知识产权，这样这种新版本就可以用于相同的初始疾病。
Which, to your point, there's, I wouldn't say pros and cons.
就你的观点而言，我不会说优点和缺点。
There's side effects of that sort of a system.
这种系统有副作用。
David Fajgenbaum: But what is pretty clear is that companies will typically not, as it's getting close to patent exclusivity, find a new disease to go after with that drug.
David Fajgenbaum：但非常清楚的是，公司通常不会在接近专利独占权时找到一种新的疾病来用该药物治疗。
It's usually the same disease, it's just a new formulation, so that way they can keep working on that disease.
通常是同一种疾病，只是一种新的配方，这样他们就可以继续研究这种疾病。
And what that means is that though that drug might be able to be used for a different disease, that's rarely explored.
这意味着虽然这种药物可能能够用于治疗不同的疾病，但很少有人对此进行探索。
David Fajgenbaum: And so, especially, to your point, once it's generic, I mean, all research and development discontinues, and even, you know, I mentioned earlier that there's 4,000 FDA-approved drugs.
David Fajgenbaum：所以，特别是就你的观点而言，一旦它成为仿制药，我的意思是，所有研究和开发都会停止，甚至，你知道，我之前提到有 4,000 种 FDA 批准的药物。
They work for 4,000 diseases.
它们对 4,000 种疾病有效。
That's incredible, but there's still 14,000 diseases that don't have a single treatment right now.
这令人难以置信，但目前仍有 14,000 种疾病没有单一治疗方法。
And of the 4,000 drugs we have, 80% of them are already generic, which means that there is no incentive to find a new use for those medicines.
在我们拥有的 4,000 种药物中，80% 已经是仿制药，这意味着没有动力去寻找这些药物的新用途。
David Fajgenbaum: So, every time I walk past a CVS, all I think about is how many drugs are in there that are used for one condition, but could actually help so many more kids, or adults with other conditions.
David Fajgenbaum：所以，每次我走过 CVS 时，我想到的就是里面有多少药物用于治疗一种病症，但实际上可以帮助更多患有其他病症的儿童或成人。
Andrew Huberman: And we're hearing a lot these days about lithium, as a potential protectant, for Alzheimer's or other forms of dementia.
Andrew Huberman：这些天我们听到很多关于锂作为阿尔茨海默病或其他形式痴呆症的潜在保护剂的消息。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: I don't know that the data are so solid that I'm ready to run out and take lithium, so I'm not suggesting that to anybody.
Andrew Huberman：我不知道数据是否可靠到我已经准备好用完锂来服用，所以我不会向任何人建议这一点。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: But I know a few psychiatrists that tell me for years they've been taking low-dose lithium for a couple months out of the year, based on their understanding of the data.
安德鲁·休伯曼：但我认识一些精神科医生，他们多年来告诉我，根据他们对数据的理解，他们每年有几个月服用低剂量锂。
So, you've got doctors doing things.
所以，你有医生在做事。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: People don't often talk about this, but doctors often will do things, based on their read of the literature that they're not talking to their patients about, because they're not in a position to do it ethically.
安德鲁·休伯曼：人们并不经常谈论这一点，但医生经常会根据他们阅读的文献来做一些他们没有与患者谈论的事情，因为他们无法道德地做到这一点。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
That's right.
这是正确的。
David Fajgenbaum: For sure.
大卫·法根鲍姆：当然。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: There's too much liability there.
Andrew Huberman：那里有太多的责任。
Where and how should the typical person without any training in medicine or science, or even a little background in science, go to find information about existing drugs, generic or otherwise, that could help them treat their ailments, be it a skin condition, or something as serious as cancer?
没有接受过任何医学或科学培训，甚至没有一点科学背景的典型人应该去哪里以及如何寻找有关现有药物（非专利药或其他药物）的信息，以帮助他们治疗疾病，无论是皮肤病还是癌症等严重疾病？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: What I'd recommend first is to make sure that you're connecting with whatever the disease group is for your condition.
David Fajgenbaum：我首先建议的是确保您与适合您病情的疾病组相关联。
They oftentimes are so well-connected with physicians all over the world, they hear about what things are being tried.
他们通常与世界各地的医生有着良好的联系，他们听说了正在尝试的事情。
So, connect with whatever your condition is, whatever that disease organization is.
因此，无论您的病情是什么，无论疾病组织是什么，都要与它联系。
Andrew Huberman: Could you explain disease organization?
Andrew Huberman：您能解释一下疾病的组织吗？
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
So, the Castleman Disease Collaborative Network is the group that's come together to support Castleman's patients, and to physicians and researchers.
因此，卡斯尔曼疾病合作网络是一个聚集在一起支持卡斯尔曼患者、医生和研究人员的团体。
There's an ALS association, for example.
例如，有一个 ALS 协会。
There's Michael J.
迈克尔·J.
Fox for Parkinson's disease.
福克斯治疗帕金森病。
So, find that group that has coalesced around your condition, because they'll oftentimes have, to your point, understanding about, "Hey, I heard this one patient's using this one thing." So, I'd go there first.
因此，找到围绕您的病情联合起来的小组，因为就您而言，他们通常会理解“嘿，我听说这个患者正在使用这一东西。”所以，我会先去那里。
David Fajgenbaum: The second is I would figure out where is the world's expert, who is that person that really is the guru.
David Fajgenbaum：第二个是我会弄清楚世界上的专家在哪里，谁是真正的大师。
They'll oftentimes have insights on these things.
他们常常会对这些事情有见解。
And then the third is to really keep asking questions.
第三是真正不断地提出问题。
So, even when they say, "This is the first thing that's recommended," well, is there something else that's used somewhere else?
因此，即使他们说“这是推荐的第一个东西”，那么还有其他东西在其他地方使用吗？
And I'll share one example of this.
我将分享一个这样的例子。
It's a bit heartbreaking, but also really powerful and informative, and that's that there's a rare condition called DADA2.
这有点令人心碎，但也非常强大且信息丰富，那就是有一种罕见的情况，称为 DADA2。
David Fajgenbaum: Basically, kids are born with a mutation in a gene that results in them having dozens and dozens of strokes from the time they're born, until they usually pass away in their teenage years because of the accumulated effect of literally dozens of strokes.
David Fajgenbaum：基本上，孩子出生时就带有基因突变，导致他们从出生起就患有数十次中风，直到他们通常在青少年时期去世，因为数十次中风的累积效应。
It's horrible.
太可怕了。
Well, about 20 years ago, a doctor apparently was treating a patient with DADA2, and also treating a patient with a form of vasculitis, and treated that patient with vasculitis with what's called a TNF inhibitor.
大约 20 年前，一位医生显然正在用 DADA2 治疗一名患者，同时也治疗一名患有某种血管炎的患者，并使用所谓的 TNF 抑制剂治疗该患者。
It inhibits this one cytokine called TNF.
它抑制一种称为 TNF 的细胞因子。
And he apparently had left TNF inhibitor in his vial, and he was like, "You know what?
他显然把 TNF 抑制剂留在了他的小瓶里，他说，“你知道吗？
We've got this kid over here having all these strokes.
我们这里有个孩子中风了。
Why don't I just try what I've got in this vial in this kid?" Well, the kid stopped having strokes.
我为什么不直接在这个孩子身上试试我这瓶里的东西呢？”好吧，这孩子不再中风了。
And that was amazing.
那真是太棒了。
And so, this doctor, the next few patients he had with DADA2, he treated them for their strokes.
因此，这位医生，接下来的几个接受 DADA2 治疗的患者，他治疗了他们的中风。
But about 10 years went by.
但大约10年过去了。
David Fajgenbaum: Meanwhile, hundreds and thousands of kids around the world are dying from DADA2, where the word wasn't being spread until this amazing doctor named Chip Chambers, sadly, had two children born with DADA2, and he started looking around to figure out and learned about, oh my gosh, TNF inhibitors.
David Fajgenbaum：与此同时，世界各地有成百上千的孩子死于 DADA2，这个消息直到这位名叫 Chip Chambers 的神奇医生不幸生下两个患有 DADA2 的孩子后才被传播开来，他开始四处寻找并了解天哪，TNF 抑制剂。
I was honored to be able to help Chip and his team to basically bring data together on the effectiveness of TNF inhibitors, also even come up with treatment guidelines for how do you treat DADA2.
我很荣幸能够帮助 Chip 和他的团队从根本上整合有关 TNF 抑制剂有效性的数据，甚至还提出如何治疗 DADA2 的治疗指南。
David Fajgenbaum: And it turns out that if you start kids on a TNF inhibitor, they stop having strokes, all over the world.
David Fajgenbaum：事实证明，如果让世界各地的孩子开始服用 TNF 抑制剂，他们就会停止中风。
Literally, it's a life-changer.
从字面上看，它改变了生活。
And so, the reason I share this as an example is that the world knew, someone in the world knew that you could save kids' lives with a TNF inhibitor, but the world didn't know, and we hadn't gotten the word out about it.
所以，我分享这个例子的原因是，世界都知道，世界上有人知道可以用 TNF 抑制剂拯救孩子的生命，但世界不知道，我们也没有得到相关消息。
And to me, that's so heartbreaking.
对我来说，这真是令人心碎。
It's almost like a travesty, you know?
这几乎就像一场闹剧，你知道吗？
David Fajgenbaum: It's one thing if you have a horrible disease, and everyone dies from it, and there's nothing out there.
David Fajgenbaum：如果你患有一种可怕的疾病，每个人都会死于它，而那里什么也没有，那是一回事。
But I think it's so much more heartbreaking when you think that, oh my gosh, there was something there.
但我认为，当你想到天哪，那里有什么东西时，那就更令人心碎了。
We as a system hadn't done the work to make sure people get the medicine.
作为一个系统，我们没有做好确保人们获得药物的工作。
Andrew Huberman: Yeah, I think it's a harsh reality that one's knowledge network really has a big impact on outcomes to disease.
安德鲁·休伯曼：是的，我认为一个严酷的现实是，一个人的知识网络确实对疾病的结果有很大的影响。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I mean, I sit surrounded by MDs and PhDs and people working on disease and treating disease, and I'll tell you, there's no question in my mind that, because I've experienced it when a friend's spouse or kid is dealing with something, I'm just one example of somebody who knows who to call, because I don't know the answer, but I know who might know the answer, and within two or three calls, that person is in touch with somebody who is in communication with the five or six people who are best at this around the world.
安德鲁·胡伯曼：我的意思是，我周围都是医学博士、博士以及从事疾病和治疗疾病工作的人，我会告诉你，毫无疑问，因为我在朋友的配偶或孩子正在处理某些事情时经历过这种情况，我只是知道该打电话给谁的人的一个例子，因为我不知道答案，但我知道谁可能知道答案，在两到三个电话内，那个人与正在与五六个人沟通的人取得联系。世界各地在这方面最擅长的人。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Exactly.
确切地。
Andrew Huberman: But most people don't have access to that.
Andrew Huberman：但大多数人无法接触到这一点。
It's one of the reasons I started this podcast, frankly to get people like you on here, people like Eddie Chang, who's a lifetime friend, and chair of neurosurgery at UCSF.
这是我开始这个播客的原因之一，坦率地说，是为了让像你这样的人加入到这里，像埃迪·张（Eddie Chang）这样的人，他是我一生的朋友，也是加州大学旧金山分校的神经外科主任。
I always say, "May you never need his help."
我总是说：“愿你永远不需要他的帮助。”
David Fajgenbaum: Right.
大卫·法根鲍姆：对。
Yeah.
是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: Right?
安德鲁·休伯曼：对吗？
But these are the people that I call when friends have questions about things unrelated to neurosurgery, for instance.
但例如，当朋友对与神经外科无关的问题有疑问时，我就会打电话给这些人。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: So, it seems to me there's a pretty straightforward solution, that in addition to these groups that are centered around certain diseases, there should be databases.
Andrew Huberman：所以，在我看来，有一个非常简单的解决方案，除了这些以某些疾病为中心的群体之外，还应该有数据库。
There should be ways that people can not just go online and ask a question, but go to a database, and say, "I was just diagnosed with..." or, "I'm having symptoms that are the following, and what are the existing prescription and non-prescription meds known to treat this?
应该有一些方法，让人们不仅可以上网提问，还可以访问数据库并说，“我刚刚被诊断出……”或者“我有以下症状，现有的已知可以治疗这种情况的处方药和非处方药有哪些？
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: What are the side effects?
安德鲁·休伯曼：副作用是什么？
But also, what are the potential pathways that overlap with other approved drugs that are prescription or over-the-counter?"
而且，与其他已批准的处方药或非处方药重叠的潜在途径是什么？”
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And then it should feed into a pipeline of how to get a hold of the people that could help treat that.
安德鲁·胡伯曼（Andrew Huberman）：然后它应该融入到如何找到可以帮助治疗这一问题的人员的渠道中。
It should be that straightforward.
应该就是这么简单。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Yeah.
是的。
Andrew Huberman: I mean, this is 2025.
Andrew Huberman：我的意思是，现在是 2025 年。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Exactly.
确切地。
Yeah.
是的。
Andrew Huberman: I mean, there's no reason why people should have to know somebody in the medical or scientific field at a major institution in order to be able to navigate this.
安德鲁·胡伯曼：我的意思是，人们没有理由必须认识大型机构的医学或科学领域的人才能解决这个问题。
David Fajgenbaum: I totally agree, and I think that the more I've gotten into this, the more surprised I've been that there hasn't been something like that.
David Fajgenbaum：我完全同意，而且我认为我对此了解得越多，就越惊讶于没有这样的事情发生。
This nonprofit I mentioned, Every Cure, so we use this, they're called biomedical knowledge graphs, basically mapping out what the world knows about human biology.
我提到的这个非营利组织，Every Cure，所以我们使用它，它们被称为生物医学知识图谱，基本上绘制出世界对人类生物学的了解。
We use an AI platform, and machine learning models to quantify how likely every drug is to treat every disease, and then we start at the top to go, what match looks promising.
我们使用人工智能平台和机器学习模型来量化每种药物治疗每种疾病的可能性，然后我们从顶部开始，看看什么匹配看起来有希望。
We've got nine active programs, and from those, we're moving them forward to reach patients.
我们有九个正在进行的项目，我们正在从这些项目中推动它们惠及患者。
David Fajgenbaum: And the idea is that, let's hope all nine of them end up being effective in helping patients.
David Fajgenbaum：我们的想法是，我们希望他们九个人最终都能有效地帮助患者。
That's sort of the start of this hopefully master list of additional uses for medicines that we already have.
这是我们已经拥有的药物其他用途的希望主要清单的开始。
But to your point, it's not just that they are speculative, but really that the work's been done to really prove that they actually work.
但就你的观点而言，它们不仅仅是推测性的，而且确实已经完成了工作来真正证明它们确实有效。
Andrew Huberman: I can't help but ask of some other examples of drugs that have been shown to treat things other than what most people associate that drug with.
Andrew Huberman：我忍不住要问一些其他药物的例子，这些药物已被证明可以治疗大多数人认为的药物以外的疾病。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
A few come to mind.
我想到了一些。
So, the first one's thalidomide.
所以，第一个是沙利度胺。
You probably have heard about the horrible birth defects that thalidomide caused, 50-plus years ago.
您可能听说过 50 多年前沙利度胺造成的可怕出生缺陷。
Andrew Huberman: Originally designed as an anti-miscarriage drug.
Andrew Huberman：最初被设计为一种抗流产药物。
David Fajgenbaum: Well, it was originally designed as anti-nausea for pregnant women.
David Fajgenbaum：嗯，它最初是为孕妇设计的止吐药。
So, the thought was that it could help them with their nausea.
所以，我们的想法是这可以帮助他们缓解恶心。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
Andrew Huberman: I see.
安德鲁·休伯曼：我明白了。
David Fajgenbaum: But it ended up causing horrible birth defects.
David Fajgenbaum：但它最终导致了可怕的出生缺陷。
Andrew Huberman: I see.
安德鲁·休伯曼：我明白了。
David Fajgenbaum: Children were born without limbs, and so it was taken off the market.
David Fajgenbaum：孩子出生时没有四肢，因此它被从市场上撤下。
But then about 20 years later, researchers figured out that it could be effective for leprosy.
但大约 20 年后，研究人员发现它可能对麻风病有效。
So, it's FDA-approved for leprosy, and then what's crazy is that shortly thereafter, it got FDA approval for multiple myeloma, a rare or somewhat rare hematologic blood cancer.
因此，它获得了 FDA 批准用于治疗麻风病，而令人疯狂的是，此后不久，它获得了 FDA 批准用于治疗多发性骨髓瘤，这是一种罕见或有些罕见的血液癌症。
David Fajgenbaum: And the reason that it can work for leprosy and multiple myeloma, and also the reason that it causes birth defects, is it has a major anti-angiogenic effect, so it reduces blood vessel growth.
David Fajgenbaum：它之所以能治疗麻风病和多发性骨髓瘤，也是它导致出生缺陷的原因，是因为它具有重要的抗血管生成作用，因此可以减少血管生长。
So, in the same way that you need blood vessel growth to grow limbs, you also need blood vessels, or you need overproduction, or increased blood flow for multiple myeloma cells to survive, and also in leprosy.
因此，就像你需要血管生长来生长四肢一样，你也需要血管，或者你需要过度生产，或者增加血流量才能使多发性骨髓瘤细胞生存，麻风病也是如此。
David Fajgenbaum: And so, the same compound that causes birth defects, helps treat leprosy, also treats multiple myeloma.
David Fajgenbaum：因此，导致出生缺陷的相同化合物有助于治疗麻风病，也可以治疗多发性骨髓瘤。
It's saved thousands and thousands of lives of multiple myeloma patients.
它挽救了成千上万多发性骨髓瘤患者的生命。
Again, the reason that that in particular has been utilized in multiple ways was that it had a full patent life when the work was first begun for leprosy, and then myeloma was discovered shortly thereafter.
同样，它被以多种方式利用的原因是，当首次开始针对麻风病的工作时，它具有完整的专利寿命，然后不久就发现了骨髓瘤。
David Fajgenbaum: But if a drug like thalidomide was discovered for leprosy, and then 20 years later, someone figured out it could be useful for multiple myeloma, patent is gone.
David Fajgenbaum：但是，如果像沙利度胺这样的药物被发现可以治疗麻风病，然后 20 年后，有人发现它可能对多发性骨髓瘤有用，那么专利就消失了。
And so, there wouldn't have been an incentive to then figure out that, oh, thalidomide could also be useful for multiple myeloma.
因此，就没有动力去发现，哦，沙利度胺也可能对多发性骨髓瘤有用。
The list sort of sadly goes on and on.
可悲的是，这个清单还在不断地增加。
David Fajgenbaum: I mean, one of my favorite examples is a drug called pembrolizumab that is now used for dozens of cancers, but initially it was first developed for melanoma and for lung cancer.
David Fajgenbaum：我的意思是，我最喜欢的例子之一是一种名为派姆单抗（pembrolizumab）的药物，现在用于治疗数十种癌症，但最初它首先是针对黑色素瘤和肺癌而开发的。
And actually, the work that we did in my lab, I guess this is 2016, and it was actually simple work.
实际上，我们在实验室所做的工作，我想这是 2016 年，而且实际上是简单的工作。
A patient came to us in 2016 with metastatic angiosarcoma, which is a horrible form of cancer, and his doctors told him that he was out of options, and we did something really simple.
2016 年，一位患有转移性血管肉瘤的患者来找我们，这是一种可怕的癌症，他的医生告诉他，他别无选择，我们做了一些非常简单的事情。
We went on PubMed and looked for angiosarcoma treatment.
我们继续参加 PubMed 并寻找血管肉瘤的治疗方法。
It was that simple.
就是这么简单。
David Fajgenbaum: And we came across a paper from 2013 where a researcher had looked at five tumors from five different patients with angiosarcoma, and four out of the five tumors had increased expression of PD-L1, which is a marker that you might respond to a PD-1 inhibitor.
David Fajgenbaum：我们看到了 2013 年的一篇论文，其中一位研究人员观察了来自 5 名不同血管肉瘤患者的 5 个肿瘤，发现这 5 个肿瘤中有 4 个的 PD-L1 表达增加，这是一个可能对 PD-1 抑制剂产生反应的标志物。
David Fajgenbaum: And so, even though the paper was published in 2013, and this gentleman came to us in 2016, and of course hundreds of people had died in the previous three years, no one had ever actually tested whether a PD-1 inhibitor could be useful for angiosarcoma, even though...
David Fajgenbaum：所以，尽管这篇论文发表于 2013 年，这位先生在 2016 年来找我们，当然，在过去的三年里已有数百人死亡，但没有人真正测试过 PD-1 抑制剂是否对血管肉瘤有用，尽管……
Again, it was just a laboratory study published three years earlier, but no one had ever translated that insight into using it in a patient.
再说一次，这只是三年前发表的一项实验室研究，但没有人将这一见解转化为在患者身上使用。
So, we treated Michael as the first patient ever, that we're aware of, with a PD-1 inhibitor, and he responded so incredibly well.
因此，我们将 Michael 作为我们所知的第一位使用 PD-1 抑制剂的患者进行治疗，他的反应非常好。
David Fajgenbaum: A couple things happened.
David Fajgenbaum：发生了几件事。
One is that his doctor started prescribing it to all patients with angiosarcoma.
一是他的医生开始给所有血管肉瘤患者开这种药。
It turns out it works in about 18% of patients.
事实证明，它对大约 18% 的患者有效。
So, it was a uniformly fatal cancer within one year.
因此，这是一种一年内致命的癌症。
Now, about 20% of people will live beyond a year, and it can be really transformative.
现在，大约 20% 的人将活到一年以上，这确实具有变革意义。
So, it changed clinical practice for angiosarcoma.
因此，它改变了血管肉瘤的临床实践。
The other thing it did specifically for Michael is that it has put him into now a nine-year remission.
它专门为迈克尔做的另一件事是，它使他的病情得到了九年的缓解。
David Fajgenbaum: Just last month, he walked his daughter down the aisle on her wedding day in Nashville, Tennessee, nine years after he was told that this is it.
大卫·法杰根鲍姆：就在上个月，他在田纳西州纳什维尔的女儿婚礼当天牵着女儿步入红毯，九年前，他被告知这就是婚礼了。
And so, these drugs are out there, and sometimes there's even breadcrumbs.
所以，这些药物就在那里，有时甚至还有面包屑。
It didn't require any brilliance from my lab.
它不需要我的实验室有任何才华。
We literally just had to find a study that was published three years earlier, and that again is really what drives us with this work now to say, "Can we find all these breadcrumbs?
我们实际上只需要找到三年前发表的一项研究，这又是我们现在开展这项工作的真正动力：“我们能找到所有这些面包屑吗？
Can we put them together and can we make sure people actually benefit from all the great science that's being done all over the world?
我们能否将它们放在一起，并确保人们真正受益于世界各地正在进行的所有伟大科学？
Let's actually translate it then to patients."
让我们将其实际翻译给患者。”
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
It seems to me that PubMed, and other sources of science knowledge, are great for stacking papers, and they're pretty decent in terms of how they're organized, by keyword search.
在我看来，PubMed 和其他科学知识来源非常适合堆叠论文，而且它们在通过关键词搜索进行组织方面相当不错。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: They're not perfect, but you can find stuff.
Andrew Huberman：它们并不完美，但你可以找到东西。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And you get suggestions about related articles, and somebody with a little bit of time and energy will get some degree of information there.
Andrew Huberman：你会得到有关相关文章的建议，有一点时间和精力的人会在那里获得一定程度的信息。
But it seems to me that no one has really organized the enormous database of information about science as it relates to disease.
但在我看来，似乎没有人真正组织了与疾病相关的科学信息的庞大数据库。
It occurred to me a moment ago, there should be a database where one can enter whatever knowledge they have about how old their grandparents were when they died, and of what, how old their parents are or were, maybe they're alive, maybe they're deceased.
刚才我突然想到，应该有一个数据库，人们可以在其中输入他们所掌握的关于他们的祖父母去世时多大年龄的任何知识，以及他们的父母现在或曾经多大年龄，也许他们还活着，也许他们已经去世了。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: Any knowledge, any kind of family history.
Andrew Huberman：任何知识，任何家族史。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: This is the first thing a doctor would ask you.
Andrew Huberman：这是医生会问你的第一件事。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah, exactly, yeah.
David Fajgenbaum：是的，完全正确，是的。
Andrew Huberman: If I come in and you're the MD, and if I say, "Hey, listen, I've got this swollen lymph node on the left-hand side."
Andrew Huberman：如果我进来，你是医生，如果我说，“嘿，听着，我的左侧淋巴结肿大了。”
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I don't think you're going to say, "Hey, go get it scanned." You'll say, "Any history of blank and blank in your family?"
Andrew Huberman：我认为你不会说，“嘿，去扫描一下。”你会说，“你家里有空白和空白的历史吗？”
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Exactly, yep.
没错，是的。
Yep.
是的。
Andrew Huberman: First thing, right?
安德鲁·休伯曼：首先，对吧？
One should be able to do this from home and then enter any symptom profiles they might be having, and with the appropriate cautionary notes, get some ideas back about what might be going on.
