U.S. Surgeon General Dr. Vivek Murthy: Efforts & Challenges in Promoting Public Health

This transcript version is not in its final form and will be updated.

该文字记录版本并非最终版本，将会更新。

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。

I'm Andrew Huberman, and I'm a professor of Neurobiology and Ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

Today, my guest is Dr. Vivek Murthy.

今天，我的嘉宾是 Vivek Murthy 博士。

Dr. Vivek Murthy is a medical doctor and acting Surgeon General of the United States.

维韦克·穆尔蒂 (Vivek Murthy) 博士是一位医生兼美国代理卫生局局长。

As Surgeon General of the United States, Dr. Murthy oversees more than 6000 dedicated public health officers whose job is to protect, promote and advance our nation's public health.

作为美国卫生局局长，Murthy 博士负责监管 6000 多名敬业的公共卫生官员，他们的工作是保护、促进和推进我们国家的公共卫生。

Dr. Murthy received his bachelor's degree from Harvard University and his medical degree from the Yale University School of Medicine.

Murthy 博士在哈佛大学获得学士学位，在耶鲁大学医学院获得医学学位。

Today's discussion covers some of the most important issues in public health, not just within the United States, but worldwide, including nutrition and the obesity crisis, as well as food additives and why certain food, chemicals and additives are allowed in the United States versus in other countries.

今天的讨论涵盖了一些最重要的公共卫生问题，不仅在美国国内，而且在全世界范围内，包括营养和肥胖危机，以及食品添加剂，以及为什么某些食品、化学品和添加剂在美国与其他国家相比是允许使用的。

We also discuss mental health, the youth mental health crisis, the adult mental health crisis, and the global crisis of loneliness and isolation.

我们还讨论心理健康、青少年心理健康危机、成人心理健康危机以及全球孤独和孤立危机。

We also talk about corporate interests, that is, whether or not big food and big pharma industries actually impact the research and/or decisions that the US Surgeon general takes in his directives toward public health.

我们还讨论企业利益，即大型食品和大型制药行业是否真正影响美国卫生局局长在其公共卫生指令中所做的研究和/或决定。

And of course, we discuss some of the major public health events that occurred over the last five years and the current and future landscape of how to restore faith both in public health officials, in public health policy and science more generally.

当然，我们还讨论了过去五年中发生的一些重大公共卫生事件，以及如何恢复人们对公共卫生官员、公共卫生政策和科学的信心的当前和未来前景。

By the end of today's episode, you not only will have learned a tremendous amount about public health and why you hear the particular public health directives that you do, but also how to better interpret future public health directives.

在今天的节目结束时，您不仅会学到大量有关公共卫生的知识以及为什么会听到您所做的特定公共卫生指令，还会了解如何更好地解释未来的公共卫生指令。

You will also come to learn that as Surgeon General, Dr. Murthy has both an extremely challenging job, but one that he meets with a tremendous amount of both rigor and compassion.

您还将了解到，作为外科医生，Murthy 医生的工作既极具挑战性，又充满严谨和同情心。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，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向公众提供有关科学和科学相关工具的零成本消费者信息。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Our first sponsor is Maui Nui Venison.

我们的第一个赞助商是 Maui Nui Venison。

Maui Nui Venison is the most nutrient dense and delicious red meat available.

毛伊努伊鹿肉是营养最丰富、最美味的红肉。

I've spoken before on this podcast, in solo episodes and with guests about the need to get approximately 1 gram of high quality protein per pound of body weight each day for optimal nutrition.

我之前曾在这个播客中、在个人节目中以及与嘉宾说过，每天每磅体重需要摄入大约 1 克优质蛋白质才能获得最佳营养。

Now, there are many different ways that one can do that, but a key thing is to make sure that you're not doing that by ingesting excessive calories.

现在，有很多不同的方法可以做到这一点，但关键是要确保您不会摄入过多的卡路里来做到这一点。

Maui Nui Venison has the highest density of quality protein per calorie, and it achieves that in delicious things like ground meats, venison steaks, jerky, and bone broth.

茂宜岛鹿肉每卡路里的优质蛋白质密度最高，在碎肉、鹿肉排、肉干和骨汤等美味食品中也能达到这一水平。

I particularly like the ground venison.

我特别喜欢碎鹿肉。

I make those into venison burgers probably five times a week or more.

我可能每周将它们制作成鹿肉汉堡五次或更多。

I also like the jerky for its convenience, especially when I'm traveling or I'm especially busy with work and know that I'm getting an extremely nutrient dense, high quality source of protein.

我也喜欢肉干，因为它很方便，尤其是当我在旅行或工作特别忙时，并且知道我正在获得营养极其丰富的优质蛋白质来源。

If you'd like to try Maui Nui Venison, you can go to mauinuivenisin.com/huberman and get 20% off your first order.

如果您想尝试 Maui Nui 鹿肉，您可以访问 mauinuivenisin.com/huberman 并享受首单 20% 的折扣。

Again, that's mauinuivenisin.com/huberman to get 20% off.

再次强调，mauinuivenisin.com/huberman 可以享受 20% 的折扣。

Today's episode is also brought to us by ROKA.

今天的节目也是ROKA给我们带来的。

ROKA makes eyeglasses and sunglasses that are of the absolute highest quality.

ROKA 生产绝对最高品质的眼镜和太阳镜。

I've spent a lifetime working on the biology of the visual system, and I can tell you that your visual system has to contend with an enormous number of challenges in order for you to be able to see clearly in different environments.

我花了一生的时间研究视觉系统的生物学，我可以告诉你，你的视觉系统必须应对大量的挑战，以便你能够在不同的环境中看得清楚。

ROKA understands the biology of the visual system and has designed their eyeglasses and sunglasses so that you always see with crystal clarity.

ROKA 了解视觉系统的生物学原理，并设计了眼镜和太阳镜，让您始终拥有清晰的视野。

Originally, their glasses were designed for performance, that is, for running and cycling and for sport.

最初，他们的眼镜是为性能而设计的，即跑步、骑自行车和运动。

And indeed, they can still be used for performance.

事实上，它们仍然可以用于性能。

They won't slip off your face if you get sweaty.

如果您出汗，它们不会从您的脸上滑落。

They're extremely lightweight.

它们非常轻。

But I should mention that ROKA eyeglasses and sunglasses come in some of the aesthetics more typically associated with performance glasses, like those cyborg style glasses.

但我应该提到的是，ROKA 眼镜和太阳镜具有一些通常与功能眼镜相关的美学，例如那些半机械人风格的眼镜。

But they also have a number of styles that you would be perfectly comfortable wearing out to dinner or to work.

但它们也有多种款式，您穿着去吃饭或上班时会非常舒服。

I wear readers at night or when I drive, and I wear sunglasses during the day if I happen to be driving into bright light or outside, and it's just overwhelmingly bright.

我在晚上或开车时戴上阅读器，白天如果碰巧开车进入明亮的光线下或在室外，我会戴上太阳镜，而且光线非常明亮。

I do not wear sunglasses when I do my morning sunlight viewing to set my circadian rhythm, and I suggest that you do the same.

当我早上观看阳光以设定昼夜节律时，我不戴墨镜，我建议您也这样做。

If you'd like to try ROKA eyeglasses or sunglasses, you can go to roka.com and enter the code Huberman to save 20% off your first order.

如果您想尝试 ROKA 眼镜或太阳镜，可以访问 roka.com 并输入代码 Huberman，首次订单可享受 20% 折扣。

Again, that's roka.com and enter the code Huberman at checkout.

同样，这是 roka.com，并在结账时输入代码 Huberman。

And now for my discussion with Dr. Vivek Murthy.

现在我与 Vivek Murthy 博士进行讨论。

Dr. Vivek Murthy Welcome.

Vivek Murthy 博士欢迎您。

Vivek Murthy: Thanks so much, Andrew, and please call me Vivek.

Vivek Murthy：非常感谢，安德鲁，请叫我 Vivek。

I'm informal.

我是非正式的。

Andrew Huberman: Okay.

安德鲁·休伯曼：好的。

Vivek.

维韦克。

My understanding, based on my Internet search, is that the role of the US Surgeon General is to provide scientific information on how to improve health and reduce risk of illness and injury.

根据我的互联网搜索，我的理解是，美国卫生局局长的作用是提供有关如何改善健康并降低疾病和受伤风险的科学信息。

Do I have that correct?

我说的对吗？

Vivek Murthy: That is correct.

维韦克·穆尔蒂：这是正确的。

Andrew Huberman: What are some other roles that you play that perhaps would not come up in a top hit Google search that I ought to be aware of and that our audience ought to be aware of?

安德鲁·休伯曼：你扮演的其他哪些角色可能不会出现在谷歌搜索的热门搜索中，而我应该知道，我们的观众也应该知道？

Vivek Murthy: Well, here's how I generally explain it to people.

Vivek Murthy：嗯，这就是我通常如何向人们解释的。

There are two primary roles the Surgeon General has.

外科医生有两个主要职责。

One is to engage with the public and make sure that people know about critical public health issues so they know what they are, how to protect themselves and their families.

一是与公众接触，确保人们了解重要的公共卫生问题，以便他们知道自己是什么，如何保护自己和家人。

The second role of the Surgeon general is lesser known, but it's equally as important, which is to oversee one of the eight uniformed services in the US government, and that is the United States Public Health Service.

外科医生的第二个角色鲜为人知，但同样重要，即监督美国政府八个制服部门之一，即美国公共卫生服务部门。

Many people are familiar with the Army, the Navy, the Air Force.

很多人都熟悉陆军、海军、空军。

We also have the US Public Health Service, which has 6000 officers.

我们还有美国公共卫生服务部门，有 6000 名官员。

They include doctors, nurses, physical therapists, pharmacists, public health engineers, a whole range of healthcare folks.

他们包括医生、护士、物理治疗师、药剂师、公共卫生工程师和各种医疗保健人员。

And their job is to protect our nation from public health threats.

他们的工作是保护我们的国家免受公共卫生威胁。

So, when Ebola came on the scene in 2014 in a major way in West Africa, we sent hundreds of officers to West Africa to set up the Monrovia medical unit in Liberia to treat people with Ebola domestically.

因此，当埃博拉病毒于2014年在西非大规模出现时，我们派出数百名官员前往西非，在利比里亚设立蒙罗维亚医疗队，在国内治疗埃博拉病毒感染者。

When there are hurricanes or tornadoes, we dispatch officers and deploy them to go help strengthen the public health infrastructure, but also to provide direct care.

当发生飓风或龙卷风时，我们会派遣官员并部署他们去帮助加强公共卫生基础设施，同时也提供直接护理。

We deployed thousands of officers during COVID.

在新冠疫情期间，我们部署了数千名警员。

So these officers, I'm incredibly proud of them, they could be doing lots of stuff outside government and the private sector, probably making a whole lot more money and working a lot less hard, but they're really committed to protecting the public health of the nation.

所以这些官员，我为他们感到无比自豪，他们可以在政府和私营部门之外做很多事情，可能赚更多的钱，工作的努力少得多，但他们确实致力于保护国家的公共健康。

So I have the privilege of overseeing that service as Surgeon General, and those are the jobs that I've signed up for in this role.

因此，我有幸作为外科医生负责监督这项服务，这些是我在这个职位上报名的工作。

Andrew Huberman: Got it.

安德鲁·休伯曼：明白了。

I was not aware of that role.

我不知道这个角色。

And if I understood correctly, these people, these public health officers that presumably are made up of physicians and licensed psychologists and nurses and so forth, you said they could be making substantially higher incomes in the private sector, but the work that they're doing with you is their sole career at this point.

如果我理解正确的话，这些人，这些公共卫生官员大概由医生、有执照的心理学家和护士等组成，你说他们可以在私营部门获得更高的收入，但他们与你一起做的工作是他们目前唯一的职业。

They're completely devoted to that, or they're doing this as a side hustle?

他们完全致力于此，还是将其作为副业？

Vivek Murthy: No, they are full time government employees and members of the public health service.

Vivek Murthy：不，他们是全职政府雇员和公共卫生服务人员。

Their day job is often in public health agencies, where they're embedded in communities, helping day to day to advance public health.

他们的日常工作通常是在公共卫生机构，融入社区，日常帮助促进公共卫生。

And during times of emergency, we deploy them, and they're extraordinarily well trained.

在紧急情况下，我们会部署他们，他们训练有素。

They're experienced at dealing with adversity, but they bring a combination of skill and heart to their work.

他们在应对逆境方面经验丰富，但他们将技巧和热情结合到了工作中。

And you really need both to be effective at public health.

两者确实都需要在公共卫生方面发挥作用。

Andrew Huberman: I'm glad that you mentioned the word emergency, because in preparing for our discussion today, it occurred to me that in this list of roles that your title assumes, that scientific information on how to improve health comes first.

安德鲁·胡伯曼：我很高兴你提到了“紧急情况”这个词，因为在准备今天的讨论时，我突然想到，在你的标题所承担的角色列表中，关于如何改善健康的科学信息是第一位的。

Then you mentioned emergency.

然后你提到紧急情况。

So what I'd like to talk about first is health.

所以我首先想谈的是健康。

Not lack of health, but health.

不是缺乏健康，而是缺乏健康。

So often we hear about the mental health crisis, but what we're really talking about is the lack of mental health crisis, aka mental illness.

我们经常听说心理健康危机，但我们真正谈论的是缺乏心理健康危机，即精神疾病。

And rarely do we hear, for instance, what constitutes mental health.

例如，我们很少听到什么是心理健康。

We hear what constitutes mental illness, whereas in the domain of physical health, there's a lot of information out there about how to be more physically healthy, cardiovascular exercise, resistance exercise, yoga type exercise, mobility, etc., and of course, some people have physical health ailments, and there's a lot of information in terms of how to deal with that as well.

我们听说什么是精神疾病，而在身体健康领域，有很多关于如何使身体更健康的信息，心血管运动、阻力运动、瑜伽类运动、活动能力等等，当然，有些人有身体健康疾病，也有很多关于如何处理这些疾病的信息。

But what I would like to know, before we get into the long list of issues that our nation confronts, everything from obesity to food additives to mental health issues, what is going well?

但我想知道的是，在我们讨论我们国家面临的一长串问题之前，从肥胖到食品添加剂再到心理健康问题，什么进展顺利？

In other words, in the last, let's say, five to ten years, have there been any areas of physical health and mental health improvement in the US at large that we can attribute to some of the public health initiatives directly?

换句话说，在过去五到十年中，美国整体的身体健康和心理健康改善是否有任何领域可以直接归因于某些公共卫生举措？

Vivek Murthy: So that's a really good question.

Vivek Murthy：这是一个非常好的问题。

And let me just also say about the very first point you raised, that you're absolutely right that we have operated primarily through an illness frame.

我还想谈谈您提出的第一点，您说的完全正确，我们主要是在疾病框架下进行运作的。

When we look at health, and in my mind, that's only one half of the equation.

当我们审视健康时，在我看来，这只是等式的一半。

So when we are talking about physical illness, for example, as a doctor, I learned how to diagnose and treat someone with diabetes, or with high blood pressure, or with coronary heart disease.

因此，当我们谈论身体疾病时，例如，作为一名医生，我学会了如何诊断和治疗患有糖尿病、高血压或冠心病的人。

But we also know that even if I don't have diabetes or coronary heart disease or high blood pressure, even if I don't have any diagnosable medical condition, I may not be at an optimal level of physical health.

但我们也知道，即使我没有糖尿病、冠心病或高血压，即使我没有任何可诊断的健康状况，我的身体健康状况也可能不处于最佳水平。

I may not be able to, for example, walk around the block without getting short of breath.

例如，我可能无法在街区周围行走而不会呼吸困难。

I may not be able to play with my kids because my physical fitness and stamina is insufficient.

因为我的身体素质和体力不够，可能无法和孩子们一起玩。

I may not be able to lift my luggage when I go to the airport because I don't have enough strength in my body yet, I wouldn't have a diagnosable mental illness.

我去机场的时候可能提不了行李，因为我的身体还没有足够的力气，我不会有被诊断为精神疾病的。

So I think it's easier to understand there with physical health, that we're not just aiming for lack of illness, we're aiming to optimize our physical health.

所以我认为在身体健康方面更容易理解，我们的目标不仅仅是消除疾病，我们的目标是优化我们的身体健康。

The same is true with mental health.

心理健康也是如此。

And I think when we talk about mental health, people think we're just, the sole goal here is to prevent diagnosable mental illness.

我认为当我们谈论心理健康时，人们认为我们唯一的目标是预防可诊断的精神疾病。

That is one goal, to both prevent and to manage mental illness when it arises.

这是一个目标，既要预防精神疾病，又要在精神疾病出现时对其进行管理。

But we also need to recognize there's a whole other half of the spectrum where there are people who may not have diagnosable mental illness, but are not operating optimally in their lives, and that's detracting from their fulfillment, from their functionality, like in not just at work, but also in their communities and in their families.

但我们还需要认识到，还有另外一半的人可能没有可诊断的精神疾病，但他们的生活并没有达到最佳状态，这损害了他们的成就感和功能，不仅在工作中，而且在社区和家庭中也是如此。

And so I think part of the conversation that I want us to have as a country is about how to optimize mental health and well being, and that includes preventing mental illness, but it is much broader and bigger than that alone.

因此，我认为我希望我们作为一个国家进行的对话的一部分是关于如何优化心理健康和福祉，其中包括预防精神疾病，但它比这本身更广泛和更大。

Andrew Huberman: Great.

安德鲁·休伯曼： 太好了。

Yeah.

是的。

I think it's so important that we recognize that treating disease is critical, obviously, but that there's a lot that can be done to improve one's health, even in the absence of any known disease.

我认为这一点非常重要，我们认识到治疗疾病显然是至关重要的，但即使没有任何已知的疾病，也可以做很多事情来改善一个人的健康。

And you've got all these officers, these incredible physicians and nurses and people at your disposal.

你们还有所有这些官员、这些令人难以置信的医生、护士以及可供你们调遣的人员。

My hope is that they would also be accessible for, and currently carrying out efforts to transmit information to people about, hey, here are the things that you can do every day, every week, every month in order to make your life as healthy as possible, as well as rushing in under conditions of public health crisis.

我希望他们也能接触到，目前正在努力向人们传递信息，嘿，这里是你每天、每周、每月可以做的事情，以便让你的生活尽可能健康，以及在公共卫生危机的情况下冲进去。

Vivek Murthy: Yeah, it's a good point.

Vivek Murthy：是的，这是一个很好的观点。

And certainly many of our officers do focus on this broader rubric around well being, but it's part of how we need, I think, the broader health system and public health system to operate even outside of government.

当然，我们的许多官员确实关注这一更广泛的福祉问题，但我认为，这是我们需要更广泛的卫生系统和公共卫生系统（甚至在政府之外运作）的一部分。

And this, I think, will require significant change and shift in how we think about our jobs.

我认为，这需要我们对工作的看法发生重大改变和转变。

Like when I went to medical school, the vast majority of the focus was on diagnosing and treating illness.

就像我上医学院时一样，绝大多数重点都是诊断和治疗疾病。

There was much, much less focus on thinking about how to enhance well being.

人们很少关注如何提高幸福感。

But when you talk to people in their lives, it becomes clear that they want to do more than just prevent diagnosable illness.

但当你与生活中的人们交谈时，你就会发现，他们想做的不仅仅是预防可诊断的疾病。

They want to be able to walk their child down the aisle and have the endurance to do that.

他们希望能够带领孩子走上红毯，并有耐力做到这一点。

They want to be able to be independent often and carry their groceries or carry their luggage.

他们希望能够经常独立并携带杂货或行李。

This is why I think we've got to broaden our focus in public health.

这就是为什么我认为我们必须扩大对公共卫生的关注。

And, look, when I came into this role, by the way, I was not expecting to serve in government.

顺便说一句，当我担任这个角色时，我并没有想到要在政府任职。

This is not part of some five, 10, 30 year plan.

这不是五年、十年、三十年计划的一部分。

When I was a kid, I was interested in medicine, but I always thought I was going to practice medicine like my dad did and like the clinic my mom ran.

当我还是个孩子的时候，我对医学很感兴趣，但我一直以为我会像我父亲和我妈妈经营的诊所那样行医。

Put up a shingle, see patients, and be a primary care doctor and feel good about the work I was doing.

搭起牌子，看望病人，成为一名初级保健医生，并对我所做的工作感到满意。

But what happened to me along the way is I trained in medicine.

但一路上发生在我身上的事情是我接受了医学训练。

I got interested in technology, spent seven years building a technology company that was focused on health.

我对科技产生了兴趣，花了七年时间建立了一家专注于健康的科技公司。

I became increasingly worried about the way we were delivering health care, and it felt like our health care system was broken.

我越来越担心我们提供医疗保健的方式，感觉我们的医疗保健系统已经崩溃了。

People who needed care couldn't get it.

需要照顾的人得不到照顾。

It was often too expensive to get care.

获得护理的费用往往太高。

We were focusing on treatment solely and not enough on prevention.

我们只注重治疗，而对预防不够重视。

So, I started getting involved in advocating for a better health care system with doctors around the country when, despite all that, I still never thought I would work in government.

因此，我开始与全国各地的医生一起倡导更好的医疗保健系统，尽管如此，我仍然从未想过自己会在政府工作。

But in 2013 is when President Obama's team reached out to me and asked if I'd be interested in considering the position of Surgeon General.

但在 2013 年，奥巴马总统的团队联系了我，询问我是否有兴趣考虑担任卫生局局长的职位。

And what was interesting to me about this position is it's actually very different from most positions that are appointed by the president and government in that it's supposed to be an independent position.

我对这个职位感兴趣的是，它实际上与总统和政府任命的大多数职位有很大不同，因为它应该是一个独立的职位。

So my agenda, the issues I choose to take on, are not determined by a president or a party.

因此，我的议程，我选择处理的问题，不是由总统或政党决定的。

They're determined by science and the public interest.

它们是由科学和公共利益决定的。

And that's what guides me.

这就是指导我的。

That's what guided me in that first term when I served and when President Biden asked me to come back and serve as Surgeon General a second time.

这就是我在第一个任期内任职时以及当拜登总统要求我回来第二次担任卫生局局长时的指导。

That's what's guided me here, too.

这也是引导我来到这里的原因。

Andrew Huberman: So Biden is not sending you notes saying, hey, could you put some effort into getting messages out about COVID, or could you put more effort into getting your team over to Maui to deal with the tragedy there?

安德鲁·胡伯曼：所以拜登不会给你发便条说，嘿，你能花点精力传播有关新冠病毒的信息吗？或者你能花更多精力让你的团队前往毛伊岛应对那里的悲剧吗？

Which is a long arc tragedy, right?

这是一场长弧悲剧吧？

We get the news in, a blast of this happened, and then the next blast comes in about something else, and we forget that there are physical and mental health crises that are ongoing.

我们收到新闻，发生了一起爆炸事件，然后下一次爆炸事件发生在其他事情上，我们忘记了身体和心理健康危机正在持续。

And then I have to imagine, then start to overlap with one another.

然后我必须想象，然后开始相互重叠。

So is it your decision where and how to deploy the financial and human resources?

那么，在哪里以及如何部署财务和人力资源是由您决定的吗？

Like, okay, we're going to put ten people on Maui.

就像，好吧，我们要在毛伊岛派十个人。

We're going to put five people in the Central states going around talking to major organizations about what they need to do to prepare for this winter.

我们将派五个人在中部各州与主要组织讨论他们需要为今年冬天做哪些准备。

Is that how it works, or are you getting memos?

是这样的吗，还是你收到了备忘录？

And in other words, who's your boss?

换句话说，谁是你的老板？

Everyone has a boss.

每个人都有一个老板。

At some level.

在某种程度上。

Mine are the listeners of this podcast at some level.

我的在某种程度上是这个播客的听众。

I work for them.

我为他们工作。

It used to also be my bulldog, Costello.

它也曾经是我的斗牛犬，科斯特洛。

Vivek Murthy: My boss, my wife and my two kids who are five and seven.

Vivek Murthy：我的老板、我的妻子和我的两个孩子，一个五岁，一个七岁。

I do what they tell me to.

我按照他们的吩咐去做。

Andrew Huberman: Got it?

安德鲁·休伯曼：明白了吗？

Vivek Murthy: But how we make our decisions in the office, actually it's a bit different with those two roles.

Vivek Murthy：但是我们在办公室做出决定的方式实际上这两个角色有点不同。

So with the second one, with overseeing the commission corps, our 6000 officers there, the decisions about how and when we deploy officers are collaborative, right?

因此，对于第二个任务，即监督委员会部队，我们那里有 6000 名军官，关于如何以及何时部署军官的决定是协作的，对吗？

So we work with other colleagues throughout the Department of Health and Human Services.

因此，我们与卫生与公众服务部的其他同事合作。

We work with people in FEMA across the administration, but we also work with states.

我们与整个政府的联邦应急管理局人员合作，但我们也与各州合作。

So sometimes states, often states will put in a request and say, hey, we need support here, can you help?

因此，有时各州通常会提出请求并说，嘿，我们这里需要支持，你能帮忙吗？

So we'll work with colleagues across our department to say, okay, well we can mobilize our commission corps officers, what assets can you mobilize?

因此，我们将与我们部门的同事一起说，好吧，我们可以动员我们的委员会军官，你可以动员哪些资产？

And then collectively we will send a team out there.

然后我们将共同派遣一个团队前往那里。

So for example, we have officers helping in Maui right now, particularly with mental health needs, which are, I worry, only going to continue to grow over the weeks and months ahead.

举例来说，我们现在有官员在毛伊岛提供帮助，特别是满足心理健康需求，我担心，这些需求在未来几周和几个月内只会继续增长。

On the other side of the house, when it comes to deciding which issues we engage with the public on, like in this case, mental health has been a big focus area for me.

另一方面，在决定我们与公众讨论哪些问题时，就像在这个例子中一样，心理健康一直是我关注的一个重点领域。

On that front, while we know we are open to suggestions from the public, members of Congress sometimes say, hey, can you help the public understand this issue?

在这方面，虽然我们知道我们愿意接受公众的建议，但国会议员有时会说，嘿，你能帮助公众理解这个问题吗？

A lot of people have ideas and opinions, but the decision about which issues to focus on, those are our offices.

很多人有想法和意见，但决定关注哪些问题是我们的办公室。

And to me that's important because part of the reason over time I believe the public came to have some degree of faith and trust in the office is because they hoped that the office was functioning the way you hope your doctor is functioning, which is being an independent source of information for you and a source that has your best interests at heart, that's not being pulled aside by political interests or by other agendas, but the primary agenda is how can I help your health?

对我来说这很重要，因为随着时间的推移，我相信公众对办公室有了一定程度的信心和信任，部分原因是他们希望办公室按照你希望你的医生运作的方式运作，这是你的独立信息来源，是一个将你的最大利益放在心上的来源，不会被政治利益或其他议程拉到一边，但首要议程是我如何帮助你的健康？

And so for me we have to make an independent assessment there and say, okay, where is the need the greatest here?

因此，对我来说，我们必须在那里进行独立评估，然后说，好吧，这里最大的需求在哪里？

Where can we make the biggest difference?

我们可以在哪里做出最大的改变？

Sometimes we may not build an initiative on an issue and that doesn't mean that issue is unimportant or that it's not affecting a lot of people, but we have to make hard decisions about where to put limited resources.

有时我们可能不会针对某个问题提出倡议，这并不意味着该问题不重要或不会影响很多人，但我们必须就将有限的资源投入何处做出艰难的决定。

And so when I was a Surgeon General the first time, one of the big areas I focused on was the opioid crisis that we were dealing with as well as the e-cigarette use among youth because we were seeing a dramatic increase among kids in e-cigarette use.

因此，当我第一次担任外科医生时，我关注的一个重要领域是我们正在处理的阿片类药物危机以及青少年中电子烟的使用，因为我们看到儿童中电子烟的使用急剧增加。

Andrew Huberman: Can I just ask you?

安德鲁·休伯曼：我可以问你吗？

Sorry to interrupt, but I think it's relevant here.

抱歉打扰，但我认为这与此相关。

Has that increase continued of e-cigarette use, aka vaping?

电子烟（又称电子烟）的使用量持续增加吗？

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

So we still see, unfortunately, there have been some improvements, but we still see way too many kids who are using vaping devices early on.

因此，不幸的是，我们仍然看到已经有了一些改进，但我们仍然看到太多的孩子很早就开始使用电子烟设备。

And part of what we did from our office is recognizing that we actually issued the first federal report on e-cigarettes and youth.

我们办公室所做的部分工作是认识到我们实际上发布了第一份关于电子烟和青少年的联邦报告。

We called the country's attention to the fact that this was a crisis.

我们呼吁全国注意这是一场危机。

We worked with members of Congress to talk about the kind of action we needed from a legislative and regulatory perspective, and worked with colleagues at the FDA and in government as well.

我们与国会议员合作，从立法和监管的角度讨论我们需要采取的行动，并与 FDA 和政府的同事合作。

But there are two things that are really most important in guiding our choice about priorities.

但有两件事对于指导我们选择优先事项来说确实是最重要的。

One is data.

一是数据。

We look at what the numbers actually tell us about the impact these issues are having on the population, as well as the trajectory of rise.

我们看看这些数字实际上告诉我们这些问题对人口的影响以及增长的轨迹。

If something's getting dramatically worse and people don't realize, it might be an area for us to focus.

如果事情变得非常糟糕而人们没有意识到，这可能是我们需要关注的一个领域。

But the other critical factor is what I hear from people on the road.

但另一个关键因素是我从路上听到的人的声音。

So I try to spend as much time as I can visiting communities across the country, doing town halls, meeting with community members, and just trying to, frankly, just listen to what's on their mind.

因此，我尝试花尽可能多的时间访问全国各地的社区，参加市政厅活动，与社区成员会面，坦率地说，只是尝试倾听他们的想法。

And that's where I actually get a lot of information as well.

实际上我也从那里获得了很多信息。

That's actually how I came to focus on the issue of loneliness and isolation.

这实际上就是我开始关注孤独和孤立问题的方式。

It wasn't because it popped up in a report as being the leading public health issue in the country.