人们应该能够在家中执行此操作，然后输入他们可能出现的任何症状概况，并通过适当的警告注释，获得有关可能发生的情况的一些想法。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Now, that might sound like, oh, this is people playing their own doctor, but I'll tell you right now, if I put in left armpit lymph node pain, or swelling into any online search engine, it's going to tell me some of the worst possible outcomes.
安德鲁·胡伯曼：现在，这听起来可能像是，哦，这是人们在扮演自己的医生，但我现在就告诉你，如果我将左腋窝淋巴结疼痛或肿胀输入任何在线搜索引擎，它会告诉我一些最糟糕的可能结果。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: So, it's not like we need to shield people from potential outcomes.
安德鲁·胡伯曼：所以，我们不需要保护人们免受潜在结果的影响。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
David Fajgenbaum: Totally.
大卫·法根鲍姆：完全可以。
Andrew Huberman: But it seems to me that this should be pushed through an AI read of PubMed, which already exists, right?
Andrew Huberman：但在我看来，这应该通过 PubMed 的人工智能阅读来推动，而 PubMed 已经存在，对吧？
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: Most of the large language models are trained on the entire internet, including PubMed, and that it should point somebody in some actionable directions, including which of these groups...
Andrew Huberman：大多数大型语言模型都是在整个互联网上进行训练的，包括 PubMed，它应该为某人指明一些可行的方向，包括哪些群体......
I meant to ask this earlier...
我早就想问这个了...
Excuse me, which of the various groups for a given disease is the best one?
请问，针对特定疾病的各个组中哪一组最好？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah, exactly.
大卫·法根鲍姆：是的，完全正确。
Andrew Huberman: Like if somebody's kid, God forbid, has a blood cancer, which group do you go to?
安德鲁·休伯曼：就像如果某人的孩子（上帝禁止）患有血癌，你会加入哪个小组？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Is there a best one?
Andrew Huberman：有最好的吗？
Are these rated by anybody?
这些有人评价过吗？
I'm not trying to throw our arms around all of medicine here, and all of the problems in the world, but it seems to me that all of this is tractable.
我并不是想拥抱所有的医学和世界上的所有问题，但在我看来，所有这些都是可以解决的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Someone just needs to get organized about the database.
Andrew Huberman：有人只需要对数据库进行组织。
David Fajgenbaum: I completely agree.
David Fajgenbaum：我完全同意。
I think that there's such randomness to healthcare and to our biomedical research system.
我认为医疗保健和我们的生物医学研究系统存在如此大的随机性。
I think that's probably maybe the most heartbreaking part of this all, is that because it's so random, Michael gets a drug and he walks his daughter down the aisle nine years later, and a bunch of other people don't get a drug and they aren't alive.
我认为这可能是这一切中最令人心碎的部分，因为它是如此随机，迈克尔得到了一种毒品，九年后他带着他的女儿走上了红毯，而其他一群人没有得到毒品，他们就不再活着了。
And so, I love the idea of that centralized database.
因此，我喜欢集中式数据库的想法。
I think that there's a company called OpenEvidence, which is trying to basically create a GPT but for healthcare.
我认为有一家名为 OpenEvidence 的公司，它正在尝试基本上创建一个用于医疗保健的 GPT。
David Fajgenbaum: I don't think it's to where you described it, where you can really put in your personal family information and get answers.
David Fajgenbaum：我认为这并不是你所描述的那样，你可以真正输入你的个人家庭信息并获得答案。
But I'm hopeful that others will.
但我希望其他人也能这么做。
The role that I see our work, and my work, fitting into that is basically finding as many of these connections and proving them out in the lab and in clinical trials as possible.
我认为我们的工作以及我的工作所扮演的角色基本上就是找到尽可能多的这些联系，并在实验室和临床试验中尽可能地证明它们。
David Fajgenbaum: So, that way, when you type in your disease and your situation, that that drug that we worked on rises to the top, because it wasn't just a connection in PubMed, but it was a connection in PubMed that we've validated in the lab and that we did the trial to prove that it works.
David Fajgenbaum：这样，当您输入您的疾病和情况时，我们研究的药物就会上升到顶部，因为它不仅仅是 PubMed 中的连接，而且是我们在实验室中验证过的 PubMed 中的连接，并且我们进行了试验以证明它有效。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
It's kind of wild that on a completely different end of the spectrum, recently everyone's talking about creatine.
最近每个人都在谈论肌酸，这有点疯狂。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Yeah.
是的。
Andrew Huberman: Creatine, creatine, creatine.
安德鲁·休伯曼：肌酸，肌酸，肌酸。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Okay.
安德鲁·休伯曼：好的。
I've been taking creatine since my teens because I heard back then that it would help make me stronger and it'll make you stronger.
我从十几岁起就开始服用肌酸，因为我当时就听说它会帮助我变得更强壮，也会让你变得更强壮。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Now people are talking about creatine for women, for men, for older people, and under conditions of sleep deprivation for cognitive support.
Andrew Huberman：现在人们正在谈论肌酸对于女性、男性、老年人以及在睡眠不足的情况下的认知支持。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Let's face it, the effects, while documented, are fairly mild for cognitive support, but they're there.
Andrew Huberman：让我们面对现实吧，虽然有记录，但对于认知支持的影响相当轻微，但它们确实存在。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: And this is not being touted as a treatment for dementia, although it might help offset some minor dementia or something like that.
安德鲁·胡伯曼：这并没有被吹捧为痴呆症的治疗方法，尽管它可能有助于抵消一些轻微的痴呆症或类似的疾病。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: I don't know.
安德鲁·休伯曼：我不知道。
But the point is that people are talking about it, it's in the news, it's covered all the time.
但重点是人们正在谈论它，它出现在新闻中，它一直在报道。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: But we really should be talking about, or also talking about drugs like aspirin that can be very useful potentially for colon cancer and for heart attack, not just for pain, and all the other examples that are out there.
安德鲁·休伯曼：但我们确实应该谈论，或者也谈论像阿司匹林这样的药物，这些药物对于结肠癌和心脏病发作非常有用，而不仅仅是止痛，以及所有其他例子。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: But I think there's this fear that if you talk about a drug, that people are just going to start taking it as an attempt at a prophylactic, right?
安德鲁·休伯曼：但我认为，如果你谈论一种药物，人们就会开始将其视为一种预防药物，对吧？
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: And I think that there's a lot of caution around that, for understandable reasons.
Andrew Huberman：我认为出于可以理解的原因，对此需要非常谨慎。
But I want to know...
但我想知道...
I just turned 50, I want to know all the things that I could be taking to potentially offset heart attack because I'm already exercising, and trying to get my sleep, and doing all that stuff.
我刚满 50 岁，我想知道我可以采取哪些措施来潜在地抵消心脏病发作，因为我已经在锻炼，试图入睡，并做了所有这些事情。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Exactly.
确切地。
Andrew Huberman: And then I can make a decision.
Andrew Huberman：然后我就可以做出决定。
So, where is the database of information about, as a 50-year-old male who does the following things to support his health, no history of heart disease in my family that I'm aware of, well, what drugs are on the counter, or molecules that exist behind a script from a doctor that could potentially extend my life?
那么，作为一名 50 岁的男性，他做了以下事情来支持自己的健康，我知道我的家族中没有心脏病史，柜台上有哪些药物，或者医生处方背后存在可能延长我生命的分子，这些信息数据库在哪里？
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: I want to know that information.
Andrew Huberman：我想知道这些信息。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And we're talking about creatine.
Andrew Huberman：我们谈论的是肌酸。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: So, for once, I'm not being disparaging of supplements, but it doesn't make any sense.
Andrew Huberman：所以，这一次，我并不是在贬低补充剂，但这没有任何意义。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: The conversation is skewed in the wrong direction.
Andrew Huberman：谈话的方向是错误的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
I think that what we're trying to do with Every Cure, and with our work, is trying to start this conversation and keep the conversation going so that way you can go to your doctor with X drug.
我认为，我们在 Every Cure 和我们的工作中所做的就是尝试开始这种对话并保持这种对话，这样你就可以带着 X 药物去看医生。
I mentioned that we have nine active programs.
我提到我们有九个活跃计划。
So, on the one end of the spectrum, really common is our program with lidocaine and breast cancer where we're doing laboratory work.
因此，一方面，真正常见的是我们正在进行实验室工作的利多卡因和乳腺癌项目。
We're also evaluating clinical data, and I hope at some point in the future that the data is strong enough.
我们还在评估临床数据，我希望在未来的某个时候，数据足够强大。
David Fajgenbaum: And if it is, then we'll work to encourage every woman who's about to go in for breast cancer surgery to talk to their surgeon beforehand and say, "Hey, I want to make sure you do this," and so really empowering them in that way.
David Fajgenbaum：如果是的话，那么我们将努力鼓励每一位即将接受乳腺癌手术的女性事先与她们的外科医生交谈，并说：“嘿，我想确保你这样做”，从而真正以这种方式赋予她们权力。
But all the way through even to the rarest of conditions, there's a condition called Bachmann-Bupp syndrome where kids are born with a mutation that cause them to have elevated levels of an enzyme called ODC1.
但即使是最罕见的情况，也有一种称为巴赫曼-布普综合症的情况，孩子出生时就带有一种突变，导致他们体内一种称为 ODC1 的酶水平升高。
David Fajgenbaum: And basically, they're on feeding tubes.
David Fajgenbaum：基本上，它们都靠饲管。
They are wheelchair or bed-bound, unless you give them a drug that was made for African sleeping sickness, which is a perfect covalent binder to ODC1.
他们要么坐轮椅，要么卧床不起，除非你给他们服用一种治疗非洲昏睡病的药物，这种药物是 ODC1 的完美共价结合剂。
So, that enzyme that's too high in these kids, African sleeping sickness medicine actually binds to ODC1.
因此，这些孩子体内含量过高的酶——非洲昏睡病药物——实际上与 ODC1 结合。
And if you start it early enough in life, these kids get their feeding tube taken out.
如果你很早就开始这样做，这些孩子的饲管就会被拔掉。
They might be able to sit up.
他们也许能够坐起来。
They can even play with their siblings.
他们甚至可以和兄弟姐妹一起玩。
And so, the reason I mention this is that there aren't that many people with Bachmann-Bupp.
所以，我提到这一点的原因是，患有巴赫曼-布普病的人并不多。
David Fajgenbaum: In fact, it's only been described in 20 kids, which means there's probably hundreds of kids, because the medical literature is typically behind reality.
David Fajgenbaum：事实上，只在 20 个孩子中描述过这种情况，这意味着可能有数百个孩子，因为医学文献通常落后于现实。
But let's say there's hundreds of kids.
但假设有数百个孩子。
At some point, we're going to need to get the word out so that way we can find every kid possible with Bachmann-Bupp so they can get this medication, DFMO.
在某些时候，我们需要将消息传出去，这样我们就可以找到每个可能患有 Bachmann-Bupp 的孩子，这样他们就可以获得这种药物，DFMO。
And so, these are microcosms of what you're talking about, which is that no one should suffer from Bachmann-Bupp without being on DFMO.
因此，这些都是您所谈论的内容的缩影，即如果没有加入 DFMO，任何人都不应遭受 Bachmann-Bupp 的困扰。
No one should have breast cancer without having had lidocaine.
没有人应该在没有服用利多卡因的情况下患乳腺癌。
David Fajgenbaum: No one should be a healthy 50-year-old man who might be able to have their risk of heart attack reduced.
David Fajgenbaum：没有人应该是一个能够降低心脏病发作风险的 50 岁健康男性。
It might be that colchicine is helpful for reducing your risk of heart disease.
秋水仙碱可能有助于降低患心脏病的风险。
But to your point, how can we get this more proactively so we're not just sort of hoping and waiting that all these random things line up?
但就你的观点而言，我们怎样才能更主动地做到这一点，这样我们就不会只是希望和等待所有这些随机的事情排列起来？
Andrew Huberman: We used to use colchicine in the lab.
Andrew Huberman：我们过去在实验室中使用秋水仙碱。
David Fajgenbaum: So, colchicine's an interesting one.
David Fajgenbaum：所以，秋水仙碱是一种有趣的药物。
So, colchicine is typically utilized for gout.
因此，秋水仙碱通常用于治疗痛风。
It's been around forever.
它一直存在。
Actually, I learned that it's, like, 3,000 years ago was when it started being used, because gout often occurs in individuals who consume too much alcohol.
事实上，我了解到它是在 3000 年前开始使用的，因为痛风经常发生在饮酒过多的人身上。
And so, apparently, in Egypt 3,000 years ago, some of the wealthy people were drinking too much alcohol and somehow they figured out that this molecule, colchicine, of course I think it was a root at the time, could be helpful for reducing gout.
因此，显然，在 3000 年前的埃及，一些富人喝了太多的酒，不知何故，他们发现这种分子，秋水仙碱，当然我认为它当时是一种根，可能有助于减少痛风。
David Fajgenbaum: And we should fact-check that statement, because I don't know the exact details, but it's been around a long time.
David Fajgenbaum：我们应该对该声明进行事实核查，因为我不知道确切的细节，但它已经存在很长时间了。
Andrew Huberman: If there were a database, you could just go to the database.
Andrew Huberman：如果有数据库，你就可以访问该数据库。
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
Andrew Huberman: You can tell tell where my mind's going.
Andrew Huberman：你可以看出我在想什么。
David Fajgenbaum: Yeah, exactly.
大卫·法根鲍姆：是的，完全正确。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
David Fajgenbaum: So, colchicine's been around forever.
David Fajgenbaum：所以，秋水仙碱一直存在。
It's been used for gout for decades.
它已被用于治疗痛风数十年。
People who have gouty arthritis, they get these painful joints.
患有痛风性关节炎的人会出现这些关节疼痛。
If you give them colchicine, it helps them out.
如果你给他们秋水仙碱，就会帮助他们摆脱困境。
Well, a researcher a couple decades ago had a hypothesis that because of its anti-inflammatory properties, and a few other properties of colchicine, that it might be able to reduce the risk of heart attacks in people who have already had a heart attack, or maybe in general, but in particular in people who have already had a heart attack.
几十年前，一位研究人员提出了一个假设，由于秋水仙碱的抗炎特性以及其他一些特性，它可能能够降低已经患有心脏病的人或一般人的心脏病发作风险，但尤其是已经患有心脏病的人。
David Fajgenbaum: And because it's been around forever, they really couldn't raise the funding needed to do all the trials to prove it, because heart disease prevention trials are big, expensive trials.
David Fajgenbaum：因为它一直存在，所以他们真的无法筹集到进行所有试验来证明这一点所需的资金，因为心脏病预防试验是大型且昂贵的试验。
You've got to follow people for years to prove that they didn't get a heart attack, versus people who got a placebo.
你必须跟踪人们多年才能证明他们没有心脏病发作，而不是服用安慰剂的人。
David Fajgenbaum: So, they ended up changing the dose of that medicine, of colchicine.
David Fajgenbaum：所以，他们最终改变了秋水仙碱药物的剂量。
So, it's a slightly different dose from the one they use for gouty arthritis, but it has a very substantial reduction in heart disease risk if you had a prior heart attack and, in particular, if you had a prior heart attack and you have diabetes, a really, really meaningful reduction.
因此，它的剂量与他们用于治疗痛风性关节炎的剂量略有不同，但如果您以前有过心脏病发作，特别是如果您以前有过心脏病发作并且患有糖尿病，那么它可以非常显着地降低患心脏病的风险，这是一个非常非常有意义的降低。
So, it got FDA approval for that particular subpopulation.
因此，它获得了 FDA 批准用于该特定亚群。
But I mention it because if they hadn't changed the dose, it would've been a paper that some academic would've published that I think colchicine could help, and no one would have ever done the big trial.
但我之所以提到它，是因为如果他们没有改变剂量，一些学者就会发表一篇论文，我认为秋水仙碱可以有所帮助，而且没有人会进行这项大型试验。
And again, that's sort of the tragedy here, is that people are literally not having heart attacks right now because they're on colchicine, but if not for someone figuring out a way to make the system work, you know, they would've had their heart attack.
再说一遍，这就是悲剧，人们现在实际上并没有心脏病发作，因为他们服用了秋水仙碱，但如果不是有人找到一种方法让系统正常工作，你知道，他们就会心脏病发作。
Andrew Huberman: We've known for a long time that there are things that we can do to improve our sleep, and that includes things that we can take, things like magnesium threonate, theanine, chamomile extract, and glycine, along with lesser known things like saffron and valerian root.
Andrew Huberman：我们很早就知道我们可以采取一些措施来改善睡眠，其中包括我们可以服用的东西，例如苏糖酸镁、茶氨酸、洋甘菊提取物和甘氨酸，以及一些鲜为人知的东西，例如藏红花和缬草根。
These are all clinically supported ingredients that can help you fall asleep, stay asleep, and wake up feeling more refreshed.
这些都是经过临床支持的成分，可以帮助您入睡、保持睡眠状态，并且醒来时感觉更加神清气爽。
I'm excited to share that our longtime sponsor, AG1, just created a new product called AGZ, a nightly drink designed to help you get better sleep and have you wake up feeling super refreshed.
我很高兴与大家分享，我们的长期赞助商 AG1 刚刚创造了一款名为 AGZ 的新产品，这是一种夜间饮料，旨在帮助您获得更好的睡眠，让您醒来时感觉神清气爽。
Andrew Huberman: Over the past few years, I've worked with the team at AG1 to help create this new AGZ formula.
Andrew Huberman：在过去的几年里，我与 AG1 的团队合作，帮助创建了这个新的 AGZ 公式。
It has the best sleep-supporting compounds in exactly the right ratios in one easy-to-drink mix.
它在一种易于饮用的混合物中以完全正确的比例含有最好的睡眠支持化合物。
This removes all the complexity of trying to forage the vast landscape of supplements focused on sleep and figuring out the right dosages and which ones to take for you.
这消除了尝试寻找大量针对睡眠的补充剂以及确定正确剂量和适合您服用的补充剂的所有复杂性。
AGZ is, to my knowledge, the most comprehensive sleep supplement on the market.
据我所知，AGZ 是市场上最全面的睡眠补充剂。
Andrew Huberman: I take it 30 to 60 minutes before sleep, it's delicious by the way, and it dramatically increases both the quality and the depth of my sleep.
Andrew Huberman：我在睡前 30 到 60 分钟服用它，顺便说一句，它很美味，而且它极大地提高了我的睡眠质量和深度。
I know that both from my subjective experience of my sleep and because I track my sleep.
我知道这一点，既来自我对睡眠的主观体验，也因为我跟踪了我的睡眠。
I'm excited for everyone to try this new AGZ formulation and to enjoy the benefits of better sleep.
我很高兴每个人都能尝试这种新的 AGZ 配方并享受更好睡眠的好处。
AGZ is available in chocolate, chocolate mint, and mixed berry flavors, and as I mentioned before, they're all extremely delicious.
AGZ 有巧克力、巧克力薄荷和混合浆果口味，正如我之前提到的，它们都非常美味。
My favorite of the three has to be, I think, chocolate mint, but I really like them all.
我认为这三者中我最喜欢的是巧克力薄荷，但我真的很喜欢它们。
Andrew Huberman: If you would like to try AGZ, go to drinkagz.com/huberman to get a special offer.
Andrew Huberman：如果您想尝试 AGZ，请访问 Drinkagz.com/huberman 以获得特别优惠。
Again, that's drinkagz.com/huberman.
再说一遍，这是 Drinkagz.com/huberman。
Andrew Huberman: Today's episode is also brought to us by David.
安德鲁·休伯曼：今天的节目也是大卫给我们带来的。
David makes a protein bar unlike any other.
大卫制作的蛋白质棒与众不同。
It has 28 grams of protein, only 150 calories, and zero grams of sugar.
它含有 28 克蛋白质，仅 150 卡路里，零克糖。
That's right, 28 grams of protein and 75% of its calories come from protein.
没错，28克蛋白质，其75%的热量都来自于蛋白质。
That's 50% higher than the next closest protein bar.
这比第二接近的蛋白质棒高出 50%。
Andrew Huberman: These bars from David also taste amazing.
Andrew Huberman：大卫的这些巧克力棒味道也很棒。
Right now, my favorite flavor is the new cinnamon roll flavor, but I also like the chocolate chip cookie dough flavor, and I also like the salted peanut butter flavor.
现在，我最喜欢的口味是新的肉桂卷口味，但我也喜欢巧克力饼干面团口味，我也喜欢咸花生酱口味。
Basically, I like all the flavors.
基本上所有的口味我都喜欢。
They're all delicious.
它们都很好吃。
Also, big news, David bars are now back in stock.
另外，还有一个大消息，大卫金条现在又重新有货了。
They were sold out for several months because they are that popular, but they are now back in stock.
由于它们太受欢迎，它们被抢购一空几个月，但现在又有货了。
Andrew Huberman: By eating a David bar, I'm able to get 28 grams of protein in the calories of a snack, which makes it very easy for me to meet my protein goals of one gram of protein per pound of body weight per day, and to do so without eating excess calories.
Andrew Huberman：通过吃 David 能量棒，我可以在一份零食的卡路里中获取 28 克蛋白质，这使我很容易实现每天每磅体重 1 克蛋白质的蛋白质目标，并且无需摄入过多卡路里。
I generally eat a David bar most afternoons, and I always keep them with me when I'm away from home or traveling, because they're incredibly convenient to get enough protein.
我通常大多数下午都会吃大卫棒，当我出门在外或旅行时，我总是随身携带它们，因为它们非常方便地获取足够的蛋白质。
As I mentioned, they're incredibly delicious, and given that 28 grams of protein, they're pretty filling for just 150 calories, so they're great between meals as well.
正如我所提到的，它们非常美味，而且含有 28 克蛋白质，仅需 150 卡路里热量就可以产生饱腹感，因此在两餐之间也非常适合。
Andrew Huberman: If you'd like to try David, you can go to davidprotein.com/huberman.
Andrew Huberman：如果您想尝试 David，可以访问 david Protein.com/huberman。
Again, that's davidprotein.com/huberman.
同样，这是 david Protein.com/huberman。
Andrew Huberman: Well, I feel like we could spend hours going through the catalog of drugs for which these examples exist, and we may return to a few more, but I'm putting in a strong vote for this database.
Andrew Huberman：嗯，我觉得我们可以花几个小时浏览这些示例中存在的药物目录，并且我们可能会返回更多一些，但我对这个数据库投了强烈的一票。
I know you're working hard on this.
我知道你正在为此努力。
I'd like to talk about your journey into this, because you are not a typical doctor.
我想谈谈你的经历，因为你不是一个典型的医生。
I think that's apparent to people already.
我认为这对人们来说已经是显而易见的了。
Andrew Huberman: You care very much about human health and treating human disease, but you have a very unusual and interesting trajectory into medicine, and I do believe it's helped lead you to this very unique orientation within the field of medicine and science.
安德鲁·胡伯曼：您非常关心人类健康和治疗人类疾病，但您在医学方面有一个非常不寻常和有趣的轨迹，我相信它帮助您在医学和科学领域找到了这个非常独特的方向。
So, tell us that story and teach us about Castleman's disease.
那么，请告诉我们这个故事并告诉我们有关卡斯尔曼氏病的知识。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
Well, my story, I think really starts back when I was 18 years old, and I was a freshman at Georgetown.
嗯，我想我的故事要从我 18 岁那年开始，当时我是乔治城大学的新生。
We were talking earlier about I played football at Georgetown, and for me growing up, that was my dream to be a Division 1 college quarterback.
我们之前谈论过我在乔治城踢足球，对于我的成长来说，成为一级大学四分卫是我的梦想。
That's all I could think about.
这就是我所能想到的。
I was not quite as jacked as you, but somewhere in that realm.
我并不像你那么兴奋，但也处于那个领域。
Andrew Huberman: I saw a photo.
安德鲁·休伯曼：我看到一张照片。
You were larger than I was.
你比我大。
Yeah, we'll put up a link to a photo.
是的，我们会提供照片链接。
David was 230.
大卫230岁了。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: You're taller than I am.
安德鲁·休伯曼：你比我高。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I'm 6'1", so you're probably about 6'3".
Andrew Huberman：我身高 6 英尺 1 英寸，所以你大概身高 6 英尺 3 英寸。
David Fajgenbaum: Like 6'2".
David Fajgenbaum：大约 6 英尺 2 英寸。
David Fajgenbaum: Yeah, something like that.
David Fajgenbaum：是的，类似的事情。
Andrew Huberman: I think you might be 6'3".
Andrew Huberman：我想你可能身高 6 英尺 3 英寸。
Either that or I'm shrinking.
要么我就退缩了。
And super large, fit, low body fat.
而且超大、健美、体脂低。
I mean, you look...
我的意思是，你看起来...
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Clearly, you were a quarterback but you were large even for a quarterback.
安德鲁·胡伯曼：显然，你是一名四分卫，但即使对于四分卫来说，你也很大。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: I was, yeah.
David Fajgenbaum：是的，我是。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
Okay.
好的。
David Fajgenbaum: So, you know, that was my dream, I wanted to play college football, and I got there and I had been on campus at Georgetown for a couple weeks and I got a call that changed my life.
大卫·法根鲍姆：所以，你知道，那是我的梦想，我想参加大学橄榄球，我到达了那里，我已经在乔治敦校园呆了几个星期，我接到一个电话，改变了我的生活。
My dad called and told me that my mom had brain cancer.
我爸爸打电话告诉我，我妈妈得了脑癌。
And, Andrew, I went from all I could think about was football and I'm finally at this goal that I'd always set, to oh my gosh, this has just changed everything.
而且，安德鲁，我从我所能想到的就是足球，我终于实现了我一直设定的目标，天哪，这改变了一切。
My mom and I were so close and I was heartbroken for her.
我和妈妈是如此亲密，我为她感到心碎。
David Fajgenbaum: Glioblastoma brain tumors are uniformly fatal.
David Fajgenbaum：胶质母细胞瘤脑肿瘤都是致命的。
They're horrible.
他们太可怕了。
I was only 18, so I don't think I knew just how bad it was, but I knew it was really bad.
我当时只有 18 岁，所以我不知道事情有多糟糕，但我知道这真的很糟糕。
And watching her battle with cancer over the next 15 months just changed everything in me.
在接下来的 15 个月里，看着她与癌症作斗争，我的一切都发生了改变。
It completely locked me in, and I told her just before she passed away that I would dedicate my life to trying to find treatments for patients like her.
它完全把我锁在了里面，就在她去世前我告诉她，我将毕生致力于为像她这样的患者寻找治疗方法。
David Fajgenbaum: And she couldn't say many words, at the end, but she said, "Unconditional love." Those were the two words that she said when I told her I would do that, and I was like, "All right, I've got to do this." She wants me to do it.
大卫·法根鲍姆：最后她没能说出很多话，但她说，“无条件的爱。”当我告诉她我会这么做时，她说了这两个词，我当时想，“好吧，我必须这么做。”她要我这么做。
And for me, I sort of haven't been able to stop thinking about helping people like her from the moment that I started seeing this horrible cancer take her life in front of me.
对我来说，从我开始看到这种可怕的癌症在我面前夺走她的生命那一刻起，我就一直无法停止思考帮助像她这样的人。
And, of course, the promise that I made to her.
当然，还有我对她做出的承诺。
David Fajgenbaum: I also learned so much from her in watching her battle against brain cancer.
David Fajgenbaum：在观看她与脑癌的斗争中，我也从她身上学到了很多东西。
I'll just tell one quick story.
我只讲一个简短的故事。
So, I got that call from my dad.
就这样，我接到了爸爸打来的电话。
I immediately came home to North Carolina, and within a few days, she was having brain surgery to get the tumor resected.
我立即回到北卡罗来纳州的家中，几天之内，她就接受了脑部手术以切除肿瘤。
And they did a surgery where they put you to sleep to open up your skull, and then they actually wake you up while your skull's open.
他们做了一个手术，让你睡觉，打开你的头骨，然后他们在你的头骨打开时叫醒你。
David Fajgenbaum: And the reason for that, which you're very familiar with, is that as they're cutting out, particularly in the left side of the brain, cutting out parts of the brain tumor, you want to be able to see how far you want to go.
David Fajgenbaum：你非常熟悉的原因是，当他们切除时，特别是在大脑的左侧，切除部分脑肿瘤，你希望能够看到你想要走多远。
You ask people to speak and sort of when they start slurring their speech, you stop cutting.
你要求人们发言，当他们开始含糊其辞时，你就停止剪辑。
And so, they went through this whole surgery, it was like a four-and-a-half-hour surgery, cut out most of the tumor, but not everything.
所以，他们经历了整个手术，就像一个四个半小时的手术，切除了大部分肿瘤，但不是全部。
And they woke her back up after the surgery, and she was in the waiting area and we went back to see her.
手术后他们把她叫醒，她在等候区，我们回去看她。
David Fajgenbaum: And I remember my dad...
David Fajgenbaum：我记得我的父亲......
I've got two amazing older sisters, and my dad and I, we went back to see her and we were so nervous like, "Is it going to be our mom who's going to come out?" They took out a lot of her brain as part of this surgery, and so nervous, and we walked back, Andrew, and pulled the curtain back and I'll never forget it.
我有两个很棒的姐姐，我和爸爸，我们回去看她，我们非常紧张，“会是我们的妈妈出来吗？”作为手术的一部分，他们取出了她的很多大脑，非常紧张，我们走回去，安德鲁，拉开窗帘，我永远不会忘记它。
David Fajgenbaum: I saw my mom sitting there just about as far away as you are and she had a wrap around her head, bandages and she had this bulb coming out that was collecting fluid, and she looked at us and she pointed up to her head and she said, "Chiquita banana lady." And we just burst into laughter.
大卫·法根鲍姆：我看到我妈妈坐在那儿，就和你们一样远，她的头上缠着绷带，她拿出一个灯泡来收集液体，她看着我们，指着她的头说，“奇基塔香蕉女士。”我们突然大笑起来。
David Fajgenbaum: She was saying she looked like the Chiquita banana lady, and that, for me, was this incredible moment of just taking agency back from this horrible cancer.
David Fajgenbaum：她说她看起来像奇基塔香蕉女士，对我来说，这是从这种可怕的癌症中夺回代理权的令人难以置信的时刻。
You just went through surgery, but you're going to find something to laugh about and something to get your family to laugh at and to show that you're still there.
你刚刚经历了手术，但你会找到一些可以笑的东西，一些可以让你的家人笑的东西，并表明你还在那里。
And so, that was sort of the first of many lessons that I learned from my mom, obviously in her health, but also in her illness.
所以，这是我从妈妈那里学到的许多教训中的第一个，显然是关于她的健康，但也是关于她的疾病。
David Fajgenbaum: And so, that set me on this journey, which is, "Okay, I'm going to dedicate my life to trying to find treatments for patients like my mom.
David Fajgenbaum：所以，这让我踏上了这段旅程，那就是，“好吧，我将毕生致力于为像我妈妈这样的患者寻找治疗方法。
I'm going to try to live in the way that she did." And I was sort of well on my way.
我会努力像她那样生活。”我的进展顺利。
I finished medical...
我完成了医疗...
Or sorry, finished undergrad at Georgetown.
或者抱歉，我在乔治城大学读完本科。
I did a graduate degree at Oxford, and then I was couple years into med school at Penn, when...
我在牛津大学取得了研究生学位，然后在宾夕法尼亚大学医学院读了几年，当时……
You mentioned Castleman disease, when I went from being totally healthy, I shared earlier I'd won a bench pressing contest right around that time I was so healthy, to being in the ICU with all of my organs shutting down.
你提到卡斯尔曼病，当我从完全健康的时候，我早些时候分享过，我赢得了一场卧推比赛，当时我非常健康，到了在重症监护病房里，我所有的器官都关闭了。
Andrew Huberman: The story about your mom is a remarkable one.
安德鲁·休伯曼：关于你妈妈的故事是一个非凡的故事。
My first thought when you mentioned the Chiquita banana lady reference is that even though she was the patient, it seemed like she was successfully taking care of all of you.
当你提到奇基塔香蕉女士时，我的第一个想法是，尽管她是病人，但似乎她成功地照顾了你们所有人。
David Fajgenbaum: She was trying to take care of us.
David Fajgenbaum：她试图照顾我们。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
I know very little about her, only what you've shared, but she sounds like a very impressive woman.
我对她知之甚少，只知道你所分享的，但她听起来是一个令人印象深刻的女人。
David Fajgenbaum: She was amazing and I so appreciate you saying that.
David Fajgenbaum：她太棒了，我非常感谢你这么说。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
That comes through.
那就通过了。
So, Castleman's, I've never heard of it.
所以，卡斯尔曼的，我从来没有听说过。
Who's Castleman?
卡斯尔曼是谁？
These physicians like to name diseases after themselves.
这些医生喜欢用自己的名字来命名疾病。
But my guess is that they're not the ones with the diseases, they're the ones that discover the diseases, correct?
但我的猜测是，他们不是那些患有疾病的人，而是他们发现了这些疾病，对吗？
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
Yep.
是的。
So, Benjamin Castleman was a doctor in Boston, at Harvard.
本杰明·卡斯尔曼是波士顿哈佛的一名医生。
He'd been getting these cases of patients that were thought to have lymphoma, and they appeared like they had lymphoma, getting very, very sick very quickly.
他接诊了一些被认为患有淋巴瘤的患者，他们看起来就像患有淋巴瘤，很快就病得非常非常严重。
David Fajgenbaum: But when he looked under the microscope at them, they didn't look like a typical lymphoma patient.
David Fajgenbaum：但是当他在显微镜下观察他们时，他们看起来并不像典型的淋巴瘤患者。
And so, maybe as I share sort of what my progression looked like, I was third year med student, I had just finished an OB-GYN rotation, I had just delivered babies into the world, which is sort of a peak moment in medical school, and then within a couple weeks, I noticed that I had enlarged lymph nodes in my neck.
所以，也许当我分享我的进展情况时，我是三年级医学生，我刚刚完成妇产科轮转，我刚刚把婴儿送到这个世界，这是医学院的巅峰时刻，然后几周之内，我注意到我脖子上的淋巴结肿大了。
I felt more tired than I'd ever felt, and you're tired in med school and grad school, you know well, but I was more tired than ever.
我感觉比以往任何时候都更累，你在医学院和研究生院很累，你很清楚，但我比以往任何时候都更累。
I had horrible abdominal pain, and I noticed fluid pooling around my ankles and I thought, "This is so weird.
我的腹部疼痛得很厉害，我注意到脚踝周围有液体聚集，我想，“这太奇怪了。
What's going on?"
发生什么事了？”
David Fajgenbaum: But the fatigue got worse and worse and worse, and over the course of really it was just a couple weeks, I got so bad that I went, I took a med school exam, then I went down to the hall to the emergency department and I basically stumbled down to the ER and just told them my symptoms, and they ran blood work, and I remember my doctor coming back and looking at me and saying, "David, your liver, your kidneys, and your bone marrow are all shutting down.
大卫·法杰根鲍姆：但是疲劳变得越来越严重，真的只是几周的时间，我变得非常糟糕，我去了，我参加了医学院考试，然后我去了急诊室，我基本上跌跌撞撞地去了急诊室，只是告诉他们我的症状，他们进行了血液检查，我记得我的医生回来看着我说，“大卫，你的肝脏，你的肾脏和你的骨髓都停止运转了。
We have to hospitalize you right away."
我们必须立即将你送往医院。”
David Fajgenbaum: And I'm like, "What do you mean?" I was just like...
David Fajgenbaum：我想，“你是什么意思？”我当时就像...
I delivered a baby a couple weeks ago.
几周前我生了一个孩子。
All my organs are shutting down?
我所有的器官都停止运转了吗？
And so, they hospitalized me and I deteriorated really rapidly.
因此，他们让我住院，我的病情恶化得非常快。
I had a retinal hemorrhage that made me temporarily blind in my left eye.
我的视网膜出血导致我的左眼暂时失明。
I gained a total of about 100 pounds of fluid, because my liver and my kidneys stopped working.
由于我的肝脏和肾脏停止工作，我总共增加了约 100 磅的液体。
You saw that picture where I had just fluid everywhere because of the multi-organ failure, and I needed daily transfusions of red blood cells and platelets just to keep me alive.
你看到那张照片，由于多器官衰竭，我到处都是液体，我需要每天输注红细胞和血小板才能维持生命。
David Fajgenbaum: I was on dialysis at the time as well.
David Fajgenbaum：当时我也在接受透析。
So, basically everything was shutting down, and we had no diagnosis, so we didn't know what it was.
所以，基本上一切都停止了，我们没有诊断，所以我们不知道它是什么。
Some doctors thought it was lymphoma.
有些医生认为这是淋巴瘤。
Others thought it maybe was an autoimmune disease.
其他人认为这可能是一种自身免疫性疾病。
Others had no idea what it was.
其他人不知道那是什么。
But over the course of about 11 weeks, I got worse and worse and worse, and at one point, I was so sick that I said goodbye to my dad, and my sisters, and my girlfriend at the time, Kaitlin, and a priest came in my room and read me my last rites when I was 25 years old.
但在大约 11 周的时间里，我的情况变得越来越糟，有一次，我病得很重，以至于我向我的父亲、姐妹们和当时的女朋友凯特琳告别，一位牧师走进我的房间，给我念了我 25 岁时的最后仪式。
David Fajgenbaum: Fortunately, right around the time of having my last rites read to me, which was really the end, I didn't have more than a couple days left, that's when the diagnosis came in of Castleman disease.
David Fajgenbaum：幸运的是，就在我向我宣读最后的仪式时，这实际上是结束，我只剩下几天的时间，就在那时，我被诊断出患有卡斯尔曼病。
So basically, a pathologist looked at my lymph node and they thought I had lymphoma, but they figured it was a really aggressive lymphoma, which is a form of cancer.
基本上，病理学家检查了我的淋巴结，他们认为我患有淋巴瘤，但他们认为这是一种真正的侵袭性淋巴瘤，这是癌症的一种形式。
But they looked at it and just like Benjamin Castleman did, looked at it and said, "This doesn't look like lymphoma.
但他们看着它，就像本杰明·卡斯尔曼所做的那样，看着它并说：“这看起来不像淋巴瘤。
This actually looks different.
这实际上看起来不同。
It looks like this thing called Castleman disease," which is basically what we call an atypical lymphoproliferative disorder.
它看起来像一种叫做卡斯尔曼病的东西，”这基本上就是我们所说的非典型淋巴增殖性疾病。
So, it's kind of like lymphoma, but it's got features that are more like an autoimmune disease, and so basically your immune system becomes highly activated and starts attacking all your vital organs.
所以，它有点像淋巴瘤，但它的特征更像是一种自身免疫性疾病，所以基本上你的免疫系统变得高度激活并开始攻击你的所有重要器官。
So, the reason that all of my organs were shutting down is because my immune system was producing cytokines and other factors that were basically shutting it down.
所以，我所有的器官都关闭的原因是我的免疫系统正在产生细胞因子和其他基本上关闭它的因素。
Andrew Huberman: Do you think that the long hours of medical school, plus being athletic, very driven, contributed to the autoimmune flare-up?
安德鲁·胡伯曼：你认为长时间的医学院学习，加上运动能力强、动力十足，是否导致了自身免疫性疾病的爆发？
And we don't often discuss this, but anyone that's dealt with an autoimmune issue, even if it's like psoriasis or something, which can be very severe, but in most cases it's minor to...
我们不经常讨论这个问题，但是任何处理过自身免疫问题的人，即使是牛皮癣之类的问题，可能非常严重，但在大多数情况下，这都是轻微的......
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: You know, there are over the counter things you can use.
Andrew Huberman：你知道，有一些非处方药可以使用。
But it's associated with people who are pushing very, very hard and tend to pull long hours, and as a consequence, the immune system understandably ramps up its activity, and then goes past the tipping point where it starts attacking one's native tissue.
但这与那些工作非常非常努力、往往会长时间工作的人有关，因此，免疫系统可以理解地增强其活性，然后越过临界点，开始攻击人体的天然组织。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
It's funny, no one ever asked that, but it's the right question to ask, and I think people are always sort of afraid to get into the whys of these things happening to you.
很有趣，从来没有人问过这个问题，但这是一个正确的问题，而且我认为人们总是有点害怕了解这些事情发生在你身上的原因。
I'm glad you asked, because actually there was a paper that was published a couple years ago, I think it was in "Cell," where mice that were sleep deprived, like significantly, multi-day sleep deprived, what actually killed them was a cytokine storm due to their immune system reproducing all these cytokines.
我很高兴你问，因为实际上几年前发表了一篇论文，我认为它是在“细胞”中，其中睡眠被剥夺的小鼠，例如显着的多天睡眠剥夺，实际上杀死它们的是细胞因子风暴，因为它们的免疫系统复制了所有这些细胞因子。
Because we know that sleep deprivation is deadly, right?
因为我们知道睡眠不足是致命的，对吗？
You don't sleep enough, you know this very well.
你睡不够，你很清楚这一点。
David Fajgenbaum: But again, in these mouse studies, the actual thing that killed them was their immune system producing cytokines, including interleukin-6, which is an important cytokine in Castleman's.
David Fajgenbaum：但是，在这些小鼠研究中，真正杀死它们的是它们的免疫系统产生的细胞因子，包括白细胞介素 6，它是卡斯尔曼氏病的重要细胞因子。
And by just trying a couple medicines that basically block the production of some cytokines, you could keep the mice alive longer, really pointing to this idea that it's sleep causing some disruption in immune balance, causing excess production of cytokines, causing death.
只需尝试几种基本上阻止某些细胞因子产生的药物，就可以让小鼠活得更久，这实际上表明了这样的观点：睡眠会导致免疫平衡的破坏，导致细胞因子的过量产生，从而导致死亡。
And so, I don't know if you...
那么，我不知道你是否...
Had you seen?
你见过吗？
I can share the paper with you.
我可以与你分享这篇论文。
It's pretty fascinating.
这非常令人着迷。
Yeah.
是的。
Andrew Huberman: No, I'm not familiar with that one.
Andrew Huberman：不，我对此并不熟悉。
I just-
我只是——
David Fajgenbaum: But it connects to your point, right?
David Fajgenbaum：但这与你的观点相关，对吧？
Andrew Huberman: Yeah, I mean, again, this is all anecdotal coming from my side, anyway growing up in Silicon Valley, I've known a lot of people who have cancers, and who seem to be dealing with autoimmune things, and I know a lot of very ambitious, hard-driving people.
安德鲁·胡伯曼：是的，我的意思是，这都是我的轶事，无论如何，我是在硅谷长大的，我认识很多患有癌症的人，他们似乎正在处理自身免疫性疾病，而且我认识很多非常雄心勃勃、努力奋斗的人。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: It's baked into the culture I grew up in, you know?
Andrew Huberman：它已经融入了我成长的文化中，你知道吗？
And sometimes I've just wondered about these naturalistic observations.
有时我只是想知道这些自然主义的观察结果。
David Fajgenbaum: Yep, yep.
大卫·法根鲍姆：是的，是的。
Andrew Huberman: Again, these are not controlled studies, where some of the most hardworking, long-hour, athletic, academic, hybrid, founder people are the ones that oftentimes are dealing with severe health issues.
安德鲁·胡伯曼：再说一遍，这些都不是对照研究，其中一些最勤奋、工作时间最长、运动能力最强、学术能力最强、混合动力、创始人的人往往会面临严重的健康问题。
And, you know, how could that be?
而且，你知道，那怎么可能？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Well, maybe there's a relationship.
Andrew Huberman：嗯，也许有某种关系。
And the more I learn about the kind of general backdrop of supporting health, sleep being fundamental, and all the rest, and natural light exposure, but not too much UV, and you know this kind of thing, you've got to kind of wonder.
我对支持健康的一般背景了解得越多，睡眠是根本，以及所有其他的，以及自然光照射，但不要太多的紫外线，你知道这种事情，你一定会感到好奇。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I'm not saying people shouldn't work hard.
Andrew Huberman：我并不是说人们不应该努力工作。
Otherwise, I'm headed for a quick death, because I always worked very long hours, mostly from a place of enthusiasm, sometimes fear.
否则，我就会很快死去，因为我总是工作很长时间，主要是出于热情，有时是出于恐惧。
David Fajgenbaum: Yeah, exactly.
大卫·法根鲍姆：是的，完全正确。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: But I guess the immune system is a highly conditional system.
Andrew Huberman：但我认为免疫系统是一个高度条件化的系统。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And I'm not saying mellow, laid-back people don't get cancers, but has that ever been looked at, whether or not temperament and propensity for autoimmune-induced diseases correlate?
安德鲁·胡伯曼：我并不是说性格温和、悠闲的人不会得癌症，但有没有研究过这一点，气质和自身免疫性疾病的倾向是否相关？
David Fajgenbaum: I haven't seen it.
大卫·法根鲍姆：我还没看到。
There may be.
可能有。
I mean, what I have seen, and to your point, I think there's really strong data that among people who have autoimmune diseases, stress results in flares of their autoimmune diseases.
我的意思是，我所看到的，就你的观点而言，我认为有非常有力的数据表明，在患有自身免疫性疾病的人中，压力会导致自身免疫性疾病的发作。
And so, if you have it, stress, lack of sleep, all that sort of stuff can result in flares.
所以，如果你有这种情况，压力、睡眠不足，所有这些都会导致耀斑。
I haven't seen data on whether it's sort of like at the etiological level of actually causing it, but I think that this mouse study of these mice was sort of eye-opening for me.
我还没有看到关于它是否与实际引起它的病因学水平有点像的数据，但我认为对这些小鼠的这项小鼠研究让我大开眼界。
And I was working crazy hours, and I was, as you heard, I was on a mission.
我疯狂地工作，正如你所听到的，我正在执行一项使命。
I'm still on a mission, which is to find drugs for patients like my mom, and that meant that I worked crazy, crazy hours.
我仍然有一个使命，那就是为像我妈妈这样的病人寻找药物，这意味着我要疯狂地工作几个小时。
Andrew Huberman: I teach medical students, and they work crazy hours.
安德鲁·休伯曼：我教医科学生，他们疯狂地工作。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: It's really impressive and striking, and at times, a little concerning.
Andrew Huberman：这确实令人印象深刻且引人注目，但有时也有点令人担忧。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: So, you get this diagnosis.
安德鲁·休伯曼：所以，你得到了这个诊断。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Thank goodness they figured out it wasn't lymphoma, and it was Castleman's, because that at least gave you kind of a thin end of the wedge to start exploring various treatments.
安德鲁·胡伯曼（Andrew Huberman）：谢天谢地，他们发现这不是淋巴瘤，而是卡斯尔曼的淋巴瘤，因为这至少给了你一个薄弱的楔子，可以开始探索各种治疗方法。
At the time, was there any treatment for Castleman's disease, known treatment?
当时，是否有治疗卡斯尔曼病的已知疗法？
David Fajgenbaum: At the time, there were no approved treatments, but sort of as we were talking about earlier about like sort of information asymmetry, there was a drug that was originally developed in Japan for Castleman's.
David Fajgenbaum：当时没有批准的治疗方法，但就像我们之前讨论的信息不对称一样，有一种药物最初是在日本为 Castleman 开发的。
But my doctors didn't know to try it.
但我的医生不知道要尝试一下。
They gave a form of chemotherapy to me, which fortunately chemo sort of saved my life just in time.
他们给我进行了某种形式的化疗，幸运的是，化疗及时挽救了我的生命。
But there was this drug in Japan that has pretty strong data that it works for Castleman's, but that information hadn't...
但日本有一种药物，有相当有力的数据表明它对卡斯尔曼有效，但这些信息并没有……
And the drug's available in the U.S. for another condition.
该药在美国可用于治疗另一种病症。
David Fajgenbaum: That information exchange just hadn't happened.
David Fajgenbaum：信息交换还没有发生。
And actually, I'll share a quick story about that drug.
实际上，我将分享一个关于该药物的简短故事。
It's called tocilizumab, and it was made by a doctor named Kazu Yoshizaki, or discovered by a doctor named Kazu Yoshizaki.
它叫托珠单抗（tocilizumab），是由一位名叫吉崎和（Kazu Yoshizaki）的医生制造的，或者是由一位名叫吉崎和（Kazu Yoshizaki）的医生发现的。
And I had heard from a colleague that Kazu had given it to himself before it was given to any other humans to prove that it was safe.
我从一位同事那里听说，Kazu 在将其交给任何其他人类之前先将其交给了自己，以证明它是安全的。
Andrew Huberman: Old school medicine.
安德鲁·休伯曼：老派医学。
David Fajgenbaum: Right?
大卫·法根鲍姆：对吗？
This is the '90s, and monoclonal antibodies were a new technology, and so apparently he was afraid to give it to patients, because he didn't know what it was going to do, so he's like, "I'll give it to myself." So, I heard that, and I said, "Kazu, I heard you gave yourself tocilizumab." He said, "No, no, I didn't give it to myself.
这是 90 年代，单克隆抗体是一项新技术，所以显然他不敢把它给病人，因为他不知道它会做什么，所以他说，“我会把它给我自己。”所以，我听到了，我说，“Kazu，我听说你给自己注射了托珠单抗。”他说：“不，不，我没有给自己。
The nurse gave it to me."
是护士给我的。”
Andrew Huberman: Ah.
安德鲁·休伯曼：啊。
David Fajgenbaum: I was like, "All right, Kazu."
David Fajgenbaum：我当时想，“好吧，Kazu。”
Andrew Huberman: I love the specificity.
Andrew Huberman：我喜欢这种特殊性。
Yeah.
是的。
David Fajgenbaum: Yes, exactly.
大卫·法根鲍姆：是的，完全正确。
And so, he gave it to himself, and he didn't die when he got it.
于是，他就给了自己，得到之后他并没有死。
It was safe enough for him.
这对他来说足够安全了。
So, he studied it in Castleman's patients.
因此，他在卡斯尔曼的患者身上进行了研究。
It got approval for Castleman's in Japan, and then it got repurposed for rheumatoid arthritis here in the U.S., and a number of other autoimmune diseases.
它在日本获得了卡斯尔曼的批准，然后在美国被重新用于治疗类风湿性关节炎和许多其他自身免疫性疾病。
So, it's approved in the U.S. for autoimmune diseases.
因此，它在美国被批准用于治疗自身免疫性疾病。
But like I said, it was made for Castleman's in Japan, approved and available, but my doctors didn't even think to try it.