这并不是因为它在一份报告中突然出现，成为该国主要的公共卫生问题。

It was because everywhere I was going in 2014, 2015, whether I was talking to college students, talking to retired Americans, talking to parents in rural areas and urban areas, I kept hearing these stories about people who felt like they were all on their own, or they felt invisible, or they felt if they disappeared tomorrow, no one would even care.

因为2014年、2015年无论我去哪里，无论是与大学生交谈，与退休的美国人交谈，与农村地区和城市地区的父母交谈，我不断听到这些故事，这些人感觉自己孤身一人，或者感觉自己被忽视了，或者觉得如果明天消失了，就没有人在乎了。

Or they felt like they just didn't belong.

或者他们觉得自己不属于这里。

And it's heartbreaking to hear that from anyone.

听到任何人这样说都令人心碎。

It's particularly heartbreaking to hear it from kids who you hope are entering life and looking forward to what comes.

听到那些你希望即将进入生活并期待着即将发生的事情的孩子们说出这样的话，尤其令人心碎。

But many kids weren't feeling that way.

但很多孩子却没有这样的感觉。

Andrew Huberman: That is very useful context, and we will get back to the isolation crisis, such an important initiative that I just will thank you now for having put out the message on social media and elsewhere about that, because I think one of the questions I have, in light of what you just said, is it's clear that you've got your ear to the ground.

安德鲁·胡伯曼：这是非常有用的背景，我们将回到孤立危机，这是一项如此重要的举措，我现在要感谢你在社交媒体和其他地方发布了有关这一问题的信息，因为我认为，根据你刚才所说的，我的问题之一是，很明显你已经认真倾听了。

You're talking to different people.

你正在和不同的人说话。

It's also critically important that people hear from you and know not just what's happening, but that you perhaps want to know where the issues lie and what the actionable steps are that people can take.

同样至关重要的是，人们听取您的意见，不仅了解正在发生的事情，而且您可能想知道问题出在哪里以及人们可以采取哪些可行的步骤。

And I think that we now live in a hyper connected world.

我认为我们现在生活在一个高度互联的世界。

In fact, I'll just say that one of the reasons I launched this podcast is, in 2020 I was going on podcasts talking about things like maintaining sleep and circadian rhythm and stuff from my lab related to trying to adjust anxiety under conditions where I think everyone was anxious and sleep rhythms were disrupted, etc., and I was somewhat surprised that I didn't get a warning on my phone, hey, make sure you're getting morning sunlight.

事实上，我只想说，我推出这个播客的原因之一是，在 2020 年，我在播客上谈论诸如维持睡眠和昼夜节律之类的事情，以及我的实验室中与在我认为每个人都焦虑且睡眠节律被扰乱的情况下尝试调整焦虑有关的东西，等等，我有点惊讶我的手机上没有收到警告，嘿，确保你得到早晨的阳光。

I'll get a flood warning.

我会收到洪水警报。

I'll get a warning that I might get a warning but it's only a test warning.

我会收到一条警告，表明我可能会收到警告，但这只是测试警告。

I got three of those yesterday, living here near the coast.

我昨天得到了其中三个，住在靠近海岸的地方。

But I don't think once during the pandemic did I get an email or a public service announcement saying, hey, if you are going to be indoors a lot, you're going to have to be mindful of maintaining your circadian rhythm, because if you're not, we know, based on hundreds of studies now, that drifts in circadian rhythmicity are a precursor to mental health issues.

但我不认为在大流行期间我收到过一封电子邮件或公共服务公告说，嘿，如果你要经常呆在室内，你就必须注意保持你的昼夜节律，因为如果你不这样做，我们知道，根据现在的数百项研究，昼夜节律的漂移是心理健康问题的先兆。

In fact, there's a new idea that many, not all, suicides are preceded by a period of disrupted sleep.

事实上，有一个新观点认为，许多（并非全部）自杀事件之前都会经历一段睡眠中断的时期。

Which kind of makes sense, and it's not causal, of course, but how come during the pandemic, we each and all, as us citizens, did not get an email or a text message saying, hey, these are five things that you need to do every day to try and stay as stable as possible in this very uncertain landscape that we're in?

当然，哪一种是有道理的，而且这不是因果关系，但为什么在大流行期间，我们每个人，作为我们公民，没有收到一封电子邮件或短信说，嘿，这是你每天需要做的五件事，以便在我们所处的这个非常不确定的环境中尽可能保持稳定？

Vivek Murthy: Well, it's a really good question, and I think it's a reasonable and a very good suggestion to say that, hey, look, there should be a clear and comprehensive way that we can get messages out to everyone.

Vivek Murthy：嗯，这是一个非常好的问题，我认为这是一个合理且非常好的建议，嘿，看，应该有一个清晰而全面的方式，我们可以向每个人传达信息。

Like if we were working in a hospital system and there was a safety issue that came up, there would be an email sent to all the hospital staff members saying, hey, this is something you need to be aware of.

就像我们在医院系统中工作并且出现安全问题一样，将会向所有医院工作人员发送一封电子邮件说，嘿，这是您需要注意的事情。

So I think it's a reasonable expectation, practically, if you go back, though, over the last 20, 30 years on health issues, there hasn't been sort of an agency or an entity that has sent emails out to everyone.

所以我认为这是一个合理的期望，实际上，如果你回顾过去，在过去的 20、30 年里，在健康问题上，还没有一个机构或实体向每个人发送电子邮件。

First of all, how to send an email out to everyone in America is not a simple proposition either.

首先，如何向美国的每个人发送电子邮件也不是一个简单的命题。

Technically, it's challenging.

从技术上来说，这很有挑战性。

There's some legal issues you'd have to deal with as well.

您还必须处理一些法律问题。

Andrew Huberman: But you could do a night where you go, CNN, Fox, NBC, ABC, New York Times, Wall Street.

安德鲁·休伯曼：但是你可以在你去的地方做一个夜晚，CNN、福克斯、NBC、ABC、纽约时报、华尔街。

Like, you could hit the right wing, the left wing and everything.

就像，你可以击中右翼、左翼等等。

Vivek Murthy: Yeah, that's a really interesting suggestion.

Vivek Murthy：是的，这是一个非常有趣的建议。

Andrew Huberman: But one video just where they all agree, like, hey, this is important information.

安德鲁·休伯曼：但是他们都同意一个视频，就像，嘿，这是重要的信息。

So apolitical.

如此非政治。

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

So I would say that that kind of messaging, I would say through traditional media, certainly has happened, and it happened during COVID.

所以我想说，这种通过传统媒体传递的信息肯定已经发生过，而且是在新冠疫情期间发生的。

It happened, for example, when in the first year of COVID I was a private citizen in the prior administration, but I watched both then and at the beginning of the Biden administration.

例如，在新冠疫情爆发的第一年，我在上一届政府中还是一名普通公民，但我在当时和拜登政府初期都观看了这一切。

Many officials would go out in front of cameras and say, here are three things you need to do to keep yourself safe from COVID That was a big question people had.

许多官员会在镜头前说，为了保证自己免受新冠病毒感染，你需要做以下三件事，这是人们提出的一个大问题。

How do I keep myself safe?

我如何保证自己的安全？

Okay, here are three things you can do.

好的，您可以做以下三件事。

A couple of challenges, I would say here is that, number one, even if you hit all the major network and cable news shows, you're still not reaching everyone.

我想说的几个挑战是，第一，即使您观看了所有主要网络和有线新闻节目，您仍然无法覆盖所有人。

Right.

正确的。

Because we're living in a society where increasingly people are not watching TV, they're getting their news from other sources.

因为我们生活在一个越来越多的人不看电视的社会，他们从其他来源获取新闻。

The other thing that's important to know is that attention shifts quickly in traditional media also from issue to issue.

另一件重要的事情是，传统媒体的注意力也在不同问题之间快速转移。

And so you might get a clip out at a certain day, or you might get on all the Sunday shows, for example, but the next day that message isn't necessarily there.

因此，您可能会在某一天收到一个剪辑，或者您可能会收到所有周日的节目，例如，但第二天该消息不一定存在。

It's gone.

它消失了。

And people's attention has switched off, too.

人们的注意力也消失了。

I can count, and we've logged probably thousands of interviews at this point that we've done with mainstream media, with sort of concise messages about three things you can do to protect yourself, etc., and I'm glad we did those, we got to do them.

我可以数一数，目前我们已经记录了可能数千次与主流媒体的采访，其中包含关于您可以采取的三件事来保护自己的简洁信息等等，我很高兴我们做到了这些，我们必须这样做。

But I think one of the things we don't have right now in the country, and this is, I think, a bit of a health infrastructure challenge, is we actually don't have a quick, efficient way to reach everyone in the country with a health message.

但我认为我们国家目前还没有的一件事，我认为，这是一个卫生基础设施方面的挑战，就是我们实际上没有一种快速、有效的方法来向全国每个人传达健康信息。

Just like what you said, if you wanted to get that message about three things to protect yourself from, let's say, COVID, or three things to do to support your health and well being during a time of crisis or during a time of health.

就像您所说的那样，如果您想了解有关保护自己免受新冠病毒感染的三件事的信息，或者在危机时期或健康时期需要做的三件事来支持您的健康和福祉。

Andrew Huberman: I mean, again, not just the flood warning, because I do think that most of mental and physical health is the result of daily practices that build on themselves, sort of like compounded investments.

安德鲁·胡伯曼：我的意思是，不仅仅是洪水警告，因为我确实认为大多数身心健康都是建立在自身之上的日常实践的结果，有点像复合投资。

And then, of course, there are acute challenges and chronic challenges that people face, but things of that sort, too.

当然，人们面临着严峻的挑战和长期的挑战，但也有类似的事情。

Vivek Murthy: I think those kinds of messages in time of health are absolutely important as well.

Vivek Murthy：我认为在健康时期这些信息也绝对重要。

And I think in the sort of, I think, fast paced, crisis driven environment that we live in, unfortunately, people are often less, or paying less attention, to those maintenance and improvement messages than they are to managing the crisis messages.

我认为，不幸的是，在我们生活的快节奏、危机驱动的环境中，人们对这些维护和改进信息的关注往往少于对管理危机信息的关注。

But I think that they're equally as important.

但我认为它们同样重要。

But I do think that what you're pointing out is an infrastructure piece that needs to be built, which is a way for health authorities to reach people with information quickly and comprehensively.

但我确实认为你所指出的是需要建设的基础设施部分，这是卫生当局快速、全面地向人们提供信息的一种方式。

I'll just tell you that in the 1980s, when C.

我只想告诉你，在 20 世纪 80 年代，C.

Everett Coop was surgeon general, one thing that he had done which was interesting is he had actually sent a letter, a physical letter, to all households in America about HIV.

埃弗雷特·库普（Everett Coop）是卫生局局长，他所做的一件有趣的事情是，他实际上向美国所有家庭发送了一封关于艾滋病毒的信，一封实体信。

Andrew Huberman: A physical letter.

安德鲁·休伯曼：一封实体信。

Vivek Murthy: A physical letter.

Vivek Murthy：一封实体信。

Andrew Huberman: Some of our listeners won't know what that is.

Andrew Huberman：我们的一些听众不知道那是什么。

Vivek Murthy: A thing you read about in the history books or something shows up in your mailbox and you open it, and hopefully it's something you want to read.

Vivek Murthy：你在历史书上读到的东西，或者你的邮箱中出现的东西，你打开它，希望它是你想读的东西。

But in this case, he was worried about HIV, about the fact that people didn't know about it.

但在这种情况下，他担心艾滋病毒，担心人们不知道这一事实。

So he worked through, as I understand it, with a member of Congress, found a way to do this from a funding perspective.

因此，据我了解，他与一位国会议员合作，找到了一种从资金角度做到这一点的方法。

But it was a very unusual move and one that was never replicated since.

但这是一个非常不寻常的举动，此后再也没有被复制过。

And there was never infrastructure or funding to do that again.

而且再也没有基础设施或资金来做到这一点。

When I was Surgeon General last time, some years ago, and then this time around, one of the things I did do is I was able to send a physical letter to the medical community.

几年前，当我上次担任外科医生时，然后这一次，我所做的一件事就是我能够向医学界发送一封实体信件。

The first time, it was about the opioid use crisis, and about changing our prescribing practices in medicine so that we exposed fewer patients to the harm of opioids while making sure people who needed them actually got them.

第一次是关于阿片类药物使用危机，以及改变我们的医学处方做法，以便我们让更少的患者受到阿片类药物的伤害，同时确保需要它们的人真正得到它们。

And the second time, it was about COVID therapeutics.

第二次是关于新冠病毒治疗的。

It was about making sure that when we had data about medicines that actually worked, like Paxlovid, that we actually offered them to patients, made them available to patients, because we were realizing that many people weren't getting offered life saving medications, even though they were in high risk groups.

这是为了确保当我们获得像 Paxlovid 这样真正有效的药物的数据时，我们实际上将它们提供给患者，使它们可供患者使用，因为我们意识到许多人没有获得挽救生命的药物，即使他们属于高危人群。

So we were able to find, and again, there, too, had to sort of creatively cobble together resources, funding.

因此，我们能够找到，而且，也必须创造性地拼凑资源和资金。

This is all sort of behind the scenes government stuff.

这都是政府幕后的事情。

But the bottom line is what you want in an emergency and what you want, I think, in the long term, is a simple, clear, comprehensive way that public health messages can get out to people.

但底线是在紧急情况下你想要什么，我认为从长远来看，你想要的是一种简单、清晰、全面的方式，可以向人们传达公共卫生信息。

And to this day, what we still have to rely on are one, traditional channels, like traditional media, to cover the initiatives we put out, whether it's on social media and youth mental health, or on loneliness, or on youth mental health more broadly, we have to rely on online channels, which we do as well, or we have to look to creative partnerships that we build with people who reach different audiences.

直到今天，我们仍然必须依赖一个传统渠道，就像传统媒体一样，来报道我们提出的倡议，无论是社交媒体和青少年心理健康，还是孤独，或更广泛的青少年心理健康，我们都必须依赖在线渠道，我们也这样做，或者我们必须寻求与接触不同受众的人建立的创造性合作伙伴关系。

And then together we try to get our messages out.

然后我们一起努力传达我们的信息。

Our office does all three of these, but it's a patchwork and it's not always ideal, but it's what we do now.

我们的办公室做所有这三件事，但它是拼凑而成的，并不总是理想的，但这就是我们现在所做的。

I think part of what this reflects is a broader challenge, like in government, but also in society more broadly, which is that we have valued, historically, prevention and health communication very little.

我认为这在一定程度上反映了更广泛的挑战，例如在政府中，而且在更广泛的社会中，这就是我们从历史上看很少重视预防和健康传播。

We've put the vast majority of our resources into treatment strategies, into getting medications to people, into diagnosis.

我们已将绝大多数资源投入到治疗策略、为人们提供药物和诊断中。

And that's very important, don't get me wrong, but we are now seeing with mental health, just as one example, that if we only focus on expanding treatment and deepening our well of knowledge there and we don't do anything to help people stay well, that we just can't keep up.

这非常重要，请不要误解我的意思，但我们现在在心理健康方面看到，仅举一个例子，如果我们只专注于扩大治疗和加深我们的知识，而不做任何事情来帮助人们保持健康，我们就无法跟上。

Andrew Huberman: Because one problem feeds the other.

Andrew Huberman：因为一个问题又会引发另一个问题。

Vivek Murthy: Exactly.

维韦克·穆尔蒂：没错。

Andrew Huberman: The kids that are staying...

安德鲁·休伯曼：留下来的孩子们......

Listen, if I had grown up in today's era, I'd be on my phone and tablet late at night because I was up reading magazines and talking to friends on the phone late at night.

听着，如果我在当今时代长大，我会在深夜使用手机和平板电脑，因为我会在深夜阅读杂志并与朋友打电话。

Vivek Murthy: Right?

维韦克·穆尔蒂：对吗？

Andrew Huberman: So it's not a criticism, but disruptions in sleep, disruptions in circadian rhythm, disruptions, lack of physical activity, poor nutrition, social isolation.

安德鲁·胡伯曼：所以这不是批评，而是睡眠中断、昼夜节律中断、缺乏体力活动、营养不良、社会孤立。

I mean, these are all piling the sand much higher in this other side of what you do in terms of, and here I'm obviously stating the obvious, so it's just going to create a mountain of issues on the other side, which presumably has a larger budget, is what I'm sensing.

我的意思是，这些都把沙子堆在你所做的事情的另一边更高的地方，在这里我显然是在陈述显而易见的事情，所以这只会在另一边产生堆积如山的问题，这就是我所感觉到的，而另一边可能有更大的预算。

But there's no way that budget is large enough to deal with that.

但预算根本不足以解决这个问题。

I mean, if somebody's kid, for instance, is trying to address the issue of whether or not to go on prescription medications and/or by the way, folks and/or change their dietary intake because they feel they might have ADHD, for instance, I mean, what are they going to do?

我的意思是，例如，如果某人的孩子正在尝试解决是否继续服用处方药的问题和/或顺便说一句，人们和/或改变饮食摄入量，因为他们觉得自己可能患有多动症，例如，我的意思是，他们会做什么？

They're going to Google, they're going to listen to podcasts.

他们会去谷歌，他们会听播客。

They should be able to write first to your organization and say, what does the highest level stringency data say about these issues?

他们应该能够首先写信给您的组织并询问，关于这些问题的最高级别严格数据有何说明？

And AI should be able to tell them accurately.

人工智能应该能够准确地告诉他们。

And maybe you have somebody chime in for them.

也许有人会替他们插话。

I mean, we all pay taxes.

我的意思是，我们都纳税。

I pay federal and state taxes.

我缴纳联邦税和州税。

Vivek Murthy: Me too.

维韦克·穆尔蒂：我也是。

Andrew Huberman: And to some extent, happily so, right, because it pays for public works and many important things, police officers, firefighters, etc. But if you don't have a channel to communicate with people about what they and their kids and their relatives can do, then to some extent it feels like it's a cul de sac.

安德鲁·胡伯曼：在某种程度上，令人高兴的是，因为它为公共工程和许多重要的事情、警察、消防员等支付费用。但是，如果你没有渠道与人们沟通他们和他们的孩子和他们的亲戚可以做什么，那么在某种程度上，感觉就像是一条死胡同。

It's like, how in the world can we get healthy again, or healthier as a country.

就像，我们到底如何才能恢复健康，或者作为一个国家变得更健康。

Vivek Murthy: The part that keeps me up at night is, and one of some of the hardest decisions I have to make in the office are putting aside issues that we know deserve a lot more time and attention, but we just really don't have the resources to deal with the issues that we have dealt with.

Vivek Murthy：让我彻夜难眠的是，我在办公室必须做出的最艰难的决定之一就是搁置我们知道值得更多时间和关注的问题，但我们确实没有资源来处理我们已经处理过的问题。

I'm certainly proud of my team that we've worked hard to try to raise awareness of the issues we have taken on, whether it's around social media and youth and mental health, or whether it's around isolation or clinician burnout or other issues like that.

我当然为我的团队感到自豪，我们努力提高人们对我们所面临问题的认识，无论是社交媒体、青少年和心理健康，还是隔离、临床医生倦怠或其他类似问题。

But the truth is that there's more that needs to be done, more issues that need to be tackled, and we have to get to a place where we can talk about what I think of as the core pillars of a healthy life, which are sleep, our nutrition, our physical activity, our social relationships.

但事实是，还有更多的事情需要做，更多的问题需要解决，我们必须能够讨论我认为健康生活的核心支柱，即睡眠、我们的营养、我们的身体活动、我们的社会关系。

These are all vital elements to living a healthy life.

这些都是健康生活的重要元素。

Right now, we're not teaching kids about this in school, but if you think about education and school as a place and a force that should prep kids for the rest of their lives, it should lay a foundation for a healthy life going forward.

目前，我们并没有在学校里教孩子们这一点，但如果你把教育和学校视为一个地方和一股力量，应该为孩子们的余生做好准备，那么它应该为未来的健康生活奠定基础。

These absolutely are important elements for kids to learn about.

这些绝对是孩子们需要学习的重要元素。

I think it's as important for kids to learn about how to build and maintain healthy relationships in their life as it is, frankly, for them to learn how to read and write.

坦率地说，我认为对于孩子来说，学习如何在生活中建立和维持健康的关系与学习如何阅读和写作同样重要。

And I know that's a strong statement to make, but it is true in terms of its contribution to their happiness, their fulfillment, their health and their success.

我知道这是一个强有力的声明，但就其对他们的幸福、成就感、健康和成功的贡献而言，这是事实。

Andrew Huberman: I could not agree more.

安德鲁·休伯曼：我完全同意。

We have a series that's out now with a psychiatrist, Paul Conti, about mental health, not mental illness.

我们现在与精神病学家保罗·孔蒂合作推出了一个关于心理健康而不是精神疾病的系列节目。

About self inquiry and how to use self inquiry and practices that do not require a therapist in order to bolster mental health.

关于自我探究以及如何使用自我探究和不需要治疗师的实践来促进心理健康。

Of course, therapists can be very useful, but not everyone has access, and not everyone feels comfortable doing that.

当然，治疗师可能非常有用，但并不是每个人都有机会，也不是每个人都觉得这样做很舒服。

But we are but one channel.

但我们只是一个渠道。

I mean, you are the governing body for this.

我的意思是，你们是这件事的管理机构。

You're the Army, Navy, and Marines, so to speak, of health.

可以说，你们是负责健康的陆军、海军和海军陆战队。

As many of you know, I've been taking AG1 daily since 2012, so I'm delighted that they're sponsoring the podcast.

你们很多人都知道，自 2012 年以来我一直每天服用 AG1，所以我很高兴他们赞助这个播客。

AG1 is a vitamin mineral probiotic drink that's designed to meet all of your foundational nutrition needs.

AG1 是一种维生素矿物质益生菌饮料，旨在满足您的所有基本营养需求。

Now, of course, I try to get enough servings of vitamins and minerals through whole food sources that include vegetables and fruits every day.

当然，现在我尝试每天通过包括蔬菜和水果在内的天然食物来源获取足够的维生素和矿物质。

But oftentimes I simply can't get enough servings.

但很多时候我根本吃不到足够的份量。

But with AG1, I'm sure to get enough vitamins and minerals and the probiotics that I need.

但有了 AG1，我肯定能获得足够的维生素和矿物质以及我需要的益生菌。

And it also contains adaptogens to help buffer stress.

它还含有适应原来帮助缓解压力。

Simply put, I always feel better when I take AG1.

简而言之，当我服用 AG1 时，我总是感觉更好。

I have more focus and energy and I sleep better.

我的注意力更加集中，精力更加充沛，睡眠质量也更好。

And it also happens to taste great.

而且它的味道也很棒。

For all these reasons, whenever I'm asked if you could take just one supplement, what would it be?

出于所有这些原因，每当我被问到是否可以只服用一种补充剂时，我会选择什么？

I answer AG1.

我回答AG1。

If you'd like to try AG1, go to drinkag1.com/huberman to claim a special offer.

如果您想尝试 AG1，请访问 Drinkag1.com/huberman 以获得特别优惠。

They'll give you five free travel packs plus a year's supply of Vitamin D3K2.

他们将为您提供五个免费旅行包以及一年的维生素 D3K2 供应。

Again, that's drinkag1.com/huberman.

再说一遍，这是 Drinkag1.com/huberman。

There's lots more to explore there.

那里还有很多值得探索的地方。

We may have to do several of these together, but to touch on all of them, but maybe we could talk about a few of the things that our listeners asked about.

我们可能必须一起做其中的几件事，但要触及所有这些，但也许我们可以谈论听众询问的一些事情。

Vivek Murthy: Sure.

维韦克·穆尔蒂：当然。

Andrew Huberman: When I solicited for questions, I got more than 10,000 responses across social media in a very short amount of time.

Andrew Huberman：当我征求问题时，我在很短的时间内通过社交媒体收到了超过 10,000 条回复。

But there was some redundancy.

但有一些冗余。

One of the things that I'm very curious--

我很好奇的一件事是——

Vivek Murthy: --Can I just stay on that point, though?

Vivek Murthy：——不过我可以停留在这一点上吗？

One, I'm really glad that you asked folks to submit questions, and I was really excited to see how many people actually wrote in.

第一，我真的很高兴您要求人们提交问题，而且我很高兴看到有多少人实际写了问题。

But I think it's also just a testament to how you've done such an incredible job building a channel to the public to let people know about these topics that are so vital to our health and well being, whether it's sleep or physical activity or mental health.

但我认为这也证明了你们如何完成了如此令人难以置信的工作，为公众建立了一个渠道，让人们了解这些对我们的健康和福祉至关重要的话题，无论是睡眠、身体活动还是心理健康。

And so I just want to thank you for all the work you're doing trying to help people understand more about health.

因此，我只想感谢您为帮助人们更多地了解健康所做的所有工作。

And clearly the fact that folks are engaging, they're sending questions and they're sending comments to you means that you're building a relationship there with a lot of folks.

显然，人们参与其中，他们向您发送问题并向您发送评论，这意味着您正在与很多人建立关系。

So just kudos to you for doing that.

所以对你这样做表示赞赏。

Andrew Huberman: Well, thank you.

安德鲁·胡伯曼：好的，谢谢。

The audience of the Huberman Lab podcast is the only reason we do it.

休伯曼实验室播客的观众是我们这样做的唯一原因。

I mean, I love learning and teaching, but that's the truth.

我的意思是，我喜欢学习和教学，但这是事实。

So they are the podcast.

所以他们就是播客。

The podcast is them.

播客就是他们。

So thank you for that.

所以谢谢你。

There were a lot of questions, and I also wonder about why it is that many food additives and preservatives and dyes and things of that sort that are not allowed in Europe are allowed in US food products?

有很多问题，我也想知道为什么很多欧洲不允许的食品添加剂、防腐剂、染料之类的东西却可以在美国食品中使用？

Vivek Murthy: So, a really good question.

Vivek Murthy：这是一个非常好的问题。

And decisions around food and food safety in particular are made by the Food and Drug Administration.

特别是有关食品和食品安全的决定是由食品和药物管理局制定的。

So that's the FDA, it's a separate independent agency.

这就是 FDA，它是一个独立的机构。

It's not one that our office is involved in sort of directing in any way, and so we're not involved in those decisions, and don't have insight into how they're making their drawing their conclusions, but they do it in a process that's guided by science, just like they do with medications, with devices, etc.

我们的办公室不以任何方式参与指导，所以我们不参与这些决策，也不了解他们如何得出结论，但他们是在一个以科学为指导的过程中做到这一点的，就像他们在药物、设备等方面所做的那样。

With that said, I am concerned that dietary practices, the food that many Americans are consuming, are, in fact, not supporting their health and well being, and in many ways are detracting from it.

话虽如此，我担心饮食习惯，即许多美国人正在食用的食物，实际上并不支持他们的健康和福祉，而且在很多方面都在损害他们的健康和福祉。

When we look at highly processed foods, one of the concerns I have there is we often see sodium content is very high.

当我们观察高度加工食品时，我担心的问题之一是我们经常看到钠含量非常高。

We see the sugar content is very high, and there are certainly additives in there as well, that I think, I would love to have more data on the actual health impacts of those.

我们看到糖含量非常高，而且里面肯定也有添加剂，我想，我很想获得更多关于这些添加剂对健康的实际影响的数据。

But the bottom line is that a significant portion of our diet is comprised of highly processed foods in America.

但最重要的是，在美国，我们饮食的很大一部分是由高度加工食品组成的。

And that worries me.

这让我很担心。

The other piece of this that worries me is just how much refined sugars are being added to so much of our foods.

另一个让我担心的是我们的食物中添加了多少精制糖。

Most people think that sugars are only added to things like desserts, etc. But you look at spaghetti sauces, salad dressings, salad dressings, a lot of these things, which we think of as savory products, have sugar added to them as well.

大多数人认为糖只添加到甜点等东西中。但是你看看意大利面酱、沙拉酱、沙拉酱，很多我们认为是咸味产品的东西也添加了糖。

And so we are consuming, I think, unhealthy levels of sugar in our diet.

因此，我认为我们饮食中的糖摄入量不健康。

We are consuming a fair amount of additives, given the processed food composition in our diet.

考虑到我们饮食中的加工食品成分，我们消耗了大量的添加剂。

And I think part of the reason this is happening, and I want to be very clear, I don't fault individuals out there for the composition of their diet, necessarily, because we have also made certain decisions in our country about what we subsidize, about what's cheaper and more expensive for people.

我认为发生这种情况的部分原因是，我想非常明确的是，我并不一定会责怪人们的饮食构成，因为我们在我们的国家也就我们的补贴内容、对人们来说什么更便宜和更贵做出了某些决定。

And the cheapest foods, unfortunately, are often the most unhealthy foods, the most highly processed foods.

不幸的是，最便宜的食品往往是最不健康的食品、加工程度最高的食品。

If you are somebody who lives in a low income neighborhood, a number of these neighborhoods don't even have grocery stores in them, which is a tragedy, because you can't get fresh produce, etc. A lot of times your shopping, your grocery shopping may be done at a local convenience store, at a 711, or somewhere else that may not have the array of fresh fruits and vegetables that you and your family need.

如果您居住在低收入社区，其中许多社区甚至没有杂货店，这是一个悲剧，因为您无法购买新鲜农产品等。很多时候您的购物、杂货购物可能是在当地的便利店、711 或其他可能没有您和您的家人需要的一系列新鲜水果和蔬菜的地方进行的。

Andrew Huberman: I don't even think they have vegetables.

安德鲁·休伯曼：我什至认为他们没有蔬菜。

I think they'll occasionally have some lemons or apples, oranges, and bananas.

我想他们偶尔会吃一些柠檬或苹果、橙子和香蕉。

But when I walk into a convenience store, what I see is a pharmacy.

但当我走进一家便利店时，我看到的是一家药店。

I really do.

我真的这么做。

I see alcohol, caffeine, energy drinks that have a number of different things in them designed to stimulate different neuromodulators like dopamine and serotonin.

我看到酒精、咖啡因、能量饮料中含有许多不同的物质，旨在刺激不同的神经调节剂，如多巴胺和血清素。

I see nicotine products.

我看到尼古丁产品。

I see high sugar, highly processed foods.