但就像我说的，它是为日本的 Castleman's 制造的，已获得批准并可用，但我的医生甚至没有想到要尝试它。
Chemo saved my life, but then I relapsed a few weeks later.
化疗救了我的命，但几周后我的病情又复发了。
We tried that drug from Kazu from Japan.
我们尝试了日本 Kazu 的那种药。
David Fajgenbaum: It didn't work for me.
David Fajgenbaum：这对我不起作用。
It works in about a third of patients.
它对大约三分之一的患者有效。
And so, I ended up needing a combination of seven different chemotherapies, Adriamycin, Cytoxan, Etoposide, Velcade, Enzalutamide, Rituxan, like the worst chemos out there was what I ended up needing to get my disease into remission.
因此，我最终需要七种不同化疗的组合，阿霉素、环磷酰胺、依托泊苷、万卡得、恩杂鲁胺、利妥昔单抗，就像最糟糕的化疗是我最终需要让我的疾病得到缓解一样。
And just to give you a sense for how sick I was, this is now the third time that I almost died in a six-month period.
为了让你们了解我病得有多严重，这是我在六个月内第三次险些丧命。
I was so sick that once they started giving me that combo of seven chemos, I started feeling better with every dose.
我病得很厉害，一旦他们开始给我进行七种化疗的组合，我开始感觉每次剂量都好多了。
David Fajgenbaum: And these are the worst chemos in the world, but because they were killing my immune system, which was producing cytokines, which was killing me, I actually felt better on chemotherapy.
David Fajgenbaum：这些是世界上最糟糕的化疗，但因为它们正在杀死我的免疫系统，而免疫系统会产生细胞因子，从而杀死我，所以我实际上对化疗感觉更好。
And eventually, I got well enough to where I could be discharged from the hospital, and there's that picture I showed you from the book, which is me a couple weeks after I got out of the hospital, and I was just so thankful to be alive.
最终，我的病情恢复到了可以出院的程度，我给你们看了书中的那张照片，那是出院几周后的我，我非常庆幸自己还活着。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
We'll post a link to that photo as well, and to your book, of course.
我们也会发布该照片的链接，当然还有您的书的链接。
Yeah, that photo, if you show that photo to the typical person, they're not going to say that's a healthy looking person, but you said you were so grateful to be alive because relative to where you were before, I mean, 100 pounds of fluid accumulating in your legs and body prior to that.
是的，那张照片，如果你把这张照片拿给普通人看，他们不会说那是一个看起来很健康的人，但你说你非常感激自己还活着，因为相对于你之前的情况，我的意思是，在那之前你的腿和身体里积聚了 100 磅的液体。
David Fajgenbaum: So grateful.
大卫·法根鲍姆：非常感激。
David Fajgenbaum: Exactly.
大卫·法根鲍姆：没错。
David Fajgenbaum: It's crazy.
大卫·法根鲍姆：这太疯狂了。
Andrew Huberman: You were in a very unique position, because you have this inquisitive mind, it's very clear you were motivated not just from your illness, but motivated generally based on the story about your mom, and people would listen to you, is my guess.
安德鲁·休伯曼：你处于一个非常独特的位置，因为你有这种好奇心，很明显，你的动机不仅仅是因为你的疾病，而且通常是基于你母亲的故事，我猜人们会听你的。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: They would at least listen to your questions.
Andrew Huberman：他们至少会听你的问题。
I'm reading into this a bit, but I think many patients don't know what questions to ask.
我正在对此进行一些阅读，但我认为许多患者不知道要问什么问题。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Yep
是的
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: They don't know whether the person they're asking has access to the best answers, or even the answers.
Andrew Huberman：他们不知道他们所询问的人是否可以获得最佳答案，甚至不知道答案。
I like to think most doctors are benevolent, so let's just assume that.
我认为大多数医生都是仁慈的，所以我们就这样假设吧。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: But they're also busy and, they get as confused as anybody.
Andrew Huberman：但他们也很忙，而且和其他人一样感到困惑。
I'm not trying to knock on medicine here, but this is just the reality.
我并不是想在这里批评医学，但这就是现实。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: So, simple question, when a physician finishes their training all the way through residency, and they start practicing, let's say an oncologist or a general practitioner in the United States, but perhaps elsewhere, is the typical physician accessing the literature often?
Andrew Huberman：所以，一个简单的问题，当一名医生完成住院医师培训并开始执业时，比如说美国的肿瘤科医生或全科医生，但也许在其他地方，典型的医生是否经常查阅文献？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I know they're required to do some continuing medical education, but it could be the case that their education around a disease is just locked in at the time they finish their residency, plus any major updates that come through.
安德鲁·胡伯曼：我知道他们需要接受一些继续医学教育，但情况可能是，他们对某种疾病的教育只是在他们完成住院医师培训以及任何重大更新时就锁定了。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: How does this work?
安德鲁·休伯曼：这是如何运作的？
Because I want to know when my physician finished training, and I want to know how often they read papers, and I want to know who else is on their committee of people that they share ideas with.
因为我想知道我的医生何时完成培训，我想知道他们阅读论文的频率，我想知道他们的委员会中还有谁与他们分享想法。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I want the most connected physician in the world to be treating me.
Andrew Huberman：我希望世界上人脉最广的医生来治疗我。
David Fajgenbaum: Yeah, and I do, too.
David Fajgenbaum：是的，我也是。
And I think that the problem is that given all the constraints and requirements of a typical physician, they just don't really have that much time to do all the things that we want them to be doing.
我认为问题在于，考虑到典型医生的所有限制和要求，他们实际上没有那么多时间来做我们希望他们做的所有事情。
So, you're right.
所以，你是对的。
Physicians are reading the literature, but typically it's because they have a patient with something that maybe led them to it, or maybe someone sent that paper to them.
医生们正在阅读文献，但通常是因为他们的病人有一些可能导致他们这样做的东西，或者可能有人将该论文发送给他们。
It's very random and sort of piecemeal.
它是非常随机的并且是零碎的。
David Fajgenbaum: You know, no doctor can look at millions of papers, for example.
David Fajgenbaum：例如，你知道，没有医生可以查看数百万篇论文。
And they can't even look at the hundreds that maybe would be relevant for the diseases that they treat.
他们甚至无法查看数百种可能与他们治疗的疾病相关的疾病。
And so, they get sort of some watered down summaries.
因此，他们得到了一些淡化的摘要。
They go to a conference and they hear sort of what's being told, but it's very piecemeal.
他们去参加一个会议，听到一些正在讲的内容，但都是零碎的。
And I think the big takeaway from this whole conversation is that so much of this is piecemeal, and it's not systematic, and it is random, and it's did your doctor happen to come across this one paper?
我认为整个谈话的最大收获是，其中大部分内容都是零碎的，不是系统性的，而是随机的，你的医生是否碰巧看到了这篇论文？
David Fajgenbaum: As opposed to the world that we should be in, which is where it shouldn't matter what doctor you go to see because the data's the data.
David Fajgenbaum：与我们应该所处的世界相反，在这个世界里，你去看什么医生并不重要，因为数据就是数据。
I mean, this whole idea of like we talked about getting second opinions from doctors.
我的意思是，这整个想法就像我们谈到的从医生那里获得第二意见。
It's like for some reason we call it a second opinion, yet we believe that what's being told is exactly what should be done.
就像出于某种原因我们称之为第二意见，但我们相信所告诉的正是应该做的。
And it's like, well, it's an opinion, right?
就像，嗯，这是一种意见，对吧？
And oftentimes second opinions aren't consistent with the first opinion, because they're opinions.
通常，第二意见与第一意见不一致，因为它们只是意见。
David Fajgenbaum: I mean, they're educated, they're driven in science, or oftentimes grounded in evidence.
David Fajgenbaum：我的意思是，他们受过教育，以科学为动力，或者常常以证据为基础。
But it's still...
但它仍然...
You just don't know if your doctor's going to have the information that's needed for you.
您只是不知道您的医生是否会获得您所需的信息。
Which is sort of scary, right?
这有点可怕，对吧？
We want to go to our doctor and believe, like, full trust, you've got all the answers.
我们想要去看我们的医生，并相信，就像完全信任，你已经得到了所有的答案。
And actually, I sort of have this concept that I talk about in my book, which maybe will resonate with what we're talking about now.
事实上，我在书中谈到了这个概念，这可能会与我们现在所讨论的内容产生共鸣。
David Fajgenbaum: I called it the Santa Claus theory of civilization, which is before I got sick with Castleman's, and when I was a medical student, I had this sort of idea that there were like rooms of scientists and doctors collaborating, working together to come up with solutions, kind of like Santa's workshop and all the elves are working together, and as soon as humanly possible that a drug could be discovered, it's at your doorstep.
David Fajgenbaum：我称之为圣诞老人文明理论，这是在我患上卡斯尔曼综合症之前的。当我还是一名医科学生时，我有这样的想法，那就是科学家和医生在房间里合作，共同提出解决方案，有点像圣诞老人的工作室，所有的精灵都在一起工作，一旦人类能够发现一种药物，它就在你家门口。
As soon as they can figure out...
一旦他们能弄清楚...
But then I've sort of realized that actually there aren't workshops.
但后来我意识到实际上没有研讨会。
David Fajgenbaum: There aren't groups of scientists and doctors sitting together to figure out solutions.
David Fajgenbaum：没有一群科学家和医生坐在一起找出解决方案。
And if they are, it's just not necessarily at the pace that you had hoped that it would be at.
即使是这样，也只是不一定按照您希望的速度进行。
And so, I think that that's just one of the many things that's been a bit depressing.
所以，我认为这只是众多令人沮丧的事情之一。
Andrew Huberman: Yeah, I'm going to resist the temptation to editorialize too much on that point, because I want to get more information from you, but I can't resist saying that one of the things I've really wished for for a long time is that the model of how biomedical research is done in the United States would shift from what we call the independent investigative model, where we each have a lab.
安德鲁·休伯曼：是的，我会抵制住在这一点上发表过多社论的诱惑，因为我想从你那里获得更多信息，但我忍不住要说，我长期以来真正希望的一件事是，美国生物医学研究的模式将改变我们所谓的独立调查模式，即我们每个人都有一个实验室。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: Huberman Lab is not just a podcast.
Andrew Huberman：Huberman Lab 不仅仅是一个播客。
It was, and to some extent, still is a laboratory space, although I've certainly pared down the size of my lab in recent years for the podcast reasons, and other reasons.
从某种程度上来说，它仍然是一个实验室空间，尽管近年来我出于播客原因和其他原因确实缩小了实验室的规模。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: But the point is that in this country, you get a PhD if you decide to do a postdoc and start a laboratory.
安德鲁·胡伯曼：但关键是，在这个国家，如果你决定做博士后并建立一个实验室，你就会获得博士学位。
You have a laboratory that's named after you.
你有一个以你的名字命名的实验室。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: You get funding to do things that are really associated with your name.
Andrew Huberman：你获得资金去做那些与你的名字真正相关的事情。
It's like a small startup that can grow into a medium-sized startup, or a large startup, but you stay independent.
这就像一家小型初创公司可以成长为一家中型初创公司，或者一家大型初创公司，但你保持独立。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: The whole notion of the independent investigator is that it's a very romantic model of science, but I think we've reached the point nowadays where the sharing of information and collaboration around a particular goal is far more powerful.
安德鲁·休伯曼：独立调查员的整个概念是，它是一种非常浪漫的科学模式，但我认为我们现在已经达到了这样的程度：围绕特定目标的信息共享和协作更加强大。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: And I don't have a magic wand, and the level of influence I will have over the NIH is questionable, but what I'm really pushing for is laboratories named after a puzzle, or a disease, or a challenge and people coming together to try and solve those issues, because it's not just a matter of naming and branding.
Andrew Huberman：我没有魔杖，我对 NIH 的影响力值得怀疑，但我真正推动的是以一个谜题、一种疾病或一个挑战来命名实验室，让人们聚集在一起尝试解决这些问题，因为这不仅仅是命名和品牌的问题。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Yep.
是的。
Andrew Huberman: It has everything to do with how willing people are to share ideas, as opposed to feeling like they have to fight for their piece of the pie.
Andrew Huberman：这与人们分享想法的意愿有关，而不是感觉他们必须为自己的那块蛋糕而战。
David Fajgenbaum: That's exactly right.
David Fajgenbaum：完全正确。
Andrew Huberman: So, this is perhaps a conversation for another time, but you've done a marvelous job of not just trying to educate people about Castleman's, but your story, and we'll continue down that path in a moment, of trying to solve a problem that was life or death for you, and then taking that knowledge and instead of just saying, "Hey, I'm going to help other people with Castleman's," which you have, to really say, "Hey, let's do this for all of disease, all of medicine."
安德鲁·休伯曼：所以，这可能是另一个话题了，但你做得非常出色，不仅试图向人们介绍卡斯尔曼氏症，还讲述你的故事，我们稍后会继续沿着这条路走下去，试图解决一个对你来说生死存亡的问题，然后利用这些知识，而不是只是说，“嘿，我要帮助其他患有卡斯尔曼氏症的人”，你要真正说，“嘿，让我们这样做是为了所有的疾病，所有的医学。”
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: And it's so admirable.
安德鲁·休伯曼：这真是令人钦佩。
I have to ask, are there other physicians doing what you are doing, or are you the lone wolf out there?
我不得不问，是否有其他医生在做你正在做的事情，或者你是那里的孤独狼？
David Fajgenbaum: I think I'm probably the lone wolf in the scope of what we're doing.
David Fajgenbaum：我想我可能是我们正在做的事情范围内的独狼。
It's all FDA-approved drugs, all 4,000, and all 18,000 human diseases.
这些都是 FDA 批准的药物，全部 4,000 种，全部 18,000 种人类疾病。
I'm not aware of anyone else who's taking this sort of all-versus-all systematic, like, let's find the lowest hanging fruit.
我不知道还有谁会采取这种全面对抗一切的系统性做法，比如，让我们找到最容易实现的目标。
But there are amazing colleagues of mine who work within hematology, the doctor named Luke Chen, who calls me up when he's got patients on death's doorstep to figure out, "What can we do?
但我有一些出色的血液学同事，一位名叫卢克·陈（Luke Chen）的医生，当他的病人濒临死亡时，他打电话给我，想弄清楚，“我们能做什么？
What can we try?
我们可以尝试什么？
We're brainstorming.
我们正在集思广益。
Let's try this or try that."
让我们试试这个或试试那个。”
David Fajgenbaum: And oftentimes, they work, and this patient's alive because we tried a combination of five different chemotherapies that weren't made for that cancer.
David Fajgenbaum：通常，它们会起作用，并且该患者还活着，因为我们尝试了五种不同的化疗组合，但这些化疗并非针对该癌症。
And so, there are certainly really incredible...
所以，确实有一些令人难以置信的......
And there are so many incredible doctors all over all over the country.
全国各地都有这么多令人难以置信的医生。
Andrew Huberman: Sure.
安德鲁·休伯曼：当然。
David Fajgenbaum: And there are some who are really pushing the boundaries of what's possible.
David Fajgenbaum：有些人确实在突破可能的界限。
But I'm not aware of any other effort that's being made that's really at the system level, of like, "I don't care in particular the name of the disease or the name of the drug.
但我不知道正在做出任何其他真正在系统级别的努力，例如，“我并不特别关心疾病的名称或药物的名称。
I just believe that the 4,000 drugs we have today should help all the patients who can benefit from them."
我只是相信我们今天拥有的 4000 种药物应该可以帮助所有能够从中受益的患者。”
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
David Fajgenbaum: Period.
大卫·法根鲍姆：就是这样。
No one should suffer if there's a drug at your CVS that could help you.
如果您的 CVS 中有一种可以帮助您的药物，那么没有人会受苦。
And so, the problem is that that's not the world we're in.
所以，问题是这不是我们所处的世界。
The problem is that we've got to create that world.
问题是我们必须创造那个世界。
And so, that's what we're doing.
所以，这就是我们正在做的事情。
Andrew Huberman: Yeah, and most scientists are incentivized to find new things.
安德鲁·休伯曼：是的，大多数科学家都有动力去发现新事物。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: And most physicians are not scientists.
安德鲁·休伯曼：大多数医生都不是科学家。
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
Andrew Huberman: I'm not saying scientists are better, but the two need each other.
安德鲁·休伯曼：我并不是说科学家更好，但两者需要彼此。
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
Andrew Huberman: So, anyway, I will now pull back on my desire to editorialize about how the system could be better.
安德鲁·休伯曼：所以，无论如何，我现在将不再发表有关如何改进系统的社论。
My hope is that some of this will be implemented going forward.
我希望其中的一些内容能够在未来得到实施。
But if you would, you're sitting here now very much alive.
但如果你愿意的话，你现在就坐在这里，充满活力。
How did this story progress?
这个故事是如何进展的？
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
So, you know, I mentioned that I got that chemotherapy, got out of the hospital, went back to med school at Penn, as a third-year med student.
所以，你知道，我提到我接受了化疗，出院了，回到宾夕法尼亚大学医学院，成为一名三年级的医学院学生。
Andrew Huberman: How much time did you gap?
Andrew Huberman：你们间隔了多少时间？
David Fajgenbaum: Spent six months in the hospital, and then about six months in medical leave, just sort of building myself back up.
David Fajgenbaum：在医院呆了六个月，然后休了大约六个月的病假，只是为了让自己恢复过来。
Amazingly, I had this girlfriend Kaitlin, by my side through it all.
令人惊讶的是，我有女朋友凯特琳，她一直陪伴在我身边。
Kaitlin never left my side, was just amazing.
凯特琳从未离开过我身边，真是太棒了。
And got back to med school.
并回到医学院。
So, it was now a total of a year, because six months in the hospital, six months recovering, and I was so excited to be back and to really get back on that path that I had before, which is that I'm going to go into oncology.
所以，现在总共是一年了，因为住院了六个月，康复了六个月，我很高兴能回来并真正回到我以前的道路上，那就是我将进入肿瘤学。
I'm going to help patients like my mom.
我要帮助像我妈妈这样的病人。
And I was on an experimental drug.
我正在服用一种实验性药物。
David Fajgenbaum: It's actually a drug that's very similar to the drug that my friend, Kazu, made.
David Fajgenbaum：这实际上是一种药物，与我的朋友 Kazu 制造的药物非常相似。
And unfortunately, about a year after I got out of the hospital, I was back in the hospital again with a relapse.
不幸的是，出院大约一年后，我又因病情复发再次入院。
And that relapse was really tough for a few reasons.
由于某些原因，这种复发确实很艰难。
One, I almost died again for the fourth time.
一，我第四次差点又死了。
And I was in the ICU for a month, with all of my organs shutting down.
我在重症监护室住了一个月，所有器官都停止运转。
David Fajgenbaum: But maybe what was even harder than that, was that I was on that experimental drug that we had hoped would keep me in remission, and it was helping other patients.
David Fajgenbaum：但也许比这更困难的是，我正在服用我们希望能让我病情缓解的实验药物，而且它正在帮助其他患者。
And my doctor explained to me that we were out of options.
我的医生向我解释说我们别无选择。
He said, "David, we've tried everything.
他说：“大卫，我们已经尝试了一切。
You know, we tried these chemotherapies.
你知道，我们尝试过这些化疗。
We tried this one experimental drug.
我们尝试了这种实验药物。
There's nothing more that we can do." And there was a few-minute period where my dad, and my sisters, and my girlfriend around me, and we were just bawling our eyes out.
我们无能为力。”有几分钟的时间，我的爸爸、我的姐妹们和我的女朋友围着我，我们只是痛哭流涕。
David Fajgenbaum: You know, this is the world's expert, to use the Santa Claus theory.
David Fajgenbaum：你知道，这是世界专家，使用圣诞老人理论。
This is Santa Claus telling you, "There's nothing more." And I kept probing him, like, "Is there any cell type or signaling pathway, or is there something we can target?" And he said, "David, there's nothing." "Is there anything in early stage of development?" "David, there is nothing." And so, we just bawled.
这是圣诞老人告诉你：“没有什么了。”我不断地询问他，“是否有任何细胞类型或信号通路，或者有什么我们可以瞄准的东西？”他说：“大卫，什么都没有。” “有什么处于早期开发阶段吗？” “大卫，什么都没有。”所以，我们只是嚎啕大哭。
David Fajgenbaum: And then I had a really sort of a moment of clarity, where it was basically I heard what he was saying, but then I thought to myself, "You just gave me seven chemotherapies that were made for lymphoma and multiple myeloma, and they've saved my life now three times.
David Fajgenbaum：然后我有一个真正清醒的时刻，基本上我听到了他在说什么，但后来我对自己说，“你刚刚给了我七种针对淋巴瘤和多发性骨髓瘤的化疗，它们已经三次挽救了我的生命。
It's not long-term.
这不是长期的。
I know I keep relapsing, but if these seven chemotherapies are working, how do we know there's not an eighth chemotherapy, or a ninth drug for something else?
我知道我的病情一直在复发，但如果这七种化疗有效，我们怎么知道没有第八种化疗或第九种药物用于其他治疗？
Like, you can't tell me...
就像，你不能告诉我...
We haven't tried all 4,000 drugs.
我们还没有尝试过所有 4,000 种药物。
We've just tried the drugs that maybe we've thought to try."
我们刚刚尝试了我们可能想尝试的药物。”
David Fajgenbaum: And so, I just locked in right then, and I turned to my family and just sort of wiped away my tears, and said, "I'm going to dedicate the rest of my life, however long that's going to be, it might be a couple days, maybe it'll be a couple months, but however long I've got to try to find out, is there a drug out there that could help me and other patients with my disease that's made for another condition?" And I became just totally locked in on this.
David Fajgenbaum：所以，我当时就锁定了目标，然后转向我的家人，擦干眼泪，说道：“我将奉献我的余生，不管这会持续多久，可能是几天，也可能是几个月，但无论我需要花多长时间去寻找答案，是否有一种药物可以帮助我和其他患有我的疾病的患者，而这种药物是针对另一种情况而设计的？”我完全陷入了这个困境。
David Fajgenbaum: And part of it, too, for why it had to be a repurposed drug is that I didn't have a billion dollars and 15 years to make a new drug from scratch.
David Fajgenbaum：部分原因是我没有 10 亿美元和 15 年的时间来从头开始生产一种新药。
I wouldn't even have known where to start, right?
我什至不知道从哪里开始，对吧？
But I had examples where my life was saved by drugs that weren't made for me, and so I just said, "Well, we should do everything we can to find something else." And so, I started storing blood samples on myself every couple weeks shortly thereafter.
但我也有过一些例子，我的生命被不是为我设计的药物救了，所以我只是说，“好吧，我们应该尽一切努力寻找其他东西。”因此，此后不久，我开始每隔几周在自己身上储存一次血液样本。
Started doing some work in the lab.
开始在实验室做一些工作。
I was literally an MD who had a master's in public health who knew nothing about the lab but started working...
我实际上是一名医学博士，拥有公共卫生硕士学位，对实验室一无所知，但开始工作......
Andrew Huberman: We call that dangerous.
Andrew Huberman：我们称之为危险。
David Fajgenbaum: Yeah, exactly.
大卫·法根鲍姆：是的，完全正确。
Very dangerous.
非常危险。
And with a clock ticking, right?
时钟滴答作响，对吗？
So, you've got a lack of skills, which the clock's ticking down.
所以，你缺乏技能，而且时间已经不多了。
Very dangerous.
非常危险。
And so, started doing laboratory experiments.
于是，开始做实验室实验。
Did a lot of flow cytometry to characterize immune cells that were activated.
进行了大量的流式细胞术来表征被激活的免疫细胞。
Did something called serum proteomics, where I measured 1,000 proteins in my blood.
我进行了血清蛋白质组学研究，测量了血液中的 1,000 种蛋白质。
Andrew Huberman: Who's letting you do all...
安德鲁·休伯曼：谁让你做这一切......
I mean, whose lab space are you using?
我的意思是，你使用谁的实验室空间？
David Fajgenbaum: So, a colleague...
David Fajgenbaum：所以，一位同事......
Andrew Huberman: Were you breaking in at night?
Andrew Huberman：你是在晚上闯入的吗？
David Fajgenbaum: No, I wasn't breaking in at night.
David Fajgenbaum：不，我没有在晚上闯入。
A colleague was very generous to...
一位同事非常慷慨地...
Andrew Huberman: All right.
安德鲁·休伯曼：好的。
Andrew Huberman: People have done it.
安德鲁·休伯曼：人们已经做到了。
David Fajgenbaum: A very kind colleague gave me some space in her lab.
David Fajgenbaum：一位非常友善的同事在她的实验室里给了我一些空间。
And so, I was doing this work in the lab, and also trying to look at other drugs that were being used for other related conditions to see what could work for me, and we were making progress.
因此，我在实验室进行这项工作，并尝试研究用于其他相关病症的其他药物，看看哪些药物对我有效，我们正在取得进展。
I started a foundation called the Castleman Disease Collaborative Network.
我创办了一个名为卡斯尔曼疾病合作网络的基金会。
We really were pushing things forward, and I was optimistic that we would find something.
我们确实在推动事情向前发展，我很乐观地认为我们会找到一些东西。
David Fajgenbaum: And then I relapsed, fifth time, back in the ICU, organs shutting down, doctor explaining to my family that this is it.