我看到高糖、高度加工的食品。

And keep in mind, I was a teenager.

请记住，我当时还是个青少年。

I mean, I drank my slurpees, I had my butterfingers.

我的意思是，我喝了我的思乐冰，我有我的手指。

I wasn't Bart Simpson, like, in my level of butterfingers, but I liked them.

在我的胡言乱语水平上，我不像巴特·辛普森，但我喜欢他们。

But it was a smaller fraction of what we ate.

但这只是我们吃的一小部分。

And when we were at home, those foods were either not available or we certainly weren't allowed to eat them in ad libitum.

当我们在家时，这些食物要么没有，要么我们当然不被允许随意吃。

Okay, so what's clear to me is that the FDA makes decisions about what is safe, what's not safe.

好的，我清楚的是 FDA 会决定什么是安全的，什么是不安全的。

But, for instance, this last year, there were several papers published in high quality journals showing that if people eat just high, just sweet and savory foods combined, that neural circuits in the brain rewire through process of neuroplasticity that drives increased appetite and changes the response to healthier foods so that they don't taste as satiating.

但是，例如，去年，在高质量期刊上发表的几篇论文表明，如果人们只吃高热量、甜味和咸味的食物，大脑中的神经回路就会通过神经可塑性过程进行重新连接，从而增加食欲并改变对健康食物的反应，从而使它们尝起来不会那么饱。

Okay, that's sort of a duh to a lot of people.

好吧，这对很多人来说都是一种废话。

But I think it was an important set of findings because it said the brain actually changes in response to the very rich, flavorful foods that are associated with highly processed or even moderately processed foods.

但我认为这是一组重要的发现，因为它表明大脑实际上会响应与高度加工甚至适度加工的食物相关的非常丰富、美味的食物而发生变化。

That's just a couple of studies.

这只是一些研究。

There was nothing in those studies that said if you eat these foods, you're going to develop cancer.

这些研究中没有任何内容表明如果你吃这些食物就会患上癌症。

But at some point, one has to, as a citizen, a tax paying citizen, speaking on behalf of many other tax paying citizens, I have to sort of take a step back and say, how long do we wait?

但在某些时候，作为一名公民，一名纳税公民，代表许多其他纳税公民发言，我必须退后一步说，我们还要等多久？

Do we have to get a randomized clinical trial about the 500,000 sick kids that grow into sick adults and then run a trial where they go on an elimination diet where they're eating only unprocessed vegan or unprocessed meat and vegetable, or unprocessed starch and vegetable?

我们是否必须对 500,000 名患病儿童成长为患病成年人进行随机临床试验，然后进行一项试验，让他们进行消除饮食，只吃未加工的素食或未加工的肉类和蔬菜，或未加工的淀粉和蔬菜？

Then we're talking about a 30 year health crisis before we intervene.

然后我们谈论的是在我们干预之前长达 30 年的健康危机。

Why not?

为什么不呢？

If I were in charge, which I'm not, and clearly I wouldn't survive in a government organization because, well, I've got the uniform down.

如果我负责，但我不是，显然我无法在政府组织中生存，因为，好吧，我已经把制服脱下来了。

I always wear the same thing, but a uniform.

我总是穿同样的衣服，但是制服。

But I wouldn't, because I would want to say, wait, why not err on the side of caution?

但我不会，因为我想说，等等，为什么不谨慎一点呢？

Why not send out this AI generated text message that tells everybody in all the languages that Americans speak and can understand, hey, you get to make choices about what you eat.

为什么不发送这条人工智能生成的短信，用美国人所说和能理解的所有语言告诉每个人，嘿，你可以选择吃什么。

But you should be aware that making your diet comprised of more than 15% to 20% of these foods is potentially going to lead to serious issues down the road.

但您应该意识到，如果您的饮食中含有超过 15% 到 20% 的此类食物，可能会导致日后出现严重问题。

And those serious issues are extremely serious.

而那些严重的问题是极其严重的。

I mean, the obesity crisis is really a crisis of both body and brain metabolic challenge that we can talk about.

我的意思是，肥胖危机实际上是我们可以谈论的身体和大脑代谢挑战的危机。

So who sets the thresholds?

那么门槛是谁设定的呢？

In other words, why is it that in this country, we have to wait until people start to get really sick and dying and really struggling before something is done in the direction of their health?

换句话说，为什么在这个国家，我们必须等到人们开始真正生病、死亡并真正挣扎时，才采取有利于他们健康的措施？

And I'm not blaming you.

我并没有责怪你。

I just want to understand because--

我只是想明白，因为——

Vivek Murthy: --Good question--

维韦克·穆尔蒂：——好问题——

Andrew Huberman: --The wealthy people I know care a lot about their food sources, and they pay a lot of attention to it.

安德鲁·休伯曼：——我认识的富人非常关心他们的食物来源，而且他们对此给予了很多关注。

And why aren't we allowing everyone the opportunity to make better choices?

为什么我们不让每个人都有机会做出更好的选择呢？

Vivek Murthy: So this is the right question.

Vivek Murthy：所以这是正确的问题。

And this is something I think about a lot because I'm conscious about what I eat.

这是我经常思考的事情，因为我对自己吃的东西很在意。

But I also talk to folks around the country and realize a lot of people don't have either the information or the resources to actually purchase healthy food, and to know what's going to be good for them and for their families.

但我也与全国各地的人们交谈，意识到很多人没有信息或资源来实际购买健康食品，也不知道什么对他们和他们的家人有好处。

This is why I mentioned we have a list of issues that we would work on if we had more resources.

这就是为什么我提到我们有一个问题清单，如果我们有更多资源，我们将致力于解决这些问题。

This is actually one of them, because to me, one of the most common questions people ask is, what should I eat?

这实际上是其中之一，因为对我来说，人们最常见的问题之一是，我应该吃什么？

That's simple, but it's vexing.

这很简单，但是却很麻烦。

It's complicated.

情况很复杂。

It's incredibly confusing if you go online and just try to search for information.

如果您上网并只是尝试搜索信息，那会非常令人困惑。

And it's a classic example of where it's important to have an objective scientific authority that can come and then speak on broad principles around diet, that can talk about what we know and don't know.

这是一个典型的例子，说明拥有一个客观的科学权威非常重要，他可以就饮食的广泛原则发表言论，可以谈论我们知道和不知道的事情。

So here's an important thing.

所以这是一件重要的事情。

I think a lot of times people may see something as on the market, they might read lists of ingredients.

我认为很多时候人们可能会在市场上看到一些东西，他们可能会阅读成分列表。

They don't recognize half of them because they're additives, but they figure, well, if it's there, then it must have been studied for 30, 40 years, and there must be no harmful consequences.

他们不认识其中的一半，因为它们是添加剂，但他们认为，好吧，如果它存在，那么它一定已经被研究了 30、40 年，而且一定不会产生有害后果。

But sometimes things are put out there because we have short term data that says that they're okay, but there may be a need for more long term data helping people understand, what do we know, what do we not know is important, so that people can make decisions for themselves based on how much risk they want to take.

但有时候，事情之所以被公布出来，是因为我们有短期数据表明它们没问题，但可能需要更长期的数据来帮助人们理解，我们知道什么，我们不知道什么是重要的，以便人们可以根据他们想要承担的风险程度为自己做出决定。

The other thing, though, that concerns me here, Andrew, is, look, I'll tell you, I have a bias here.

不过，安德鲁，我关心的另一件事是，听着，我告诉你，我在这里有偏见。

And my bias is that I am worried about the additives and other products we have in food that don't have long term data.

我的偏见是，我担心食品中的添加剂和其他产品没有长期数据。

That's clear in terms of health risk.

就健康风险而言，这一点是显而易见的。

And so because of that, my bias is generally to think, how can we get people minimally or less processed foods, and how can we get them more fruits and vegetables, how can we make sure that they have that more available to them?

因此，我的偏见通常是思考，我们如何才能让人们获得最少或更少的加工食品，以及我们如何才能为他们提供更多的水果和蔬菜，我们如何确保他们有更多的可用食物？

But we've got to not only make the information available, but we have to make it accessible from a cost perspective.

但我们不仅要提供信息，而且还必须从成本角度提供信息。

If you don't have a grocery store in your community, if vegetables and fruits cost three times what other foods do, that's going to be a problem, right?

如果您的社区没有杂货店，如果蔬菜和水果的价格是其他食物的三倍，那将是一个问题，对吧？

To change diet, the other thing we have to keep in mind is that food companies, a lot of them, do a great job of actually trying to get healthy, nutritious food out to people, and kudos to them.

为了改变饮食习惯，我们必须记住的另一件事是，很多食品公司在努力为人们提供健康、营养的食品方面做得很好，并为他们赢得了荣誉。

But I worry also that there's an incentive also to just try to sell more and more and more of your product.

但我也担心，人们也会有动力去尝试销售越来越多的产品。

And one of the ways to do that is to try to hack the body to kind of figure out, okay, well, what kind of synthetic additives could I put together here?

实现这一目标的方法之一就是尝试破解身体，弄清楚，好吧，我可以在这里添加什么样的合成添加剂？

Or what kind of combination of nutrients could I put together that will get people coming back for more and more and more?

或者我可以将什么样的营养素组合在一起，让人们越来越多地回来购买？

Andrew Huberman: And we saw this in the nicotine industry.

Andrew Huberman：我们在尼古丁行业看到了这一点。

Vivek Murthy: You saw it in the nicotine industry, I would say another in parallel, you see it in social media as well, where the business model of the social media platforms is built on volume of use.

Vivek Murthy：你在尼古丁行业中看到了这一点，我想说的是，在社交媒体中也看到了这一点，社交媒体平台的商业模式建立在使用量的基础上。

Right?

正确的？

How much time am I spending on the platforms?

我在这些平台上花费了多少时间？

It's not quality of time, it's quantity of time.

重要的不是时间的质量，而是时间的数量。

So if that's the business model, then you're going to design your platform to maximize how much time someone spends on them, regardless of whether it's detracting from sleep, detracting from in-person interaction, detracting from anything else that's healthy, regardless of whether that may be causing certain harms.

因此，如果这就是商业模式，那么你将设计你的平台，以最大限度地增加人们在这些平台上花费的时间，无论它是否会影响睡眠、影响面对面的互动、影响其他健康的事物，无论这是否会造成某些伤害。

The business model dictates in many ways how these things are designed.

商业模式在很多方面决定了这些东西的设计方式。

And that applies, I think, to food as well, which is why I think it's incumbent upon us to be particularly cautious with highly processed foods, foods that have additives, and to understand how is this impacting our brain, how is that impacting our satiety?

我认为这也适用于食物，这就是为什么我认为我们有责任对高度加工的食品、含有添加剂的食品特别谨慎，并了解这如何影响我们的大脑，如何影响我们的饱腹感？

How is it leading potentially to greater ingestion that is healthy, and leading to things like obesity, which have a whole host of other medical conditions, from cancer to arthritis to diabetes and heart disease associated with it?

它是如何潜在地导致更多的健康摄入，并导致肥胖等问题，而肥胖会导致一系列其他疾病，从癌症到关节炎，从糖尿病到与之相关的心脏病？

Those are the questions.

这些就是问题。

As a citizen, as a father of two young kids who's trying to bring them up with a healthy lifestyle, those are the questions that I would want to know the answers to.

作为一名公民，作为两个孩子的父亲，并试图以健康的生活方式养育他们，这些都是我想知道答案的问题。

And it's one of the reasons I think these kinds of objective reports are so important for the public.

这就是我认为此类客观报告对公众如此重要的原因之一。

Andrew Huberman: I'm trying to see the scope of the problem and the mechanics involved in trying to alleviate these issues are complex.

Andrew Huberman：我正在尝试了解问题的范围，并且尝试缓解这些问题所涉及的机制很复杂。

I see that.

我明白了。

They aren't all, so, one of the things that is important to do that, though, is you need to have authorities that can speak to these issues that are insulated from political retribution, explain this--

但它们并不是全部，因此，要做到这一点，重要的事情之一是，你需要有权威机构能够谈论这些不受政治报复的问题，解释一下这一点——

--Amen to that.

——阿门。

Listen, I have somebody.

听着，我有人了。

Forgive me for interrupting, but somebody who, from time to time, will make, not recommendations, but will offer information about potential actionable items, things that people could do or not do, according to a couple of studies that have come out.

请原谅我打断，但根据已经发表的几项研究，有人会时不时地提出建议，而不是建议，而是提供有关潜在可操作项目、人们可以做或不做的事情的信息。

I mean, I've come under intense scrutiny from my colleagues who are like, wait, that's not a randomized controlled trial.

我的意思是，我受到了同事们的严格审查，他们说，等等，这不是一项随机对照试验。

How can you do that?

你怎么能这么做呢？

And yet, I know from being in this field for a long time that, for instance, the emerging therapies for PTSD and depression that are now based on federal funding for things like, and I'm not recommending this, by the way, for children or for everybody, but, for instance, the macrodose psilocybin, therapeutically supported legal use of psilocybin for major depression, the data there, they're not perfect, but they're pretty darn good compared to the major SSRIs.

然而，我在这个领域工作了很长一段时间，我知道，例如，针对创伤后应激障碍和抑郁症的新兴疗法，现在是基于联邦资助的，顺便说一下，我并不是向儿童或所有人推荐这种疗法，但是，例如，大剂量裸盖菇素，在治疗上支持裸盖菇素治疗重度抑郁症的合法用途，那里的数据并不完美，但与主要的 SSRI 相比，它们相当好。

But for years, if an academic said the words I just said, they'd lose their job almost instantaneously because they're controlled substances.

但多年来，如果一位学者说了我刚才所说的话，他们几乎会立即失去工作，因为它们是受管制药物。

That's a to do, but then there are a number of things that we're talking about here that are just about making better choices about things to avoid.

这是要做的事情，但是我们在这里讨论的很多事情只是为了对要避免的事情做出更好的选择。

If people understood, I think, that is sugar poison?

如果人们明白的话，我想，那就是糖毒？

Well, some of my audience will say sugar is poison.

好吧，我的一些听众会说糖是毒药。

It's as addictive as cocaine.

它就像可卡因一样令人上瘾。

Look, it is not as addictive as cocaine or heroin.

看，它不像可卡因或海洛因那样容易上瘾。

It is not.

它不是。

However, if a child or adult is eating very sweet or very savory foods of any kind consistently, if those are not healthy foods or if they contain unhealthy additives, over time, the brain will rewire so that healthy foods don't taste as good, they won't be the choices that people make, and you're going to end up with a sick individual, period.

然而，如果一个孩子或成人持续吃任何类型的非常甜或非常咸的食物，如果这些食物不是健康食品或者含有不健康的添加剂，随着时间的推移，大脑会重新布线，使健康食物的味道不再那么好，它们不会成为人们的选择，最终你会得病。

And I don't think we need one more clinical trial funded by federal tax dollars to support that statement.

我认为我们不需要再进行一项由联邦税收资助的临床试验来支持这一声明。

What I'm starting to gather is that you're a very rational, grounded, broad thinking individual.

我开始收集的信息是，您是一个非常理性、脚踏实地、思维广泛的人。

I'm not just saying that because you're sitting here and you're trained in medicine and you understand the science, but that you don't have the means at your disposal to put out a call that says, hey, folks, having some sugar, every once in a while, it's treating the kids to ice cream, great.

我这么说并不是因为你坐在这里，接受过医学培训，了解科学，而是因为你没有办法打电话说，嘿，伙计们，吃点糖，每隔一段时间，就请孩子们吃冰淇淋，太好了。

But if 80% or more of the diet of our kids isn't made up of minimally or non processed foods.

但如果我们孩子 80% 或更多的饮食不是由最低限度或非加工食品组成。

Their brains are going to be rewired in unhealthy ways.

他们的大脑将以不健康的方式被重新连接。

And you can almost expect that they're going to have some health challenge in the future.

你几乎可以预见他们将来会面临一些健康挑战。

That may not be autism or schizophrenia, but is going to be a major health challenge, and that is serious.

这可能不是自闭症或精神分裂症，但将是一个重大的健康挑战，而且是严重的。

And now's the time to intervene by avoiding certain things.

现在是通过避免某些事情来进行干预的时候了。

And if you don't want to do it, look, it's a free country at that level, you're welcome to do it, but you'd be better off spending X number of dollars on these healthier foods, because there's also, and we know this from my colleague Alia Crum's laboratory at Stanford, that even the mere knowledge that certain foods are nutritious can lead to more satiety from eating those foods at the level of hormone release, not just psychologically.

如果你不想这样做，看，这是一个自由国家在这个水平上，欢迎你这样做，但你最好花 X 美元购买这些更健康的食物，因为还有，我们从我的同事阿莉亚·克拉姆在斯坦福大学的实验室知道这一点，即使只是知道某些食物是有营养的，也可以通过在激素释放水平上吃这些食物来产生更多的饱腹感，而不仅仅是心理上的。

You're telling yourself the orange is as tasty and filling as a candy bar, but the understanding of the fact that it is nutritious actually leads to shifts in patterns of ghrelin secretion, etc. So people can feel better on a healthier, slightly lower calorie, nutrient enriched diet of healthy proteins and fruits and vegetables.

你告诉自己橙子像棒棒糖一样美味可口，但对它营养丰富的事实的理解实际上会导致生长素释放肽分泌模式的改变等。因此，人们可以在健康、热量稍低、营养丰富的健康蛋白质、水果和蔬菜饮食中感觉更好。

And it's not a mind trick, it's physiology.

这不是心理技巧，而是生理学。

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

Andrew Huberman: Anyway, I think I feel your pain, frankly.

安德鲁·休伯曼：无论如何，坦白说，我想我能感受到你的痛苦。

Vivek Murthy: And I'll tell you, look, sometimes people ask, hey, why don't you just go out and say a couple of statements that you just said?

Vivek Murthy：我告诉你，听着，有时人们会问，嘿，你为什么不出去说几句你刚才说过的话呢？

Wouldn't that be fine?

这样不好吗？

Why is time needed to prep something like that?

为什么需要时间来准备这样的事情？

Why are resources needed, etc.?

为什么需要资源等等？

Here's actually why.

这实际上是原因。

I know in today's day and age, it's easy to just go and rattle off the cuff statements or shoot from the hip--

我知道在今天这个时代，很容易就随口说出或随口而出——

Andrew Huberman: --You're welcome on my social media channels anytime--

安德鲁·胡伯曼：——欢迎您随时访问我的社交媒体频道——

Vivek Murthy: Andrew Huberman: No, really, to get the word out to millions of people.

Vivek Murthy：Andrew Huberman：不，真的，是为了向数百万人传达信息。

Vivek Murthy: No, I appreciate that, and I may take you up on that.

Vivek Murthy：不，我很欣赏这一点，我可能会接受你的建议。

But I'll tell you that one of the things we always do, recognizing that when we put out statements that people, one they trust, it's coming from a scientific authority and that it's been vetted.

但我会告诉你，我们总是做的一件事是，认识到当我们发表人们信任的声明时，它来自科学权威，并且经过审查。

So we put the effort and time into vetting this thoroughly.

因此，我们投入精力和时间对此进行彻底审查。

We check sources, we look at the data, we talk to experts, we think about how to communicate this in the right way.

我们检查来源，查看数据，与专家交谈，思考如何以正确的方式进行沟通。

That's the work, the behind the scenes work that we do before we put out sort of reports and initiatives, because we want people to have confidence in what they're hearing.

这就是我们在发布各种报告和倡议之前所做的幕后工作，因为我们希望人们对他们所听到的内容充满信心。

We also know that when we put out initiatives that other people build on them.

我们还知道，当我们提出倡议时，其他人会以此为基础。

Philanthropists and foundations will then think about, should I fund work in this area?

然后慈善家和基金会会思考，我应该资助这个领域的工作吗？

Schools and workplaces will think about shifting some of their practices.

学校和工作场所将考虑改变他们的一些做法。

Policymakers will also think about legislation that they may want to design based on that.

政策制定者还将考虑他们可能希望在此基础上设计的立法。

So we want to make sure it's really solid.

所以我们要确保它确实坚固。

But the point I was making when I said also that we have to make sure that not just our office, but folks who are in public health and who are in medicine, who are trying to speak to the public about their health, that they are protected from retribution and attacks.

但我所表达的观点是，我们不仅要确保我们的办公室，还要确保从事公共卫生和医学工作的人们，以及试图向公众谈论自己健康状况的人们，确保他们免受报复和攻击。

This is what I meant, which is that saying things about diet, saying things about tobacco, these can be challenging for some folks because there are industries built around these, which may not always like what you have to say if it hurts their business model or their bottom line.

这就是我的意思，那就是谈论有关饮食的事情，谈论有关烟草的事情，这些对某些人来说可能具有挑战性，因为围绕这些而建立的行业可能并不总是喜欢你所说的，如果它损害了他们的商业模式或他们的底线。

And they may then lean on political leaders, elected leaders, others, to then try to silence you or shut you up.

然后他们可能会依靠政治领导人、民选领导人或其他人，试图让你保持沉默或让你闭嘴。

And I'll tell you, I've experienced this in the past.

我会告诉你，我过去经历过这种情况。

I was Surgeon General during my first term.

我在第一个任期内担任外科医生。

I had issued two key reports.

我发布了两份重要报告。

One was on alcohol, drugs and health, about the addiction crisis, and the other was about the e-cigarette crisis among youth.

一个是关于酒精、毒品和健康，关于成瘾危机，另一个是关于年轻人的电子烟危机。

I will tell you that there were plenty of people who were very unhappy that I was issuing the first federal report on e-cigarettes, folks who felt that, hey, this is going to make folks unhappy.

我会告诉你，有很多人对我发布第一份关于电子烟的联邦报告非常不满，他们觉得，嘿，这会让人们不高兴。

It's going to create political pressure.

这将产生政治压力。

It's going to create a lot of problems.

这会产生很多问题。

Similarly with alcohol, drugs and health, there are many folks who said, hey, if you do this, you're really going to upset the alcohol industry.

与酒精、毒品和健康类似，很多人说，嘿，如果你这样做，你真的会扰乱酒精行业。

Do you really need to have alcohol in the report?

报告中真的需要有酒精吗？

Why don't you just focus on other drugs?

为什么不专注于其他药物呢？

Why don't you take alcohol out of the title?

你为什么不把酒精从标题中去掉呢？

All of these sort of concerns telling you this.

所有这些问题都在告诉你这一点。

Andrew Huberman: These are people who get paid by the alcohol industry?

安德鲁·休伯曼：这些人是从酒精行业获得报酬的？

Vivek Murthy: No, these are people in government who are reading the tea leaves and who are supportive of the work we're doing, but are saying, hey, you're going to really upset a lot of people in industry.

Vivek Murthy：不，这些政府人员正在阅读茶叶并支持我们正在做的工作，但他们说，嘿，你真的会让很多业界人士感到不安。

Andrew Huberman: You're also going to help a lot of people.

安德鲁·休伯曼：你也会帮助很多人。

Vivek Murthy: Yeah, well, this is what it comes down to.

Vivek Murthy：是的，嗯，归根结底就是这个。

They say, well, and if you upset folks, then they're going to try to fire you.

他们说，好吧，如果你让人们不高兴，那么他们就会试图解雇你。

They're going to try to do all these things to which, honestly, my response to a lot of these, and the reason we just put them out anyway was because I said, well, the worst thing that can happen is I get fired, and that's okay.

他们会尝试做所有这些事情，老实说，我对其中很多事情的反应，我们之所以把它们放出来，是因为我说，好吧，可能发生的最糟糕的事情就是我被解雇，那没关系。

If I go out knowing I did the right thing here, then I'm fine with that.

如果我出去时知道我在这里做了正确的事，那么我就同意了。

I'm not looking to build a lifelong career in government.

我并不打算在政府部门建立终身职业生涯。

I'm not doing this job to get to the next thing on the ladder.

我做这份工作并不是为了完成阶梯上的下一件事情。

This is about serving for the time I can.

这是关于尽我所能的服务。

I want to be able to go to sleep at night, look myself in the mirror and know I did so with integrity.

我希望能够在晚上入睡时，看着镜子中的自己，并知道我这样做是诚实的。

So that was an easy decision for me.

所以这对我来说是一个简单的决定。

But my point is that we have to be thoughtful, that in these issues that they're going to be headwinds, right?

但我的观点是，我们必须深思熟虑，在这些问题上它们将成为逆风，对吧？

I'm sure in your case, for example, you've probably gotten pushback from folks about talking about certain things that may have rankled folks who may have had an interest in those issues.

例如，我确信在你的情况下，你可能会因为谈论某些可能激怒那些可能对这些问题感兴趣的人的事情而受到人们的抵制。

And that's okay.

没关系。

You keep talking about them as you should, and I'm grateful for that.

你继续按你应该的方式谈论它们，对此我很感激。

But this is especially important at a time where I think public trust in our institutions more broadly and in science and in medicine have taken a hit over the last few years.

但在我认为公众对我们更广泛的机构以及对科学和医学的信任在过去几年中受到打击的时候，这一点尤其重要。

And I think it's a time where we have to be even more vigilant, those of us in medicine and public health, to make sure that what we do is based on data, that we're transparent about why we're saying what we're saying, that we are also clear about what we know and what we don't know.

我认为，现在我们医学和公共卫生领域的人必须更加警惕，以确保我们所做的事情基于数据，我们对我们所说的原因保持透明，我们也清楚我们知道什么和我们不知道什么。

So that if recommendations change over time, people recognize that this isn't necessarily flip flopping.

因此，如果建议随着时间的推移而改变，人们就会认识到这不一定是反复无常的。

You should change your recommendations if the data changes, if the circumstances change.

如果数据发生变化、情况发生变化，您应该更改您的建议。

So anyway, this is all part of the work that we've got to do.

所以无论如何，这都是我们必须做的工作的一部分。

But to me, this is a really important part of the work.

但对我来说，这是工作中非常重要的一部分。

The integrity behind our work in public health is not just about the issue we're taking on today.

我们公共卫生工作背后的诚信不仅仅涉及我们今天面临的问题。

It's about the trust that we need to rebuild in the field more broadly.

这是我们需要在更广泛的领域重建的信任。

Andrew Huberman: So if I understand correctly, if you were to, for instance, put out a call that, you know, there are food additives that are allowed in the US, that are not allowed in Europe, that may be of risk.

安德鲁·胡伯曼：所以，如果我理解正确的话，例如，如果你打电话说，有些食品添加剂在美国是允许的，而在欧洲是不允许的，那可能会有风险。

We don't have enough data at present to say to avoid these things.

目前我们没有足够的数据来说明如何避免这些事情。

But here's a kind of a yellow, you know, green, known to be safe.

但这里有一种黄色，你知道，绿色，众所周知是安全的。

Red, clearly known to be unsafe, yellow, we just don't know yet, not enough data.

红色，显然已知不安全，黄色，我们只是还不知道，没有足够的数据。

So here's what my recommendation would be for my children.

这就是我对我的孩子的建议。

It's a free country.

这是一个自由的国家。

There are people that argue it's not, but at least at the level of which foods you want to buy with your own budget, it's a free country.

有人认为不是，但至少在你想用自己的预算购买哪些食物的水平上，这是一个自由的国家。

So you're saying that you get messages that warnings about certain things could lead to pushback.

所以你是说你收到了关于某些事情的警告可能会导致抵制的消息。

But I have to imagine that there's something, and I'm not a conspiracy theorist, but there has to be either the people that are saying, look, there could be problems, are just friction averse.

但我必须想象有一些东西，我不是阴谋论者，但必须有人说，看，可能有问题，只是厌恶摩擦。

They just don't like anyone to be angry at anyone, or there must be some incentive for things to remain quiet.

他们只是不喜欢任何人对任何人生气，或者必须有某种动机让事情保持安静。

Certainly the government has not had problems saying to do things or to not do things that upset companies or shut down companies or elevated companies and their success.

当然，政府在说做或不做让公司感到不安、关闭公司或提升公司及其成功的事情时没有遇到任何问题。

So I'd like to know more about the back contour of this.

所以我想更多地了解它的背部轮廓。

Vivek Murthy: Well, look, I think, and this is not too dissimilar for I think, what happens in other industries.

Vivek Murthy：嗯，我认为这与其他行业发生的情况并没有太大不同。

But whenever you do something, whether it's in the private sector, government people weigh, what are the pros and cons, what's the pushback I'm going to get?

但每当你做某事时，无论是在私营部门，还是政府人员，都会权衡利弊是什么，我会受到什么阻力？

How do I deal with that pushback, right?

我该如何应对这种阻力，对吗？

And pushback isn't always a bad thing.

阻力并不总是坏事。

If you get pushback from the public, people, hey, that doesn't make sense to me, etc., you should listen to that and use it to inform your approach.

如果你受到公众、人们的反对，嘿，这对我来说没有意义等等，你应该倾听并用它来指导你的方法。

Andrew Huberman: But that's the public whose your job is to serve.

安德鲁·休伯曼：但你的工作就是服务公众。

I'm talking about pushback from companies is different.

我说的是来自公司的阻力是不同的。

Vivek Murthy: Right.

维韦克·穆尔蒂：是的。

So when pushback comes from people who have a financial interest in the product that you may be commenting on, then you need to know about that, number one, so that you know how to mitigate it.

因此，当阻力来自于你可能评论的产品有经济利益的人时，那么你需要了解这一点，第一，这样你就知道如何减轻它。

And while people may take different approaches to this, my approach as a public official, as Surgeon General, has been to say, at the end of the day, I'm happy to hear from anyone in terms of their concerns or pushback, but the end of the day, what's going to guide my decisions about what issues we take on, what decisions we make and what we say to the public is going to be what is driven by science and the public interest.

虽然人们对此可能采取不同的方法，但作为一名公职人员，作为外科医生，我的做法是，归根结底，我很高兴听到任何人的担忧或反对意见，但归根结底，指导我决定我们要处理什么问题、我们做出什么决定以及我们向公众说什么的将是由科学和公共利益驱动的。

And if that means it's politically inconvenient, that's okay.

如果这意味着这在政治上不方便，那也没关系。

If that means that something happens to my job, that's okay, too.

如果这意味着我的工作发生了什么事，那也没关系。

Look, the bottom line is life is short.

听着，最重要的是生命是短暂的。

We don't know how much time we have here.

我们不知道我们在这里还有多少时间。

We may as well make the time we have count.

我们不妨珍惜我们所拥有的时间。

We may as well do the things that are right and that are going to serve people.

我们不妨做一些正确的、为人民服务的事情。

That's my simple philosophy my parents taught me when I was growing up.

这是我成长过程中父母教给我的简单哲学。

So that's an approach I bring to this.

这就是我为此提出的一种方法。

And that's why, if we were to do, let's say, an initiative on diet, I have no doubt that some of the things that we would say would be perturbing to folks who had a financial interest in the industry, because I don't think that the current setup in the industry is serving the public well.

这就是为什么，如果我们要做一项关于饮食的倡议，我毫不怀疑我们所说的一些事情会让那些在该行业有经济利益的人感到不安，因为我认为该行业目前的设置并没有很好地为公众服务。

I think we have made unhealthy foods cheap.

我认为我们已经让不健康的食品变得便宜了。

That's a problem.

这是一个问题。

We've made healthy foods expensive.

我们让健康食品变得昂贵。

That's a problem.

这是一个问题。

We've put health, from a dietary perspective, out of reach for millions of Americans.

从饮食的角度来看，我们已经让数百万美国人无法获得健康。

That is a fundamental problem.

这是一个根本问题。

And we've also disempowered people by not giving them the information that they need to make decisions.

我们还没有向人们提供做出决策所需的信息，从而剥夺了他们的权力。

So even if you have resources, I guarantee there are people listening to this podcast and many more people out there who go to the grocery store and just feel confused, like, what on earth should I buy?

因此，即使你有资源，我保证会有人听这个播客，还有更多的人去杂货店，只是感到困惑，比如，我到底应该买什么？

What's healthy?

什么是健康的？

What's okay anymore?

现在还好吗？

It's just hard to know.

这只是很难知道。

And so I think we've done a disservice by not doing more to help the public understand and access healthy foods.

因此，我认为我们没有采取更多措施帮助公众了解和获取健康食品，从而造成了伤害。

And again, it's why it's an issue that was on our list of issues that we would want to work on, because I think that the public health need here is immense.

再说一次，这就是为什么这个问题出现在我们想要解决的问题清单上，因为我认为这里的公共卫生需求是巨大的。

Andrew Huberman: I'd like to just take a brief break and thank one of our sponsors, which is LMNT.

Andrew Huberman：我想短暂休息一下并感谢我们的赞助商之一，即 LMNT。

LMNT is an electrolyte drink that has everything you need and nothing you don't.

LMNT 是一种电解质饮料，拥有您需要的一切，没有您不需要的东西。

That means plenty of salt, sodium, magnesium, and potassium, the so-called electrolytes, and no sugar.

这意味着需要大量的盐、钠、镁和钾，即所谓的电解质，并且不含糖。

Salt, magnesium and potassium are critical to the function of all the cells in your body, in particular to the function of your nerve cells, also called neurons.

盐、镁和钾对于体内所有细胞的功能至关重要，特别是对于神经细胞（也称为神经元）的功能。

Now, people, of course, have varying levels of requirements for sodium, so people with hypertension or prehypertension probably shouldn't increase their sodium.

当然，现在人们对钠的需求量不同，因此患有高血压或高血压前期的人可能不应该增加钠的摄入量。

However, many people are surprised to find that by increasing their sodium intake, they are able to function better cognitively and physically.

然而，许多人惊讶地发现，通过增加钠的摄入量，他们能够在认知和身体方面发挥更好的作用。

And that's because a lot of people, especially people who are following low carbohydrate or even moderate carbohydrate and really clean diets, oftentimes they're excreting a lot of water and electrolytes along with it, and simply by increasing their electrolyte intake using LMNT, they just feel better and function better.

这是因为很多人，尤其是那些遵循低碳水化合物甚至中等碳水化合物和真正清洁饮食的人，通常他们会排出大量的水和电解质，只需使用 LMNT 增加电解质摄入量，他们就会感觉更好，功能也更好。

I typically drink LMNT first thing in the morning when I wake up in order to hydrate my body and make sure I have enough electrolytes.

我通常早上起床后第一件事就是喝 LMNT，为身体补充水分并确保有足够的电解质。

And while I do any kind of physical training, and certainly I drink LMNT in my water when I'm in the sauna and after going in the sauna because that causes quite a lot of sweating.

当我进行任何形式的体能训练时，当然，当我在桑拿房中以及桑拿房后，我会在水中喝 LMNT，因为这会导致大量出汗。

If you'd like to try LMNT, you can go to drinklmnt, that's L-M-N-T, .com/huberman to claim a free element sample pack with your purchase.

如果您想尝试 LMNT，可以前往 Drinklmnt（即 L-M-N-T, .com/huberman）在购买时索取免费元素样品包。

Again, that's drinklmn.com/humberman.

同样，这是 Drinklmn.com/humberman。

I have a question about trust in big institutions and public health initiatives in general.

我有一个关于对大型机构和总体公共卫生倡议的信任的问题。

The question is about masks.

问题是关于口罩。

Early in the pandemic, as I recall, we were told that masks were not necessary, then we were told they are necessary.

我记得，在大流行初期，我们被告知不需要戴口罩，后来又被告知戴口罩是必要的。

And I think for a lot of people, that flip in messaging landed like a parent telling their teenage kid to always wear a seatbelt.

我认为对于很多人来说，这种信息传递的转变就像父母告诉他们十几岁的孩子要始终系好安全带一样。

But then you look into the front seat and mom and dad aren't wearing seatbelts.

但当你看看前座时，妈妈和爸爸都没有系安全带。

And as anyone who's been around teenagers or has been one, you make that mistake once, you're not making it again, and you may never recover from that particular example.

作为任何一个在青少年身边或曾经是青少年的人，你犯过一次这样的错误，你不会再犯，而且你可能永远不会从那个特定的例子中恢复过来。

In other words, the public felt like there was a switch of messaging.

换句话说，公众感觉信息传递发生了转变。

But what I don't recall happening was, hey, we got that one wrong.

但我不记得发生的是，嘿，我们搞错了。

So sorry.

很抱歉。

On us.

在我们身上。

You know what?

你知道吗？

The new data say blank.

新数据显示为空白。

What I recall was a message of don't and then do.

我记得的是一条“不做，然后做”的信息。

But there wasn't a lot of kind of acknowledgement of how challenging the situation was.

但人们并没有充分认识到这种情况有多么具有挑战性。

It was just a lot of top down mandates, and in my opinion, and this is just my opinion, I think that led to a pretty rapid distrust of subsequent messages from which we still haven't really recovered.

这只是很多自上而下的命令，在我看来，这只是我的观点，我认为这导致了对后续消息的相当快的不信任，而我们还没有真正从中恢复过来。

And so why do you think it's so challenging for public facing officials to just say, look, we're doing the best we can at the moment, screwed up before changing the message now may change again?

那么，为什么你认为对于面向公众的官员来说，只是说，看，我们目前正在尽力而为，在改变信息之前搞砸了，现在可能会再次改变？

We're navigating this in real time.

我们正在实时处理这个问题。

It's dynamic.

它是动态的。

Please stay with us because it goes without saying, there's been a huge chasm around this and related issues.

请继续关注我们，因为不言而喻，在这个问题和相关问题上存在着巨大的分歧。

Vivek Murthy: Yeah, look, it's an important question.

Vivek Murthy：是的，这是一个重要的问题。

And look, I want to be thoughtful about how I comment on what was done in the first year of the pandemic.

看，我想仔细考虑一下我如何评论大流行第一年所做的事情。

I was a citizen outside government, and I don't know what was happening inside government in terms of the decisions that were made there.

我是政府之外的公民，我不知道政府内部发生了什么以及所做的决定。

But I do know sometimes from my experience in Ebola and in Zika, during those experiences we had as a country, that in the fog of war, when everything's coming at you, sometimes it's hard to make the right decision all the time.

但我有时确实从我在埃博拉和寨卡的经历中知道，在我们作为一个国家的经历中，在战争的迷雾中，当一切都向你袭来时，有时很难一直做出正确的决定。

So I want to give some of those folks who were there in the first year of the pandemic some benefit of the doubt.

因此，我想为那些在大流行第一年参与其中的人提供一些疑虑。

But I do think that the important thing, the principle I certainly try to follow, is that one, I think that, we can all do better.

但我确实认为，重要的是，我当然会努力遵循的原则是，我认为我们都可以做得更好。

I can do better, certainly, too.

我当然也可以做得更好。

But I think an important principle for us in public health communication has to be that we're clear that we're transparent about what we know and what we don't know and that we explain the why to people.

但我认为，我们在公共卫生沟通中的一个重要原则必须是，我们清楚地知道我们所知道的和我们不知道的事情是透明的，并且我们向人们解释原因。

So if we're telling someone to do something, why?

那么，如果我们告诉某人做某事，为什么？

Is it because there's a lot of data behind it?

是因为背后有很多数据吗？

Is it because it's a sort of expert agreement, best practice?

是因为这是一种专家协议、最佳实践吗？

Because sometimes, as you know, in medicine, sometimes when we don't have enough data to guide us on a therapeutic approach, but when the problem is imminent, then sometimes experts will get together and put together expert informed guidelines to say, okay, look, based on our best judgment and the limited data we have, here's what we would recommend.

因为有时，正如你所知，在医学上，有时当我们没有足够的数据来指导我们采取治疗方法时，但当问题迫在眉睫时，有时专家会聚集在一起，整理出专家知情的指导方针，说，好吧，看看，根据我们的最佳判断和我们拥有的有限数据，这就是我们的建议。

And as the data evolves, we will change and modify those recommendations.

随着数据的发展，我们将更改和修改这些建议。

We do that with hypertension, right?

我们对高血压就是这么做的，对吗？

Evolve and update recommendations.

发展和更新建议。

We do that with lipids here, too.

我们在这里也用脂质做到这一点。

I think that has to be a key part of the approach.

我认为这必须是该方法的关键部分。

I think one of the challenges that I saw many public health officials encounter was even when they went out with comprehensive messages like that, which are hard to fit into a sound bite or into simple posts on social media, often a lot of that wasn't covered.

我认为，我看到许多公共卫生官员遇到的挑战之一是，即使他们发出了这样的综合信息，这些信息也很难融入原声摘要或社交媒体上的简单帖子中，其中很多内容通常都没有涵盖。

What gets covered is the top line.

被覆盖的是顶线。

This is what's being recommended, that's what's being required, etc. All the explanation is lost.

这是所推荐的，这是所要求的，等等。所有的解释都丢失了。

It's missing.

它不见了。

And I think we also are living in a time where people are reading headlines, they're living busy lives.

我认为我们也生活在一个人们阅读头条新闻、过着忙碌生活的时代。

They're not necessarily always hearing all of the nuance that's being explained, but I think that that's a challenge.

他们不一定总是能听到所解释的所有细微差别，但我认为这是一个挑战。

I know many public officials struggled with how do you deliver nuanced information at a time when there isn't a clear black and white answer to things.

我知道许多公职人员都在纠结如何在事情没有明确的非黑即白答案的情况下传递细致入微的信息。

But I think the last piece around this is something I was taught early in medical school, is to approach your patients with humility, recognizing that even though you have more training than they do, you aren't living their life.

但我认为最后一点是我在医学院早期学到的东西，就是以谦逊的态度对待你的病人，认识到即使你比他们接受了更多的培训，你也没有过他们的生活。

You don't necessarily know what they're going through, and you shouldn't assume things about them.

你不一定知道他们正在经历什么，你也不应该假设他们的事情。

And so approaching with humility means that you've got to recognize that not everyone's going to be able to follow your guidance.

因此，谦虚地对待意味着您必须认识到并非每个人都能遵循您的指导。

And if they aren't able to, that doesn't mean you criticize them.

如果他们做不到，这并不意味着你批评他们。

It also means recognizing that people may have ideas or suggestions for you that may actually improve your recommendations or how you communicate.

它还意味着认识到人们可能对您有想法或建议，这些想法或建议实际上可能会改善您的建议或沟通方式。

And so these are the principles, I think, that are important in public communication.

因此，我认为这些原则在公共传播中很重要。

But I think that both the challenge of translating nuanced arguments into what's actually covered, that was tough for many public health officials.

但我认为，对于许多公共卫生官员来说，将细致入微的论点转化为实际涵盖的内容是一项艰巨的挑战。

I think the other thing, honestly, just on a human level, that became hard for many of them.

我认为另一件事，老实说，就人类层面而言，这对他们中的许多人来说变得困难。

And I'm thinking particularly about local and state public health officials who are on the front lines that I talk to a lot was they ended up getting attacked a lot and abused a lot during the pandemic.

我特别想到的是地方和州公共卫生官员，他们在前线，我经常与他们交谈，因为他们在大流行期间受到了很多攻击和虐待。

And I don't just mean, like, attacked online.

我的意思不仅仅是在线攻击。

I mean, people showing up at their houses, people harassing their children, people threatening their safety.

我的意思是，人们出现在他们的家中，人们骚扰他们的孩子，人们威胁他们的安全。

This was often people who were upset about some of the requirements that were being put down from local departments of health.

这些人通常对当地卫生部门提出的一些要求感到不安。

And you can understand that COVID was as stressful a time as we've seen recently.

您可以理解，新冠疫情期间的压力与我们最近所看到的一样。

People lost their jobs.

人们失去了工作。

People were losing loved ones.

人们正在失去亲人。

I mean, talk about a stressful time.

我的意思是，谈论一段充满压力的时期。

But I think at a human level, public health officials who were exposed to that kind of abuse and who started to worry about their children's safety, many of them stepped out of the arena and said, is this really worth it to put my family at risk?

但我认为，从人性的角度来看，遭受过这种虐待并开始担心孩子安全的公共卫生官员，他们中的许多人走出舞台并说，让我的家人处于危险之中真的值得吗？

And that was hard because we lost a lot of good public health people in that respect.

这很困难，因为我们在这方面失去了很多优秀的公共卫生人员。

So I think in addition to having sort of these core principles of public health communication in place, I think what we also need to restore is an environment, frankly, of humility and civility, where we don't attack people who maybe have different views or are coming out with recommendations that are not palatable to us.

因此，我认为除了制定公共卫生沟通的这些核心原则之外，坦率地说，我认为我们还需要恢复一种谦逊和文明的环境，在这种环境中，我们不会攻击那些可能有不同观点或提出我们不可接受的建议的人。

And I think it's also incumbent upon our leaders in society to not stoke that kind of resentment and violence as well, because that happened during the pandemic as COVID got increasingly politicized.

我认为我们的社会领导人也有责任不煽动这种怨恨和暴力，因为这种情况发生在新冠疫情期间，随着新冠病毒变得越来越政治化。

And while that may have been at times done for political reasons here or there, the people who suffered were both the public health leaders who were trying to do the right thing for their communities and the public themselves, who weren't able to have a clear, direct channel and a dialogue with their public health officials because a lot of that ended up getting closed off.

虽然有时这样做可能是出于政治原因，但遭受苦难的人都是试图为社区和公众做正确事情的公共卫生领导人，他们无法与公共卫生官员建立清晰、直接的渠道和对话，因为其中很多最终都被关闭了。

Andrew Huberman: Yeah, I feel like there was a lot of talking down to the dissenters in the general public.

安德鲁·休伯曼：是的，我觉得公众中对持不同政见者进行了很多贬低。

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

Andrew Huberman: And I totally agree, getting violent or harassing people with whom you disagree is totally inappropriate.

安德鲁·休伯曼：我完全同意，对与你意见不同的人使用暴力或骚扰是完全不合适的。

Vivek Murthy: Andrew, the one thing to say about the humility piece, and I'll give you an example here of where I think this could have and should have been done better, is in an effort, for example, around masks to recommend that people wear masks.

维韦克·穆尔蒂：安德鲁，关于谦虚的文章，我要说的一件事是，我在这里给你举一个例子，我认为这可以而且应该做得更好，例如，围绕口罩，建议人们戴口罩。

And one important thing just to know, is that when it comes to schools requiring masks, those are decisions that are made on local levels.

要知道的一件重要的事情是，当涉及到需要戴口罩的学校时，这些都是地方层面做出的决定。

The federal government doesn't mandate masks in schools.

联邦政府不强制要求学校佩戴口罩。

It doesn't have the authority to do that.

它没有权力这样做。

So those are local decisions.

所以这些都是当地的决定。

But at the end of the day, there were people who did not want their children to wear masks for a variety of reasons.

但归根结底，还是有人以各种理由不希望自己的孩子戴口罩。

Some worried about their development, social development.

有些人担心他们的发展、社会的发展。

Some worried that it was adding stress to their kids.

一些人担心这会给他们的孩子增加压力。

People had different reasons why they may or may not have wanted their children to wear masks.

人们希望或不希望孩子戴口罩的原因各不相同。

And one of the things I think that was not helpful was that when there were parents who made the decision they didn't want their kids to wear masks, I think some of them received a lot of criticism.

我认为这没有帮助的一件事是，当有些父母决定不希望自己的孩子戴口罩时，我认为其中一些人受到了很多批评。

Without people necessarily stopping to understand why they may have been making that decision.

人们不一定会停下来理解他们为什么做出这个决定。

Because I'll say, as a parent whose children were in school, my kids are five and seven, and the first year of the pandemic, they were doing preschool virtually, which was a nightmare.

因为我想说，作为一个孩子在上学的家长，我的孩子分别是五岁和七岁，在大流行的第一年，他们几乎在上学前班，这是一场噩梦。

It was incredibly hard for us.

这对我们来说非常困难。

Even when they got back to school in the fall of 2021, it was a really tough adjustment for them, and I could understand some of the concerns that parents were having, wondering about, hey, how are these precautions affecting my child's experience and social development?

即使他们在 2021 年秋季重返学校，这对他们来说也是一个非常艰难的调整，我可以理解父母的一些担忧，他们想知道，嘿，这些预防措施如何影响我孩子的经历和社交发展？

So on the whole, the recommendation may still be, hey, improve ventilation in your classrooms, recommend masking, recommend testing, etc. But those recommendations, I think, have to be made in a way that acknowledges the humanity of people who may have a different point of view or may make a different decision for their child.

因此，总的来说，建议可能仍然是，嘿，改善教室的通风，建议佩戴口罩，建议进行测试等。但我认为，这些建议的提出方式必须承认那些可能持有不同观点或可能为孩子做出不同决定的人的人性。

And I know that when localities made the decision, in many cases, to require schools and their kids in their district to wear a mask, that put some parents who didn't want that, put them in a hard place.

我知道，在很多情况下，当地方做出决定，要求所在地区的学校及其孩子戴口罩时，这让一些不希望这样做的家长陷入了困境。

But I think that our failure was to actually have an open, honest, respectful conversation about this.

但我认为我们的失败在于实际上没有就此事进行公开、诚实、尊重的对话。

Where we didn't feel like we were each being attacked as parents for our decisions or as community members for the decisions we were making, I think that not only hindered the response, but I think it actually contributed to this division, this sense of black and whiteness, that, hey, it's us against them.

如果我们不觉得我们每个人都因为自己的决定而受到攻击，或者作为社区成员因为我们所做的决定而受到攻击，我认为这不仅阻碍了反应，而且我认为这实际上促成了这种分裂，这种黑白分明的感觉，嘿，是我们反对他们。

And then suddenly, if I was against one measure, then I was against all of them.

然后突然之间，如果我反对一项措施，那么我就会反对所有措施。

Or if I was for one measure, I was for all of them.

或者，如果我支持一项措施，那么我也支持所有措施。

Because we just started segregating into sides, and this became a polarized experience at a time where really it should have been a crisis that brought us together, as messy as it was.

因为我们刚刚开始分成两派，这变成了一种两极分化的经历，而实际上，本来应该是一场危机，让我们聚集在一起，尽管事情很混乱。

And that, honestly, Andrew, is what I worry about most for the next pandemic.

老实说，安德鲁，这是我对下一次大流行最担心的事情。

I think we've learned a lot from this pandemic about how to manufacture vaccines, how to develop them quickly, how to distribute them efficiently.

我认为我们从这次大流行中学到了很多关于如何生产疫苗、如何快速开发疫苗以及如何有效分配疫苗的知识。

We had one of the most historic and effective vaccine distribution efforts in this country, even though it certainly could have been better, but it was historic by all measures.

我们进行了这个国家最具历史意义和最有效的疫苗分发工作之一，尽管它肯定可以做得更好，但从所有方面来看，它都是历史性的。

We've learned a lot about how to do vaccines, therapeutics, a lot of the nuts and bolts of a pandemic response.

我们学到了很多关于如何开发疫苗、治疗方法以及应对大流行病的许多具体细节的知识。

But I worry what we are still struggling with is how we build trust, how we communicate with the public, and how we stay together as a country in the face of adversity.

但我担心我们仍在努力解决的是如何建立信任、如何与公众沟通以及如何在逆境中团结一致。

Because if we're divided the way we were during COVID during the next pandemic, or a threat that may come from a foreign adversary, that's a huge national security issue for us.

因为如果我们在下一次大流行期间像新冠疫情期间那样分裂，或者可能来自外国对手的威胁，这对我们来说是一个巨大的国家安全问题。

And so that's what keeps me up at night when I think about the next pandemic that may come.

因此，当我想到下一次可能到来的大流行时，这就是让我彻夜难眠的原因。

Andrew Huberman: Two questions related to what you just said.

Andrew Huberman：有两个问题与你刚才所说的内容相关。

First of all, as it relates to vaccines, in my opinion, and I think the opinion of many people out there, that the response to the next pandemic will be heavily contingent on at least some sort of acknowledgment that there are people who at least feel that there have been vaccine injuries, right?

首先，因为它与疫苗有关，在我看来，而且我认为很多人都认为，对下一次大流行的反应将在很大程度上取决于至少某种程度的承认，即至少有人认为存在疫苗伤害，对吗？

To simply say, okay, the previous round with COVID went this way, and now there's now Virus X.

简单地说，好吧，上一轮新冠病毒就是这样，现在又出现了病毒 X。

Let's hope not, God forbid, but sounds like it's coming at some point, and people are going to think to the last time, and they're going to immediately say, well, the last time we were told to take a vaccine, some people had a good experience with that, other people didn't.

我们希望不会，上帝禁止，但听起来它会在某个时候到来，人们会思考最后一次，他们会立即说，好吧，上次我们被告知要接种疫苗时，有些人对此有很好的经历，其他人则没有。

And in this empathy model of acknowledging and letting your moral compass guide and understanding the why behind what people are doing and how they're reacting, it seems to me that now would be the time to at least try and understand where they're coming from, even if one disagrees, maybe even especially if one disagrees, and try and get people aligned now before the next pandemic, what efforts are being made, if any, to try and acknowledge that some people really do feel as if they were harmed?

在这种承认并让你的道德指南针指导和理解人们行为背后的原因以及他们如何反应的同理心模式中，在我看来，现在至少是时候尝试理解他们来自哪里，即使有人不同意，甚至特别是如果有人不同意，并在下一次大流行之前尝试让人们保持一致，正在做出哪些努力（如果有的话）来尝试并承认有些人确实感觉自己受到了伤害？

I'm not saying they were or not, but clearly there are people who feel that they or people they know were harmed.

我并不是说他们是或不是，但显然有人觉得他们或他们认识的人受到了伤害。

Is there an effort to present them with data, to have discussions with them, to try and get people aligned so that the next time around we can be more of a unified front, whatever the necessary response happens to be?

是否努力向他们提供数据，与他们进行讨论，尝试让人们保持一致，以便下次我们可以更加统一战线，无论必要的反应是什么？

Vivek Murthy: It's a really important question.

Vivek Murthy：这是一个非常重要的问题。

And to me, I always go back to sort of first principles from practicing medicine which is if there is a medicine you give a patient, and even if it helps 99.99% of patients, but this one particular patient happened to be harmed by it, you go in, you acknowledge it, you talk about it, and you together chart out a path for how you want to move forward.

对我来说，我总是回到行医的首要原则，那就是如果你给病人一种药物，即使它对 99.99% 的病人有帮助，但这个特定的病人碰巧受到了它的伤害，你进去，你承认它，你谈论它，然后你们一起制定一条你想要如何前进的道路。

And the path forward might be, yes, let's get rid of that medication, but let's use an alternative.

前进的道路可能是，是的，让我们摆脱这种药物，但让我们使用替代品。

Let's try it, or we can't use that medication anymore.

我们试试吧，不然我们就不能再用那个药了。

Here are the risks you may sustain, but we'll find other ways to protect you.

以下是您可能面临的风险，但我们会找到其他方法来保护您。

So that's what we would do in medicine.

这就是我们在医学上要做的事情。

That's what I've done with patients over the years.

这就是我多年来对病人所做的事情。

I think here, too, similarly, when it comes to tracking adverse events from vaccines, this is an area where the CDC and the FDA track and collaborate.

我认为，同样，在跟踪疫苗不良事件时，这是 CDC 和 FDA 跟踪和合作的领域。

And tracking means not only collecting reports from the public and from clinicians when they see an effect that may be related to a vaccine, but it also involves analyzing those to see, were they correlated or was there actual causation there?

跟踪不仅意味着当公众和临床医生发现可能与疫苗相关的效应时收集他们的报告，还意味着分析这些报告，看看它们是否相关或是否存在实际因果关系？

Because if today, for example, I felt unwell, and I trace back what happened yesterday, and it turns out, hey, I ate this burrito that was out in the sun for way too long, the question is, am I feeling sick because the burrito, or did the burrito just happen to be something that happened that is independent of how I'm feeling?

因为如果今天，例如，我感觉不舒服，我回溯昨天发生的事情，结果发现，嘿，我吃了这个在阳光下晒太久的卷饼，问题是，我感到不舒服是因为卷饼，还是卷饼只是碰巧发生了与我的感觉无关的事情？

Maybe it turns out somebody was actually sick with a GI bug around me, and that's the reason that I'm feeling the way I am today.

也许我周围有人真的患有胃肠病，这就是我今天的感觉的原因。

So the analysis that needs to be done on cases that are reported is important, and it's something that the CDC and the FDA do together.

因此，需要对报告的病例进行分析很重要，这是 CDC 和 FDA 共同做的事情。

Now, that analysis, I think, is essential to communicate clearly to the public.

现在，我认为这种分析对于向公众清楚地传达信息至关重要。

And whenever I engage with folks in the public, which we do often, and people will talk to me about their experiences with vaccines, I do think it's important to acknowledge what people have gone through.

每当我与公众接触时（我们经常这样做），人们会向我谈论他们的疫苗经历，我确实认为承认人们经历过的事情很重要。

Some people, for example, when I got vaccinated for COVID, for example, I felt like I had mild flu like symptoms for a couple of days.

例如，有些人，当我接种新冠疫苗时，我感觉自己有几天出现了轻微的流感样症状。

It wasn't great.

这不太好。

I would have preferred I didn't have those feelings, and then I felt better a couple of days later, and then I moved on.

我希望自己没有这些感觉，几天后我感觉好多了，然后我就继续前进。

But I acknowledged it didn't feel good to feel that way.

但我承认这种感觉并不好。

There are other people who may have had experiences where they felt that they had more serious side effects, and there may be a question, was that related to the vaccine or not?

还有其他人可能有过这样的经历，他们觉得自己有更严重的副作用，可能有人会问，这与疫苗有关吗？

So I think we have to both hear and acknowledge those.

所以我认为我们必须听到并承认这些。

I certainly try to do that.

我当然会尝试这样做。

I think it's important to keep doing that across all of government.

我认为整个政府继续这样做很重要。

But I also think it's important for us to help people understand the process that we have to go through to understand whether those are related or not.

但我也认为帮助人们了解我们必须经历的过程来了解这些是否相关对我们来说很重要。

If you go online and the CDC's site where they collect a lot of this information and you just purely look at reports that are given of potential adverse effects, you can't sort of take that and ah, those are all related to the vaccine.

如果你上网和疾病预防控制中心的网站收集大量此类信息，而你只是纯粹查看有关潜在不良影响的报告，你就无法接受这些，啊，这些都与疫苗有关。

Look at this rate of harm.

看看这个伤害率。

It's extraordinarily high because we don't actually do that with any other vaccine or medicine.

它非常高，因为我们实际上没有使用任何其他疫苗或药物来做到这一点。

Sure, we start there, we do the analysis and we try to understand what's actually related or not.

当然，我们从这里开始，进行分析，并尝试了解实际相关或不相关的内容。

So I think that's what we've got to do here, too.

所以我认为这也是我们必须要做的。

One last thing I'll say is that it's important, also, for us to help put this in context of other vaccines and medicines and interventions that we use.

我要说的最后一件事是，对于我们来说，帮助将其与我们使用的其他疫苗、药物和干预措施结合起来也很重要。

So for example, take Tylenol, for example.

以泰诺为例。

Most people think, oh, well, Tylenol, it's safe.

大多数人认为，哦，泰诺，它很安全。

There's nothing bad happens if you take Tylenol, etc. But people who track the data know that Tylenol, by and large, is generally speaking, a safe medication.

如果您服用泰诺等药物，不会有什么不好的事情发生。但是跟踪数据的人知道，泰诺总体上来说是一种安全的药物。

But there are people who experience adverse effects from Tylenol, liver damage and other adverse effects, and that data is available.

但有些人会经历泰诺的不良反应、肝损伤和其他不良反应，并且这些数据是可用的。

But what has happened in the case of that medication is that the risks and benefits are both analyzed and then a recommendation is put forward about a generally safe way to use it.

但就该药物而言，我们对风险和益处进行了分析，然后提出了一般安全的使用方法的建议。

And then there's data put out about the side effects, common or rare.

然后还有关于常见或罕见副作用的数据。

But I think sometimes we also forget that a lot of the medicines that we have come to take and just see as a normal part of our life, just like any other vaccine, there's some rate of rare side effects that will happen.

但我认为有时我们也会忘记，我们服用的许多药物只是我们生活中正常的一部分，就像任何其他疫苗一样，也会发生一定程度的罕见副作用。

I say that because what I worry about in the black and white environment that we're living in is sometimes people will take an anecdote about a potential adverse effect and will portray that as the rule.