David Fajgenbaum：然后我病情复发，第五次，回到重症监护室，器官停止运转，医生向我的家人解释说就是这样了。
In fact, it was so bad at one point that, for some reason over these years, I think it was maybe a bit of denial, I'd never put together a will.
事实上，有一次情况非常糟糕，以至于这些年来，出于某种原因，我认为这可能是一种否认，我从未立过遗嘱。
But this time, the fifth time, my doctor told family, you need this, you need to put down.
但这一次，第五次，我的医生告诉家人，你需要这个，你需要放下。
And so, I had a piece of printer paper that the nurse gave me, and I sort of wrote down who I wanted my things to go to, and I didn't have much but...
所以，我有一张护士给我的打印纸，我写下了我想要把东西送给谁，我没有太多，但是......
Cried, hugged my girlfriend.
哭着抱住了女朋友。
She was my fiancé at that time, Kaitlin.
她当时是我的未婚夫凯特琳。
David Fajgenbaum: Just so disappointed that I hadn't figured something out.
David Fajgenbaum：我非常失望，因为我没有弄清楚一些事情。
Because what I didn't mention is that from that lab work, I thought two drugs might be able to work and we tried both of them.
因为我没有提到的是，从实验室工作来看，我认为两种药物可能有效，我们尝试了这两种药物。
We tried Cyclosporine and we tried IVIG and it didn't work, and I got worse, and I ended up back in the hospital.
我们尝试了环孢素，也尝试了 IVIG，但没有效果，我的情况变得更糟，最后我又回到了医院。
And so the two drugs we tried, I thought that was it, like I got my shot and I missed.
所以我们尝试了两种药物，我想就是这样，就像我得到了机会但我错过了。
And I felt so disappointed.
我感到非常失望。
And I remember saying goodbye to everyone and starting to sort of have life fade away.
我记得和每个人都说了再见，生命开始消逝。
And I thought that was it.
我想就是这样了。
And they gave me all the chemo.
他们给了我所有的化疗。
They gave me the highest dose of Etoposide, this horrible chemo that you could imagine, and two days later I started to wake up.
他们给了我最高剂量的依托泊苷，这是你可以想象的可怕的化疗，两天后我开始醒来。
And, Andrew, there's this sense...
而且，安德鲁，有这种感觉......
I call it overtime and it's basically like it's like extra time in a game where every second counts.
我称之为加时赛，它基本上就像比赛中的加时赛，每一秒都很重要。
David Fajgenbaum: And I can't tell you the joy that comes from getting...
David Fajgenbaum：我无法告诉你获得……所带来的喜悦。
Like when you start to wake up after you've said goodbye to the people you love and you're looking at them, and my sister Gina is here, and Kaitlin's here, and my dad's there, and I'm like, "Oh my gosh." When you start getting life back that you thought you lost, and this is now the fifth time, I can't put into words what it was like, but I remember as soon as I started waking up, I saw them and I was like, "Gina, I need you to get the lymph node that's in North Carolina to Philadelphia.
就像当你在告别你所爱的人之后开始醒来，你看着他们，我的妹妹吉娜在这里，凯特琳在这里，我爸爸在那里，我就像，“哦，天哪。”当你开始恢复你以为自己失去的生活时，这已经是第五次了，我无法用语言形容那是什么样的感觉，但我记得当我开始醒来时，我看到了他们，我说，“吉娜，我需要你把北卡罗来纳州的淋巴结送到费城。
Kaitlin, I need you to get my serum samples that are downstairs in Little Rock, Arkansas, to Philly." Like, I got another shot at this.
凯特琳，我需要你把我在阿肯色州小石城楼下的血清样本送到费城。”就像，我又得到了一次机会。
And I remember starting to wake up and being like, "Oh my gosh, I'm going to get another shot." And so, about three weeks later I was out of the hospital.
我记得我开始醒来时就想，“天哪，我要再注射一次。”就这样，大约三周后，我出院了。
I was back in Philadelphia, and that started about a month-long period where I thawed all those samples.
我回到费城，开始了大约一个月的时间，我解冻了所有这些样本。
I did more flow cytometry, I did more serum proteomics, I did immunohistochemistry on my lymph node.
我做了更多的流式细胞术，我做了更多的血清蛋白质组学，我对我的淋巴结做了免疫组织化学检查。
David Fajgenbaum: And when you put all the data together, what I discovered was that a communication line in your immune system, or in all of our immune systems, called mTOR, was turned into overdrive.
David Fajgenbaum：当你把所有数据放在一起时，我发现你的免疫系统或我们所有的免疫系统中的一条通信线路，称为 mTOR，被变成了超速状态。
And I had a lymph node that I had resected during my last relapse where I actually looked at it and I stained it for mTOR activation, and it came back blazingly positive.
我在上次复发时切除了一个淋巴结，我实际上观察了它，并对它进行了 mTOR 激活染色，结果呈阳性。
And so, I took the data to my doctor and said, "What do you think about trying an mTOR inhibitor on me?" Sirolimus had never been used before.
因此，我把这些数据带给我的医生并说道：“您对在我身上尝试 mTOR 抑制剂有何看法？”以前从未使用过西罗莫司。
Rapamycin's the other name for this drug.
雷帕霉素是这种药物的另一个名称。
Had never been used before for Castleman's, but it's approved for organ transplant rejection, and I sort of had nothing else to try.
以前从未用于卡斯尔曼氏症，但它被批准用于器官移植排斥反应，我几乎没有其他可尝试的。
And so my doctor prescribed it to me and, you know...
所以我的医生给我开了它，你知道......
Andrew Huberman: Rapa?
安德鲁·休伯曼：拉帕？
David Fajgenbaum: Rapa, at the dose of a transplant dose.
David Fajgenbaum：Rapa，采用移植剂量。
So, I take Rapamycin at the same dose that a kidney transplant patient would take.
因此，我服用雷帕霉素的剂量与肾移植患者服用的剂量相同。
It's a lot higher than the typical longevity dosing that people do.
这比人们通常使用的长寿剂量要高得多。
Andrew Huberman: My dose of Rapa for longevity is zero.
Andrew Huberman：我的 Rapa 长寿剂量为零。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
What do you do?
你做什么工作？
Zero?
零？
Andrew Huberman: Yeah, I'm not a fan.
安德鲁·休伯曼：是的，我不是粉丝。
David Fajgenbaum: Okay.
大卫·法根鲍姆：好的。
Andrew Huberman: We can talk about that a little later, but...
Andrew Huberman：我们可以稍后再讨论这个问题，但是......
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Yeah, we definitely should.
是的，我们绝对应该这样做。
Andrew Huberman: A lot of people that were taking Rapa for longevity purposes.
Andrew Huberman：很多人服用 Rapa 是为了长寿。
David Fajgenbaum: Are off of it now.
David Fajgenbaum：现在就结束吧。
Andrew Huberman: I don't want to, because I'll get it wrong.
Andrew Huberman：我不想，因为我会弄错。
I don't know what Peter Attia is doing right now.
我不知道彼得·阿提亚现在在做什么。
He's a friend.
他是一个朋友。
We could call him.
我们可以打电话给他。
But my understanding is that a number of people who were very bullish on Rapa for longevity are no longer bullish on Rapa for longevity.
但我的理解是，一些非常看好Rapa长寿的人不再看好Rapa长寿。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
I've definitely seen that shift, and I'm not sure if it's based on human data, because I don't think anyone's ever done the data, the study in humans, but the reason that people were bullish on it is that every organism that you give Rapamycin to, the earlier you give it to them, the longer they live.
我确实看到了这种转变，我不确定它是否基于人类数据，因为我认为没有人做过这些数据，对人类进行过研究，但人们看好它的原因是，你给予雷帕霉素的每一种生物体，你越早给予它们，它们的寿命就越长。
Now, these are organisms that are in cage settings that are not getting exposed to viruses and pathogens.
现在，这些生物体被关在笼子里，不会接触病毒和病原体。
So, that's probably part of it.
所以，这可能是其中的一部分。
I think that whatever maybe longevity benefit you get from the metabolic aspect of Rapamycin, I think that's counteracted by the fact that we don't live in cages and we actually get exposed to pathogens.
我认为无论雷帕霉素的代谢方面对您的长寿有何好处，我认为这都会被我们不住在笼子里并且实际上会接触病原体这一事实所抵消。
And so, there's probably a negative effect in terms of survival, because Rapamycin is a very potent immunosuppressant.
因此，雷帕霉素可能会对生存产生负面影响，因为雷帕霉素是一种非常有效的免疫抑制剂。
The doses that I take, I take such a high dose that if I were to get your kidney transplanted into me, my immune system wouldn't notice your kidney in my body.
我服用的剂量非常高，如果我将你的肾脏移植到我体内，我的免疫系统不会注意到你的肾脏在我体内。
I mean, that's the level of dose I take.
我的意思是，这就是我服用的剂量水平。
David Fajgenbaum: And so, Sirolimus is approved for organ transplant rejection.
David Fajgenbaum：因此，西罗莫司被批准用于器官移植排斥反应。
As you mentioned, it's used sometimes in the setting of longevity.
正如您提到的，它有时用于长寿的情况。
And it had never been used before for Castleman's.
而且卡斯尔曼以前从未使用过它。
In the three and a half years before I started taking it, I almost died five times from my disease.
在我开始服用它之前的三年半里，我有五次差点死于这种疾病。
I said goodbye to my family on five different occasions, and my doctors were sure I wasn't going to survive.
我在五个不同的场合向家人告别，我的医生确信我活不下去了。
David Fajgenbaum: Since starting Rapamycin, it's now been 11 and three quarter years that I've been in remission on this drug, and it's just sort of like...
David Fajgenbaum：自从开始使用雷帕霉素以来，我服用这种药物已经有 11 年又四分之三的时间了，这有点像……
It feels like such a dream.
感觉就像是一场梦。
Andrew Huberman: Awesome.
安德鲁·休伯曼：太棒了。
I mean, just no other word for it.
我的意思是，没有其他词可以形容它。
Your description of overtime is I think a very apt one.
我认为你对加班的描述非常贴切。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: And I find it equally apt that when you're emerging from near death, you're calling plays like a quarterback.
安德鲁·胡伯曼：我发现当你从濒临死亡中苏醒时，你会像四分卫一样指挥比赛，这同样恰当。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: You're telling your sister what she's going to do with your lymph node.
安德鲁·休伯曼：你正在告诉你妹妹她将如何处理你的淋巴结。
She's going to run the lymph nodes down field, right?
她要在现场进行淋巴结检查，对吗？
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: You're calling plays.
安德鲁·休伯曼：你在说戏剧。
And to me, you're the quarterback, playing quarterback again.
对我来说，你是四分卫，再次打四分卫。
And I can't help but ask the past that you had as an athlete, do you think it served you?
我忍不住问你作为运动员的过去，你认为它对你有用吗？
I mean, the level of drive and determination to say like, "Oh, these eight drugs helped me for a while.
我的意思是，动力和决心的水平，比如说：“哦，这八种药物一度帮助了我。
They're no longer helping.
他们不再帮忙了。
There's got to be a ninth.
一定还有第九个。
Try the ninth." Doesn't work.
试试第九个。”不起作用。
Okay, let's try something else.
好吧，我们试试别的东西。
Almost dead.
差点死了。
Coming out of near death.
从濒临死亡中走出来。
"All right, you run the lymph node this way." I mean, it's almost impossible to not wonder whether or not you learned some of that resilience playing sport.
“好吧，你就这样检查淋巴结。”我的意思是，几乎不可能不怀疑你是否在运动中学到了一些韧性。
David Fajgenbaum: A lot from playing sports.
David Fajgenbaum：很多来自运动。
I think that your listeners may not know Georgetown even has a football team, but we do have a football team.
我想你们的听众可能不知道乔治城甚至有一支足球队，但我们确实有一支足球队。
Andrew Huberman: Is it any good?
安德鲁·休伯曼：有什么好处吗？
No, I'm just kidding.
不，我只是开玩笑。
David Fajgenbaum: Depends on who you ask.
David Fajgenbaum：取决于你问的是谁。
We play...
我们玩...
Andrew Huberman: I'm sure it's very good.
Andrew Huberman：我确信这非常好。
Good enough to be in some league, right?
足以进入某个联盟，对吧？
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
David Fajgenbaum: Yeah, it's division...
David Fajgenbaum：是的，这是分裂......
We play Ivy League schools, so it's like Patriot League, Ivy League schools.
我们和常春藤联盟学校比赛，所以就像爱国者联盟、常春藤联盟学校一样。
But the reason I mentioned that is that we lost a lot of football games.
但我提到这一点的原因是我们输掉了很多足球比赛。
So, certainly there's a bunch of things I learned from football.
所以，我确实从足球中学到了很多东西。
I mean, first off, I decided when I was eight years old that I wanted to be a Division I college quarterback.
我的意思是，首先，我八岁时就决定要成为一级大学四分卫。
I decided as an eight-year-old and, Andrew, I literally had poster boards all over my walls with how far I could throw a football, how accurate I was, how fast my 40-yard dash time was, how fast my mile dash, for the next 10 years, and this literally, that's all I could think about.
我在八岁的时候就决定了，安德鲁，我的墙上贴满了海报板，上面写着我能把足球扔多远，我的准确度有多高，我的 40 码冲刺时间有多快，我的一英里冲刺速度有多快，在接下来的 10 年里，这就是我能想到的一切。
I was just locked in.
我刚刚被锁在里面。
And that sort of, like, 10 years of working towards a mission is sort of the same sort of approach you need to take to solve a massive problem in healthcare, to discover a drug.
为完成一项使命而奋斗 10 年的时间，与解决医疗保健领域的重大问题、发现药物所需采取的方法是一样的。
It's that same sort of, you know, just constant drive.
你知道，这就是同样的持续驱动力。
So, I think one part was that it was the first of what's now been a few of these sprints that I've gone on.
所以，我认为其中一个原因是，这是我现在正在进行的一些冲刺中的第一个。
So, I think that was part of it.
所以，我认为这是其中的一部分。
Another is I mentioned sort of loss and resilience.
另一个是我提到的某种损失和恢复力。
David Fajgenbaum: We lost a lot of football games, you get back up and you just sort of keep fighting.
大卫·法根鲍姆：我们输掉了很多足球比赛，当你重新站起来时，你就会继续战斗。
But also physical pain and challenges.
但也有身体上的痛苦和挑战。
You know, I've broken both my collarbones, broken both my hands at different times.
你知道，我的双锁骨、双手都曾多次骨折。
I remember there were times when for punishment for the team, we did something called rolling, where literally you just start rolling on your side on the football field until everyone gets sick, and then you stop rolling, but that's like you're rolling for a long time until everyone gets sick.
我记得有几次，为了对球队进行惩罚，我们做了一种叫做滚动的事情，实际上你只是开始在足球场上滚动，直到每个人都生病了，然后你停止滚动，但这就像你滚动了很长时间，直到每个人都生病了。
That's the kind of physical, like I wouldn't use the word abuse, but it's the sort of physical demands that get put on your body that enable you to then gain 100 pounds of fluid in the hospital and be in the worst pain you could ever imagine.
这就是一种身体上的需求，就像我不会使用“虐待”这个词一样，但正是这种身体上的需求对你的身体提出了要求，使你能够在医院里摄入 100 磅的液体，并承受你能想象到的最严重的疼痛。
I mean, it was way worse pain than breaking my collarbones, but I'd felt bad pain before.
我的意思是，这比锁骨骨折更痛苦，但我以前也感到过剧烈的疼痛。
And so, I can feel some bad pain now, and I think that a lot of that came from football.
所以，我现在能感受到一些剧烈的疼痛，我认为其中很大一部分来自足球。
David Fajgenbaum: I also think that when I was in the ICU for that first six-month period, I learned a lot about myself, and I learned a lot about how do you overcome challenging situations.
David Fajgenbaum：我还认为，当我在重症监护病房的前六个月里，我对自己有了很多了解，并且了解了如何克服具有挑战性的情况。
And I think there were three things that really helped me.
我认为有三件事对我真正有帮助。
So, the first was that the whole time I was in the ICU for that six-month period, I had this clear vision for the future, which was a family with Kaitlin, who I was dating at the time, and a career discovering drugs for patients in memory of my mom.
所以，第一件事是，在我住在重症监护病房的六个月期间，我对未来有一个清晰的愿景，那就是与我当时约会的凯特琳组成一个家庭，以及为纪念我母亲的患者发现药物的职业。
So, that clear vision for the future helped to deal with what was just horrible, excruciating pain, because of the fluid that you gain around your organs.
因此，对未来的清晰愿景有助于应对因器官周围积液而带来的可怕、难以忍受的疼痛。
It felt like I was getting basically simultaneously stabbed for months at a time.
感觉就像我基本上同时被刺伤了几个月。
So, one is vision for the future.
因此，一是对未来的愿景。
David Fajgenbaum: Two was that I got so much strength from my family around me, like my dad, my sisters, Kaitlin, they were holding my hands and I could feel their strength in my hands, and they were literally helping me to keep going.
大卫·法根鲍姆：第二，我从周围的家人那里得到了很大的力量，比如我的爸爸、我的姐妹们、凯特琳，他们握着我的手，我能感觉到他们的力量在我手中，他们确实在帮助我继续前进。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
David Fajgenbaum: And I remember there was a moment during when I'd very first gotten sick, so the first time I almost died from my disease, and doctors came in, said I wasn't going to make it.
David Fajgenbaum：我记得有那么一刻，当我第一次生病时，我第一次几乎死于我的疾病，医生进来说我活不下去了。
We had no diagnosis at this time.
我们当时还没有诊断。
David Fajgenbaum: Said goodbye to my family, you know, just heartbroken, and I remember with every breath I took, just the horrible pain.
大卫·法根鲍姆：和我的家人告别，你知道，我心碎了，我每次呼吸都记得可怕的痛苦。
And so, when you have that much pain with every breath, you start slowing your breathing, and I was starting to let go.
所以，当你每次呼吸都感到那么痛苦时，你开始放慢呼吸，我开始放手。
I was letting go, and I thought that I was maybe going to miss out on a couple of days of life, but, you know, "I'm in a lot of pain.
我正在放手，我想我可能会错过几天的生活，但是，你知道，“我很痛苦。
I'm just going to slow down and let go." And I remember hearing my sister, Gina, who was on my left side, she was holding my hand, I remember her looking at me and everyone else was crying and sort of like, I think was maybe had an idea for what was going to happen, but Gina was holding my hand and she said, "Just breathe, Dave.
我只是要放慢脚步并放手。”我记得听到我姐姐吉娜在我左边，她握着我的手，我记得她看着我，其他人都在哭，有点像，我想可能知道会发生什么，但吉娜握着我的手，她说，“呼吸吧，戴夫。
Just breathe." And I remember when I heard that, I was like, "All right, I'm going to do one more breath, and it's going to be really painful, but I got this." And I did one more, and I did another one, and fortunately the medicines that I'd received helped me to make it a little bit longer.
呼吸吧。”我记得当我听到这个消息时，我想，“好吧，我要再呼吸一次，这会非常痛苦，但我明白了。”我又做了一次，又做了一次，幸运的是，我收到的药物帮助我把时间延长了一点。
David Fajgenbaum: And so, the key takeaway for me was that you can do anything for, like, one minute, or one hour, or one day, but you can't do...
David Fajgenbaum：所以，对我来说最重要的一点是，你可以做任何事情，比如一分钟、一小时或一天，但你不能……
Like, if you had told me at the beginning, "David, you're going to be in the worst pain of your life for six months.
就像，如果你一开始就告诉我，“大卫，你将在六个月内经历一生中最痛苦的痛苦。
It's going to be horrible.
这将是非常可怕的。
You're going to suffer.
你会受苦的。
Your organs will be failing," no way I would have the strength to survive that.
你的器官将会衰竭，”我绝对没有力气活下去。
But I could survive for one minute, and one hour, and one day, and I think a lot of that you learn.
但我可以生存一分钟、一小时、一天，我想你可以学到很多。
I think I learned some of that from playing football, and I think that just this sort of, like, putting your body through a lot of challenges I think helped me a lot.
我想我从踢足球中学到了一些，我认为这种让你的身体经历很多挑战的方式对我帮助很大。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
Older sister or younger sister?
姐姐还是妹妹？
David Fajgenbaum: Two older sisters, yeah.
David Fajgenbaum：是的，有两个姐姐。
Lisa and Gina are seven and five years older than me.
丽莎和吉娜比我大七岁和五岁。
Andrew Huberman: Awesome, man.
安德鲁·休伯曼：太棒了，伙计。
As the younger brother of a older sister, they're the best.
作为姐姐的弟弟，他们是最棒的。
David Fajgenbaum: They're the best.
大卫·法根鲍姆：他们是最好的。
David Fajgenbaum: They're the best.
大卫·法根鲍姆：他们是最好的。
Andrew Huberman: The best, yep.
安德鲁·休伯曼：是的，最好的。
Big shout out for the sisters, older and younger.
为姐姐们大声喊叫，无论是年长的还是年幼的。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: The best.
安德鲁·休伯曼：最好的。
Andrew Huberman: I'd like to take a quick break and acknowledge one of our sponsors, Function.
Andrew Huberman：我想稍微休息一下，并感谢我们的赞助商之一 Function。
Last year, I became a Function member after searching for the most comprehensive approach to lab testing.
去年，在寻找最全面的实验室测试方法后，我成为了 Function 成员。
Function provides over 100 advanced lab tests that give you a key snapshot of your entire bodily health.
Function 提供 100 多项高级实验室测试，为您提供整个身体健康状况的关键快照。
This snapshot offers you with insights on your heart health, hormone health, immune functioning, nutrient levels, and much more.
此快照为您提供有关心脏健康、激素健康、免疫功能、营养水平等方面的见解。
Andrew Huberman: They've also recently added tests for toxins, such as BPA exposure from harmful plastics, and tests for PFASs, or forever chemicals.
Andrew Huberman：他们最近还增加了毒素测试，例如有害塑料中的 BPA 暴露，以及 PFAS 或永久化学物质的测试。
Function not only provides testing of over 100 biomarkers key to your physical and mental health, but it also analyzes these results and provides insights from top doctors who are expert in the relevant areas.
Function 不仅提供对您的身心健康至关重要的 100 多种生物标记物的测试，而且还分析这些结果并提供相关领域专家的顶级医生的见解。
For example, in one of my first tests with Function, I learned that I had elevated levels of mercury in my blood.
例如，在我第一次使用 Function 进行测试时，我发现我的血液中汞含量升高。
Andrew Huberman: Function not only helped me detect that, but offered insights into how best to reduce my mercury levels, which included limiting my tuna consumption, I'd been eating a lot of tuna, while also making an effort to eat more leafy greens and supplementing with NAC and acetylcysteine, both of which can support glutathione production and detoxification.
Andrew Huberman：功能不仅帮助我发现了这一点，而且还提供了如何最好地降低汞含量的见解，其中包括限制我的金枪鱼摄入量，我一直在吃大量金枪鱼，同时还努力多吃绿叶蔬菜并补充 NAC 和乙酰半胱氨酸，这两者都可以支持谷胱甘肽的产生和解毒。
And I should say, by taking a second Function test, that approach worked.
我应该说，通过进行第二次功能测试，这种方法奏效了。
Comprehensive blood testing is vitally important.
全面的血液检测至关重要。
There's so many things related to your mental and physical health that can only be detected in a blood test.
有很多与您的心理和身体健康相关的事情只能通过血液检查来检测。
Andrew Huberman: The problem is blood testing has always been very expensive and complicated.
Andrew Huberman：问题是血液检测一直非常昂贵且复杂。
In contrast, I've been super impressed by Function's simplicity and at the level of cost.
相比之下，Function 的简单性和成本水平给我留下了深刻的印象。
It is very affordable.
这是非常实惠的。
As a consequence, I decided to join their scientific advisory board, and I'm thrilled that they're sponsoring the podcast.
因此，我决定加入他们的科学顾问委员会，我很高兴他们赞助了这个播客。
If you'd like to try Function, you can go to functionhealth.com/huberman.
如果您想尝试 Function，可以访问 functionhealth.com/huberman。
Function currently has a waitlist of over 250,000 people, but they're offering early access to Huberman podcast listeners.
Function 目前有超过 250,000 人的候补名单，但他们正在为 Huberman 播客听众提供早期访问服务。
Again, that's functionhealth.com/huberman to get early access to Function.
同样，可以通过 functionhealth.com/huberman 提前访问 Function。
Andrew Huberman: You had an amazing team, so another parallel to football, and another signal that for people combating disease or just general health issues, that social support piece is so key.
安德鲁·胡伯曼（Andrew Huberman）：你们拥有一支出色的团队，这与足球是另一个相似之处，也是另一个信号，表明对于与疾病或只是一般健康问题作斗争的人们来说，社会支持非常关键。
I mean, there's so much data on this.
我的意思是，这方面有很多数据。
And we've done podcasts about this, and we could probably do 100 more, and the message is always the same, which is to the best that you can surround yourself with at least one person you can rely on, and the best way to do that is to be that person to people.
我们已经制作了有关此的播客，我们可能还可以制作 100 个以上，而且传达的信息始终是相同的，那就是最好让自己周围至少有一个可以信赖的人，而做到这一点的最佳方法就是成为人们中的那个人。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Should you stay healthy, you have that person.
Andrew Huberman：如果你保持健康，你就有那个人。
Should you not be healthy, you have that person.
如果你不健康，你就有那个人。
So, yeah, and over and over.
所以，是的，一遍又一遍。
It's really an incredible story, because you emerge from it with 11 years of overtime.
这真是一个令人难以置信的故事，因为你用了11年的加班才从这个故事中走出来。
Do you still think about it as overtime?
你还认为这是加班吗？
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
I do.
我愿意。
Fifth overtime, yep.
第五个加时赛，是的。
Although, I will admit, I think to your question, I don't have the same sort of...
虽然，我承认，我认为对于你的问题，我没有同样的......
Because in overtime, there's both fear and clarity, and the fear, I think, drives some clarity, and I think you'd be able to talk to the science of it a lot more than I would.
因为在加时赛中，既有恐惧，也有清晰，我认为恐惧会带来一些清晰，我认为你能够比我更多地谈论它的科学性。
David Fajgenbaum: I will say, as 11 years and three quarter of a year go by, there isn't maybe the same heightened sense of, like, "I'm in overtime."
David Fajgenbaum：我想说，随着 11 年又四分之三的时间过去，可能不会再有同样强烈的感觉，比如“我正在加时赛”。
David Fajgenbaum: But every once in a while, I have a port where I get my infusion every few months on my chest.
David Fajgenbaum：但每隔一段时间，我的胸口就会有一个端口，每隔几个月就可以输液。
I've got scars on my neck from where lymph nodes got taken out.
我的脖子上有淋巴结切除处留下的疤痕。
And every once in a while, I just sort of put my hand here and here, and it reminds me, okay, I'm in overtime.
每隔一段时间，我就会把手伸到这里和这里，它会提醒我，好吧，我正在加时赛。
Like, I've got to be really thankful because we don't know how much time we have.
就像，我必须非常感激，因为我们不知道我们还有多少时间。
Andrew Huberman: The brain's wild in this way.
Andrew Huberman：大脑在这方面是疯狂的。
We had a guest on this podcast, Michael Easter.
我们在这个播客上邀请了一位嘉宾，迈克尔·复活节。
He wrote the book "The Comfort Crisis."
他写了《舒适危机》一书。
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
Andrew Huberman: It was an incredible book, really, about how to navigate life generally, and doing really hard things voluntarily.
安德鲁·休伯曼：这确实是一本令人难以置信的书，讲述了如何驾驭生活，以及自愿做真正困难的事情。
And he'd go do really hard expeditions, and then come back from them with a renewed sense of gratitude for, like the smallest things, the smallest things.
他会去进行非常艰苦的探险，然后带着新的感激之情回来，就像最小的事情一样。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Yes.
是的。
Andrew Huberman: And I asked him, you know, "How long does that gratitude last?"
安德鲁·休伯曼：我问他，你知道，“这种感激之情能持续多久？”
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And I think he said, "About two months, and then it resets."
安德鲁·胡伯曼：我想他说的是，“大约两个月，然后它就会重置。”
David Fajgenbaum: Oh.
大卫·法根鲍姆：哦。
Andrew Huberman: And of course, those weren't life or death circumstances of the sort that you're describing.
安德鲁·胡伯曼：当然，那些不是你所描述的那种生死攸关的情况。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: So, he just goes on more of these things, right?
安德鲁·休伯曼：所以，他只是继续做更多这样的事情，对吧？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
That's great.
那太棒了。
Andrew Huberman: And it's a wonderful book, and dare I say, an important book for people healthy, and certainly healthy or sick.
安德鲁·休伯曼：这是一本很棒的书，我敢说，对于健康的人来说，尤其是健康或患病的人来说，这是一本重要的书。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I think this notion that you're on borrowed time, or overtime, it's hard to hold onto, because you also have to just live your life.
安德鲁·休伯曼：我认为这种“借来的时间”或“加班”的观念很难坚持下去，因为你也必须过自己的生活。
But clearly, you're making the most of that, and as I mentioned earlier in service to others.
但显然，你正在充分利用这一点，正如我之前在为他人服务时提到的那样。
So, your background as an athlete helped you navigate this health challenge.
因此，您作为运动员的背景可以帮助您应对这一健康挑战。
Then the health challenge dovetails with your work as a physician, and you're really a physician scientist, because you hold both titles formally, and as a practitioner.
那么健康挑战与你作为一名医生的工作相吻合，你真的是一名医学科学家，因为你同时拥有正式的头衔和从业者的头衔。
David Fajgenbaum: That's right.
大卫·法根鲍姆：没错。
Andrew Huberman: So, nowadays, do you get contacted by people all the time whose kid or themselves are dealing with a challenging disease with the question, "Is there a drug that's approved that can help me, or a combination of drugs?"
安德鲁·休伯曼：那么，如今，是否经常有人联系您，他们的孩子或他们自己正在应对一种具有挑战性的疾病，并提出这样的问题：“是否有一种已批准的药物或药物组合可以帮助我？”
David Fajgenbaum: We do.
大卫·法根鲍姆：我们愿意。
We get contacted a lot.
我们经常联系。
And to share sort of what these last 11 and a half years have looked like, so after medical school, I actually enrolled in business school in part because I realized that the greatest barriers to progress did not appear to be scientific or medical.
为了分享过去 11 年半的情况，所以在医学院毕业后，我实际上进入了商学院，部分原因是我意识到进步的最大障碍似乎不是科学或医学。
They had to do with things like getting people to collaborate with one another, efficient use of resources, coming up with a strategy to solve a disease.
他们必须处理诸如让人们相互合作、有效利用资源、制定解决疾病的策略等事情。
David Fajgenbaum: So, it was actually in business school that I discovered sirolimus that saved my life.
David Fajgenbaum：实际上，我是在商学院发现西罗莫司救了我的命。
And after business school, I joined the faculty at Penn and set up a lab.
从商学院毕业后，我加入了宾夕法尼亚大学并建立了一个实验室。
And we got started out first focused on Castleman's, and first it was about understanding how does mTOR play a role in Castleman's disease, started treating other patients with the drug that I'm on, sirolimus.
我们首先关注 Castleman 病，首先是了解 mTOR 如何在 Castleman 病中发挥作用，开始用我正在使用的药物西罗莫司治疗其他患者。
And so, I'll never forget we treated a patient in Brazil, and then treated a patient in New Zealand, but I just heard about them.
因此，我永远不会忘记我们在巴西治疗了一名患者，然后在新西兰治疗了一名患者，但我只是听说过他们。
I wasn't physically with them.
我没有和他们在一起。
But then the fourth patient we treated was a patient named Joey, who was a child, just a 13-year-old boy at Children's Hospital of Philadelphia, and it completely turned his disease around.
但是我们治疗的第四个病人是一位名叫乔伊的病人，他还是个孩子，只是费城儿童医院的一个 13 岁男孩，这彻底扭转了他的病情。
He was literally dying in the children's hospital.
他在儿童医院里真的快要死了。
David Fajgenbaum: We used sirolimus, and I would come in every day to see him, and I'll never forget seeing the blood work, seeing him the couple days after we started sirolimus, and it was just, Andrew, it was so incredible to see this boy who was on death's doorstep start to turn around because of the drug that saved me, and now we're saving other people.
David Fajgenbaum：我们使用西罗莫司，我每天都会来看他，我永远不会忘记看到血液工作，在我们开始使用西罗莫司几天后看到他，安德鲁，看到这个濒临死亡的男孩开始好转，因为药物救了我，现在我们正在拯救其他人，真是太不可思议了。
And again, we'd use it in Brazil, use it in New Zealand, but I hadn't seen them.
再说一遍，我们会在巴西使用它，在新西兰使用它，但我没有看到它们。
I hadn't felt what his family was feeling.
我没有感受到他家人的感受。
I actually just saw Joey a couple days ago, and his parents a couple days ago as well.
事实上，我几天前才见过乔伊，几天前也见过他的父母。
He's a college student at Temple University now.
他现在是天普大学的一名大学生。
David Fajgenbaum: But, so that, for me, was this huge moment.
David Fajgenbaum：但是，对我来说，这是一个重要的时刻。
It's like, "Oh my gosh.
就像，“天哪。
The drug I'm on is helping other people.
我服用的药物正在帮助其他人。
It's not just a sort of one-off thing." And then we found a drug that's used for a bone marrow condition called myelofibrosis, that we thought could also treat Castleman's patients.
这不仅仅是一种一次性的事情。”然后我们发现了一种用于治疗骨髓纤维化的药物，我们认为它也可以治疗卡斯尔曼的患者。
So, there was a young girl named Kyla in a hospital in Chicago, wasn't responding to anything, and she didn't respond to my drug either, sirolimus, and we recommended her doctor try ruxolitinib, first time ever for Castleman disease, and she responded incredibly well.
所以，芝加哥的一家医院里有一个名叫凯拉的年轻女孩，她对任何药物都没有反应，她对我的药物西罗莫司也没有反应，我们建议她的医生尝试鲁索替尼，这是第一次治疗卡斯尔曼病，她的反应非常好。
She's in college now at Marquette University.
她现在在马凯特大学上大学。
She's going to be a nurse.
她要成为一名护士。
David Fajgenbaum: And that was amazing.
David Fajgenbaum：这太棒了。
I was like, "Okay, not only did we find this drug for me and give it to other people, but now we found another drug for Castleman's." Like, "Wow, maybe there's even more we can do." So, our lab kept working and working, and that's when Michael, the patient with angiosarcoma came to us back in 2016, and we found out that this drug for melanoma could actually treat his angiosarcoma cancer.
我当时想，“好吧，我们不仅为我找到了这种药物并将其提供给其他人，而且现在我们还为卡斯尔曼找到了另一种药物。”就像，“哇，也许我们还能做更多的事情。”所以，我们的实验室一直在工作，直到 2016 年血管肉瘤患者 Michael 来到我们这里，我们发现这种治疗黑色素瘤的药物实际上可以治疗他的血管肉瘤癌症。
David Fajgenbaum: And then it's, "Oh my gosh, we can find it for another disease." And this, over the course of the last 11 years has totaled 14 drugs for diseases they weren't intended for.
David Fajgenbaum：然后就是，“天哪，我们可以找到它来治疗另一种疾病。”在过去 11 年里，总共有 14 种药物用于治疗原本不适合治疗的疾病。
And with every one of them, we get so excited, and then we also think to ourselves, "How many more drugs are there out there that are made for one disease that could actually treat more diseases?" And so, that meant that three years ago, as artificial intelligence was really continuing to move forward at an incredible pace, my co-founders, Grant Mitchell and Tracey Sikora.
对于每一种药物，我们都感到非常兴奋，然后我们也在想，“还有多少药物是针对一种疾病而制造的，实际上可以治疗更多的疾病？”因此，这意味着三年前，当人工智能确实继续以令人难以置信的速度向前发展时，我的联合创始人格兰特·米切尔和特雷西·西科拉。
Grant was utilizing artificial intelligence to support drug companies with finding new uses for their medicines, to find subpopulations that might benefit from their medicines.
格兰特正在利用人工智能来支持制药公司寻找其药物的新用途，找到可能受益于其药物的亚人群。
But we thought, what if instead of using AI one drug company at a time to find one new use for a medicine, what if we could utilize artificial intelligence to scan across all drugs and all diseases to find the best opportunities?
但我们想，如果我们可以利用人工智能扫描所有药物和所有疾病以找到最佳机会，而不是一次为一家制药公司寻找一种药物的新用途，会怎样呢？
David Fajgenbaum: So, we started Every Cure three years ago, and since starting Every Cure, you're absolutely right, we get contacted by lots of patients and families, and we try to help them any way that we can.
David Fajgenbaum：所以，我们三年前开始了 Every Cure，自从开始 Every Cure 以来，你是完全正确的，我们收到了很多患者和家属的联系，我们尽力以任何方式帮助他们。
And I'll share a couple really exciting examples.
我将分享几个非常令人兴奋的例子。
David Fajgenbaum: And at the same time that we're having all these incomings about people that are on death's door, what we keep focusing on is, can we find these matches, like lidocaine for breast cancer, or DFMO for Bachmann-Bupp, that syndrome I mentioned, can we find these matches and do the work so that way people don't get to death's doorstep?
David Fajgenbaum：与此同时，我们收到了所有这些关于濒临死亡的人的信息，我们一直关注的是，我们能否找到这些匹配，例如治疗乳腺癌的利多卡因，或治疗巴赫曼-布普综合征的 DFMO，我提到过，我们能否找到这些匹配并开展工作，使人们不会濒临死亡？
Do the work to do the clinical studies, get the word out so doctors who are prescribing them, so they're not coming to us for a Hail Mary, but we're actually getting the work done ahead of time, so that way the drug is just being used.
做好临床研究的工作，把消息传出去，这样开处方的医生就不会来找我们万福玛丽了，但我们实际上是在提前完成工作，这样药物就可以被使用。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
David Fajgenbaum: Can we match every drug to every disease that they can treat and do the work to get it to people?
David Fajgenbaum：我们能否将每种药物与它们可以治疗的每种疾病相匹配，并努力将其提供给人们？
Because that's really, I think, the way that we really solve problems at scale, as opposed to this sort of that one-off Hail Mary approach.
因为我认为，这确实是我们真正大规模解决问题的方式，而不是这种一次性的万福玛丽方法。
But I'll share a couple one-off approaches that I'm really, really proud of.
但我将分享一些我非常非常自豪的一次性方法。
One of them is a patient named Al in Vancouver, who wasn't responding to any medicines.
其中一位是温哥华的一位名叫阿尔的患者，他对任何药物都没有反应。
He also has Castleman's and the subtype that I have, the really deadly one.
他还患有卡斯尔曼氏症和我所拥有的亚型，这是真正致命的亚型。
David Fajgenbaum: And the number one ranked drug in our machine learning algorithm for Castleman disease when we ran it for the first time two years ago, was a TNF inhibitor, actually.
David Fajgenbaum：两年前我们首次运行卡斯尔曼病机器学习算法时，排名第一的药物实际上是 TNF 抑制剂。
I mentioned TNF earlier.
我之前提到过 TNF。
And based on some other work in our lab, we thought that maybe we could try it for him.
根据我们实验室的其他一些工作，我们认为也许我们可以为他尝试一下。
He received the drug.
他收到了药物。
He responded really well.
他的反应非常好。
Andrew Huberman: For Castleman's?
安德鲁·休伯曼：卡斯尔曼的？
David Fajgenbaum: For Castleman's, yeah.
David Fajgenbaum：对于卡斯尔曼来说，是的。
TNF inhibitor.
肿瘤坏死因子抑制剂。
Andrew Huberman: TNF?
安德鲁·休伯曼：TNF？
Tumor necrosis factor?
肿瘤坏死因子？
David Fajgenbaum: Yeah, TNF inhibitor.
David Fajgenbaum：是的，TNF 抑制剂。
Yeah, so, sorry, not TNF directly, the inhibitor of TNF, exactly.
是的，所以，抱歉，不是直接的 TNF，确切地说是 TNF 的抑制剂。
So, we gave him adalimumab, and he responded incredibly well.
因此，我们给了他阿达木单抗，他的反应非常好。
He's been doing great now for two years.
两年来他的表现一直很好。
Published in "The New England Journal of Medicine" earlier this year.
今年早些时候发表在《新英格兰医学杂志》上。
Andrew Huberman: Can I ask you, forgive me for interrupting.
Andrew Huberman：请问您可以吗？请原谅我打扰您。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
Andrew Huberman: Okay, so an inhibitor of tumor necrosis factor alpha.
Andrew Huberman：好的，肿瘤坏死因子α抑制剂。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: TNF-alpha is involved in an inflammatory response.
Andrew Huberman：TNF-α 参与炎症反应。
Earlier you said that this inhibitor can help treat this condition of multiple strokes in childhood.
您之前说过，这种抑制剂可以帮助治疗儿童多次中风的情况。
David Fajgenbaum: DADA2.
大卫·法根鲍姆：DADA2。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: Okay, strokes are basically bleeding out in brain areas, essentially.
安德鲁·胡伯曼：好的，中风基本上是大脑区域出血。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Right?
安德鲁·休伯曼：对吗？
Okay, I'm sure there's a mechanistic pathway that can be, you know, connected to that, right, involving any number of things.
好吧，我确信有一个机械途径可以与此相关，对吧，涉及很多事情。
David Fajgenbaum: Connected, yeah.
David Fajgenbaum：互联，是的。
Andrew Huberman: And I'm sure there's a mechanistic pathway that can be linked to this other observation.
安德鲁·休伯曼：我确信有一个机制途径可以与其他观察结果联系起来。
Does it matter to you?
这对你来说重要吗？
Like does it matter that, I think I actually have seen papers where TNF-alpha is involved in the kind of like endothelial neural interface.
就像这很重要一样，我想我实际上已经看过一些论文，其中 TNF-α 涉及类似内皮神经界面的内容。
And then you have inflammation, and then you have some shearing, and then you have bleeding, and okay, so like I can...
然后你会发炎，然后你会剪毛，然后你会流血，好吧，就像我可以......
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yep, yep.
大卫·法根鲍姆：是的，是的。
Andrew Huberman: It's a just so story in my mind, that works, right?
Andrew Huberman：这在我看来就是一个故事，有效，对吧？
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: Does it matter, or is the goal to screen drugs in patients, as these Hail Mary passes, and figure out things that work, and then worry about mechanism later?
安德鲁·胡伯曼：这重要吗？或者目标是在万福玛利亚过去时在患者中筛选药物，找出有效的方法，然后再担心机制？
This is typically not the way science and medicine is done.
这通常不是科学和医学的工作方式。
Especially in this country.
尤其是在这个国家。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: People don't like the notion of eating a plant, or eating a seed and then seeing benefits and not knowing what the molecules are.
安德鲁·休伯曼：人们不喜欢吃植物或吃种子，然后看到好处却不知道分子是什么的想法。
I mean, we like reductionist science in this country.
我的意思是，我们喜欢这个国家的还原论科学。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: This is changing somewhat, but that's been the pattern.
Andrew Huberman：这种情况正在发生一些变化，但这就是模式。
To you, for a patient that's suffering, is all that matters that they get better?
对您来说，对于一个正在遭受痛苦的病人来说，他们好起来就很重要吗？
I could understand why that might be the case.
我能理解为什么会出现这种情况。
David Fajgenbaum: Yes, 100%.
大卫·法根鲍姆：是的，100%。
Ever since I saw my mom die from brain cancer, all I've wanted to do is think about how can we help people with these horrible conditions.
自从我看到妈妈死于脑癌以来，我一直想做的就是思考我们如何帮助患有这些可怕疾病的人们。
And then when I went through my own experience, I realized that, oh my gosh, helping people with these horrible conditions may not be spending my whole career to develop one drug.
然后，当我经历自己的经历时，我意识到，天哪，帮助那些患有这些可怕疾病的人可能并不需要花费我的整个职业生涯来开发一种药物。
It might actually be spending my whole career finding out all the uses for all these other drugs.
实际上，我的整个职业生涯可能都在寻找所有这些其他药物的所有用途。
And to use a football analogy, it's like we've got all these drugs that are on like, you know, the one yard line that could be useful for a new condition, but there's no incentive to do that, so can we just push them in?
用足球来比喻，就像我们已经拥有所有这些药物，你知道，一码线可能对新的情况有用，但没有动力这样做，所以我们可以把它们推进去吗？
So, yes, it's all about can we help patients?
所以，是的，关键在于我们能否帮助患者？
And I think it goes bidirectionally.
我认为这是双向的。
So, when a drug helps a patient, like that TNF inhibitor helped Al, we believe it's because T cells in Castleman's patients, CD4-positive T cells, are producing too much TNF when they become activated and we've shown that in the lab.
因此，当一种药物帮助患者时，就像 TNF 抑制剂帮助 Al 一样，我们相信这是因为 Castleman 患者体内的 T 细胞（CD4 阳性 T 细胞）在被激活时会产生过多的 TNF，我们已经在实验室中证明了这一点。
David Fajgenbaum: So, you can actually start working backwards.
David Fajgenbaum：所以，你实际上可以开始逆向工作。
So, like when a TNF inhibitor helps the patient, so let's look at their blood and let's figure out why.
因此，就像 TNF 抑制剂对患者有帮助一样，让我们看看他们的血液并找出原因。
And then maybe we can learn something for the next patient.
然后也许我们可以为下一个病人学到一些东西。
So, I think it should be bidirectional.
所以我觉得应该是双向的。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
David Fajgenbaum: Clinical observations, and in the lab, and let's go in both directions.
David Fajgenbaum：临床观察和实验室观察，让我们从两个方向进行。
And then I also wanted to share about another patient named Joseph, who has a rare cancer called POEMS syndrome, and so his girlfriend, Tara, reached out to us in one of these sort of Hail Mary attempts, because his doctors were getting ready to take him off life support because he was dying from his POEMS syndrome.
然后我还想分享另一位名叫约瑟夫的患者，他患有一种名为 POEMS 综合征的罕见癌症，因此他的女朋友塔拉在此类万福玛丽的尝试中向我们伸出了援手，因为他的医生正准备让他停止生命支持，因为他死于 POEMS 综合征。
And we recommended three drugs that are typically used for multiple myeloma.
我们推荐了三种通常用于治疗多发性骨髓瘤的药物。
We mentioned myeloma earlier.
我们之前提到过骨髓瘤。
Myeloma and POEMS are really, really similar.
骨髓瘤和 POEMS 非常非常相似。
David Fajgenbaum: So again, it wasn't rocket science to recommend three drugs that are used for a really similar form of cancer for his condition, but he was dying, his doctors were afraid to try chemotherapy, they were worried that it would kill him, the drugs themself, but they were going to take him off life support so they tried it, and he responded incredibly well.
David Fajgenbaum：再说一次，推荐三种用于治疗与他的病情非常相似的癌症的药物并不是火箭科学，但他快要死了，他的医生不敢尝试化疗，他们担心这会杀死他，药物本身，但他们要让他脱离生命维持系统，所以他们尝试了，他的反应非常好。
He's been doing great.
他一直做得很好。
It's been over a year and a half of remission.
已经缓解了一年半多了。
David Fajgenbaum: And I mention all of these examples because like each one of them sort of teaches us something else about this, and that's that like, they're similar conditions, yet they weren't being, you know...
大卫·法根鲍姆：我提到所有这些例子是因为它们中的每一个都教会了我们一些关于这一点的其他东西，那就是，它们的条件相似，但它们并不是，你知道......
But we weren't thinking creatively.
但我们并没有进行创造性的思考。
Yes, there were no treatments for POEMS syndrome, but there were treatments for myeloma, and so there's shared mechanisms between the two.
是的，POEMS 综合征没有治疗方法，但骨髓瘤有治疗方法，因此两者之间存在共同的机制。
So, I think that some doctors are doing this, but we have to create a system where we uncover these and then we can get it out to the masses so they use them.
所以，我认为一些医生正在这样做，但我们必须创建一个系统来发现这些，然后我们可以将其传播给大众，以便他们使用它们。
Andrew Huberman: ...
安德鲁·休伯曼：...
the fear is that you try one of these novel drug applications, drugs are-- Sorry, existing drugs used in a novel way, to be very specific with the language here.
担心的是你尝试其中一种新的药物应用，药物是——抱歉，现有的药物以一种新的方式使用，这里的语言非常具体。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And the patient gets sick or dies.
Andrew Huberman：病人生病或死亡。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: You know, it wasn't, but...
安德鲁·休伯曼：你知道，事实并非如此，但是……
Gosh, maybe a decade and a half ago that this kid was given gene therapy and died.
天哪，也许十五年前，这个孩子接受了基因治疗然后就死了。
David Fajgenbaum: Yes, yes.
大卫·法根鲍姆：是的，是的。
Andrew Huberman: And that delayed, setback, however you want to view it, the whole field of gene therapy by a very long time.
Andrew Huberman：不管你怎么看，整个基因治疗领域的挫折都被推迟了很长一段时间。
All it takes is one patient death.
只需要一名患者死亡即可。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: And then in the supplement realm, I don't know if you remember this, because we're about 10 years apart and you're younger than I am, is tryptophan, the amino acid, to induce sleep.
Andrew Huberman：然后在补充剂领域，我不知道你是否还记得这一点，因为我们相差大约 10 岁，而且你比我年轻，色氨酸是一种氨基酸，可以促进睡眠。
David Fajgenbaum: It's exactly 10 years, yeah.
David Fajgenbaum：是的，整整 10 年了。
Andrew Huberman: Because, you know, it's in the serotonin synthesis pathway, but the binders used in a particular batch of tryptophan that I think was sold out of Japan ended up being contaminated, and somebody got very ill and died.
Andrew Huberman：因为，你知道，它是在血清素合成途径中，但我认为是从日本出售的特定批次色氨酸中使用的粘合剂最终被污染，有人得了重病并死亡。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Oh my God.
大卫·法根鲍姆：天啊。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: You couldn't buy tryptophan for a long time.
Andrew Huberman：很长一段时间你都买不到色氨酸。
Now, tryptophan is not as critical as life-saving drugs, in my opinion, except for the naturally occurring tryptophan, of course.