我这么说是因为我担心，在我们生活的黑白环境中，有时人们会采取有关潜在不利影响的轶事，并将其描绘成规则。

And we'll say, well, look, I know somebody who had this side effect, so nobody should take this because this is what's going to happen to you.

我们会说，好吧，听着，我知道有人有这种副作用，所以没有人应该服用这个，因为这就是会发生在你身上的事情。

If we did that, nobody would ever take Tylenol, no one would ever take ibuprofen, no one would take Nyquil, no one would take any of the common medications that we pick up at the drugstore and that we commonly use.

如果我们这样做，没有人会服用泰诺，没有人会服用布洛芬，没有人会服用奈奎尔，没有人会服用我们在药店购买和常用的任何常见药物。

So that's how I think we have to approach this, with a combination of clear communication, empathic listening and data and context.

所以我认为我们必须结合清晰的沟通、同理心的倾听以及数据和背景来解决这个问题。

Again, that doesn't fit neatly in a social media post per se, but I think part of what we need to do as a country is rebuild the relationship honestly, between the medical and public health establishment and the public.

同样，这本身并不完全适合社交媒体帖子，但我认为作为一个国家，我们需要做的部分工作是诚实地重建医疗和公共卫生机构与公众之间的关系。

And I think it starts with this kind of communication.

我认为一切都始于这种沟通。

Andrew Huberman: The other question I had about the next pandemic, and the one we just had is, why not have committees of people of diverse backgrounds, socioeconomic diversity, racial diversity, every aspect of diversity, rather than individuals standing there telling us what to do?

安德鲁·休伯曼：我对下一次大流行的另一个问题是，为什么不让具有不同背景、社会经济多样性、种族多样性、多样性的各个方面的人组成委员会，而不是由个人站在那里告诉我们该做什么？

For several reasons, one is we are a country of many different people.

出于多种原因，其中之一是我们是一个由许多不同人民组成的国家。

I think there are dozens, if not hundreds of scientific papers showing that patients follow the advice of doctors that look like them and sound like them or to whom they would aspire to be like, we know this.

我认为有数十篇甚至数百篇科学论文表明，患者会听从那些看起来像他们、听起来像他们或他们渴望成为的医生的建议，我们知道这一点。

And yet public health officials typically are unitary.

然而公共卫生官员通常都是单一的。

One person telling us, do this, don't do that, this is a good idea, that's a bad idea.

一个人告诉我们，做这个，不要做那个，这是一个好主意，那是一个坏主意。

I'm but one citizen, but I'm putting up both hands, both feet, and all toes and saying that committees, small but diverse committees that people can relate to and feel as if the messages that they're getting are vetted through a common understanding.

我只是一名公民，但我举起双手、双脚和所有脚趾，说委员会是小型但多元化的委员会，人们可以与这些委员会产生共鸣，并感觉他们收到的信息是经过共识审查的。

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

So it's a really good suggestion, and I couldn't agree with you more that a diversity of voices is really important to get a message out.

所以这是一个非常好的建议，我非常同意你的观点，即多样化的声音对于传达信息非常重要。

And during COVID actually, that's one of the things that our office actually was helping to build, was something called the community core, where we recognize very clearly, and this is something I came to see as a doctor.

事实上，在新冠疫情期间，我们的办公室实际上正在帮助建立一个叫做社区核心的东西，我们非常清楚地认识到这一点，这也是我作为一名医生来看望的东西。

Sometimes I was the right person to message to a patient.

有时我是向病人传达信息的合适人选。

Sometimes I wasn't right, sometimes it was the nurse.

有时候是我错了，有时候是护士错了。

Sometimes it was the medical student.

Sometimes it was the medical student.

Sometimes it was an administrator or the social worker who had different background, different life experiences.

有时是管理者或社会工作者，他们有不同的背景、不同的生活经历。

So part of this work is knowing when to step up and when to step back.

因此，这项工作的一部分就是知道什么时候该挺身而出，什么时候该退一步。

But the community core that we were building was a really diverse group of people, and a lot of them had public health backgrounds, but a lot of them were community leaders who understood health, even though they didn't have formal training.

但我们正在建立的社区核心是一群真正多元化的人，其中很多人具有公共卫生背景，但他们中的很多人是了解健康的社区领导者，即使他们没有接受过正式培训。

But they're people who knew their communities, and they had the trust of their communities, and they understood what was going on.

但他们是了解自己社区的人，他们得到了社区的信任，他们了解正在发生的事情。

They wanted to be helpful.

They wanted to be helpful.

So we brought them together to say, okay, look, here's what the science is telling us.

所以我们把他们聚集在一起说，好吧，看，这就是科学告诉我们的。

Here are the general recommendations.

以下是一般建议。

Here's what we would provide.

Here's what we would provide.

You ask us any questions you have, like, if there's something we don't know, we'll go back and look it up.

您可以向我们提出任何问题，例如，如果有什么我们不知道的事情，我们会回去查找。

But you're the leaders in your community.

But you're the leaders in your community.

They should be hearing from you about these messages.

他们应该会收到您关于这些消息的消息。

And then those folks went out, and actually, we worked closely with them, collaborated with them.

然后这些人就出去了，实际上，我们与他们密切合作。

They would design the messages for their community based on what they thought made sense.

他们会根据他们认为有意义的内容为社区设计信息。

They weren't taking what we said word for word, and we didn't want them to.

他们没有逐字逐句地接受我们所说的话，我们也不希望他们这样做。

But to me, that kind of diverse approach is what we need more of.

但对我来说，我们更需要这种多样化的方法。

Now, I'll tell you what I would have liked.

Now, I'll tell you what I would have liked.

I would have liked if more media networks put those folks on TV and got them on the radio.

如果有更多的媒体网络将这些人放到电视上并让他们出现在广播中，我会很高兴。

Because it's important that many of them were showing up in their communities.

因为他们中的许多人出现在他们的社区中很重要。

We're knocking on doors, we're doing local podcasts, etc. And that was great.

我们正在挨家挨户敲门，我们正在做本地播客等等。这太棒了。

But I would have liked more of their faces carried on TV.

但我希望他们的面孔更多地出现在电视上。

So that's a place where when we talk to media, and when I talk to folks in media, one of the things I encourage them and push them to do also is to say, look, if you can take more of these diverse faces and voices and put them out there, that's actually good for the community.

因此，当我们与媒体交谈时，当我与媒体人士交谈时，我鼓励他们并推动他们做的一件事就是说，看，如果你能把更多这些不同的面孔和声音放在那里，这实际上对社区有好处。

And it also helps people see that it's not like one or two people who are sort of pushing an agenda here.

它还可以帮助人们认识到，并不是一两个人在这里推动一项议程。

This is like the public health community is big.

This is like the public health community is big.

It's broad.

它很广泛。

It's diverse.

它是多种多样的。

It has a lot of voices.

它有很多声音。

And the more voices we can hear from as public, I think the better off we are.

我认为我们从公众那里听到的声音越多，我们的生活就越好。

Andrew Huberman: Here again, I genuinely hope and pray that we don't have another pandemic.

安德鲁·休伯曼：我再次真诚地希望并祈祷我们不会再次发生大流行。

But if and when we do, I hope there will be committees rather than individuals.

但如果我们这样做的话，我希望是委员会而不是个人。

I know this is a thing in this country.

我知道这是这个国家的事情。

We like the idea that one person is going to save the climate, one person's going to save transportation, one person.

我们喜欢这样的想法：一个人将拯救气候，一个人将拯救交通，一个人。

The COVID is the Person of the Year type approach.

新冠肺炎是年度人物类型的方法。

I know, but then we get frustrated when that person does things or makes decisions that we don't like in their public or personal life, and then it all seems to fall into division.

我知道，但是当那个人在公共或个人生活中做我们不喜欢的事情或做出我们不喜欢的决定时，我们会感到沮丧，然后一切似乎都陷入分裂。

And I just feel like I'm not talking about groups of hundreds of people, but small groups.

我只是觉得我说的不是数百人的团体，而是小团体。

So I think we're aligned in that way.

所以我认为我们在这方面是一致的。

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

And look, there's a notion that, I think sometimes we do want the one person who can not only necessarily have all our trust and we can look to, but also who we can hold accountable if something doesn't quite work out or we don't like something.

听着，有一种观念是，我认为有时我们确实想要一个不仅能够得到我们所有信任和我们可以指望的人，而且还需要一个在事情不太顺利或我们不喜欢某件事时我们可以追究责任的人。

And while I get that sort of mentality, I think that in this moment, especially when we're trying to rebuild trust, I think it's important for people to know that what they may be hearing in terms of medical or public health recommendations, it's important for them to know how broad an audience that's coming from, or broad a group of experts.

虽然我有这种心态，但我认为此时此刻，特别是当我们试图重建信任时，我认为让人们知道他们可能听到的医疗或公共卫生建议很重要，了解这些建议的受众范围或专家群体的范围有多大也很重要。

And there was a lot more broad agreement, for example, during COVID and during Ebola, during Zika, on public health recommendations.

例如，在新冠疫情期间、埃博拉病毒期间、寨卡病毒期间，就公共卫生建议达成了更广泛的共识。

But you wouldn't always know it if you turned on the TV because you were seeing the same couple of faces.

但如果你打开电视，你并不总是知道这一点，因为你看到的是同样的两张脸。

So I think we have to certainly diversify that.

所以我认为我们必须使其多样化。

One other thing I think I'll tell you that's important here, is I think we have to also think about how we fund groups on the ground that are doing the hard work of getting public health messages out.

我想我要告诉你的另一件事很重要，我认为我们还必须考虑如何资助那些正在努力传播公共卫生信息的实地团体。

Because one of the things that those groups often would tell me, and these are, I might say these groups, I'm talking about the community organization that spent years in a neighborhood getting to know families, where folks recognize them when they're walking down the street.

因为这些团体经常告诉我的事情之一，我可能会说这些团体，我谈论的是社区组织，该组织花了数年时间在社区中了解家庭，人们在街上行走时认出他们。

They're like, oh, yeah, that's the person from organization X.

他们说，哦，是的，那是 X 组织的人。

They understand us.

他们理解我们。

They get us.

他们抓住了我们。

They're looking out for us.

他们正在寻找我们。

A lot of those organizations had spent their resources helping the community, getting to know the community, but they didn't have sophisticated mechanisms to apply for grants.

许多组织都花费了资源来帮助社区、了解社区，但他们没有复杂的机制来申请赠款。

For example, they didn't have grant writers who had done this a thousand times.

例如，他们没有做过一千次这样的资助作者。

So historically, those groups have a hard time getting support and funding.

从历史上看，这些团体很难获得支持和资金。

So I'll tell you one interesting thing my wife did, which I certainly was very proud of, is she was helping to build an effort and to build a nonprofit organization with a couple of colleagues.

所以我要告诉你我妻子所做的一件有趣的事情，我当然对此感到非常自豪，那就是她正在与几位同事一起努力并建立一个非营利组织。

That organization of people who knew how to get money, how to apply for grants, how to get foundation support, but who also had the wisdom to know that the most important thing they could do was to give portions of that money to groups on the ground.

这个组织的成员知道如何获得资金、如何申请赠款、如何获得基金会的支持，但他们也有智慧知道他们能做的最重要的事情就是将部分资金捐赠给当地的团体。

So they saw themselves as an organization that channeled money to groups that had trust, and they executed their mission that way.

因此，他们将自己视为一个向信任的团体输送资金的组织，并以这种方式执行他们的使命。

And that was very effective.

这非常有效。

And I think we need more of that.

我认为我们需要更多这样的东西。

When it comes to disseminating funding, one thing I think many people may or may not appreciate is that it's actually hard for government to put out a lot of money at once and to do so quickly.

在分配资金方面，我认为许多人可能会或可能不会意识到的一件事是，政府实际上很难立即投入大量资金并迅速投入。

Right when you've got a lot of funds that you need to get into communities, what happens is the federal government often will give it to states.

当你有大量资金需要投入社区时，联邦政府通常会将其提供给各州。

States will then give it to local communities, to the local department of public health, potentially, and then they will look to distribute it to others.

然后，各州会将其提供给当地社区、当地公共卫生部门，然后他们将寻求将其分发给其他人。

That takes time.

这需要时间。

But it also means if you're not connected to that network, if you don't know your local department of health or you're not connected to the state department of health, sometimes it can be challenging to figure out how to get the money.

但这也意味着，如果您没有连接到该网络，如果您不知道当地的卫生部门，或者您没有连接到州卫生部门，有时弄清楚如何获得这笔钱可能会很困难。

And so I think we need more operations like what my wife and others have been building to try to get those funds directly to the folks who don't necessarily have the most fancy grant writing operation, but they have the relationships, because at the end of the day, it's those relationships that create the trust.

因此，我认为我们需要更多的行动，就像我的妻子和其他人一直在建立的那样，试图将这些资金直接提供给那些不一定有最花哨的拨款写作行动的人，但他们有关系，因为归根结底，正是这些关系创造了信任。

It's a trust that allows life saving information to get to people, and that's the link that's missing.

这是一种信任，可以让人们获得拯救生命的信息，而这正是我们所缺失的环节。

Andrew Huberman: Very interesting.

安德鲁·休伯曼：非常有趣。

Pharma, Big Pharma.

制药公司，大型制药公司。

I got a lot of questions about whether or not Big Pharma is on the take for every public health initiative.

我收到了很多关于大型制药公司是否参与每项公共卫生举措的问题。

Now, as somebody who understands a bit about and certainly believes in the use of certain prescription medications, I find most questions about, "Big Pharma" to overlook the fact that there are thousands, if not hundreds of thousands of medications that save lives and enrich people's lives that are prescription drugs.

现在，作为一个稍微了解并且相信某些处方药的使用的人，我发现大多数关于“大型制药公司”的问题都忽视了这样一个事实：有数千种甚至数十万种可以挽救生命并丰富人们生活的药物都是处方药。

I also believe my audience knows, I say it over and over again, that better living through chemistry still requires better living.

我也相信我的听众知道，我一遍又一遍地说，通过化学更好的生活仍然需要更好的生活。

We still have to get our sunlight, get our sleep, social connection, good nutrition, exercise, and all those things.

我们仍然需要阳光、睡眠、社交、良好的营养、锻炼等等。

There's just no pill that's going to replace those.

没有任何药物可以替代它们。

But I think it's a valid question that people are asking, is there a direct relationship between big pharma and public health initiatives in a way that should have us concerned about the messaging that we're getting at times and the fact that the United States consumes the vast majority of drugs for mental health, for instance, as compared to other countries?

但我认为人们提出的一个合理的问题是，大型制药公司和公共卫生举措之间是否存在直接关系，是否应该让我们关注我们有时收到的信息以及美国消费绝大多数用于精神健康的药物这一事实，例如，与其他国家相比？

So that's one question.

这是一个问题。

And then I want to dovetail into that question.

然后我想切入这个问题。

What are your thoughts on the fact that there's a history of the tobacco industry being very interdigitated, shall we say, with government policies in ways that had us basically injure, if not kill, millions of Americans, and then eventually say, you can't smoke near a hospital, you can't smoke anywhere, there's very few places where you can consume tobacco products.

您对烟草业历史上相互交叉的事实有何看法，容我们说，政府的政策基本上伤害了（如果不是杀死）数百万美国人，然后最终说，你不能在医院附近吸烟，你不能在任何地方吸烟，很少有地方可以消费烟草产品。

That kind of relationship and financial incentives and then a lot of backpedaling later, I think, wore on people's trust.

我认为，这种关系和经济激励以及后来的大量倒退削弱了人们的信任。

So how should we frame the relationship between the pharmaceutical industry, government, and public health initiatives in a way that is at least halfway functional?

那么，我们应该如何以至少一半功能的方式构建制药行业、政府和公共卫生倡议之间的关系呢？

Vivek Murthy: Look, I understand where the concern and the suspicion comes from.

Vivek Murthy：看，我理解担忧和怀疑从何而来。

And I think it's important that public health initiatives and medical advice is independent of the influence of industries that may seek to profit from what's being recommended or from medications that are being prescribed.

我认为重要的是，公共卫生举措和医疗建议应独立于可能寻求从推荐内容或处方药物中获利的行业的影响。

And we have a history in medicine of doctors who were given gifts and vacations and all kinds of fancy things by pharma companies in an effort to influence what they prescribe.

在医学界，我们有这样的历史：制药公司向医生赠送礼物、假期和各种花哨的东西，以影响他们开出的处方。

That was really problematic, and now we're seeing a lot less of that, which is good.

这确实是个问题，现在我们看到的问题已经少了很多，这很好。

A lot of rules are being put in place by medical societies and professional societies and by academic institutions to say this is an unacceptable way to practice, and that's really important, because I do think that human psychology is that sometimes we underestimate how much we're influenced by incentives.

医学会、专业协会和学术机构制定了很多规则，表明这是一种不可接受的实践方式，这非常重要，因为我确实认为人类心理学有时会低估我们受激励影响的程度。

We think, yeah, I'm getting that, but I know how to make independent decisions.

我们认为，是的，我明白了，但我知道如何做出独立的决定。

But at the end of the day, we're human and we're influenced, or it's a great drug.

但归根结底，我们是人类，我们会受到影响，或者它是一种很棒的药物。

Andrew Huberman: It could be, wow, this is a drug that's really helping my patients.

Andrew Huberman：这可能是，哇，这是一种真正帮助我的患者的药物。

I'm happy to recommend it to them.

我很高兴向他们推荐它。

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

I want to separate one thing, though.

不过，我想分开一件事。

Taking money from pharma companies as a physician, I think, is highly problematic.

我认为，作为一名医生从制药公司拿钱是很成问题的。

I think it's hard to say that it doesn't influence practice.

我觉得很难说不影响实践。

Maybe it doesn't for some people, but it's really hard to know who those people are.

也许对某些人来说不是这样，但真的很难知道那些人是谁。

I do think that separate from that, you can be a physician who prescribes medications because you believe they work.

I do think that separate from that, you can be a physician who prescribes medications because you believe they work.

Look, as a doctor, I have prescribed many antibiotics during cases of infection that have helped my patients, and I would prescribe those again.

看，作为一名医生，我在感染病例中开了很多抗生素，这对我的病人有帮助，我还会再次开这些药。

I am glad that those exist.

我很高兴这些存在。

In many cases, they've saved the lives of patients I was caring for in the hospital.

在很多情况下，他们挽救了我在医院照顾的病人的生命。

So that's what should drive us.

这就是我们的动力。

Does the data show that they work and does our patient need them?

数据是否表明它们有效并且我们的患者是否需要它们？

That's what should drive our decisions when it comes to public health recommendations.

当涉及公共卫生建议时，这应该是我们决策的驱动力。

Here, too, I think a similar principle holds, which is that I don't think that pharma money should be influencing our public health decisions, which means that it shouldn't be funding our public health organizations that are making recommendations.

在这里，我也认为类似的原则成立，那就是我认为制药资金不应该影响我们的公共卫生决策，这意味着它不应该资助我们提出建议的公共卫生组织。

Certainly, I know this is obvious to you, but I'll say, just to be clear for everyone who's listening, our office doesn't take any money from industry.

当然，我知道这对你来说是显而易见的，但我要说的是，为了让每个听众都清楚，我们的办公室不从工业界拿走任何资金。

Not just the pharma industry, from any industry.

不只是制药行业，任何行业都是如此。

The money that we get is allocated by Congress.

我们得到的钱是由国会分配的。

At the end of the day, it's taxpayer money, and that's all we get.

归根结底，这是纳税人的钱，这就是我们得到的一切。

And that's important.

这很重要。

We don't want money from pharmaceutical companies, but that's important because people need to know that these decisions are not being made for financial gain.

我们不需要制药公司的钱，但这很重要，因为人们需要知道这些决定不是为了经济利益而做出的。

With that being said, there's a broader concern I have, Andrew, which is I think that we have become a pill for every problem society where we look for a quick fix of a medicine for every challenge that we may incur.

话虽这么说，安德鲁，我还有一个更广泛的担忧，那就是我认为我们已经成为每个问题社会的一剂药丸，我们为我们可能遇到的每一个挑战寻找快速解决方案。

And sometimes, yes, I'm a believer that if science helps us create medications that can help solve disease, we should use them appropriately.

有时，是的，我相信，如果科学帮助我们创造出有助于解决疾病的药物，我们就应该正确使用它们。

But I think we discount heavily the behavioral changes that we need to make, the more broader societal and environmental changes that we need to make that influence our health.

但我认为我们严重低估了我们需要做出的行为改变，以及我们需要做出的更广泛的社会和环境改变来影响我们的健康。

Our food environment matters for our health.

我们的食物环境关系到我们的健康。

Our decisions about how physically active we are matter for our health.

我们关于身体活动程度的决定对我们的健康很重要。

Whether or not we sleep matters for our health.

我们是否睡觉对我们的健康很重要。

And all of these impact our mental health and well being as well.

所有这些也会影响我们的心理健康和福祉。

And so when I think about that bias, that, to me, is not always stemming from money that came from a pharmaceutical company.

因此，当我想到这种偏见时，对我来说，这种偏见并不总是源于制药公司的资金。

Although I think the ads that we see all the time from pharma companies, I think, try to convince us that, hey, just take this pill once a day and all your problems will go away.

尽管我认为我们经常看到的制药公司的广告，但我认为，试图说服我们，嘿，只要每天服用一次这种药，所有的问题都会消失。

But I think it's more complex than that.

但我认为事情比这更复杂。

And I think that even in the healthcare setting, if you're seeing a patient who has pain, who's having intense pain, it feels easier sometimes to prescribe a medication for that pain rather than trying to deal with non medication based approaches or try to get the deeper origins of the pain.

我认为，即使在医疗保健环境中，如果您看到一位患有疼痛、剧烈疼痛的患者，有时开药治疗疼痛会比尝试处理非药物方法或尝试了解疼痛的更深层次根源更容易。

I'm not saying that's what doctors do all the time, but I'm saying that we're living in an environment and a broader culture where we increasingly reach for something that we see as a quick, immediate fix.

我并不是说这就是医生一直在做的事情，而是说我们生活在一个环境和更广泛的文化中，我们越来越多地寻求我们认为快速、立即解决的方法。

And again, I don't blame people for that.

再说一遍，我不会因此责怪人们。

We'd rather take a quick fix over something that's going to take a long time.

我们宁愿快速解决问题，也不愿花很长时间解决问题。

But I think it is selling us, I think sometimes a false hope, which is that that's all we need to solve our problems.

但我认为它正在出卖我们，我认为有时这是一个错误的希望，这就是我们解决问题所需要的一切。

And I think a lot of times you need more.

我认为很多时候你需要更多。

You need the behavioral changes, you need the environmental changes.

你需要行为改变，你需要环境改变。

That's one of my big concerns in terms of how we communicate about health.

就我们如何沟通健康而言，这是我最关心的问题之一。

Andrew Huberman: Would a potential solution be this idea of small committees?

Andrew Huberman：小型委员会的想法是否是一个潜在的解决方案？

So let's say somebody is experiencing chronic pain, localized or general, that they would go to their general practitioner.

假设有人正在经历慢性疼痛，无论是局部疼痛还是全身疼痛，他们都会去看全科医生。

But in the room would also be somebody who understands somatic medicine, a trained clinical psychologist who understands somatics, that the body and the brain are linked through the nervous system, and could also assess possible psychological roots of the issue.

但房间里也会有一个了解躯体医学的人，一位训练有素的临床心理学家，了解躯体学，身体和大脑通过神经系统联系在一起，也可以评估问题可能的心理根源。

And then somebody in the room who can make behavioral, nutritional, maybe even supplementation based, safe supplementation based recommendations, and then the physician who can say...

然后房间里有人可以提出行为、营养、甚至基于补充剂、基于安全补充剂的建议，然后医生可以说……

And in addition to that, I think the person should have on hand a five milligram dosage of a prescription drug that if they need it, they could take.

除此之外，我认为这个人手头上应该有五毫克剂量的处方药，如果他们需要的话，可以服用。

And I think it would provide a lot of protections against potential adverse effects of any one of those things in isolation.

我认为它将提供很多保护措施，防止其中任何一件事情单独产生的潜在不利影响。

There are great protections in having people meet in groups for lots of reasons, and the person would feel very well cared for.

由于多种原因，让人们聚集在一起会得到很大的保护，而且人们会感到受到很好的照顾。

So, again, small committees of people with diverse expertise pooling together to treat people from, for lack of a better word, a more holistic perspective.

因此，再一次，由具有不同专业知识的人组成的小委员会聚集在一起，从更全面的角度来对待人们，因为缺乏更好的词来形容。

Why not?

为什么不呢？

Vivek Murthy: You're describing the dream.

Vivek Murthy：你正在描述这个梦。

I think that's exactly what we need, interdisciplinary teams that can provide integrative care, recognizing that in this day and age, there's not one person who has all the expertise to help us figure out how to best manage our health challenges.

我认为这正是我们所需要的，能够提供综合护理的跨学科团队，认识到在当今时代，没有一个人拥有所有专业知识来帮助我们弄清楚如何最好地应对我们的健康挑战。

I think what we have not figured out are a couple of things.

I think what we have not figured out are a couple of things.

Number one, who are all the right people who need to be in the room, or the sort of virtual room, if you will.

Number one, who are all the right people who need to be in the room, or the sort of virtual room, if you will.

The second is, how do we create a structure, a healthcare system, where that can actually happen with efficiency, where it can be reimbursed appropriately?

第二个问题是，我们如何创建一个结构，一个医疗保健系统，可以有效地实现这一点，并可以适当地得到补偿？

But that's what we should be doing.

但这就是我们应该做的。

And then the third leg of that is the group experience for patients.

And then the third leg of that is the group experience for patients.

There's increasingly more clinics and healthcare systems around the country that are working on creating group experiences where patients who all, let's say, are working on their diabetes come together, let's say, once a week, and they meet with the healthcare practitioner.

全国各地越来越多的诊所和医疗保健系统正在致力于创造团体体验，让所有正在治疗糖尿病的患者每周聚集一次，并与医疗保健从业者会面。

That might be in addition to their individual appointments.

That might be in addition to their individual appointments.

But there is so much power in groups coming together, groups of patients who can find community, who can help each other learn from each other's experiences.

但是，聚集在一起的团体、能够找到社区、能够帮助彼此从彼此的经验中学习的团体具有如此强大的力量。

That's highly underutilized right now in medicine.

That's highly underutilized right now in medicine.

But to really do this well, Andrew, I think, means that we have to pull back from the model we have had for years in medicine, which has been a very highly individual type model, which says, okay, you go to your doctor, you see your doctor one on one, you get everything you need.

但安德鲁，我认为，要真正做好这件事，意味着我们必须放弃多年来在医学领域所采用的模式，这是一种非常高度个人化的模式，它说，好吧，你去看医生，一对一地看医生，你就会得到你需要的一切。

Maybe you need to go see a specialist, okay?

也许你需要去看专家，好吗？

Then you wait a few weeks, get another appointment, drive 30 miles, go see somebody else.

Then you wait a few weeks, get another appointment, drive 30 miles, go see somebody else.

Maybe they're connected to the electronic health system, maybe they're not.

Maybe they're connected to the electronic health system, maybe they're not.

Maybe they know what was discussed, maybe they don't.

也许他们知道讨论的内容，也许他们不知道。

Maybe they'll call and talk to their primary care doctor, but maybe they won't because they're too busy.

也许他们会打电话与他们的初级保健医生交谈，但也许他们不会，因为他们太忙了。

And then you as a patient are stuck trying to piece all this together.

And then you as a patient are stuck trying to piece all this together.

Andrew Huberman: While often in pain, well, yeah, in physical and emotional anguish.

Andrew Huberman: While often in pain, well, yeah, in physical and emotional anguish.

I'm not referring to my own experience, although I've had mild examples compared to what other people have dealt with.

I'm not referring to my own experience, although I've had mild examples compared to what other people have dealt with.

But people with chronic pain are irritable for understandable reasons, or maybe somebody is close, veering towards suicidal depression.

但患有慢性疼痛的人会出于可以理解的原因而变得烦躁，或者可能是某个亲近的人导致抑郁症自杀。

Then there's the interpersonal effects.

然后是人际关系的影响。

I mean, I feel like the crisis is one of a lack of efficiency and thoroughness.

I mean, I feel like the crisis is one of a lack of efficiency and thoroughness.

Again, I'm not throwing stones at the medical profession.

再说一遍，我并不是在向医学界扔石头。

I, like you, believe that it's a collection of mostly well meaning people trying to do their best.

我和你一样，相信这是一群努力做到最好的善意人士的集合。

But the specialist model and the referral model is incredibly cumbersome.

But the specialist model and the referral model is incredibly cumbersome.

Vivek Murthy: It really is cumbersome.

Vivek Murthy：这确实很麻烦。

And like you look, having worked with many medical professions over the years, these are colleagues who I deeply admire.

And like you look, having worked with many medical professions over the years, these are colleagues who I deeply admire.

I mean, they're there for the right reasons.

我的意思是，他们的存在是有正当理由的。

They want to help people alleviate suffering, but they too are feeling burned out and frustrated by the inefficiencies of the system.

They want to help people alleviate suffering, but they too are feeling burned out and frustrated by the inefficiencies of the system.

Because I'll tell you, one of the greatest contributors to burnout for doctors and nurses is a lack of self efficacy.

因为我会告诉你，导致医生和护士倦怠的最大因素之一是缺乏自我效能。

It's seeing a patient who has a problem in front of you and feeling like you can't get them the help that they need.

就是看到一个病人在你面前遇到问题，却感觉你无法为他们提供他们需要的帮助。

That is the greatest paper cut, if you will, to the sort of spirit of clinicians.

That is the greatest paper cut, if you will, to the sort of spirit of clinicians.

And many find themselves in that circumstance where they either find that they know what's needed, but the system is throwing up prior authorizations or other insurance hurdles and preventing their patient from getting that care, or they are kind of at the edge of their expertise.

许多人发现自己处于这种情况，他们要么发现自己知道需要什么，但系统设置了事先授权或其他保险障碍并阻止他们的患者获得护理，或者他们处于专业知识的边缘。

This happens to pediatricians and primary care doctors more broadly, all the time with mental health.

这种情况更广泛地发生在儿科医生和初级保健医生身上，在心理健康方面一直如此。

Most of the mental health care that's delivered in this country is delivered in primary care offices.

这个国家提供的大部分精神卫生保健服务都是在初级保健办公室提供的。

Now, primary care doctors didn't necessarily train specifically and only in mental health, yet they find themselves having to manage a lot of that, including increasingly complex substance use disorders and treatment resistant depression, and they need help figuring that out.

现在，初级保健医生不一定只接受心理健康方面的专门培训，但他们发现自己必须应对很多问题，包括日益复杂的物质使用障碍和难治性抑郁症，他们需要帮助来解决这个问题。

But if you don't have a lot of resources to get that referral, to collaborate with mental health professionals, then you're stuck on your own figuring that out.

但如果你没有足够的资源来获得推荐、与心理健康专家合作，那么你就只能靠自己去解决这个问题。

And so I think the pain is being experienced mostly by patients, but also very much so by clinicians, and that's why that overhaul is needed.

因此，我认为这种痛苦主要是由患者经历的，但临床医生也同样如此，这就是为什么需要进行彻底改革。

And I think, look, a lot of this is, I'm not a healthcare economist per se, but

我认为，看，其中很多是，我本身不是医疗保健经济学家，但是

I will say that a lot of this, I think, is tied into the business model that we built around medicine.

我想说，我认为，这很大程度上与我们围绕医学建立的商业模式有关。

The notion that we're paying individual people for individual services and individual procedures that are done.

我们为个人提供的个人服务和所完成的个人程序付费的概念。

While that has some merit in some cases, what we really care about is that the person is getting efficient, integrated, multidisciplinary care overall.

虽然这在某些情况下有一定的优点，但我们真正关心的是患者总体上得到高效、综合、多学科的护理。

And so when health systems, for example, come together and say, okay, rather than sort of focusing on the amount I'm getting reimbursed for every procedure, we're going to take more of a value based approach here where we say, okay, we've got a certain amount of money to care for certain people.

因此，例如，当卫生系统聚集在一起说，好吧，而不是关注我每次手术得到的报销金额时，我们将采取更多基于价值的方法，我们说，好吧，我们有一定数量的钱来照顾某些人。

What's the most efficient way for us to provide them care, recognizing if we don't do that, it's not only bad for them, but our costs in the long term will go up because we're not getting reimbursed for every procedure.

我们为他们提供护理的最有效方法是什么，认识到如果我们不这样做，不仅对他们不利，而且从长远来看，我们的成本将会上升，因为我们无法为每项手术获得报销。

We're getting reimbursed for the care, overall care that we're taking for a patient.

我们将为患者提供的护理、整体护理得到报销。

So there are more of these value based models that are being adopted.

因此，越来越多的基于价值的模型正在被采用。

Certainly in 2010, when the Affordable Care Act was passed and when other measures were taken in the Obama administration, in Medicare, that really pushed value based payment models forward.

当然，在 2010 年，当《平价医疗法案》获得通过以及奥巴马政府在医疗保险领域采取其他措施时，确实推动了基于价值的支付模式的发展。

And again, they're not perfect.

再说一遍，它们并不完美。

They need their own tweaks.

他们需要自己的调整。

But I don't think that the existing financial structure that we had in medicine was serving us in terms of delivering the kind of multidisciplinary, integrated, efficient care that we increasingly need.

但我不认为我们在医学领域现有的财务结构能够为我们提供越来越需要的多学科、综合、高效的护理。

Andrew Huberman: Tough problem.

安德鲁·休伯曼：这是一个棘手的问题。

But through recognition of tough problems comes good solutions.

但通过认识到棘手的问题，就会有好的解决方案。

That's my belief.

这就是我的信念。

I'm an optimist.

我是一个乐观主义者。

At the end of the day, you mentioned mental health.

最后，您提到了心理健康。

Lately, you've been increasingly vocal about the crisis of isolation.

最近，您越来越直言不讳地谈论孤立危机。

Vivek Murthy: Just one second, Andrew.

Vivek Murthy：请稍等，安德鲁。

Before we go there, one thing about the tough problems.

在我们去那里之前，先讲一件事关于棘手的问题。

You're exactly right, and the problem is the longer we take to acknowledge and address these tough problems, the more entrenched the interests become that profit from the status quo.

你说得完全正确，问题是我们承认和解决这些棘手问题的时间越长，从现状中获利的利益就越根深蒂固。

Right.

正确的。

So if you look at the private insurance industry right now, there are so many challenges we have right now with patients and clinicians saying that they know what care is needed, but it gets denied.

因此，如果你看看现在的私人保险行业，我们现在面临着很多挑战，患者和临床医生说他们知道需要什么护理，但却遭到拒绝。

They know what care is needed, but prior authorizations get thrown up there and required even for a medicine that clearly your patient needs urgently.

他们知道需要什么护理，但即使对于患者显然迫切需要的药物，也需要事先授权。

I've had the experience myself of having a family member who has needed a medication for an urgent situation and then being told that the pharmacy will not fill it because it requires a prior authorization, but that can't be processed until the weekend is over because no one's in the office to approve the prior authorization.

我自己就有过这样的经历：有一个家庭成员在紧急情况下需要药物，然后被告知药房不会配药，因为它需要事先授权，但要到周末结束才能处理，因为办公室里没有人批准事先授权。

And you're thinking to yourself, does this make any sense?

你会想，这有什么意义吗？

Like, this is an urgent situation.

就像，这是一个紧急情况。

My family member needs this medication.

我的家人需要这种药物。

I've also had the experience as a doctor of fighting for my patients who have been denied care by an insurance company and being on the phone saying, I'm sitting here in front of my patient.

作为一名医生，我也有过为那些被保险公司拒绝提供护理的病人而奋斗的经历，我在电话里说，我就坐在病人面前。

I know that they are sick.

我知道他们病了。

I know they can't go home.

我知道他们不能回家。

I know they need to be in rehab.

我知道他们需要接受康复治疗。

There's nobody literally to help them at home.

家里没有人真正可以帮助他们。

But then not having the rehab bed approved by somebody who's not even there.

但康复床却没有得到根本不在场的人的批准。

And there's also just a practice that we've seen time and time again where insurance companies will also just burden clinicians with more and more requests for information before they will agree to reimburse for services that have already been delivered for a patient who needs them, which is just creating more and more barriers, hoping that if you're a small time doc out there who's got a shingle that you put up, you don't have a lot of resources.

还有一种我们一次又一次看到的做法，保险公司只会向临床医生提出越来越多的信息请求，然后他们才会同意报销已经为有需要的患者提供的服务，这只会造成越来越多的障碍，希望如果你是一个小医生，有一张牌，你没有太多的资源。

How are you going to keep fighting all of this and sending more and more paperwork, and eventually you'll just give up?

您将如何继续与这一切作斗争并发送越来越多的文件，最终您会放弃？

We have a lot of problems right there.

我们那里有很多问题。

In an industry that should be delivering care, often is doing good things, but too often is allowing barriers to be put up to the care that's needed.

在一个应该提供护理的行业中，通常会做好事，但往往会为所需的护理设置障碍。

And this is particularly true with mental health.

对于心理健康来说尤其如此。

I know we're going to talk about that, but mental health care has just been such a difficult thing for people to get in our country.

我知道我们会讨论这个问题，但是对于我们国家的人们来说，获得心理健康护理是一件非常困难的事情。

And part of the reason, there are many reasons, but one of them is that insurance companies historically did not reimburse adequately or in the same level for mental health care as they did for physical health care.

部分原因有很多，但其中之一是保险公司历来没有为精神医疗保健提供足够的补偿或在与身体医疗保健相同的水平上进行补偿。

Or if they did, they would only reimburse for a limited number of sessions that you could have.

或者，即使他们这样做了，他们也只会报销您可以参加的有限次数的会议。

But if you're a mom out there who sees her child struggling with depression, you're really worried.

但如果你是一位母亲，看到自己的孩子与抑郁症作斗争，你真的会很担心。

You don't want to be told, you know what, you can only get three sessions.

你不想被告知，你知道吗，你只能参加三个疗程。

That's it.

就是这样。

What are you supposed to do after three sessions?

三堂课结束后你应该做什么？

And so what has happened is that even though in 2008, there was a law passed called the Addiction Equity and Mental Health parity law, even though that was passed to try to close that gap, there were many ways that insurance companies were skirting it.

因此，尽管 2008 年通过了一项名为《成瘾公平与心理健康平等法》的法律，尽管它的通过是为了试图缩小这一差距，但保险公司还是有很多方法来规避它。

So, one, the law wasn't even being adequately enforced for many years.

因此，第一，多年来该法律甚至没有得到充分执行。

But two, insurance companies sometimes would say, okay, we're reimbursing adequately.

但第二，保险公司有时会说，好吧，我们报销得很充分。

But when you look in the network, they had very few providers, so you really couldn't access somebody.

但是当你查看网络时，他们的提供商很少，所以你真的无法访问某人。

So that was a problem for patients.

所以这对患者来说是一个问题。

And then the other challenge is that they would say, okay, you can see somebody, but you've got to complete this prior authorization, have that completed by your primary care doctor, etc., again throwing up more and more barriers.

然后另一个挑战是他们会说，好吧，你可以见某人，但你必须完成这个事先授权，由你的初级保健医生等完成，这再次设置了越来越多的障碍。

So very recently, in fact, just a few weeks ago, President Biden just announced that we are, as an administration, putting out a proposed rule to actually strengthen the mental health parity law to prevent some of these what I think of as abusive practices because they're preventing people who need care from getting it.

事实上，就在几周前，拜登总统刚刚宣布，我们作为一个政府，将提出一项拟议规则，以实际加强精神健康平等法，以防止其中一些我认为是滥用行为，因为它们阻止了需要护理的人获得护理。

And if you've ever been, as I know many people have been who are listening to this, if you've ever been in a situation where you or somebody you love has struggled with a mental health concern, what you need in that circumstance is help.

如果你曾经经历过，正如我知道很多正在听这个演讲的人曾经经历过的那样，如果你曾经经历过你或你所爱的人与心理健康问题作斗争的情况，那么在这种情况下你需要的就是帮助。

You don't need to be filling out paperwork.

您不需要填写文件。

You don't need to be waiting three months to actually get care.

您不需要等待三个月才能真正得到护理。

You don't need to show up and be told only, you only have two more appointments.

您不需要出现并被告知，您只剩下两次预约。

You need to know that help is there when you need it.

您需要知道，当您需要时，帮助就在那里。

And a lot of these denials are being issued to people who have done their part of the bargain.

其中很多拒绝的对象都是那些已经尽到了自己义务的人。

They've paid their premiums, they've held up their end of the bargain, and care should be there for them when they need it.

他们已经支付了保费，他们已经履行了自己的承诺，当他们需要的时候，应该为他们提供护理。

So anyway, this is something that upsets me a lot because I have seen too many patients over the years struggle without the care that they deserve and should get because of barriers that are being thrown up by industry.

所以无论如何，这让我很沮丧，因为多年来我看到太多的患者由于行业设置的障碍而得不到他们应得和应该得到的护理。

But I say all that just to say that when you take on big problems, you will run up against entrenched interests.

但我说这些只是想说，当你解决大问题时，你就会遇到根深蒂固的利益。

And that's a fight we have to take on.

这是我们必须进行的一场战斗。

We can't shy away from it.

我们不能回避它。

We can't say, you know, this is politically too difficult.

我们不能说，你知道，这在政治上太困难了。

One of the things I'm very proud of is that we're finally negotiating on drug prices through the Medicare program, something that should have been done decades ago, but it's finally happening now.

我非常自豪的一件事是，我们终于通过医疗保险计划就药品价格进行谈判，这本来应该在几十年前完成，但现在终于发生了。

The administration decided this has got to happen.

政府决定这必须发生。

It was passed by Congress.

该法案已获得国会通过。

This is good.

这很好。

And it makes no sense that we would pay more than we need to and pass the cost on to taxpayers when we can negotiate.

当我们可以谈判时，我们支付超出我们需要的费用并将成本转嫁给纳税人是没有意义的。

And we got to get, look, if you're collecting taxes, as government, you should be doing your best to make sure every one of those dollars is being spent well.

我们必须明白，如果你在征税，作为政府，你应该尽最大努力确保每一块钱都用得其所。

Right, because somebody took money out of their paycheck, didn't use it for their family, didn't use it for their kids, and they gave it to the government for good reason, because that supports first responders, police officers, a whole bunch of services that we need.

是的，因为有人从他们的薪水里拿了钱，没有用它来养家糊口，没有用它来养孩子，他们把钱交给政府是有充分理由的，因为这支持了急救人员、警察，以及我们需要的一大堆服务。

But the responsibility in government is to make sure that money is being used well and to pay more for medications than we should makes no sense at all, especially for patients and taxpayers.

但政府的责任是确保资金得到充分利用，为药物支付超出应有费用的费用根本没有意义，尤其是对患者和纳税人而言。

Andrew Huberman: So clearly some steps in the right direction are occurring.

Andrew Huberman：很明显，一些朝着正确方向迈出的步伐正在发生。

While on the topic of mental health, let's talk about the isolation crisis.

说到心理健康这个话题，我们来谈谈孤立危机。

What is the isolation crisis?

什么是孤立危机？

What aspects of mental and physical health is it impacting?

它影响心理和身体健康的哪些方面？

And then perhaps most importantly, what can we each and all do about it?

也许最重要的是，我们每个人都能为此做些什么？

Vivek Murthy: Well, this is one of those issues that if you had told me, Andrew, ten years ago, hey, you and I are going to be sitting here talking about loneliness and isolation, I would have said, I don't think so, but I was really educated by people I met across the country about the fact that this was a real problem.

维韦克·穆尔蒂：嗯，这是一个问题，如果你十年前告诉我，安德鲁，嘿，你和我将坐在这里谈论孤独和孤立，我会说，我不这么认为，但我在全国各地遇到的人确实教育了我，这是一个真正的问题。

And the truth is, it was familiar to me because of my own personal experiences as a child.

事实上，由于我小时候的个人经历，它对我来说很熟悉。

I struggled a lot with a sense of loneliness and isolation.

我在孤独感和孤立感中挣扎了很多。

I was really shy as a kid.

我小时候真的很害羞。

I was pretty introverted, and I wanted to make friends and hang out with other kids, but it took me a while to actually build those relationships, so I spent a lot of time feeling left out.

我非常内向，我想交朋友并与其他孩子一起出去玩，但我花了一段时间才真正建立这些关系，所以我花了很多时间感到被排斥。

There were times when I would, in elementary school, there were days where I pretended I had a stomachache so that my mom wouldn't make me go to school.

小学时，有时我会假装肚子疼，以免妈妈不让我去上学。

And it wasn't because I was scared of a test or a teacher, but because I didn't want to walk into the cafeteria one more time and be scared that there was nobody to sit next to or that no one would want me to be at their bench.

这并不是因为我害怕考试或害怕老师，而是因为我不想再一次走进自助餐厅，害怕没有人可以坐在旁边，或者没有人希望我坐在他们的板凳上。

I know what it feels like, and I also know what the shame is like, because I never told my parents about this.

我知道那是什么感觉，我也知道羞耻是什么感觉，因为我从来没有告诉过我的父母这件事。

I never told anyone about that, because even though I knew my parents loved me, I just felt like, hey, if I'm feeling this lonely, it means that something's wrong with me.

我从来没有告诉过任何人这件事，因为尽管我知道我的父母爱我，但我只是觉得，嘿，如果我感到如此孤独，那就意味着我出了问题。

I'm not likable.

我不讨人喜欢。

I'm not lovable.

我不可爱。

It's got to be my fault in some way.

在某种程度上这一定是我的错。

It was only years later, Andrew, when I talked to friends from grade school, that I realized that a lot of them were feeling the same thing.

安德鲁，几年后，当我与小学的朋友交谈时，我意识到他们中的很多人都有同样的感觉。

We were all struggling by ourselves.

我们都在独自挣扎。

No one really knew it.

没有人真正知道这一点。

And I came to see a lot of this as a doctor when I was taking care of patients.

作为一名医生，当我照顾病人时，我看到了很多这样的情况。

And I never took a class on loneliness in medical school.

我从未在医学院上过关于孤独的课程。

It wasn't part of our residency curriculum.

这不是我们住院医师课程的一部分。

Yet when I showed up in the hospital, I found that the patient who had come in with a diabetic wound infection or who had come in because they had had a heart attack, when I sat down and talked to them, often in the background, they would talk about how lonely they were.

然而，当我出现在医院时，我发现那些患有糖尿病伤口感染或因心脏病发作而进来的病人，当我坐下来与他们交谈时，他们通常会在后台谈论他们是多么孤独。

Sometimes I would ask them, hey, I need to have a difficult conversation about your diagnosis.

有时我会问他们，嘿，我需要就你的诊断进行一次艰难的对话。

Is there somebody you'd want me to call to be with you during this time?

在这段时间里，你想让我打电话给谁来陪你吗？

And too often, the answer was, I wish there was, but there's nobody, I'll just have the conversation by myself.

很多时候，答案是，我希望有，但没有人，我只能自己进行对话。

But it was when I was Surgeon General that I realized that those experiences weren't limited to me and my patients, but they were incredibly common.

但当我担任外科医生时，我意识到这些经历不仅限于我和我的病人，而且非常普遍。

And two things I learned when I dug into the data, Andrew, was, number one, that loneliness is exceedingly common, with one in two adults in America reporting measurable levels of loneliness.

安德鲁，当我深入研究数据时，我了解到的两件事是，第一，孤独是非常普遍的，在美国有两分之一的成年人报告了可测量的孤独程度。

But the numbers are actually even higher among young adults and adolescents.

但年轻人和青少年的数字实际上更高。

The numbers among youth, actually, depending on the surveys you look at, are between 70% to 80% who say that they are struggling with loneliness.

事实上，根据你所看到的调查，年轻人中的人数在 70% 到 80% 之间，他们表示自己正在与孤独作斗争。

So, that's the first thing that I learned.

所以，这是我学到的第一件事。

But the second thing was how consequential loneliness was.

但第二件事是孤独感有多么严重。

I used to think loneliness was just a bad feeling.

我曾经以为孤独只是一种不好的感觉。

What I came to see in digging into the scientific literature was that feeling socially disconnected, being lonely and isolated, was actually associated with increased risk of depression, anxiety, suicide, but also an increased risk of cardiovascular disease, of dementia.

在深入研究科学文献时，我发现，感觉与社会脱节、孤独和孤立，实际上与抑郁、焦虑、自杀的风险增加有关，而且也与心血管疾病和痴呆的风险增加有关。

And these are not small risks.

而这些都是不小的风险。

We're talking about 29% increase in the risk of coronary heart disease, 31% risk in the increased risk of stroke, 50% increased risk of dementia among older people, increased risk of premature death, and the mortality impact of loneliness, by the way, and loneliness and isolation is comparable to the mortality impact of many other illnesses.

顺便说一句，我们谈论的是冠心病风险增加 29%，中风风险增加 31%，老年人患痴呆症的风险增加 50%，过早死亡的风险增加，以及孤独对死亡率的影响，而孤独和孤立对死亡率的影响与许多其他疾病的死亡率影响相当。

In fact, it's even greater than the mortality impact we see associated with obesity, which is something we clearly recognize as a public health issue.

事实上，它甚至比我们所看到的与肥胖相关的死亡率影响更大，我们清楚地认识到肥胖是一个公共卫生问题。

So you put all this together, and for me, one of the key takeaways is that loneliness and isolation are critical public health challenges that are hiding behind the curtain, behind this wall of stigma and shame.

所以你把所有这些放在一起，对我来说，关键的结论之一是孤独和孤立是隐藏在幕后、耻辱和耻辱之墙后面的关键公共卫生挑战。

And unless we talk about it and address it, unless we reconcile what's been happening to us over the last 50 years where fewer and fewer people are participating in community organizations, where more and more people are feeling isolated, then we're not going to be able to repair the fraying foundations of society, which are grounded fundamentally in our connection to one another.

除非我们谈论它并解决它，除非我们调和过去 50 年发生在我们身上的事情，即参与社区组织的人越来越少，越来越多的人感到孤立，否则我们将无法修复脆弱的社会基础，而这些基础从根本上建立在我们彼此的联系之上。

Andrew Huberman: You mentioned community organizations.

Andrew Huberman：您提到了社区组织。

Could you elaborate on those growing up in the '70s and '80s, I was exposed to community soccer teams, swim team, there was a community pool.

您能否详细介绍一下那些在 70 年代和 80 年代长大的人，我接触过社区足球队、游泳队，还有社区游泳池。

These were all public things.

这些都是公共的事情。

There were churches, synagogues, and mosques.

有教堂、犹太教堂和清真寺。

Are we not seeing as much participation in those types of organizations anymore?

我们是否不再看到这些类型的组织有那么多的参与？

And what other types of organizations are out there that come to mind when you think about the isolation crisis?

当您想到孤立危机时，您会想到哪些其他类型的组织？

Vivek Murthy: Yeah.

维韦克·穆尔蒂：是的。

So there are several factors that have led to us being as isolated as we are.

因此，有几个因素导致我们如此孤立。

One of them, as you mentioned, is the decline in participation in community organizations.

正如您提到的，其中之一是社区组织参与度的下降。

This isn't a recent phenomenon.

这并不是最近才出现的现象。

This has been happening over the last half century in America.

过去半个世纪以来，这种情况一直在美国发生。

We've seen lower participation in faith organizations, in recreational leagues, in service organizations, and other community groups.

我们发现信仰组织、娱乐联盟、服务组织和其他社区团体的参与度较低。

That used to bring us together, and I think we can talk about the reasons why that has been the case.

这曾经让我们走到一起，我想我们可以谈谈造成这种情况的原因。

But one of the key consequences of that is that people don't have places where they can come together and get to know one another, especially across differences.

但这样做的主要后果之一是，人们没有地方可以聚集在一起并相互了解，尤其是跨越差异。

So we actually associate more and more with people who are like us.

所以我们实际上越来越多地与像我们一样的人交往。

But this has also been fueled by a few other factors that are going on at the same time.

但这也受到同时发生的其他一些因素的推动。

One is that just from a cultural perspective, as modernity has arrived, not just in the US, but in other countries, we've seen that people are more mobile.

一是仅从文化角度来看，随着现代化的到来，不仅在美国，而且在其他国家，我们都看到人们的流动性更强。

They move around more.

他们走动的次数更多。

We don't always stay in the community that we grew up in.

我们并不总是留在我们长大的社区中。

We tend to, even if we move somewhere else for school, we may go somewhere else for a job, we may change jobs and move somewhere else.

我们倾向于，即使我们搬到其他地方上学，我们也可能去其他地方工作，我们可能会换工作并搬到其他地方。

We are leaving behind communities that we grew up with, that we went to school with, that we worked with.

我们正在离开那些与我们一起成长、一起上学、一起工作的社区。

And I'm not saying that's all a bad thing.

我并不是说这都是坏事。

We have more opportunities, and that's a really good thing.

我们有更多的机会，这是一件好事。

But I think one thing that we have not accounted for is the cost of these changes.

但我认为我们没有考虑到的一件事是这些变化的成本。

If we know what the costs are of certain actions, we may still take those actions, but we may find ways to mitigate the costs.

如果我们知道某些行动的成本是多少，我们仍然可以采取这些行动，但我们可能会找到减轻成本的方法。

We may, in this case, invest more in our relationships, be more conscious about reaching out to other people, going to visit them.

在这种情况下，我们可能会在人际关系上投入更多，更有意识地接触其他人，拜访他们。

But that has been a quiet but devastating consequence.

但这是一个悄无声息但却具有毁灭性的后果。

The other piece with modernity is that we have more convenience in our life, which means that we also don't need to see other people to get certain things done, like buying groceries or mailing an item out or getting something from the store, I can sit in the comfort of my home and have everything just come to me.

现代性的另一个方面是我们的生活更加便利，这意味着我们也不需要看到其他人来完成某些事情，比如购买杂货或邮寄物品或从商店取东西，我可以坐在舒适的家里，一切都来找我。

Now, on the one hand, that's incredibly efficient, but I think efficiency is an interesting thing because it's only one factor we should be considering in our lives.

现在，一方面，这是非常高效的，但我认为效率是一件有趣的事情，因为它只是我们在生活中应该考虑的一个因素。

There, too, we have to ask the cost.

在那里，我们也必须询问费用。

And one interesting thing about COVID as many people in the first year of COVID when we were all separated from one another, when we finally came back together again, I had so many people who said to me, you know what I expected to miss?

关于新冠病毒的一个有趣的事情是，在新冠病毒爆发的第一年，当我们彼此分离时，当我们最终再次聚在一起时，有很多人对我说，你知道我会错过什么吗？

My parents and my siblings and my friends, not being able to see them.

我的父母、兄弟姐妹和朋友，无法见到他们。

What I didn't expect was missing the strangers that I saw at the coffee shop or the folks who I ran into at the grocery store or seeing neighbors as I walked down the street.

我没想到的是，我想念在咖啡店看到的陌生人，在杂货店遇到的人，或者在街上行走时看到的邻居。

I actually missed that more than I thought I would.

事实上，我比我想象的更想念它。

So we have lost out on some of those interactions and those loose ties but the final thing to keep in mind also is about what is happening with how we are using social media technology, which I think has fundamentally transformed how we interact with one another and how we see ourselves and each other.

因此，我们失去了一些互动和松散的联系，但最后要记住的是我们如何使用社交媒体技术正在发生的事情，我认为这从根本上改变了我们彼此互动的方式以及我们如何看待自己和彼此。

And this is particularly true for young people who are growing up as digital natives.

对于作为数字原住民成长的年轻人来说尤其如此。

But what has happened there, I worry, is that, and it's not that social media is all bad.

但我担心，那里发生的事情就是这样，而且社交媒体并不是全都是坏事。

Just to be clear, technology, I'm a believer in technology, broadly speaking, I'm a user of technology.

需要明确的是，技术，我是技术的信徒，从广义上讲，我是技术的用户。

I spent seven years building a tech company.

我花了七年时间建立了一家科技公司。

I'm a believer in tech.

我是科技的信徒。

But I think whether technology helps or hurts us is about how it's designed and ultimately about how it ends up being used.

但我认为技术是否帮助或伤害我们取决于它的设计方式以及最终如何使用它。

And what we've seen with social media as well is that for many people, it ended up leading to in-person connections being replaced with online connections.

我们在社交媒体上也看到，对于许多人来说，它最终导致面对面的联系被在线联系所取代。

We came to somehow value and almost seek out more and more followers and friends on social media, feeling like somehow that made us more connected.

我们开始重视并在社交媒体上寻找越来越多的关注者和朋友，感觉这让我们之间的联系更加紧密。

But the nature of dialogue also changed.

但对话的性质也发生了变化。

Like, as human beings, we evolved over thousands of years to not just understand the words someone is saying, but to hear the tone of their voice, to see their facial expression.

就像人类一样，我们经过数千年的进化，不仅能理解某人所说的话，还能听到他们的语气，看到他们的面部表情。

Like you and I are sitting across, and we're both processing our body language, right?

就像你和我坐在一起，我们都在处理我们的肢体语言，对吧？

And I'm seeing you nod your head, and I'm seeing your eyes focus.

我看到你点头，我看到你的目光聚焦。

All of that matters to how we communicate.

所有这些都对我们如何沟通很重要。

But also, you and I are less likely to say something hurtful right now to one another because we can see each other.

而且，你和我现在不太可能互相说一些伤人的话，因为我们可以见面。

If I said something hurtful to you, I'd probably see the pain or consternation on your face, and that might give me pause.

如果我说了一些伤害你的话，我可能会看到你脸上的痛苦或惊愕，这可能会让我停下来。

When you're communicating online with other people without any of that information or without any of the sort of barriers, if you will, that makes you pause before you hurt someone.

当你在没有任何信息或没有任何障碍的情况下与其他人在线交流时，如果你愿意的话，这会让你在伤害别人之前停下来。

It leads to a very different kind of communication, one that can be quite hurtful at times.

它会带来一种非常不同的沟通方式，有时可能会非常伤人。

And I also think that one thing many people don't recognize is that to communicate with somebody else and reach out and build a relationship with someone, it actually takes a certain amount of self esteem to do that.

我还认为，许多人没有意识到的一件事是，要与他人沟通并与某人建立关系，实际上需要一定的自尊才能做到这一点。

You have to believe the other person is going to want to hang out with you.

你必须相信对方会想和你一起出去玩。

They're going to see something valuable in you.

他们会在你身上看到一些有价值的东西。

And for many young people, what has happened, and I think, frankly, for many older people, too, is their experience on social media has shredded their self esteem as they're constantly comparing themselves to other people.

对于许多年轻人来说，所发生的事情，坦率地说，对于许多老年人来说，他们在社交媒体上的经历也粉碎了他们的自尊，因为他们不断地将自己与其他人进行比较。

When you and I were growing up in the 80s, we compared ourselves to other people, too.

当你和我在 80 年代长大时，我们也将自己与其他人进行比较。

People have for millennia.

人们已经有几千年了。

But what's fundamentally different now is that in a given day, you can compare yourself to thousands of images that you see online.

但现在根本不同的是，在某一天，您可以将自己与网上看到的数千张图片进行比较。

That's actually literally what people, young people, tell me.

这实际上就是人们、年轻人告诉我的。

I do roundtables with college students and high school students all the time around the country.

我一直在全国各地与大学生和高中生举行圆桌会议。

And the three things they tell me most consistently about their experience of social media is it makes them feel worse about themselves, worse about their friendships, but they can't get off it because the platforms are designed to maximize the amount of time they spend on them.

关于他们的社交媒体体验，他们告诉我最一致的三件事是，社交媒体让他们对自己感觉更糟，对他们的友谊更糟，但他们无法摆脱它，因为这些平台的设计目的是最大限度地增加他们在平台上花费的时间。

So you put all of this together, and I think what has happened is that we're talking more, but we understand each other less.

所以你把所有这些放在一起，我认为发生的事情是我们谈论得更多，但我们彼此理解更少。

We have a lot of information, but we're lacking in the wisdom that comes from human relationships.