现在，在我看来，色氨酸并不像救生药物那么重要，当然，天然存在的色氨酸除外。
David Fajgenbaum: Yeah, yeah, of course.
大卫·法根鲍姆：是的，是的，当然。
Andrew Huberman: But all it takes is one bad situation, and the whole thing gets vaulted for a very long time.
安德鲁·休伯曼：但只要出现一种糟糕的情况，整个事情就会持续很长一段时间。
So, how do you mitigate that risk?
那么，如何降低这种风险呢？
Is it by only focusing on patients that are really, kind of at the end of their rope in terms of possibilities?
是不是只关注那些在可能性方面确实处于困境的患者？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And it seems to me that the medical community has been pretty open to what you're doing.
Andrew Huberman：在我看来，医学界对你所做的事情持相当开放的态度。
But I have a little bit of a traditionalist fear voice in the back of my head.
但我的脑海里有一点传统主义者的恐惧声音。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Like, what if you start giving aspirin to kids with this other condition, and kids start getting really, really sick, and you can't pull those symptoms back?
安德鲁·胡伯曼：比如，如果你开始给患有这种其他病症的孩子服用阿司匹林，而孩子们开始变得非常非常病，而你无法消除这些症状，该怎么办？
David Fajgenbaum: Strokes or something, yeah.
David Fajgenbaum：中风什么的，是的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Because it's one thing to halt a drug, and symptoms stop.
安德鲁·休伯曼：因为停止用药是一回事，症状就会停止。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: It's another to halt a drug, and those side effects, symptoms, or whatever you want to call them, persist, and a kid, and God forbid, a kid dies.
安德鲁·休伯曼：停止用药是另一回事，那些副作用、症状，或者任何你想称呼的东西，持续存在，一个孩子，上帝保佑，一个孩子会死。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: You know?
安德鲁·休伯曼：你知道吗？
So, what you're doing is extremely exciting, but it's also risky.
所以，你所做的事情非常令人兴奋，但也有风险。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
You're asking all the right questions.
你问了所有正确的问题。
I mean, I think that there are a couple of ways that we think about this, and one is that we really do try to avoid the Hail Marys.
我的意思是，我认为我们可以通过多种方式来思考这个问题，其中之一是我们确实尽力避免万福玛利亚。
As you mentioned, and as you thought, lots of people are reaching out to us, and unless we have solid evidence about a drug for that disease, we don't want to just speculate, because, to your point, speculation can actually lead to harm.
正如你所提到的，正如你所想的，很多人正在向我们伸出援手，除非我们有关于治疗这种疾病的药物的确凿证据，否则我们不想只是推测，因为，就你的观点而言，推测实际上可能会导致伤害。
So, there's this fine line between speculation that could save a life and harm, and of course, we are only doing what we're doing to help people.
因此，拯救生命和伤害之间的猜测之间存在着微妙的界限，当然，我们所做的只是为了帮助人们。
David Fajgenbaum: It's a nonprofit organization.
David Fajgenbaum：这是一个非营利组织。
We literally just exist just to help people.
我们的存在只是为了帮助人们。
There's nothing else here to it.
这里没有其他的了。
So, we definitely don't want to cause harm.
所以，我们绝对不想造成伤害。
So one part is that we focus on...
所以一部分是我们专注于...
We look across everything versus everything, every drug versus every disease, to find the best opportunities, and then we move them forward in a really rigorous way.
我们审视一切事物、每种药物与每种疾病，寻找最佳机会，然后以非常严格的方式推动它们向前发展。
We do laboratory studies.
我们进行实验室研究。
We do clinical trials.
我们做临床试验。
We evaluate the results of those trials.
我们评估这些试验的结果。
David Fajgenbaum: We look in observational data so we can be really rigorous about the things that we do at the end of the day and say, "We are advocating for this use." That's one way to do it.
David Fajgenbaum：我们查看观察数据，这样我们就可以非常严格地对待我们在一天结束时所做的事情，并说：“我们正在提倡这种用途。”这是一种方法。
The other thing to consider is that there's always a physician that's prescribing the medicine to the patient.
另一件需要考虑的事情是，总是有一位医生在给病人开药。
And so, the best thing we can do is to educate those physicians and those patients on what it is that maybe we found in a clinical trial or in the lab work.
因此，我们能做的最好的事情就是让这些医生和患者了解我们在临床试验或实验室工作中可能发现的内容。
But it still has to be a decision between the patient and their physician.
但这仍然需要患者和医生之间的决定。
Andrew Huberman: And what about outside the domain of disease in the domain of health?
Andrew Huberman：那么在疾病领域之外的健康领域呢？
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
Andrew Huberman: Very brief anecdote.
安德鲁·休伯曼：非常简短的轶事。
Colleagues of mine, some don't like it when I tell this story, but I'm going to tell it anyway.
我的同事们，有些人不喜欢我讲这个故事，但我还是要讲。
David Fajgenbaum: I love it.
大卫·法根鲍姆：我喜欢它。
Andrew Huberman: Because many years ago, I went to visit Columbia University School of Medicine, right?
Andrew Huberman：因为很多年前，我去参观了哥伦比亚大学医学院，对吗？
This is like-- Columbia Med's a fantastic place, and there's a Nobel Prize-winning neuroscientist there.
这就像——哥伦比亚医学院是一个很棒的地方，那里有一位获得诺贝尔奖的神经科学家。
David Fajgenbaum: Amazing.
大卫·法根鲍姆：太棒了。
Andrew Huberman: Met with him to discuss his work.
Andrew Huberman：与他会面讨论他的工作。
He happens to be an MD.
他恰好是一名医学博士。
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
Andrew Huberman: But he's a researcher, and I noticed he chewed six pieces of Nicorette inside of the 45 minutes we met.
Andrew Huberman：但他是一名研究员，我注意到他在我们会面的 45 分钟内咀嚼了 6 块 Nicorette。
So I asked him like, "What are you doing?"
所以我问他：“你在做什么？”
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Yeah.
是的。
Andrew Huberman: The guy was in his late 60s then, and now he's in his late 70s, very, very sharp.
Andrew Huberman：这家伙当时已经 60 多岁了，现在他已经 70 多岁了，非常非常敏锐。
The Nobel Prize wasn't an accident.
诺贝尔奖并非偶然。
He looked at me like this, and he said, "Nicotine is protective against Alzheimer's and Parkinson's." He said, "Smoking..." and, there wasn't really vaping then, but "Smoking will kill you."
他这样看着我，然后说：“尼古丁可以预防阿尔茨海默氏症和帕金森氏症。”他说，“吸烟……”，当时还没有真正的电子烟，但“吸烟会杀了你。”
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: "But nicotine isn't carcinogenic.
安德鲁·休伯曼：“但尼古丁不会致癌。
Nicotine, despite raising blood pressure, protects dopaminergic neurons and cholinergic neurons.
尽管尼古丁会升高血压，但它可以保护多巴胺能神经元和胆碱能神经元。
So that's why I do it." And he said that he used to smoke, and he was much sharper.
所以这就是我这样做的原因。”而且他说他以前抽烟，脾气比较敏锐。
Now he uses Nicorette, and I thought, "Well, should I use Nicorette?" So I said, "Should I be doing this?" He said, "You're young.
现在他使用 Nicorette，我想，“那么，我应该使用 Nicorette 吗？”所以我说：“我应该这样做吗？”他说：“你还年轻。
You probably want to wait until you're in your 60s or 70s."
你可能想等到 60 多岁或 70 多岁时。”
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
Andrew Huberman: But he said, "But it's protective against Parkinson's and Alzheimer's."
安德鲁·休伯曼：但他说，“但它可以预防帕金森氏症和阿尔茨海默氏症。”
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: And he also said, "Don't get your head hit.
安德鲁·休伯曼：他还说，“不要撞到你的头。
Don't play football."
别踢足球了。”
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Whoops.
哎呀。
Andrew Huberman: You know, this kind of thing.
安德鲁·休伯曼：你知道，这种事情。
Okay, so I took that, and I decided, "All right, someday I'll chew Nicorette." Now nicotine is all the rage.
好吧，所以我接受了，然后我决定，“好吧，有一天我会咀嚼尼古雷特。”现在尼古丁风靡一时。
I actually don't suggest that most people take nicotine because of the blood pressure effects.
事实上，我不建议大多数人服用尼古丁，因为它会影响血压。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: Vasoconstrictor, there could be other things.
Andrew Huberman：血管收缩剂，可能还有其他东西。
It's very, very popular but very, very habit-forming/addictive.
它非常非常流行，但非常非常容易形成习惯/上瘾。
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
Andrew Huberman: So I want to be very clear about that.
Andrew Huberman：所以我想非常清楚地说明这一点。
But I realize there are really smart people inside of my profession who have medical degrees who are doing things to promote their health, like take lithium, not continuously, but for one or two months per year.
但我意识到，在我的职业中，有一些非常聪明的人拥有医学学位，他们正在做一些促进健康的事情，比如服用锂，不是连续服用，而是每年一两个月。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: I know a colleague doing that, a colleague like, taking nicotine.
安德鲁·休伯曼：我认识一位同事这样做，一位同事服用尼古丁。
Who's now in his late 70s and still very, very sharp.
他现在已经 70 多岁了，但仍然非常非常敏锐。
Now, you can't run the other...
现在，你不能运行另一个......
David Fajgenbaum: Yeah, yeah.
大卫·法根鲍姆：是的，是的。
Andrew Huberman: You can't be the control experiment for yourself.
Andrew Huberman：你不能成为你自己的对照实验。
But what I want to know is, do you think that there are things that are of value that people can and should explore to maintain or promote their health to avoid disease in the same kind of framework that you're approaching the treatment of disease?
但我想知道的是，您是否认为人们可以而且应该探索一些有价值的东西来维持或促进他们的健康，以避免疾病，就像您正在治疗疾病一样？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Absolutely, and I think we need to be as rigorous in this realm as in the world of treating disease.
David Fajgenbaum：当然，我认为我们在这个领域需要像在疾病治疗领域一样严格。
I think that the challenge is that there's such limited data, right?
我认为挑战在于数据如此有限，对吗？
Like, you said, your one friend is doing really well, but it's hard to know if it was because of the Nicorette or if he was going to be fine either way.
就像你说的，你的一个朋友做得很好，但很难知道这是因为尼古雷特还是他是否会好起来。
David Fajgenbaum: I just think we have to figure out ways.
David Fajgenbaum：我只是认为我们必须找到方法。
And I think you've done such a great job of spotlighting these opportunities, so that people will think about it more and actually will do further investigation.
我认为你们在关注这些机会方面做得非常出色，这样人们就会更多地思考它，并且实际上会做进一步的调查。
And I was thinking in terms of this prevention side of things about GLP-1s, and so, there's interesting evidence emerging, and you'll know better than I will, but around improvement in Parkinson's symptoms in patients that are on GLP-1s and have Parkinson's disease, improvements or reduction in risk of Alzheimer's and also breast cancer, and people who are on GLP-1s.
我正在考虑 GLP-1 的预防方面，因此，出现了有趣的证据，你会比我更了解，但围绕服用 GLP-1 和患有帕金森病的患者的帕金森症状的改善，改善或降低阿尔茨海默病和乳腺癌的风险以及服用 GLP-1 的人。
David Fajgenbaum: And so, there's likely a very complex interplay between weight loss, and maybe it's the GLP-1s that are reducing the risk of these things because of metabolic effects, maybe there are direct effects, maybe it's anti-inflammatory.
David Fajgenbaum：因此，减肥之间可能存在非常复杂的相互作用，也许是 GLP-1 由于代谢作用而降低了这些事情的风险，也许有直接作用，也许是抗炎作用。
So these are preventative concepts with pharmaceutical products that I think we need to be thinking about.
因此，我认为我们需要考虑这些是药品的预防概念。
And to your point, there really isn't an actual line between natural and pharmaceutical.
就您而言，天然和药物之间确实没有实际界限。
David Fajgenbaum: I mean, think about the drug I'm on, sirolimus.
David Fajgenbaum：我的意思是，想想我正在服用的药物，西罗莫司。
It's called rapamycin because it was found on the island of Rapa Nui in the soil, and I don't know if you know that story.
它之所以被称为雷帕霉素，是因为它是在拉帕努伊岛的土壤中发现的，不知道你是否知道这个故事。
It was found in...
它被发现于...
Andrew Huberman: No.
安德鲁·休伯曼：不。
David Fajgenbaum: So rapamycin, or sirolimus, the other name for it, was found in the soil of the island of Rapa Nui, and there was a researcher at Wyeth Pharmaceuticals who was going all around the Pacific Ocean to a bunch of different islands and picking up soil samples.
David Fajgenbaum：雷帕霉素，或西罗莫司，它的另一个名字，是在拉帕努伊岛的土壤中发现的，惠氏制药公司的一名研究人员绕太平洋到了许多不同的岛屿并采集了土壤样本。
David Fajgenbaum: And he thought that maybe I could find some drugs in the soil, and he eventually found this molecule, now called rapamycin, where they synthesized a bunch of it.
David Fajgenbaum：他认为也许我可以在土壤中找到一些药物，他最终发现了这种分子，现在称为雷帕霉素，他们在那里合成了一堆它。
It's completely naturally occurring.
这是完全自然发生的。
The other name for Rapa Nui is Easter Island.
拉帕努伊岛的另一个名字是复活节岛。
It's from the island of Easter Island.
它来自复活节岛。
David Fajgenbaum: So synthesized it, and they initially thought that it might be a good drug for-- As an antifungal, but it's a lousy antifungal.
David Fajgenbaum：这样合成了它，他们最初认为它可能是一种很好的药物——作为一种抗真菌药物，但它是一种糟糕的抗真菌药物。
And so, they were trying to figure out what else could it do, and they found out that it's a really potent immunosuppressant.
因此，他们试图弄清楚它还有什么作用，他们发现它是一种非常有效的免疫抑制剂。
And in fact, the research into the immunosuppressor role ended up really accelerating understanding of how the mTOR pathway works in the first place, and it actually is an amazing story that was done on "Radiolab" about how it eventually, or at one point, it was shelved.
事实上，对免疫抑制剂作用的研究最终确实加速了对 mTOR 通路如何发挥作用的理解，这实际上是“Radiolab”上的一个令人惊奇的故事，讲述了它最终或在某个时刻如何被搁置。
David Fajgenbaum: Wyeth and Pfizer decided not to study it, and then it sort of got taken off the shelf, and it got approved for organ transplant rejection.
David Fajgenbaum：惠氏和辉瑞决定不研究它，然后它就被下架了，并被批准用于器官移植排斥反应。
But I just think about something like that.
但我只是在想类似的事情。
I mean, if that scientist hadn't picked up the soil sample in Rapa Nui, I'm not sitting here with you talking to you, right?
我的意思是，如果那位科学家没有在拉帕努伊采集土壤样本，我就不会坐在这里和你说话，对吧？
Andrew Huberman: Incredible.
安德鲁·休伯曼：难以置信。
David Fajgenbaum: And of course, there's thousands of people all over the world who aren't sitting here talking to anyone because that drug wouldn't have been discovered, and it was in the soil, and it's not some pharmaceutical synthetic thing.
David Fajgenbaum：当然，世界各地有成千上万的人没有坐在这里与任何人交谈，因为这种药物不会被发现，它就在土壤中，而不是某种药物合成物。
This is a totally naturally occurring compound.
这是一种完全天然存在的化合物。
David Fajgenbaum: So, I think the line that we put between creatine and sirolimus and GLP-1s, there's a lot of overlap here.
David Fajgenbaum：所以，我认为我们在肌酸、西罗莫司和 GLP-1 之间划定的界限有很多重叠。
And yes, some of these molecules are very much synthesized.
是的，其中一些分子在很大程度上是合成的。
And you think about the chemos that I've gotten are like horrible compounds that you probably don't want to put in your body.
你会想到我接受的化疗就像可怕的化合物，你可能不想放入你的体内。
But it's a lot grayer than I think we like to think it is.
但它比我想象的要灰暗得多。
Andrew Huberman: I think the term is "bioprospecting" when people from pharmaceutical companies go out and look for things in nature and then develop drugs from them.
Andrew Huberman：我认为这个词就是“生物勘探”，制药公司的人们出去寻找自然界的东西，然后从中开发药物。
David Fajgenbaum: Oh, yeah.
大卫·法根鲍姆：哦，是的。
Andrew Huberman: We had a guy on here, a very impressive guy, Chris McCurdy.
Andrew Huberman：我们这里有一个人，一个非常令人印象深刻的人，Chris McCurdy。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: He's down in Florida.
安德鲁·休伯曼：他在佛罗里达州。
He studies kratom and kratom leaf products.
他研究卡痛叶和卡痛叶产品。
David Fajgenbaum: Okay, kratom.
David Fajgenbaum：好的，卡痛叶。
Andrew Huberman: Kratom is a...
安德鲁·休伯曼：卡痛是...
It's being sold as a kind of natural opioid replacement.
它作为一种天然阿片类药物替代品出售。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: Anytime it comes up, I have to be very careful because you all cut clips, and you take them out of context.
安德鲁·休伯曼：无论什么时候出现，我都必须非常小心，因为你们都剪辑剪辑，而且断章取义。
So I'm going to just-- I've learned how to guard against that.
所以我要——我已经学会了如何防范这种情况。
Forgive me.
对不起。
But kratom products and the kratom leaf have been used by some former prescription opioid addicts to get off those prescription drugs.
但卡痛叶产品和卡痛叶已被一些前处方阿片类药物成瘾者用来戒除处方药。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: However, it's very clear that a lot of these products, which are sold over the counter in convenience stores, corner stores, 7-Eleven, et cetera.
Andrew Huberman：但是，很明显，很多此类产品在便利店、街角商店、7-11 等柜台出售。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: CVS.
安德鲁·休伯曼：CVS。
It can also be highly addictive alone, and they're sold to kids.
它本身也很容易让人上瘾，所以它们被卖给孩子们。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: It's a serious, serious issue.
安德鲁·休伯曼：这是一个非常非常严重的问题。
But the kratom leaf, "kra-tom," I think, is the way the traditional pronunciation, contains a bunch of different plant alkaloids.
但我认为卡痛叶“kra-tom”是传统发音，含有一堆不同的植物生物碱。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: And the synthesized purified kratom is the one that has this pain relief aspect, that also can be very addictive.
Andrew Huberman：合成的纯化卡痛叶具有缓解疼痛的作用，而且很容易让人上瘾。
And we discussed the coca plant and cocaine, but also other elements within the coca plant that, he runs a laboratory, that are being isolated and being tested for different pain relief and psychoactive properties that can be very beneficial to people.
我们讨论了古柯植物和可卡因，还讨论了古柯植物中的其他元素，他经营着一个实验室，这些元素正在被分离并测试其不同的止痛和精神活性特性，这些特性对人们非常有益。
David Fajgenbaum: Oh.
大卫·法根鲍姆：哦。
Andrew Huberman: So, bioprospecting is something that drug companies don't really discuss a lot, but the way they're doing this is going into nature, looking at the kratom leaf and the coca plant.
Andrew Huberman：所以，生物勘探是制药公司很少讨论的事情，但他们这样做的方式是进入大自然，观察卡痛叶和古柯植物。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: Mucuna pruriens is this velvety bean that is 99% L-DOPA.
Andrew Huberman：黧豆是一种柔软的豆子，含有 99% 的左旋多巴。
David Fajgenbaum: Hm.
大卫·法根鲍姆：嗯。
David Fajgenbaum: Oh, really?
大卫·法根鲍姆：哦，真的吗？
Wow.
哇。
Andrew Huberman: Yeah.
安德鲁·休伯曼：是的。
Which you can buy this over the counter.
您可以在柜台购买。
David Fajgenbaum: Fascinating.
大卫·法根鲍姆：令人着迷。
Andrew Huberman: So we think it-- So the line between supplementation and prescription drugs is very, very fine.
Andrew Huberman：所以我们认为补充剂和处方药之间的界限非常非常好。
David Fajgenbaum: It is.
大卫·法根鲍姆：是的。
Andrew Huberman: It's just that there's no control over over-the-counter stuff.
Andrew Huberman：只是无法控制非处方药。
David Fajgenbaum: Exactly.
大卫·法根鲍姆：没错。
Andrew Huberman: And so, this is where it runs into problems and gets a bad reputation, and understandably so.
Andrew Huberman：因此，这就是它遇到问题并获得坏名声的地方，这是可以理解的。
We don't want people harming themselves with this.
我们不希望人们因此伤害自己。
I'm beginning to think that what's really needed, and people in the current administration do listen to the podcast.
我开始认为真正需要的是，现任政府的人们确实在听播客。
I don't know what they do with the information, but I think we need more thoughtful, safe bioprospecting to develop drugs that they can be tested in preclinical models, animals.
我不知道他们如何处理这些信息，但我认为我们需要更周到、更安全的生物勘探来开发可以在临床前模型和动物中进行测试的药物。
Preclinical means animals, folks.
临床前意味着动物、人类。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And then eventually clinical trials.
Andrew Huberman：然后最终是临床试验。
But I don't know that we have the time for clinical trials on all these bioprospected molecules, or even the molecules that you're talking about, which are already FDA approved.
但我不知道我们是否有时间对所有这些生物勘探分子进行临床试验，甚至是你所说的那些已经获得 FDA 批准的分子。
It sounds like a lot of it just has to be run in real time in people.
听起来很多事情只需要在人们身上实时运行即可。
Like, the experiment, in some sense, has to be done in humans.
就像，从某种意义上说，实验必须在人类身上进行。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: I just don't see...
安德鲁·休伯曼：我只是不明白......
Otherwise, it's going to be another 50 years before we have a cure for Alzheimer's or we solve some of the most serious psychiatric illnesses.
否则，我们还需要 50 年才能治愈阿尔茨海默氏症或解决一些最严重的精神疾病。
David Fajgenbaum: I agree.
大卫·法根鲍姆：我同意。
The answer comes from actually testing these things in humans.
答案来自于在人类身上实际测试这些东西。
There are so many things that cure mice, and they don't ever translate to humans, and vice versa.
有很多东西可以治愈老鼠，但它们永远无法转化为人类，反之亦然。
So, I think that I'm really bullish on the idea of leveraging the world's biomedical knowledge and using artificial intelligence to help to prioritize among all of these different things.
因此，我认为我非常看好利用世界生物医学知识并使用人工智能来帮助确定所有这些不同事物的优先顺序的想法。
David Fajgenbaum: And so, at the end of the day, we talk about the 4,000 drugs and the 18,000 diseases, the reason we do the scoring on everything versus everything is so that we can just know where to start.
David Fajgenbaum：所以，在一天结束时，我们谈论 4,000 种药物和 18,000 种疾病，我们对所有事物进行评分的原因是这样我们就可以知道从哪里开始。
Because we rank everything versus everything, and maybe the fifth highest-scoring thing is the thing to go after, but maybe the 10,000th highest-scoring thing is.
因为我们对所有事物进行排名，也许得分第五高的事物是我们要追求的事物，但也许得分最高的事物是第 10,000 个事物。
So this point being is that AI can at least help us to focus in on where do you start because, to your point, there's so many opportunities of the existing drugs that we have, of the molecules that are already available in nature.
所以这一点是，人工智能至少可以帮助我们专注于从哪里开始，因为就你的观点而言，我们现有的药物、自然界中已经存在的分子有很多机会。
David Fajgenbaum: But you need somewhere to start, and I think AI is really well-positioned to direct us humans to where to start.
David Fajgenbaum：但你需要从某个地方开始，我认为人工智能确实能够很好地指导我们人类从哪里开始。
Andrew Huberman: Amen to that because in theory with AI, you could develop, I guess they call it, in silico.
Andrew Huberman：阿门，因为从理论上讲，人工智能可以在计算机中进行开发，我想他们称之为计算机。
You could say, "Let's run 10,000 cell cultures in parallel."
您可以说，“让我们并行运行 10,000 个细胞培养物。”
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
Andrew Huberman: The graduate student cost is nothing.
Andrew Huberman：研究生的费用不算什么。
They don't need to sleep.
他们不需要睡觉。
It's AI after all.
毕竟这是人工智能。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: And with all the properties of this immune cell type, different concentrations of drug, and while it's not a real-world experiment, you can get an indication of what the outcome might be and what might be worth taking a better look at.
Andrew Huberman：凭借这种免疫细胞类型的所有特性、不同浓度的药物，虽然这不是真实世界的实验，但您可以了解结果可能是什么以及哪些可能值得更好地研究。
Is that what you're imagining?
这就是你想象的吗？
David Fajgenbaum: That's right, and also that's a true simulation where the work hasn't been done.
David Fajgenbaum：没错，而且这是一个真正的模拟，但工作尚未完成。
What is also the case is that, as you know, there are labs all over the world running experiments all the time on various cell lines and animal models, and humans.
正如你所知，情况也是如此，世界各地都有实验室一直在对各种细胞系、动物模型和人类进行实验。
All that's happening, and so what I really am bullish on using AI for is not to simulate something that hasn't been done yet, but it's actually to find connections between what has been done.
所有这一切都在发生，所以我真正看好人工智能的目的不是模拟尚未完成的事情，而是实际上找到已完成的事情之间的联系。
David Fajgenbaum: So, in the example earlier, that one lab found increased PD-L1 expression in this one form of cancer, and this drug inhibits PD-1.