我们有很多信息，但缺乏来自人际关系的智慧。

And I think that that's really hurt us.

我认为这确实伤害了我们。

We see it certainly in the data that tells us about mental and physical health outcomes.

我们在告诉我们心理和身体健康结果的数据中确实看到了这一点。

But there's also the human suffering component.

但也有人类痛苦的部分。

Andrew, it's really heartbreaking for me to travel around the country and to hear from people of all ages, often in quiet whispers about their struggles with isolation, about how they feel like they just don't matter at all, about how they feel like they just don't have a place where they belong.

安德鲁，对我来说，在全国各地旅行并听到各个年龄段的人们的声音真的很令人心碎，他们经常低声谈论他们与孤立的斗争，他们感觉自己根本不重要，他们感觉自己没有属于自己的地方。

And these people on the outside look perfectly fine.

而且这些人表面上看起来都很好。

They're posting happy things online.

他们在网上发布快乐的事情。

To the folks at work, they're seeming like everything's going great.

对于工作中的人们来说，他们似乎一切都很顺利。

But this is why I always tell people, loneliness is a great masquerader.

但这就是为什么我总是告诉人们，孤独是一个伟大的伪装者。

It can look like withdrawal and sadness.

它看起来像是退缩和悲伤。

It can look like anger and irritability.

它看起来像是愤怒和烦躁。

It can look like aloofness as well.

它也可能看起来很冷漠。

And so it's only when we stop to ask someone how they're doing, when we take pause for a moment to maybe reflect on what's happening in their life, that we realize that, wow, the majority of people in our country are actually struggling with loneliness.

因此，只有当我们停下来询问某人过得怎么样时，当我们停下来思考一下他们​​生活中发生的事情时，我们才会意识到，哇，我们国家的大多数人实际上都在与孤独作斗争。

Andrew Huberman: Yeah.

安德鲁·休伯曼：是的。

I'm a firm believer that our nervous system evolved under conditions of close interpersonal and direct connection.

我坚信我们的神经系统是在人际关系密切和直接联系的条件下进化的。

And to suddenly throw a technology in front of ourselves that deprives our nervous system of its normal development is clearly going to lead to bad places.

突然将一项剥夺我们神经系统正常发育的技术扔到我们面前，显然会导致糟糕的结果。

It's also clear to me, based on what you just described, that when we go on social media, we see something, but they don't really see us.

根据你刚才的描述，我也很清楚，当我们在社交媒体上时，我们看到了一些东西，但他们并没有真正看到我们。

Hence, perhaps why people get aggressive in the comment section.

这也许就是人们在评论部分变得咄咄逼人的原因。

They want to be heard.

他们希望被听到。

We want to be seen.

我们希望被看到。

I think all of us want to be seen and see other people, and social media doesn't allow for it so easily.

我认为我们所有人都希望被看到并看到其他人，而社交媒体并不那么容易做到这一点。

I also know that a lot of young people will congregate with their friends to play video games online.

我还知道很多年轻人会和朋友一起在线玩电子游戏。

But that's different.

但那是不同的。

You're essentially showing up as an avatar.

你本质上是作为一个化身出现的。

And when we were kids, we also played different characters in our games, but, oh, so different now.

当我们还是孩子的时候，我们也在游戏中扮演不同的角色，但是，哦，现在不同了。

Do you think that there will be a youth rebellion movement against these kinds of technologies?

您认为青年人会发起针对此类技术的反叛运动吗？

I mean, there's a long history of young people rebelling against the stuff that's been put in front of them, and they're like, no more, we're going to rebel.

我的意思是，年轻人反抗摆在他们面前的东西的历史由来已久，他们就像，不再，我们要反抗。

In fact, that was the way that youth overcame the nicotine epidemic.

事实上，这就是年轻人克服尼古丁流行的方式。

If you recall, it was the advertising pitching them against or pitting them against wealthy, cackling older men in rooms counting their money.

如果你还记得的话，那是广告让他们与富有的、在房间里数钱的咯咯笑的年长男人竞争。

That was what actually was successful in getting kids to not smoke, because kids have a rebellious streak, as opposed to when they were told, hey, smoking is terrible for you.

这实际上是成功地让孩子们不吸烟，因为孩子们有叛逆的倾向，而不是当他们被告知，嘿，吸烟对你来说很糟糕。

Your lungs are going to fill with cancer.

你的肺部将充满癌症。

Kids didn't stop smoking.

孩子们并没有戒烟。

Teens didn't stop smoking.

青少年没有戒烟。

Rebellion has been baked into our nervous system in the adolescent and teen years.

在青少年时期，叛逆已经融入了我们的神经系统。

So do you see a rebellion against this social isolation?

那么您是否看到了对这种社会孤立的反抗？

Are kids going to start putting away their phones and hanging out together again?

孩子们会开始收起手机并再次一起出去玩吗？

And that's going to rescue us?

那会拯救我们吗？

And that's a way of saying, what can we do for them?

这就是说，我们能为他们做什么？

What can they do for themselves, and what can we do as adults?

他们能为自己做什么，而我们作为成年人又能做什么？

Because there are a lot of, the silent suffering is the thing I also really worry about.

因为有很多，默默的受苦也是我真正担心的事情。

Vivek Murthy: So it's a good question.

Vivek Murthy：这是一个很好的问题。

And I think there is already a movement that's building among young people to create distance between them, themselves, and their devices, and particularly social media.

我认为年轻人中已经有一场运动正在兴起，以在他们、他们自己和他们的设备（尤其是社交媒体）之间拉开距离。

And it's cropping up in different ways.

它以不同的方式出现。

I'm meeting more and more.

我见面的次数越来越多了。

Some of these are organized efforts, but I'm also meeting more families where the parents gets together have decided that they're going to delay using social media until past middle school, or in some cases even later, or where they're deciding that they're going to draw boundaries around social media use, or they're going to replace their smartphone with a dumb phone that allows them to do things like text and make phone calls and use maps and all that stuff, but doesn't necessarily have social media apps on it.

其中一些是有组织的努力，但我也遇到了更多的家庭，父母聚集在一起决定他们将推迟使用社交媒体，直到中学毕业，或者在某些情况下甚至更晚，或者他们决定他们将在社交媒体的使用方面划定界限，或者他们将用一部愚蠢的手机取代他们的智能手机，让他们可以做诸如发短信、打电话、使用地图之类的事情，但不一定有社交媒体应用程序。

Now, this is still a small minority, and we're dealing with a bit of a network effect here, right?

现在，这仍然是少数，我们正在处理一些网络效应，对吗？

Because if you're the only one who's not on social media in your middle school class, then you might feel left out, which is why it's so important for parents and kids to actually do this together.

因为如果你是中学班级中唯一一个不使用社交媒体的人，那么你可能会感到被排除在外，这就是为什么父母和孩子真正一起做这件事是如此重要。

But I do think that to use your analogy with smoking, that one thing that I think many young people bristle against, is this notion of being manipulated and used for the profit of a social media platform.

但我确实认为，用你与吸烟的类比来说，我认为许多年轻人感到愤怒的一件事是，为了社交媒体平台的利润而被操纵和利用的概念。

And the reality is that, again, we've talked about how the fundamental business model for most social media platforms is built on how much time you spend on those platforms.

现实是，我们再次讨论了大多数社交媒体平台的基本商业模式是如何建立在您在这些平台上花费的时间的基础上的。

That translates to ad revenue and that translates to the bottom line.

这转化为广告收入，也转化为利润。

Whereas, what I care about as a parent, as Surgeon General, is about how well that time is being spent.

然而，作为一名家长和外科医生，我关心的是这些时间被花得如何。

Is it actually contributing to the health and well being of a young person?

它真的有助于年轻人的健康和福祉吗？

Or is it not?

或者不是吗？

Is it actually harming them?

真的是在伤害他们吗？

And this is where I think, when I go out and talk to young people about this, number one, I'm so impressed by a lot of young people because they already have a lot of these insights.

这就是我认为，当我出去与年轻人谈论这个问题时，第一，很多年轻人给我留下了深刻的印象，因为他们已经有了很多这些见解。

They're the ones living it right.

他们才是正确生活的人。

They're not thinking that this is all perfect and it's all a pure benefit here.

他们并不认为这一切都是完美的，这只是纯粹的好处。

They're the ones telling me that it makes them feel worse about themselves and their friendships, but they're also having a hard time getting off of it, because, again, of how these platforms are designed.

他们告诉我，这让他们对自己和友谊感觉更糟，但他们也很难摆脱它，因为这些平台的设计方式。

So about a third of adolescents are saying that they're staying up till midnight or later on weeknights using their devices.

因此，大约三分之一的青少年表示，他们会使用设备熬夜至午夜或更晚。

And a lot of that is social media use.

其中很大一部分是社交媒体的使用。

And this takes away from sleep, which we know, and you know better than anyone, is so critical to the mental health and well being of all of us, but of young people in particular, who are at a critical phase of development.

这会影响睡眠，我们知道，你比任何人都清楚，睡眠对于我们所有人的心理健康和福祉至关重要，尤其是处于发展关键阶段的年轻人。

The other thing that is very concerning to me is that nearly half of adolescents say that using social media has made them feel worse about their body image, as they're constantly comparing themselves to others online.

另一件让我非常担心的事情是，近一半的青少年表示，使用社交媒体让他们对自己的身体形象感觉更糟，因为他们不断地将自己与网上的其他人进行比较。

And we used to think that this is just girls who are experiencing this.

我们曾经认为这只是女孩经历的事情。

And yes, it is a lot of young girls who are experiencing these body image issues, but now it's increasingly boys as well.

是的，很多年轻女孩都在经历这些身体形象问题，但现在男孩也越来越多。

So this is happening across the board.

所以这种情况正在全面发生。

But the other piece, I think, that concerns me, thinking about mental health symptoms, is that we look at how much time kids are using social media.

但我认为，让我担心的另一件事是，考虑到心理健康症状，我们会观察孩子们使用社交媒体的时间。

On average, adolescents are using it for three and a half hours a day, on average.

青少年平均每天使用它的时间为三个半小时。

Andrew Huberman: Just social media.

安德鲁·休伯曼：只是社交媒体。

Vivek Murthy: Just social media.

Vivek Murthy：只是社交媒体。

And that means many are using it for far more than that.

这意味着许多人使用它的目的远不止于此。

And what you're finding, though, is that for adolescents who use it three hours or more in a given day, their risk of anxiety or depression symptoms double.

然而，你发现，对于每天使用三个小时或更长时间的青少年来说，他们出现焦虑或抑郁症状的风险会增加一倍。

And if the average use is three and a half a day, that means that millions of kids all across our country, the majority of our kids, are at risk here.

如果平均使用时间是三天半，那就意味着我们全国数以百万计的孩子（我们的大多数孩子）都处于危险之中。

And so you put all this together, and it paints a very concerning picture.

所以你把所有这些放在一起，就描绘出了一幅非常令人担忧的画面。

Whatever benefits there may be, for some kids, of using social media, and there are some, and we lay out some of this in our advisory on social media.

对于某些孩子来说，使用社交媒体可能有什么好处，而且确实有一些好处，我们在社交媒体建议中列出了其中的一些好处。

Some kids find social media is a great way to express themselves, to reach other people, to find support, especially if they're from a community that doesn't have a lot of folks who are like them around.

有些孩子发现社交媒体是表达自己、接触其他人、寻求支持的好方法，尤其是当他们来自一个没有很多像他们一样的人的社区时。

It can be really reassuring to connect with others.

与他人联系真的可以让人安心。

But we can't say that to get those benefits, we have to subject our children to all of these other harms.

但我们不能说，为了获得这些好处，我们就必须让我们的孩子遭受所有这些其他伤害。

Kids are experiencing exposure to harmful content, to harassment and bullying online.

孩子们正在经历接触有害内容、网上骚扰和欺凌的情况。

Six out of ten adolescent girls are saying they've been approached by strangers on social media in ways that made them feel very uncomfortable.

十分之六的青春期女孩表示，陌生人在社交媒体上接近她们的方式让她们感到非常不舒服。

Our kids are also finding that health promoting activities in their lives are being cannibalized by their use of social media.

我们的孩子还发现，他们生活中的健康促进活动正在因社交媒体的使用而被蚕食。

That it's detracting from time for sleep, in person interaction, physical activity, and the erosion of self esteem really concerns me as well, because you need that not just for social interaction, but look, as a father, I want my children to grow up being confident about who they are, being confident enough to be authentic as they show up in the world, to not feel like they need to create some brand that's different from who they fundamentally are, just to sell that to the world.

它会减少睡眠时间、人际交往、体力活动以及自尊心的侵蚀，这也让我很担心，因为你不仅需要社交互动，而且作为一名父亲，我希望我的孩子们在成长过程中对自己是谁充满信心，有足够的信心在他们出现在世界上时表现得真实，而不是觉得他们需要创建一些与他们本质不同的品牌，只是为了把它卖给世界。

I want them to know who they are and to be comfortable being who they are, and to encourage other people to do the same, to support them in their efforts to be authentic.

我希望他们知道自己是谁，并乐于做自己，并鼓励其他人也这样做，支持他们努力保持真实。

That's what I want my kids to do.

这就是我希望我的孩子们做的事情。

That's not what's happening to a lot of kids on social media.

这并不是很多孩子在社交媒体上发生的事情。

So I think we not only need more kids to understand this and just support them in their efforts to create space and sacred spaces away from social media, but we need to support parents here, too, because, Andrew, my big concern with parents is, look, we've taken this technology, which is rapidly evolving, which we didn't grow up with as kids, and we've told parents, you manage it all on your own.

所以我认为我们不仅需要更多的孩子理解这一点，支持他们努力创造远离社交媒体的空间和神圣空间，而且我们也需要支持父母，因为安德鲁，我对父母最关心的是，看，我们已经采用了这项正在迅速发展的技术，但我们小时候并没有伴随着它长大，我们已经告诉父母，你自己管理这一切。

We put the entire burden on parents and kids to manage this.

我们把处理这件事的全部责任都交给了父母和孩子。

When we were growing up, you remember the motor vehicle fatalities were really high in America, and we didn't say, okay, you know what, that's just the price of modern life.

当我们长大的时候，你记得美国的机动车死亡率非常高，我们并没有说，好吧，你知道吗，这只是现代生活的代价。

We just have to accept it and keep moving on with our lives.

我们只需要接受它并继续我们的生活。

We said, hold on, we don't have to go back to horses and buggies, but we also don't need to accept this death rate.

我们说，等等，我们不必再回到马匹和马车上，但我们也不需要接受这样的死亡率。

We need to make this experience safer.

我们需要让这种体验更加安全。

And so we put in place with the advocacy and support of incredible groups like MADD and others across the country (MADD mean Mothers Against Drunk Driving), ultimately, the government put in place safety standards that got us seatbelts, airbags, crash testing to make sure the frame of cars were robust in the setting of an accident.

因此，在 MADD 和全国其他组织（MADD 的意思是反对醉酒驾驶母亲组织）等令人难以置信的团体的倡导和支持下，我们制定了安全标准，最终政府制定了安全标准，为我们提供了安全带、安全气囊和碰撞测试，以确保汽车框架在发生事故时坚固耐用。

And that helped us reduce motor vehicle accidents and deaths.

这帮助我们减少了机动车事故和死亡。

And that's what we need here, too.

这也是我们所需要的。

We need to have the backs of parents and kids.

我们需要父母和孩子的支持。

And that means, from a policy perspective, putting in place safety standards to protect kids from exposure to harmful content, from the experience of bullying and harassment, and that also protect them from features that would seek to manipulate them into excessive use, which is happening far too often right now.

这意味着，从政策角度来看，制定安全标准来保护孩子们免遭有害内容、欺凌和骚扰的困扰，并保护他们免受旨在操纵他们过度使用的功能的影响，这种情况现在经常发生。

We also need a policy that requires data transparency from the companies.

我们还需要一项要求公司数据透明的政策。

Researchers tell us all the time that these are independent researchers.

研究人员一直告诉我们，他们是独立的研究人员。

They tell us they are having a hard time getting full access to the data from the social media platforms about the full impact of the platforms on the mental health of kids as a parent.

他们告诉我们，他们很难从社交媒体平台上全面获取关于这些平台对父母孩子心理健康的全面影响的数据。

When we bought car seats for my children when they were born, we looked up the safety data.

当我们为孩子出生时购买汽车安全座椅时，我们查阅了安全数据。

Like many parents, we wanted to make sure the car seats were safe.

和许多父母一样，我们希望确保汽车座椅的安全。

But if you had told me that, hey, the manufacturers of these car seats are actually not disclosing some of the data on the impact on children, but go ahead and buy it anyway, I'm sure other people are buying these car seats, you should be fine.

但如果你告诉我，嘿，这些汽车座椅的制造商实际上没有透露一些关于对儿童影响的数据，但无论如何还是去买吧，我相信其他人也在购买这些汽车座椅，你应该没问题。

I would have been very disturbed by that.

我会对此感到非常不安。

No parent wants to feel that information is being hidden from them about the health impact of products on their kids.

没有哪个家长希望自己被隐藏有关产品对孩子健康影响的信息。

That's what we have right now.

这就是我们现在所拥有的。

So this is a place where I think while, yes, and we'll talk about some steps parents can take, because I want to get to practical steps that people who are here as parents or people with kids in their lives can take, but we need policymakers to step up and step into the void here and to fill the gap, because this is too much, again, to just ask parents to manage entirely on their own.

因此，我想，是的，我们将讨论父母可以采取的一些步骤，因为我希望采取实际步骤，供身为父母或生活中有孩子的人采取，但我们需要政策制定者挺身而出，填补这里的空白，填补空白，因为这再次要求父母完全自行管理，这太过分了。

And this isn't, again, about telling parents what to do and restricting them.

这并不是告诉父母该做什么并限制他们。

This is about giving them the support they need so they have confidence when they see a technology out there, a device out there, a product out there for kids that they know it's been tested, that it's been studied, and that it's actually safe for their children.

这是为了向他们提供所需的支持，这样当他们看到一种技术、一种设备、一种为孩子们准备的产品时，他们就会有信心，因为他们知道这些技术已经过测试、已经过研究，而且对他们的孩子来说实际上是安全的。

Andrew Huberman: My understanding is that in countries like China, there are limits as to how many hours kids can be on screens, period.

安德鲁·休伯曼：我的理解是，在中国这样的国家，孩子们在屏幕上呆的时间是有限制的。

And when I was a kid, we were allowed to watch TV for a certain number of, I think it was a half an hour or an hour.

当我还是个孩子的时候，我们被允许看一定数量的电视，我想是半小时或一个小时。

My mom was constantly kicking us out of the house.

我妈妈经常把我们赶出家门。

Literally, you got to leave the house.

从字面上看，你必须离开家。

You got to go down the street and play, and fortunately I liked outdoor activities.

你必须去街上玩，幸运的是我喜欢户外活动。

Nowadays, we also have the issue that a lot of parents are on their phones at soccer games and at kids events, and so the kids are modeling their parents.

如今，我们还面临一个问题，即许多父母在足球比赛和儿童活动中使用手机，因此孩子们正在模仿他们的父母。

Parents are distracted as well, so there's a lack of social connection.

父母也分心，因此缺乏社交联系。

People, even in immediate family, people are screened on TV, there's laptops, there's multiple phones, iPads.

人们，甚至是直系亲属，都在电视上放映，有笔记本电脑、多部手机、iPad。

People are more engaged in the screen portals often than their own portals.

人们通常更多地关注屏幕门户而不是自己的门户。

You go to a concert and people are watching the concert through their screen so that they can send the same image that everyone around them is sending out to the world.

你去听一场音乐会，人们通过屏幕观看音乐会，这样他们就可以向世界发送与周围的每个人发送的相同的图像。

If you think about it, it's kind of crazy, but I guess they want to capture that unique experience, but it's not unique at all.

如果你仔细想想，这有点疯狂，但我猜他们想捕捉那种独特的体验，但它根本不是独一无二的。

That's the myth.

这就是神话。

That's the illusion.

这就是幻觉。

There's nothing unique about your post of something that you went to go see.

你所发布的关于你去看的东西并没有什么独特之处。

What would be truly unique is to just experience that in real time.

真正独特的是实时体验。

It's so wild to think about what we think of as our unique portal is actually not unique at all.

我们的想法是如此疯狂，因为我们独特的门户实际上一点也不独特。

It's what we do with it.

这就是我们用它做的事情。

My stance is glean and learn information online, then go use it in real life.

我的立场是在网上收集和学习信息，然后在现实生活中使用它。

Come back from time to time, maybe an hour, a day, maximum or so.

时不时地回来一次，也许一个小时，一天，最多左右。

Vivek Murthy: Can I just underscore the two words you said, real life?

Vivek Murthy：我可以强调一下你所说的两个词，现实生活吗？

Because that, I think, is a really important key here, which is that all of real life isn't happening on social media.

因为我认为这是一个非常重要的关键，那就是现实生活中的所有事情并不是都发生在社交媒体上。

There's a whole world out there which I think is real life, which is happening offline.

我认为外面的世界就是现实生活，它在线下发生。

And what's happening online too often is distorted.

网上发生的事情经常被扭曲。

It's giving us, even just take the images that we see of people, their summer beach images, their great vacation images.

它给了我们，甚至只是拍摄我们看到的人们的照片，他们的夏日海滩照片，他们美好的假期照片。

That's not representative of their entire life, of how they're living their life.

这并不代表他们的整个生活，也不代表他们的生活方式。

But we see that.

但我们看到了这一点。

We see people's anger and their vitriol, and we come to believe over time that that's how people feel.

我们看到人们的愤怒和刻薄，随着时间的推移，我们逐渐相信这就是人们的感受。

That's what people are dealing with and experiencing in their life.

这就是人们在生活中正在处理和经历的事情。

And we've just got to get your mom, I love what your mom did of getting you guys outside.

我们必须找到你妈妈，我喜欢你妈妈带你们出去的做法。

My parents did the same thing, too.

我的父母也做了同样的事情。

I was very blessed to have two parents who didn't come, you know, they didn't have a lot of resources growing up.

我很幸运有两个没有来的父母，你知道，他们成长过程中没有很多资源。

They didn't come to this country with a lot of resources.

他们来到这个国家时并没有拥有很多资源。

But one of the greatest gifts they gave us is that they loved us unconditionally.

但他们给我们最伟大的礼物之一就是他们无条件地爱我们。

The other great gift that they gave us is they pushed us to just explore, to meet people to learn about the world.

他们给我们的另一件伟大的礼物是他们推动我们去探索，去结识人们以了解世界。

They wanted us outside playing, experimenting, just discovering the world, riding our bike around the neighborhood, and that's what we did.

他们希望我们在外面玩耍、尝试、探索世界、骑自行车在附近转悠，这就是我们所做的。

But right now, two critical things that kids need for their mental health and development are two important forces, I should say, that are impacting their mental health and development.

但现在，我应该说，孩子们心理健康和发展所需的两个关键因素是影响他们心理健康和发展的两个重要力量。

One is social media, but the second also is the lack of unstructured playtime that kids have.

一是社交媒体，二是孩子们缺乏无组织的游戏时间。

Like, unstructured playtime is time when we as kids learn how to negotiate situations with other kids, how to resolve conflict, how to recognize what's going on in someone else's eyes before they say something.

就像，无组织的游戏时间是我们作为孩子学习如何与其他孩子协商情况，如何解决冲突，如何在别人说话之前识别他们眼中发生的事情的时间。

We learn how to collaborate and play with other kids.

我们学习如何与其他孩子合作和玩耍。

There's a lot you learn on the playground, as it turns out.

事实证明，你在操场上可以学到很多东西。

But I worry that right now that we've almost somehow made that kind of unstructured time seem inefficient.

但我担心现在我们几乎以某种方式让这种无组织的时间显得效率低下。

We've set these standards for our kids that they need to be getting fancy jobs and into fancy colleges and making X amount of money.

我们为我们的孩子设定了这些标准，他们需要找到好工作，进入好大学，赚 X 笔钱。

And the path to doing that is to be enrolled in X number of activities after school and to do all this stuff in school.

实现这一目标的途径是在放学后参加X数量的活动，并在学校做所有这些事情。

And their lives are so hyperstructured that I worry that the time to just play, to be creative, to reflect and think, to just have unstructured time with other kids has evaporated.

他们的生活是如此的高度结构化，以至于我担心玩耍、发挥创造力、反思和思考、与其他孩子一起度过的无组织时间的时间已经消失了。

And I think that that also is hurting the mental health and well being of our children.

我认为这也损害了我们孩子的心理健康和福祉。

Andrew Huberman: I love the idea that unstructured playtime could be framed in the accurate context of the nervous system developing the way it was supposed to develop.

Andrew Huberman：我喜欢这样的想法，即可以在神经系统按照其应有的方式发展的准确背景下构建非结构化的游戏时间。

I would argue that success is going to be easiest for children that engage in the real world more.

我认为，对于更多地参与现实世界的孩子来说，成功将是最容易的。

In fact, there's great risk to posting everything that you do online.

事实上，将您所做的一切发布到网上存在很大的风险。

We've seen some examples of that preventing people from getting into or staying in college based on things they said or did previously that they shouldn't have said or done.

我们已经看到了一些例子，这些例子表明，人们因为之前说过或做过的不应该说或做的事情而阻止他们进入或留在大学。

Those are kind of negative highlighted cases.

这些都是负面的突出案例。

But in general, we know that the nervous system thrives on diversity of types of interactions and social interactions in particular.

但总的来说，我们知道神经系统的繁荣取决于互动类型的多样性，特别是社交互动。

I'm just restating what you just said.

我只是重申一下你刚才所说的话。

So if ever there was a call for kids to get out into non screen life, let's call for it and engage their nervous system that way, it without question is going to benefit them in terms of their ability to learn and retain information, perform well in school, which is not everything life's about.

因此，如果有人呼吁孩子们进入非屏幕生活，让我们呼吁这样做，并以这种方式调动他们的神经系统，毫无疑问，这将有利于他们学习和保留信息的能力，在学校表现良好，而这并不是生活的全部。

But let's face it, we still live in a society where hitting those milestones on a consistent basis is the best predictor of people being able to live self sustained lives, build families, and that sort of thing.

但让我们面对现实吧，我们仍然生活在这样一个社会，在这个社会中，持续实现这些里程碑是人们能够过上自给自足的生活、建立家庭等事情的最佳预测指标。

So you mentioned a few actionable items for parents as it relates to kids.

所以你提到了一些与孩子有关的家长可采取行动的项目。

Maybe, well, not maybe, limit their screen time, force them outside in the safe weather and safe conditions, of course.

当然，也许，好吧，不也许，限制他们的屏幕时间，迫使他们在安全的天气和安全的条件下外出。

But what about adults as well?

但成年人又如何呢？

What can we all do?

我们大家能做什么？

Should we be restricting our screen time to X number of hours per day?

我们是否应该将每天看屏幕的时间限制在 X 小时？

I mean, you're the Surgeon General.

我的意思是，你是外科医生。

If you had a magic wand, which I realize you don't, and you could make a highly informed recommendation about what the thresholds for too much time on social media are, what would it be?

如果你有一根魔杖（我知道你没有），并且你可以就在社交媒体上花费过多时间的阈值提出一个非常明智的建议，那么它会是什么？

2 hours, 3 hours?

2小时，3小时？

Vivek Murthy: Yeah, it's a good question.

Vivek Murthy：是的，这是一个很好的问题。

And let me actually go through some of these things that parents can do for kids and that we can all do for ourselves.

让我实际回顾一下父母可以为孩子做的一些事情，以及我们都可以为自己做的事情。

With kids in particular.

尤其是带着孩子。

What I would do specifically with social media is, and this is frankly what I'm planning to do with my wife for our kids as they grow up.

我特别想用社交媒体做的是，坦率地说，这也是我计划和我的妻子一起为我们的孩子做的，让他们长大。

Number one, I would seek to delay the use of social media past middle school at minimum.

第一，我会寻求至少在中学以后推迟使用社交媒体。

And I know that that is hard to do at a time where all kids are on social media and you don't want your child to be the only one left out and to be lonely as a result.

我知道，在所有孩子都使用社交媒体的时代，这是很难做到的，而且您也不希望您的孩子成为唯一被排除在外的人，并因此而感到孤独。

Andrew Huberman: So that means no account of their own.

Andrew Huberman：所以这意味着没有他们自己的账户。

Vivek Murthy: It means no account of their own, okay, and I would see, to the best of your ability, see if there are other parents that you can partner with to do this, because it's hard to do alone as a parent.

Vivek Murthy：这意味着没有他们自己的账户，好吧，我会尽力看看是否有其他父母可以与你合作来做到这一点，因为作为父母很难单独做到这一点。

But it's also, if there are other parents you're partnering with, that means there are other kids who are also delaying use.

但如果有其他父母与您合作，那就意味着还有其他孩子也在推迟使用。

That means your child is not alone.

这意味着您的孩子并不孤单。

And I think if you start the conversation with other parents, you'll realize a lot of them are worried about the same things you are.

我认为，如果你开始与其他父母交谈，你会发现他们中的很多人都和你一样担心。

They may have thought about delaying use, but they also don't want their kid to be the only one.

他们可能考虑过推迟使用，但他们也不希望自己的孩子成为唯一的使用者。

So this becomes a numbers challenge.

所以这成为一个数字挑战。

But partnership can help us.

但伙伴关系可以帮助我们。

If your child's already on social media, what I'd recommend is to create sacred spaces in their lives that are technology free.

如果您的孩子已经使用社交媒体，我的建议是在他们的生活中创造不受技术影响的神圣空间。

And specifically, I would think about the hour before bedtime and throughout the night as time that you want to protect because kids are losing, not just sleep, because they're going to sleep later because they're on their devices, but they're also waking up in the middle of the night, maybe to use the bathroom, maybe to get some water, and then they get back on their devices again.

具体来说，我会考虑睡前一小时和整个晚上作为你想要保护的时间，因为孩子们正在失去，而不仅仅是睡眠，因为他们会因为使用设备而睡得更晚，但他们也会在半夜醒来，也许是去洗手间，也许是去喝点水，然后他们又会再次使用他们的设备。

So the quality of their sleep is being significantly impacted by access to those devices during the night.

因此，他们的睡眠质量会因夜间使用这些设备而受到显着影响。

So I would protect that time, hour before bed throughout the night.

所以我会整夜保护这段时间，即睡前一小时。

I would also make sure meal times were tech free zones so that people actually, that you talk to one another, you see one another, and time with friends and family members when you're out at a birthday party, etc. Make that tech free time.

我还会确保进餐时间是无科技区，这样人们实际上可以互相交谈、见面，以及在外出参加生日聚会等时与朋友和家人共度时光。让那段无科技的时间。

Let them focus on their time with other people.

让他们专注于与他人相处的时间。

Those three tech free zones can do a world of good to help your child.

这三个无科技区可以为您的孩子带来很多好处。

And then the last thing I'd recommend here of the many things I think parents could do is to start a dialogue with your child about their use of social media.

在我认为父母可以做的许多事情中，我在这里建议的最后一件事就是与您的孩子就社交媒体的使用展开对话。

We don't always know how social media is making our kids feel, and we may realize when we talk to them that they actually have their own concerns.

我们并不总是知道社交媒体让我们的孩子有何感受，当我们与他们交谈时，我们可能会意识到他们实际上有自己的担忧。

They might say, yeah, it's not making me feel really good, but it's just, like, hard not to be on it.

他们可能会说，是的，这并没有让我感觉很好，但就是很难不参与其中。

Everyone's, like, texting on this, or everyone's sharing information and posting pictures on it.

每个人都在上面发短信，或者每个人都在上面分享信息并发布图片。

I feel like I need to be on it.

我觉得我需要参与其中。

You can only help them start to manage that if you know that's a challenge that they're having.

只有当您知道这是他们面临的挑战时，您才能帮助他们开始应对这一挑战。

So opening up a conversation so your child knows that you're not judging them, but you're trying to understand their experience is important also so that you can help them understand what is not acceptable for them to experience on social media.

因此，打开对话，让您的孩子知道您不是在评判他们，而是尝试了解他们的经历也很重要，这样您就可以帮助他们了解他们在社交媒体上经历的不可接受的事情。

If they're being harassed or bullied by strangers, that is a problem.

如果他们受到陌生人的骚扰或欺凌，那就是一个问题。

You want your child to tell you about that, to report that if they see something posted online that's really concerning to them.

您希望您的孩子告诉您这一点，如果他们看到网上发布的与他们真正相关的内容，请报告。

Let's say they see a friend post that they're thinking of taking their own life or harming themselves in another way.

假设他们看到朋友发帖说他们正在考虑结束自己的生命或以其他方式伤害自己。

You want them to note that that's important to flag and to get help, that they shouldn't just scroll past that.

您希望他们注意到标记和获得帮助很重要，他们不应该只是滚动过去。

So that conversation is really important.

所以这次谈话非常重要。

And finally, as parents, we can lead by example, right?

最后，作为父母，我们可以以身作则，对吗？

And this is hard because the truth is we've been talking about social media and youth, and that's what the subject of my Surgeon General's advisory was on.

这很难，因为事实是我们一直在谈论社交媒体和青年，而这正是我的外科医生部长建议的主题。

But I have concerns about adults, too.

但我也担心成年人。

I see it as somebody who's had challenges in my own use of social media, finding sometimes it bleeds past my bedtime, and I've realized, I think I'm going to check something for five minutes.

我认为这是一个在使用社交媒体方面遇到挑战的人，发现有时它会在我就寝时间之后流血，我意识到，我想我要花五分钟检查一些东西。

An hour later, I'm still there scrolling through something.

一个小时后，我仍然在那里滚动浏览一些东西。

And sometimes I find myself, over the years, I find myself comparing myself also to posts I see online in unhealthy ways.

有时我发现自己，多年来，我发现自己也在以不健康的方式将自己与我在网上看到的帖子进行比较。

Sometimes I find myself sort of pulled into content that ends up being angry and vitriolic and leaves me feeling worse at the end.

有时我发现自己陷入了某种内容之中，最终变得愤怒和尖酸刻薄，最后让我感觉更糟。

So I've experienced this as well.

所以我也经历过这样的事情。

And I think as parents, one of the hardest things to do is to follow this advice we're giving our kids, to draw those boundaries as well and to put our devices away when we're around our kids.

我认为作为父母，最难做的事情之一就是遵循我们给孩子的建议，划定这些界限，并在孩子身边时把我们的设备收起来。

One experience I had, which sort of I still feel bad about, but which really helped kind of knock some sense into me, was after my son was born, my older child.

我有过一次经历，至今仍让我感到难过，但确实让我有了一些理智，那是在我的儿子出生后，我的大孩子。

I was Surgeon General at that time.

那时我是外科医生。

It was a lot going on.

发生了很多事情。

It was a busy job, etc. But I wanted to make sure that I protected bedtimes and meal times for us to be together as a family.

这是一项繁忙的工作，等等。但我想确保我保护了就寝时间和吃饭时间，以便我们一家人能够在一起。

Yet one day when I came home after dinner, when we were doing the bath time and bedtime routine and getting my son ready for the night, my wife was changing his diaper.

然而有一天，当我晚饭后回家，我们正在洗澡和就寝，并让我的儿子做好晚上的准备时，我的妻子正在给他换尿布。

And instead of helping, I was just standing at the side, scrolling through my inbox.

我没有帮忙，只是站在一边，滚动着我的收件箱。

And my wife, who has infinite patience and is like, one of the most well adjusted people that I know, just paused.

而我的妻子，她有无限的耐心，是我认识的适应能力最好的人之一，但她却停了下来。

And she turned to me, and Alice said, "do you really need to be doing that right now?" And she said it, just very quietly, but I felt such a sense of shame when she did that because I was like, what am I doing?

她转向我，爱丽丝说：“你现在真的需要这样做吗？”她这么说，只是非常安静，但当她这样做时，我感到非常羞耻，因为我想，我在做什么？

This is my infant child.

这是我的婴儿。

And the rare few hours I have with them during the day, and I'm just scrolling through my inbox on my phone, this is terrible.

白天我和他们在一起的时间很少，我只是在手机上滚动收件箱，这太糟糕了。

And look, I know that all of us do this maybe in different contexts, but it was a wake up moment for me because I realized one, as you know, well, as a neuroscientist, we can't really multitask, right?

看，我知道我们所有人都可能在不同的情况下这样做，但这对我来说是一个觉醒的时刻，因为我意识到，正如你所知，作为一名神经科学家，我们不能真正同时处理多项任务，对吧？

We're rapidly task switching, and that was a time when my head was in my inbox and my head wasn't with him and my heart wasn't with him.

我们正在快速切换任务，那段时间我的头在我的收件箱里，我的头不和他在一起，我的心也不和他在一起。

I was just distracted.

我只是心烦意乱。

And so, as parents, if we can honor those sacred times when we're with our children, to keep our devices away, meal times, sleep time, as well, it's not easy to do, but it really sets a good example for our kids.

因此，作为父母，如果我们能够尊重与孩子在一起的那些神圣时刻，让我们远离电子设备、吃饭时间、睡眠时间，这并不容易做到，但这确实为我们的孩子树立了一个很好的榜样。

All behavior change that we're talking about here, the kind of behavior change I've worked with, with patients over the years around physical activity and diet, all of this is harder to do when we're doing it by ourself.

我们在这里谈论的所有行为改变，我多年来与患者一起工作过的关于身体活动和饮食的行为改变，当我们自己做时，所有这些都更难做到。

It's a lot easier to do when we have a couple of friends or family members who we agree to do this with.

当我们有几个朋友或家人同意一起这样做时，事情就会容易得多。

We hold each other accountable.

我们互相问责。

We encourage and support each other.

我们互相鼓励、互相支持。

It's how I've been able to make the most successful behavior changes I've made in my life have come about because I have two good buddies, Dave and Sonny, who are part of my brotherhood.

这就是我一生中最成功的行为改变的方式，因为我有两个好朋友，戴夫和桑尼，他们是我兄弟情谊的一部分。

And the three of us, as brothers, talk about health.

而我们三人，就像兄弟一样，谈论健康。

We talk about our finances, we talk about our family and our friendships and our failings, and we help keep each other accountable.

我们谈论我们的财务状况，我们谈论我们的家庭、我们的友谊和我们的失败，我们帮助彼此承担责任。

I would just encourage parents, like, if this sounds daunting or overwhelming, you don't have to do this alone.

我只是鼓励父母，如果这听起来令人畏惧或难以承受，你不必独自完成这件事。

Think about one or two people, other parents, who you might want to do this with.

考虑一两个人，其他父母，你可能想和他们一起做这件事。

And I guarantee you there are a lot of us who are struggling with the same stuff, and they would probably welcome an opportunity to do this in collaboration with another parent.

我向你保证，我们很多人都在为同样的事情而苦苦挣扎，他们可能会欢迎有机会与另一位家长合作做到这一点。

Andrew Huberman: Such spectacular advice that I hope everyone will follow, not just for their kids, but for themselves.

安德鲁·胡伯曼（Andrew Huberman）：我希望每个人都能遵循如此精彩的建议，不仅为了他们的孩子，也为了他们自己。

I think that whether or not social media is addictive in the true sense of the word, is kind of a meaningless debate at this point.

我认为社交媒体是否具有真正意义上的成瘾性，在这一点上是毫无意义的争论。

It's at the very least a compulsive behavior for many of us.

对于我们许多人来说，这至少是一种强迫行为。

And as you described it in the example you gave, it becomes reflexive.

正如您在给出的示例中所描述的那样，它变得具有反射性。

Yes, we're not necessarily seeking pleasure or looking to engage in online battles.

是的，我们不一定是在寻求快乐或希望参与在线战斗。

It's become reflexive.

它已经成为反射性的。

Sort of like finding yourself with your hand in the refrigerator.

有点像发现自己的手伸进了冰箱。

Just even think about it.

甚至想一想。

You're just doing it.

你只是在做而已。

So becoming more conscious of the use and thereby more conscious of the value of putting away the screens and social media for extended periods of time each day.

因此，我们更加意识到使用屏幕和社交媒体的重要性，从而更加意识到每天长时间收起屏幕和社交媒体的价值。

And certainly in the middle of the night, folks, neuroplasticity brain rewiring happens in the middle of the night while you're asleep.

当然，在半夜，伙计们，大脑的神经可塑性重新布线发生在半夜你睡着的时候。

And when you mentioned kids awake in the middle of the night looking at their phone, I saw you flinch.

当你提到孩子们半夜醒来看手机时，我看到你退缩了。

Oh my goodness.

哦，我的天啊。

It pains me.

这让我很痛苦。

And I've looked at my phone in the middle of the night.

我也曾在半夜看手机。

I try not to, but I'm certainly not in the window of maximum plasticity either.

我尽量不这样做，但我当然也不处于可塑性最大的时期。

It's terrible for everybody, but especially terrible for kids.

这对每个人来说都很可怕，但对孩子来说尤其可怕。

What you just provided is an incredible, let's just call it, I'll call it a mandate.

你刚才提供的内容令人难以置信，我们就称之为授权吧。

You didn't say it, but a suggestion of teaming up with people to become more like minded around these issues and to really promote health.

您没有这么说，而是建议与人们合作，在这些问题上达成更多共识，并真正促进健康。

Along those lines.

沿着这些思路。

I really want to thank you, first of all, for the conversation today.

首先，我真的要感谢你今天的谈话。

You're incredibly busy.

你真是太忙了。

You're responsible for an entire country's worth of people.

你对整个国家人民的价值负责。

So to take time to sit down with me and to discuss these topics for our audience is incredibly appreciated by me and by them.

因此，我和他们都非常感谢花时间与我坐下来为我们的观众讨论这些话题。

I feel comfortable extending their gratitude here.

我很乐意在这里表达他们的谢意。

And it's also clear, based on today's conversation, that you face an enormous number of challenges at the level of budgetary challenges.

根据今天的谈话，很明显，你们在预算方面面临着巨大的挑战。

By the way, I'm going to work on that.

顺便说一句，我会努力解决这个问题。

It's hard to shut me up, as well as the huge array of issues that you confront.

很难让我闭嘴，也很难让你闭嘴。

And it's clear that it's a challenge that you've embraced for many years now under difficult conditions and that you're clearly willing to get out and talk to people and hear their criticism, hear their concerns and learn from them.

很明显，这是您多年来在困难条件下接受的挑战，并且您显然愿意走出去与人们交谈，听取他们的批评，听取他们的担忧并向他们学习。

And so it's been of great benefit to us to hear and learn from you.

因此，听到您的声音并向我们学习对我们来说非常有益。

And I hope this won't be the last of our conversations.

我希望这不会是我们的最后一次谈话。

There's many more topics to cover.

还有很多话题需要讨论。

But I just really want to thank you.

但我真的只是想谢谢你。

Thanks ever so much for the intellectual power and the emotional power that you put into what you do, because that is very clear.

非常感谢你在所做的事情中投入的智力和情感力量，因为这是非常明确的。

You're a physician first and you care about your patients, and your patients are all of us.

您首先是一名医生，您关心您的患者，而您的患者就是我们所有人。

So thank you so much.

非常感谢。

Vivek Murthy: Andrew, that's just incredibly kind of you.

Vivek Murthy：安德鲁，你真是太好了。

Thank you.

谢谢。

I appreciate that.

我很欣赏这一点。

And I've loved our conversation.

我很喜欢我们的谈话。

And for me, what I hope most of all for my kids, for our country more broadly, is that we can go deeper.

对我来说，我最希望的是我的孩子们，更广泛地说，我们的国家，我们可以走得更远。

Like beneath these surface issues.

就像这些表面问题的背后一样。

I worry that we find ourselves disagreeing about and fighting about online and recognize that there is a deeper challenge that we are facing, that I think underlies a lot of the anger and the vitriol.

我担心我们发现自己在网上存在分歧和争吵，并认识到我们面临着更深层次的挑战，我认为这是许多愤怒和尖酸刻薄的根源。

And this issue around how disconnected we've become from one another, I think is at the heart of that.

我认为这个问题的核心是我们彼此之间的脱节程度。

I don't think that there's any policy or program we can implement that's going to ultimately fix what ails society without fundamentally realizing that a lot of this is a manifestation of a society that has become more disconnected and more disinvested in one another over time.

我不认为我们可以实施任何政策或计划来最终解决社会的问题，除非我们从根本上意识到，这在很大程度上是一个社会随着时间的推移变得更加脱节和相互投资减少的表现。

And that's just not who we are.

我们不是这样的人。

It's not how we evolved over thousands of years, and it's not how we're going to thrive in the future.

这不是我们几千年来的进化方式，也不是我们未来的繁荣发展方式。

So I know that sometimes when you look at these big, intractable problems, like widespread loneliness in the United States, that it can seem hard to address these.

所以我知道，有时当你看到这些大而棘手的问题时，比如美国普遍存在的孤独感，你会发现这些问题似乎很难解决。

But I do want to encourage everyone to recognize that when it comes to human connection, that it is small steps that can make a big difference, because we are hardwired to connect as human beings.

但我确实想鼓励每个人认识到，当谈到人际关系时，小步骤可以产生大影响，因为我们生来就需要与人沟通。

And if you just pause for a moment, and if you just think for a moment in your own life about someone who has been there for you during a time of great need, somebody who has stood up for you and you couldn't stand up for yourself, someone who's helped to remind you of why you're still a good person.

如果你停下来一会儿，如果你在自己的生活中想一想，有人在你最需要帮助的时候一直在你身边，有人在你无法为自己挺身而出时为你挺身而出，有人帮助提醒你为什么你仍然是一个好人。

Why you still have worth and value to add to the world, even when you have lost faith in yourself.

为什么即使你对自己失去了信心，你仍然有为世界增添价值和价值。

When you think about their faith in you, about their support for you, about their love for you, think about how healing that was.

当你想到他们对你的信心、对你的支持、对你的爱时，想想这是多么治愈的事情。

That's the power that we have to help each other heal.

这就是我们帮助彼此治愈的力量。

We are going through an identity crisis in many ways as a country where I think we need to ask ourselves, who are we?

作为一个国家，我们在很多方面都经历着身份危机，我认为我们需要问自己，我们是谁？

Like, what defines who we are?

比如，什么定义了我们是谁？

What is the set of values that we want to guide us in our life and to guide our country?

我们想要指导我们的生活和我们的国家的价值观是什么？

And I know that it feels like we're a nation of people who are mean, who only care about ourselves, who are throwing blame and anger at each other all the time, who are pessimistic about the future.

我知道，我们这个国家的人民都很刻薄，只关心自己，总是互相指责和愤怒，对未来感到悲观。

But I actually don't think that's really who we are.

但实际上我并不认为我们就是这样的人。

I think at our heart, we are hopeful and optimistic people.

我认为在我们内心深处，我们都是充满希望和乐观的人。

I think in our true nature, we are kind and generous to one another.

我认为，在我们的本性中，我们彼此友善、慷慨。

In our hearts, we're interdependent creatures who recognize that if someone else is suffering, we want to be out there to support them and who want people to be there to support us as well.

在我们心中，我们是相互依存的生物，我们认识到如果其他人正在受苦，我们希望在那里支持他们，并且希望人们也在那里支持我们。

That's who we really are.

这就是我们真正的样子。

But we have to make a clear choice here about our identity as individuals and as a country and recognize that that choice has real implications for everything else that we're talking about here.

但我们必须在这里对我们作为个人和国家的身份做出明确的选择，并认识到这一选择对我们在这里讨论的其他一切都有真正的影响。

That's the foundation.

这就是基础。

And when I think about my own kids growing up, like many parents, I worry about the world that they're coming into.

当我想到自己的孩子成长时，像许多父母一样，我担心他们即将进入的世界。

I worry that they're going to use the wrong word, even though their intentions are right and people are going to blame them or cast them out.

我担心他们会使用错误的词，即使他们的意图是正确的，人们会责备他们或驱逐他们。

I worry that they're going to stumble and fall down and people are just going to keep walking by, not caring, because everyone's living their own life.

我担心他们会绊倒并摔倒，而人们只是继续走过去，而不关心，因为每个人都过着自己的生活。

I worried that they might become someone who does the same thing to other people.

我担心他们可能会成为对其他人做同样事情的人。

None of which I want.

没有一个是我想要的。

What I want for all of our kids is for them to grow up in a society where we care about one another.

我希望我们所有的孩子都能在一个我们互相关心的社会中成长。

We have each other's backs.

我们有彼此的支持。

We recognize, as that old African proverb goes, that we can go fast if we go alone, but if we really want to go far, we go together.

我们认识到，正如那句古老的非洲谚语所说，如果我们单独行动，我们可以走得很快，但如果我们真的想走得更远，我们就一起走。

And that's what I want for my kids in our country.

这就是我希望我的孩子在我们国家得到的。

But that's what we each have the power to create in our own lives.

但这就是我们每个人都有能力在自己的生活中创造的东西。

It starts with the decisions we make, but how we treat one another.

它始于我们做出的决定，以及我们如何对待彼此。

Do we, for example, reach out for five minutes a day to someone that we care about?

例如，我们是否每天与我们关心的人联系五分钟？

Do we pick up the phone and call them to say, hey, I'm thinking about you?

我们是否会拿起电话告诉他们，嘿，我在想你？

We can all do that today.

今天我们都可以做到。

Do we give people the benefit of our full attention, recognizing that while time is scarce, our attention has the ability to stretch time.

我们是否让人们受益于我们的全部注意力，认识到虽然时间稀缺，但我们的注意力有能力延长时间。

It can make five minutes feel like half an hour, but it's a hard thing for people to get because they're distracted by their devices.

它可以让五分钟感觉像半个小时一样，但对于人们来说这是一件很难的事情，因为他们被他们的设备分散了注意力。

But do we give people the benefit of our full attention?

但我们是否给予人们充分关注的好处呢？

And do we look for ways to serve one another, recognizing it's through our acts of service that we actually forge powerful connections?

我们是否正在寻找相互服务的方法，认识到正是通过我们的服务行为，我们才真正建立了强大的联系？

But we also remind ourselves of how much value we have to bring to the world.

但我们也提醒自己，我们必须为世界带来多少价值。

And this is important in a time when the self esteem of so many of us, and our young people in particular, is being eroded, particularly by their use of social media.

在我们很多人，尤其是年轻人的自尊受到侵蚀（尤其是由于社交媒体的使用）而受到侵蚀的时代，这一点非常重要。

So these are the steps that we can take to build connection in our life.

因此，这些是我们可以采取的在生活中建立联系的步骤。

But the core values, I believe, have to be at the heart of our identity.

但我相信，核心价值观必须成为我们身份的核心。

These values around kindness and generosity, around courage and service, these also have to animate the decisions that we make in our life, about programs we advocate for, the policies we support, the leaders we choose.

这些围绕善良和慷慨、勇气和服务的价值观，也必须激励我们在生活中做出的决定、我们倡导的计划、我们支持的政策、我们选择的领导人。

These should all be reflections of the values that we want to see in our children and in society more broadly.

这些都应该反映我们希望在我们的孩子和更广泛的社会中看到的价值观。

Because I'll tell you that 90% plus of the decisions leaders make, they make behind closed doors.

因为我会告诉你，领导者做出的 90% 以上的决策都是闭门做出的。

And what's guiding them in those moments are their values.

在那些时刻引导他们的是他们的价值观。

That's true whether you're the leader of a company or a nonprofit organization or a leader in government.

无论您是公司领导者、非营利组织领导者还是政府领导者，都是如此。

So those values matter.

所以这些价值观很重要。

And I want us, as a country, to speak more about the values that we choose, about the identity that we want to anchor ourselves to.

我希望我们，作为一个国家，更多地谈论我们选择的价值观，以及我们想要锚定的身份。

That's the way in which I feel like America can be an even greater beacon of hope for the world, because the world is struggling with this, too.

这就是我觉得美国可以成为世界更大希望的灯塔，因为世界也在为此奋斗。

We're not the only ones who are dealing with loneliness and isolation, who are seeing anger and resentment and vitriol bubble up at extraordinary levels, who are seeing mistrust in institutions soar.

我们并不是唯一面临孤独和孤立的人，我们不是唯一看到愤怒、怨恨和尖酸刻薄的人，也不是唯一看到对机构的不信任激增的人。

Many countries are experiencing this.

许多国家正在经历这一点。

I would love America to lead the way, in some ways, in showing what it's like to embrace a more human identity that's centered around kindness and service and friendship and generosity.

我希望美国在某些方面发挥带头作用，展示拥抱以仁慈、服务、友谊和慷慨为中心的更加人性化的身份是什么样的。

To me, all of these values, ultimately, Andrew, stem from love.

对我来说，安德鲁，所有这些价值观最终都源于爱。

Love is our greatest source of power.

爱是我们最大的力量源泉。

It's our greatest source of healing.

这是我们最大的治愈源泉。

I see that as a doctor who's prescribed many medicines over the years.

我作为一名多年来开了很多药的医生看到了这一点。

But there are a few things more powerful than love and its ability to help us through difficult times and help mend the wounds seen and unseen, that we all carry with us.

但有一些东西比爱更强大，它能够帮助我们度过困难时期，帮助治愈我们所有人都带着的可见和不可见的伤口。

And I think if we recognize that, we recognize that, you know what?

我认为如果我们认识到这一点，我们就认识到这一点，你知道吗？

We don't have to have an MD after our name or have gone to nursing school to be healers.

我们不必在名字后面加上医学博士或上过护士学校才能成为治疗师。

We all have the power to help each other heal, Andrew.

我们都有能力帮助彼此治愈，安德鲁。

We are not fundamentally a nation of bystanders who just stand by while other people suffer like we're a nation of healers and hopemakers who can restore hope, that the future can be better, who can create a better life for ourselves and the people around us right now.

从根本上说，我们不是一个旁观者的国家，当其他人受苦时，我们只是袖手旁观，就像我们是一个治疗师和希望制造者的国家一样，我们可以恢复希望，未来可以更美好，可以为我们自己和我们周围的人创造更好的生活。

It's what we're capable of.

这就是我们的能力。

It's what we're built for.

这就是我们的目的。

That's the identity that I think we now more than ever need to embrace.

我认为我们现在比以往任何时候都更需要拥抱这种身份。

Andrew Huberman: Amen.

安德鲁·休伯曼：阿门。

Thank you for that.

谢谢你。

I agree.

我同意。

Love is definitely the verb that can get us where we need to go.

爱绝对是一个动词，可以让我们到达我们需要去的地方。

Thank you so much for your words, for your incredible efforts to support public health and hopefully to continue to support public health.

非常感谢您的发言，感谢您为支持公共卫生所做的令人难以置信的努力，并希望继续支持公共卫生。

I know you've been at this a long time and we have all benefited.

我知道您已经从事此工作很长时间了，我们都受益匪浅。

And thanks for your open mindedness, especially around some of the questions that invoke some challenge, and again, for your taking the time to come talk with us today.

感谢您的开放态度，特别是在一些引发挑战的问题上，再次感谢您今天抽出时间与我们交谈。

And I really also enjoyed it.

我也真的很喜欢它。

It's been a real pleasure and there was a lot of learning for me.

这真是一种乐趣，我学到了很多东西。

And like I said before, I hope it won't be the last time.

正如我之前所说，我希望这不会是最后一次。

Vivek Murthy: I hope not either.

Vivek Murthy：我也希望不会。

Now I look forward to the next time, to staying in touch and just love this conversation.

现在我期待下一次，保持联系并喜欢这次谈话。

Thank you for what you've done, for being this beautiful channel of information for the public.

感谢您所做的一切，感谢您为公众提供了这个美丽的信息渠道。

But most importantly, thank you for who you are.

但最重要的是，感谢你是谁。

Who you are, Andrew, comes across very clearly when I meet you.

当我见到你时，安德鲁，你是谁，我就很清楚了。

You have a good heart and you have good intentions.

你有一颗善良的心，你有良好的意愿。

You're a good man, and we need more people like you in the world.

你是一个好人，我们需要世界上更多像你这样的人。

Andrew Huberman: Thank you.

安德鲁·休伯曼：谢谢。

Right back at you.

就回到你身边。

Thank you for joining me for today's discussion with Dr. Vivek Murthy, the Surgeon General of the United States.

感谢您参加今天与美国外科医生维韦克·穆尔蒂 (Vivek Murthy) 博士的讨论。

I hope you found it to be as informative as I did.

我希望您发现它和我一样提供了丰富的信息。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习和/或喜欢此播客，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、零成本的方式。

In addition, please subscribe to the podcast on both Spotify and Apple.

此外，请在 Spotify 和 Apple 上订阅该播客。

And on both Spotify and Apple you can leave us up to a five star review.

在 Spotify 和 Apple 上，您都可以给我们留下五星级的评价。

If you have questions for me or comments about the podcast or topics or guests that you'd like me to cover on the Huberman Lab Podcast, please put those in the comments section on YouTube.

如果您对我有疑问，或者对您希望我在 Huberman 实验室播客上报道的播客或主题或嘉宾有意见，请将这些意见放入 YouTube 的评论部分。

I do read all the comments.

我确实阅读了所有评论。

In addition, please check out the sponsors mentioned at the beginning and throughout today's episode.

此外，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。

Not on today's episode, but on many previous episodes of the Huberman Lab podcast, we discuss supplements.

不是在今天的节目中，而是在 Huberman Lab 播客的许多之前的节目中，我们讨论了补充剂。

While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like improving sleep, for hormone support, and for focus.

虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如改善睡眠、激素支持和注意力集中。

The Huberman Lab podcast has partnered with Momentous Supplements, and we did that for several reasons.

Huberman Lab 播客与 Momentous Supplements 合作，我们这样做有几个原因。

First of all, their ingredients are of the very highest quality.

首先，他们的原料都是最高品质的。

Second of all, they tend to focus on single ingredient formulations, which make it easy to develop the most cost effective and biologically effective supplement regimen for you.

其次，他们倾向于专注于单一成分配方，这使得您可以轻松地为您开发最具成本效益和生物有效的补充方案。

And third, Momentous Supplements ship internationally, which we realize is important because many of you reside outside of the United States.

第三，重要补充剂在国际范围内运送，我们意识到这一点很重要，因为你们中的许多人居住在美国境外。

To see the supplements discussed on the Huberman Lab podcast, go to livemomentous, spelled O-U-S.

要查看 Huberman Lab 播客上讨论的补充内容，请访问 livemomentous（拼写为 O-U-S）。

So it's livemomentous.com/huberman.

所以它是 livemomentous.com/huberman。

If you're not already following me on social media, you can do so by going to Huberman Lab on all social media platforms.

如果您还没有在社交媒体上关注我，您可以通过所有社交媒体平台上的 Huberman Lab 来关注我。

So that's Instagram, Twitter, now called X, LinkedIn, Facebook, and Threads.

这就是 Instagram、Twitter（现在称为 X）、LinkedIn、Facebook 和 Threads。

On all of those platforms I cover 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 content covered on the Huberman Lab podcast.

在所有这些平台上，我介绍了科学和科学相关工具，其中一些与 Huberman Lab 播客的内容重叠，但其中大部分与 Huberman Lab 播客中涵盖的内容不同。

Again, that's Huberman Lab on all social media platforms.

再说一次，这就是所有社交媒体平台上的 Huberman Lab。

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 toolkits.

如果您尚未订阅我们的神经网络新闻通讯，神经网络新闻通讯是一份零成本的每月新闻通讯，其中包括播客摘要和工具包。

So toolkits for sleep, toolkits for learning and plasticity, toolkits related to dopamine regulation, and much more.

因此，睡眠工具包、学习和可塑性工具包、与多巴胺调节相关的工具包等等。

Again, it's all zero cost.

再说一次，这一切都是零成本。

You simply go to hubermanlab.com, go to the menu tab, scroll down to newsletter, and simply enter your email.

您只需访问 hubermanlab.com，转到菜单选项卡，向下滚动到时事通讯，然后输入您的电子邮件即可。

And we do not share your email with anybody.

我们不会与任何人分享您的电子邮件。

Thank you once again for joining me for today's discussion with the US Surgeon General, Dr. Vivek Murthy.

再次感谢您参加今天与美国卫生局局长 Vivek Murthy 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。