David Fajgenbaum：所以，在前面的例子中，一个实验室发现在这种癌症中 PD-L1 表达增加，而这种药物可以抑制 PD-1。
Andrew Huberman: Mm-hmm.
安德鲁·休伯曼：嗯嗯。
David Fajgenbaum: So therefore, let's make a connection that no one had made yet.
David Fajgenbaum：因此，让我们建立一种尚未有人建立的联系。
So there are two truths that hadn't been connected.
所以有两个事实没有联系起来。
A and B are connected.
A 和 B 已连接。
B and C are connected.
B 和 C 已连接。
Let's connect A to C.
让我们将 A 连接到 C。
And I think that AI is particularly well-suited to find these patterns of things that we know.
我认为人工智能特别适合发现我们所知道的事物的这些模式。
So it's not a total-- It's not a simulation.
所以这不是一个总体——这不是一个模拟。
David Fajgenbaum: It's actually just connecting, really, like breadcrumbs into one story.
David Fajgenbaum：实际上，它只是将面包屑连接到一个故事中。
Andrew Huberman: You're a parent?
安德鲁·休伯曼：你是家长吗？
David Fajgenbaum: I am.
大卫·法根鲍姆：我是。
Andrew Huberman: How do you navigate healthcare for a kid, knowing what you know about medicine and knowing what you know about what medicine doesn't know?
Andrew Huberman：您如何为孩子提供医疗保健，了解您对医学的了解以及了解医学所不知道的内容？
David Fajgenbaum: I'm a very rigorous parent of two kids when it comes to healthcare.
David Fajgenbaum：在医疗保健方面，我是两个孩子的非常严格的父母。
Yeah, I've got a seven-year-old and a three-year-old.
是的，我有一个七岁的孩子和一个三岁的孩子。
It feels like a dream to be here talking to you 15 years after I went through all that I've gone through.
在我经历了这一切之后 15 年后，能在这里与你们交谈，感觉就像是一场梦。
It definitely feels like a dream that I'm able to tell you I've got a seven-year-old and a three-year-old.
我能够告诉你我有一个七岁的孩子和一个三岁的孩子，这绝对感觉像做梦一样。
I'm just, I'm so lucky.
我只是，我太幸运了。
But like you said, I'm really rigorous, you know?
但就像你说的，我真的很严谨，你知道吗？
One of my doctors suggests, "Try this" for my daughter, and I ask a lot of questions.
我的一位医生建议，为我的女儿“试试这个”，我问了很多问题。
David Fajgenbaum: I mean, I try to really stay on top of things.
David Fajgenbaum：我的意思是，我努力真正掌控一切。
And it sort of gets me thinking about something I was hoping to ask you about, and it's that over the course of my challenges and sort of the ups and downs that I've had in my health and the work that I've done to find treatments, I've found that I think there's this circuit that I, again, I'd love to get your thoughts on.
这让我想到了一些我希望问你的问题，在我的挑战过程中，在我的健康方面经历过的起起落落以及我为寻找治疗方法所做的工作中，我发现我认为有一个循环，我再次很想了解你的想法。
David Fajgenbaum: So, I find that it starts with hope, so I'm hoping for some future, so maybe it's that my child's health condition will be improved, or my health condition will improve.
David Fajgenbaum：所以，我发现一切都是从希望开始的，所以我希望有一些未来，所以也许我孩子的健康状况会得到改善，或者我的健康状况会得到改善。
But you start with some sort of hope, that you hope something will happen, and then that drives some amount of action.
但你从某种希望开始，你希望某件事会发生，然后这会推动一些行动。
So, like maybe in my case, I run experiments on my own blood samples, and then that results in some impact that maybe I get or learn something.
因此，就像我的情况一样，我对自己的血液样本进行实验，然后这会产生一些影响，也许我会得到或学到一些东西。
Maybe that drug is going to work for me.
也许那种药对我有用。
And that impact gives me more hope, and then it creates this circuit.
这种影响给了我更多的希望，然后它创造了这个电路。
David Fajgenbaum: So it's hope, action, and impact, which gives you more hope, action, and impact.
David Fajgenbaum：所以希望、行动和影响力会给你带来更多的希望、行动和影响力。
And I haven't figured out exactly, like, if there's some neuroscience behind this, but I found that for me, and just thinking about your question around whether that's helping your child with a medical issue that they're facing or, again, my own, that that circuit has just been a game changer for me.
我还没有确切地弄清楚，比如，这背后是否有一些神经科学，但我发现对我来说，只是思考你的问题，这是否可以帮助你的孩子解决他们面临的医疗问题，或者，再说一遍，我自己的，那个电路对我来说只是一个游戏规则的改变者。
I don't know if there's some neuroscience behind that that you could help me to understand this hope, action, and impact.
我不知道这背后是否有一些神经科学可以帮助我理解这种希望、行动和影响。
Andrew Huberman: There absolutely is.
安德鲁·休伯曼：绝对有。
And the person who deserves credit for revealing this circuit is my colleague Joe Parvizi at Stanford, who's a neurosurgeon who was in the brain of awake patients, stimulating different brain areas in anticipation of neurosurgery, like you described earlier, and had electrodes in a structure called the mid-cingulate cortex.
值得赞扬的是我在斯坦福大学的同事乔·帕尔维兹（Joe Parvizi）揭示了这个回路，他是一名神经外科医生，他在清醒患者的大脑中，刺激不同的大脑区域以期待神经外科手术，就像你之前描述的那样，并且在称为中扣带皮层的结构中放置了电极。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
Andrew Huberman: It's part of a larger network, of course, as is every brain structure.
Andrew Huberman：当然，它是一个更大网络的一部分，就像每个大脑结构一样。
And he noticed when he stimulated a subregion called the "anterior mid-cingulate cortex" that patients would report in real-time that they felt like there was some challenge kind of bearing down on them, like going into a storm.
他注意到，当他刺激一个名为“前中扣带皮层”的子区域时，患者会实时报告，他们感觉有某种挑战正在向他们袭来，就像陷入风暴一样。
Andrew Huberman: Each one described it differently, but that the stimulation also made them feel as if they wanted to lean into that challenge.
安德鲁·休伯曼：每个人都有不同的描述，但这种刺激也让他们感觉自己想要迎接这一挑战。
Now, here's where it gets really interesting.
现在，这才是真正有趣的地方。
If he marches the electrode back a millimeter or less, completely different set of effects.
如果他将电极向后移动一毫米或更小，则会产生完全不同的效果。
Laterally, a completely different set of effects.
从侧面来看，这是一组完全不同的效果。
So the anterior mid-cingulate cortex seems to be the seat of some sort of sense of tenacity to lean into challenge.
因此，前中扣带皮层似乎是某种应对挑战的坚韧感的所在地。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: Gets really interesting when you start looking at the data of the kind of volumetric imaging of the structure in people that, for instance, successfully overcome obesity through exercise and diet, or people who decide to undertake some other challenge, like a cognitive challenge or learning how to dance, something that's challenging.
Andrew Huberman：当你开始观察人们的结构体积成像数据时，你就会变得非常有趣，例如，通过锻炼和饮食成功克服肥胖的人，或者决定接受其他挑战的人，比如认知挑战或学习跳舞等具有挑战性的事情。
David Fajgenbaum: Mm.
大卫·法根鲍姆：嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And then you look at the literature on longevity, and you look at this group of so-called "super-agers," which is a misnomer because they actually age very slowly, right?
安德鲁·休伯曼：然后你看看有关长寿的文献，你看看这群所谓的“超级老人”，这是一个用词不当，因为他们实际上衰老得很慢，对吧？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And what you find is that psychologically, they report a very strong will to live, and their anterior mid-cingulate cortex is one of just several areas that seem to maintain volume as they age relative to these age-matched cohorts.
安德鲁·胡伯曼：你会发现，从心理上来说，他们有非常强烈的生存意愿，而且他们的前中扣带皮层是少数几个随着年龄的增长而相对于这些年龄匹配的群体来说仍保持体积的区域之一。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: Now, none of these are perfect experiments on their own, but when you start to put these together as a collection of things, you realize that all the things that are the reverse of depression, so what's major depression?
安德鲁·休伯曼：现在，这些都不是完美的实验，但当你开始将这些作为一个集合时，你会意识到所有这些都是抑郁症的反面，那么什么是重度抑郁症呢？
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: A lack of positive anticipation of the future.
Andrew Huberman：对未来缺乏积极的预期。
A lack of understanding or belief, or rather, a lack of belief that changing one's behavior could change circumstances, like at a job or in a new relationship, or overcome something.
缺乏理解或信念，或者更确切地说，缺乏相信改变一个人的行为可以改变环境，比如工作或新的关系，或者克服某些事情。
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Yeah.
是的。
Andrew Huberman: And you see the exact inverse of that in people with a kind of naturally large or perhaps self-fertilized anterior mid-cingulate cortex.
安德鲁·胡伯曼（Andrew Huberman）：在具有天然大的或可能自体受精的前中扣带皮层的人中，您会发现情况正好相反。
These people report a lot of positive anticipation about some hopeful future event.
这些人对一些充满希望的未来事件抱有很多积极的期待。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
Andrew Huberman: And it's not always a big monumental thing.
Andrew Huberman：这并不总是一件具有纪念意义的大事。
Sometimes these are closer milestones, sometimes it's a bigger thing, and they live longer, and they have this incredible will to live.
有时这些是更接近的里程碑，有时这是一件更大的事情，他们的寿命更长，而且他们有令人难以置信的生存意愿。
So it seems that taking this to its kind of extreme conclusion, the will to live sits somewhere in the network of this structure.
因此，如果得出极端的结论，生存意愿似乎就存在于这个结构的网络中的某个地方。
It's not just this structure, and it's intimately related to dopamine networks, so reward reinforcement and learning networks, and all the rest.
不仅仅是这个结构，它还与多巴胺网络、奖励强化和学习网络等等密切相关。
David Fajgenbaum: Wow.
大卫·法根鲍姆：哇。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: But it's hard to pinpoint one structure, but if I had to put a pin in one structure, it would be Joe Parvizi's discovery of the anterior mid-cingulate cortex.
Andrew Huberman：但是很难确定一个结构，但如果我必须在一个结构中钉上一根钉子，那就是 Joe Parvizi 对前中扣带皮层的发现。
And it has all the elements you described: hope, plan, and action.
它具有您所描述的所有要素：希望、计划和行动。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Yep.
大卫·法根鲍姆：是的。
David Fajgenbaum: Action, exactly.
David Fajgenbaum：确实是行动。
Andrew Huberman: Repeat.
安德鲁·休伯曼：重复一遍。
David Fajgenbaum: Yes.
大卫·法根鲍姆：是的。
Andrew Huberman: And so, for people who are not ill or who are ill, having that sequence...
Andrew Huberman：因此，对于没有生病或生病的人来说，有这样的顺序......
I had a good friend who was in tier one special operations in the SEAL teams.
我有一个好朋友，他在海豹突击队的一级特种部队中工作。
He described this as, "When there's a challenge, you have to shorten the horizon and get a forward center of mass, but think duration, path, and outcome."
他将其描述为：“当遇到挑战时，你必须缩短视野并向前迈出重心，但要考虑持续时间、路径和结果。”
David Fajgenbaum: Mm-hmm.
大卫·法根鲍姆：嗯嗯。
Andrew Huberman: What path, how long, outcome, iterate.
Andrew Huberman：什么路径、多长时间、结果、迭代。
And it's the same way you work down a football field as the way you kind of lathe through these challenges.
这与你在足球场上工作的方式和你应对这些挑战的方式是一样的。
So, again, I'm creating a tapestry from a bunch of disparate things here, but none of it is outside the realm of peer-reviewed science.
所以，我再次用一堆不同的东西创造了一幅挂毯，但它们都不在同行评审的科学领域之外。
It all sits there.
一切都在那里。
So, we haven't scanned your brain.
所以，我们还没有扫描你的大脑。
Andrew Huberman: I don't think we need to know that your anterior mid-cingulate cortex is clearly very robust, and I would wager the hypothesis that it was probably built and reinforced through your postering up of athletic goals on the wall of your childhood bedroom.
安德鲁·休伯曼：我认为我们不需要知道你的前中扣带皮层显然非常强大，我敢打赌，它可能是通过你在童年卧室的墙上张贴运动目标而建立和强化的。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
David Fajgenbaum: I think you're right.
大卫·法根鲍姆：我认为你是对的。
I think you're right.
我认为你是对的。
Yeah, the more you work, the better your times get, and the better those numbers get, and then, as you said, it becomes a true circuit, you know?
是的，你工作得越多，你的时间就越好，这些数字就越好，然后，正如你所说，它变成了一个真正的电路，你知道吗？
The thing you're hoping for, when you get closer to that thing you're hoping for, it drives you to take more action, and then you can keep going in that circuit.
你所希望的事情，当你越来越接近你所希望的事情时，它会驱使你采取更多的行动，然后你就可以继续在那个循环中走下去。
Andrew Huberman: Well, clearly, you are living in that circuit, and it lives in you.
安德鲁·胡伯曼：嗯，很明显，你生活在那个回路中，它也生活在你体内。
Could you tell us about ways that people can get involved with Every Cure?
您能告诉我们人们可以参与 Every Cure 的方式吗？
I have to imagine more information is better than less.
我必须想象更多的信息总比更少的信息好。
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
Andrew Huberman: So what can people do?
安德鲁·休伯曼：那么人们能做什么呢？
David Fajgenbaum: Sure.
大卫·法根鲍姆：当然。
So, anyone can go to everycure.org/ideas and tell us about maybe there's a drug that you were prescribed off-label by your doctor, or maybe you're a researcher and you think that a drug could be used in a new way, so you can go to everycure.org/ideas, tell us about that medicine, and we'll look into it.
因此，任何人都可以访问 everycure.org/ideas 告诉我们，也许您的医生给您开了一种超说明书处方的药物，或者您是一名研究人员，您认为某种药物可以以新的方式使用，所以您可以访问 everycure.org/ideas，告诉我们有关该药物的信息，我们将对此进行研究。
We'll compare it next to our AI predictions, and we'll determine whether maybe it can be moved forward.
我们将把它与我们的人工智能预测进行比较，然后我们将确定它是否可以向前推进。
David Fajgenbaum: If you're an expert, say in neuroscience, or you name the area, you can go to everycure.org/experts, and you can sign up so that if we find a drug that might be useful for a condition that you're an expert in, you might be able to give us advice and guidance on maybe what the right development path is.
David Fajgenbaum：如果您是神经科学领域的专家，或者您指定了该领域的名称，您可以访问 everycure.org/experts，然后您可以注册，这样，如果我们找到一种可能对您所擅长的疾病有用的药物，您也许可以向我们提供建议和指导，以了解正确的开发道路是什么。
David Fajgenbaum: And anyone who's watching can help us to raise awareness about the work that we're doing.
David Fajgenbaum：任何观看的人都可以帮助我们提高人们对我们正在做的工作的认识。
So you can follow us on social media at everycure.org and beyond.
因此，您可以在 everycure.org 等社交媒体上关注我们。
I did a TED Talk recently.
我最近做了一场 TED 演讲。
You can help spread the word and check that out.
您可以帮助传播信息并进行检查。
And finally, of course, people can support our work financially.
最后，当然，人们可以在经济上支持我们的工作。
We're a nonprofit organization.
我们是一个非营利组织。
David Fajgenbaum: Clinical trials are expensive.
David Fajgenbaum：临床试验非常昂贵。
You can go online to everycure.org/donate and donate to our work.
您可以上网访问 everycure.org/donate 并为我们的工作捐款。
And we're just so excited for this opportunity we have to help people with the drugs that we have, but we realize that we can't do it alone.
我们对这个机会感到非常兴奋，我们必须用我们拥有的药物来帮助人们，但我们意识到我们无法单独做到这一点。
We actually really need the whole community to get behind us.
我们实际上真的需要整个社区的支持。
Andrew Huberman: Where is funding currently derived from?
Andrew Huberman：目前资金来自哪里？
Is it just public support?
仅仅是公众的支持吗？
David Fajgenbaum: So right now, about half of our funding actually comes from the US government, from an agency called ARPA-H.
David Fajgenbaum：所以现在，我们大约一半的资金实际上来自美国政府，来自一个名为 ARPA-H 的机构。
They're one of our earliest supporters, and the other half comes from individuals who've decided that this is important.
他们是我们最早的支持者之一，另一半来自那些认为这很重要的人。
It may be that they have a loved one that has a condition that they would love for us to work on, or maybe it's that they just want to see us be able to help patients with the drugs that we already have, and we are just so excited about that opportunity to match the drugs we have to the patients who need them.
可能是他们所爱的人患有某种疾病，他们希望我们能够帮助他们治疗，或者可能是他们只是希望看到我们能够使用我们已有的药物来帮助患者，而我们非常高兴有机会将我们拥有的药物与需要它们的患者相匹配。
Andrew Huberman: Fantastic, and I should ask, if a drug application is discovered, is there a feedback mechanism for you guys to derive income from it, or is this completely nonprofit?
Andrew Huberman：太棒了，我应该问，如果发现了药物应用，是否有反馈机制供你们从中获取收入，或者这完全是非营利性的？
David Fajgenbaum: It's completely nonprofit.
David Fajgenbaum：这完全是非营利性的。
So, I think by the end of, let's say, the next few years, I will guess that nearly all of the opportunities that we advance forward are the same dose, the same formula, no one makes any money off of them whatsoever.
所以，我认为，到了年底，比如说，未来几年，我猜我们推进的几乎所有机会都是相同的剂量、相同的公式，没有人能从中赚到任何钱。
I think there'll be rare cases where, let's say, the drug looks like it'll be effective, but it needs to get into the brain, where a tweak will have to be made, where a different dose or a formulation will be needed.
我认为在极少数情况下，药物看起来会有效，但它需要进入大脑，必须进行调整，需要不同的剂量或配方。
And I think there'll probably be rare cases where probably a company will be needed to be spun out to do it.
我认为在极少数情况下可能需要分拆一家公司来做到这一点。
David Fajgenbaum: But for the vast majority, we're nonprofit.
David Fajgenbaum：但对于绝大多数人来说，我们是非营利组织。
We just want to take the drugs we already have to use them for the diseases that could benefit from them.
我们只想服用我们已有的药物来治疗可能从中受益的疾病。
Andrew Huberman: Terrific.
安德鲁·休伯曼：太棒了。
We'll put a link to it in the show notes.
我们将在演出笔记中放置一个链接。
David Fajgenbaum: That'd be awesome.
David Fajgenbaum：那就太棒了。
Andrew Huberman: David, thank you so much for coming here today to share your story with us and just a ton of actionable knowledge for people that are healthy and continue to explore options safely, think about what's possible, understand there are things that are known, there are a lot of unknowns, and again, explore safely.
安德鲁·胡伯曼（Andrew Huberman）：大卫，非常感谢你今天来到这里与我们分享你的故事，并为那些健康并继续安全地探索选择的人们提供大量可行的知识，思考什么是可能的，了解有些事情是已知的，有很多未知的，并且再次安全地探索。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: For people that are ill, find a disease-related group that really has an eye on what's new, what's existing, who the best people are, search for a few of those, is kind of what I took away from that.
Andrew Huberman：对于生病的人，找到一个与疾病相关的小组，真正关注新的、现有的、最好的人是谁，寻找其中的一些人，这就是我从中得到的东西。
David Fajgenbaum: Yeah.
大卫·法根鲍姆：是的。
Andrew Huberman: And thank you for doing the work you do.
Andrew Huberman：感谢您所做的工作。
It's amazing.
太棒了。
We need more people like you.
我们需要更多像你这样的人。
You're truly one of a kind, so we're immensely grateful that you've taken the hardship and transmuted it into so much good.
你确实是独一无二的，所以我们非常感谢你接受了困难并将其转化为如此多的好处。
And would love to have you back sometime to talk about all the millions of other things we didn't have time to talk about.
希望您能回来讨论我们没有时间讨论的数以百万计的其他事情。
But this has been incredibly enriching for me, and I'm certain it has for everyone else.
但这对我来说是令人难以置信的丰富，我相信对其他人来说也是如此。
David Fajgenbaum: Well, thanks so much for having me.
David Fajgenbaum：嗯，非常感谢您邀请我。
Thanks for all that you do to advance the public health and also to get the word out about the work we're doing through Every Cure.
感谢您为促进公共卫生所做的一切，也感谢您通过 Every Cure 宣传我们所做的工作。
Andrew Huberman: Thank you for joining me for today's discussion with Dr. David Fajgenbaum.
Andrew Huberman：感谢您参加今天与 David Fajgenbaum 博士的讨论。
To learn more about his laboratory's work and his nonprofit, Every Cure, please see the show note captions.
要了解有关他的实验室工作和非营利组织 Every Cure 的更多信息，请参阅节目说明文字。
Andrew Huberman: If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
Andrew Huberman：如果您正在学习和/或喜欢这个播客，请订阅我们的 YouTube 频道。
That's a terrific zero-cost way to support us.
这是支持我们的绝佳零成本方式。
In addition, please follow the podcast by clicking the Follow button on both Spotify and Apple.
此外，请通过单击 Spotify 和 Apple 上的“关注”按钮来关注播客。
And on both Spotify and Apple, you can leave us up to a five-star review, and you can now leave us comments on both Spotify and Apple.
在 Spotify 和 Apple 上，您都可以给我们留下五星级的评论，现在您可以给我们留下关于 Spotify 和 Apple 的评论。
Andrew Huberman: Please also check out the sponsors mentioned at the beginning and throughout today's episode.
Andrew Huberman：另请查看今天节目开头和整个节目中提到的赞助商。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
If you have questions for me or comments about the podcast or guests or topics that you'd like me to consider for the Huberman Lab podcast, please put those in the comment section on YouTube.
如果您对我有疑问，或者对播客或嘉宾有意见，或者您希望我为 Huberman Lab 播客考虑的主题，请在 YouTube 上的评论部分留言。
I do read all the comments.
我确实阅读了所有评论。
For those of you that haven't heard, I have a new book coming out.
对于那些还没有听说过的人，我即将出版一本新书。
It's my very first book.
这是我的第一本书。
It's entitled "Protocols: An Operating Manual for the Human Body."
它的标题是“协议：人体操作手册”。
Andrew Huberman: This is a book that I've been working on for more than five years and that's based on more than 30 years of research and experience, and it covers protocols for everything from sleep to exercise to stress control, protocols related to focus and motivation, and of course, I provide the scientific substantiation for the protocols that are included.
Andrew Huberman：这是一本我花了五年多时间编写的书，它基于 30 多年的研究和经验，涵盖了从睡眠到运动到压力控制的各个方面的方案，以及与注意力和动机相关的方案，当然，我还为所包含的方案提供了科学依据。
The book is now available by pre-sale at protocolsbook.com.
该书现已在protocolbook.com 上预售。
There you can find links to various vendors.
在那里您可以找到各个供应商的链接。
You can pick the one that you like best.
您可以选择您最喜欢的一个。
Andrew Huberman: Again, the book is called "Protocols: An Operating Manual for the Human Body." And if you're not already following me on social media, I am Huberman Lab on all social media platforms.
安德鲁·休伯曼：同样，这本书的名字是“协议：人体操作手册”。如果您还没有在社交媒体上关注我，我是所有社交媒体平台上的 Huberman Lab。
So that's Instagram, X, Threads, Facebook, and LinkedIn.
这就是 Instagram、X、Threads、Facebook 和 LinkedIn。
And on all those platforms, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the information on the Huberman Lab podcast.
在所有这些平台上，我讨论科学和与科学相关的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客上的信息不同。
Andrew Huberman: Again, it's Huberman Lab on all social media platforms.
Andrew Huberman：再说一次，所有社交媒体平台上都是 Huberman 实验室。
And if you haven't already subscribed to our "Neural Network Newsletter," the "Neural Network Newsletter" is a zero-cost monthly newsletter that includes podcast summaries as well as what we call protocols in the form of one to three page PDFs that cover everything from how to optimize your sleep and how to optimize dopamine to deliberate cold exposure.
如果您还没有订阅我们的“神经网络通讯”，“神经网络通讯”是一份零成本的每月通讯，其中包括播客摘要以及我们所说的一到三页 PDF 形式的协议，涵盖从如何优化睡眠、如何优化多巴胺到故意冷暴露等所有内容。
Andrew Huberman: We have a foundational fitness protocol that covers cardiovascular training and resistance training.
Andrew Huberman：我们有一个基本的健身方案，涵盖心血管训练和阻力训练。
All of that is available at completely zero cost.
所有这些都可以完全零成本获得。
You simply go to hubermanlab.com, go to the Menu tab in the top right corner, scroll down to Newsletter, and enter your email.
您只需访问 hubermanlab.com，转到右上角的“菜单”选项卡，向下滚动到新闻通讯，然后输入您的电子邮件即可。
And I should emphasize that we do not share your email with anybody.
我要强调的是，我们不会与任何人分享您的电子邮件。
Andrew Huberman: Thank you once again for joining me for today's discussion with Dr. David Fajgenbaum.
Andrew Huberman：再次感谢您参加今天与 David Fajgenbaum 博士的讨论。
And last, but certainly not least, thank you for your interest in science.
最后但同样重要的是，感谢您对科学的兴趣。