药物故事：伊维菌素

这是《99% 隐形》。

This is 99% Invisible.

我是罗曼·马尔斯。

I'm Roman Mars.

每一种疾病、不适或病症，都对应着一种药物。

For every disease, illness, or discomfort, there is a drug.

药物多得数不清。

There are so many drugs.

有些药看似能创造奇迹、改变世界，而有些药则被用来对抗某种疾病长达数十年，最后才发现它们几乎毫无作用。

Drugs that seemingly work miracles and change the world and drugs that are put in the service of fighting a malady for decades only to learn much too late that they have almost no effect at all.

你可以通过我们服用的药物，以及这些药物旨在控制的疾病，来讲述整个世界的故事。

You could tell the story of the world through the drugs we take and the diseases they are designed to manage.

新播客《药物故事》讲的正是这个。

This is what the new podcast Drug Story is all about.

在这档节目中，创作者兼主持人托马斯·戈尔茨每次聚焦一种药物，讲述医药产业背后的故事。

On the show, creator and host Thomas Goetz tells the story of the disease business one drug at a time.

每集聚焦一种疾病和一种药物。

Each episode explores one disease and one drug.

药物成了我们观察这个世界的一扇绝佳窗口。

Drugs end up being an incredible lens to view our world.

本周我们带来《Drug Story》的一集，这是一档独立的纪实类播客，如今这种类型的节目已经很少见了，却绝对值得你认真听一听。

This week, we are featuring an episode of Drug Story, an independent documentary journalism podcast, the kind of podcast you just don't hear about anymore and one that deserves your full attention.

真的特别棒。

It is so good.

我每一集都听过了。

I've listened to every episode.

这是我的最爱之一。

Here's one of my favorites.

想象一下，每天皮肤瘙痒，一刻不停。

Imagine living with constant itching that never stops.

或者视力慢慢衰退，不是因为年纪大了，而是被一只小小的苍蝇叮了一口。

Or slowly losing your sight, not because of age, but because of a simple fly bite.

这就是盘尾丝虫病的现实，也叫河盲症。

That is the reality of onchosarcoidosis, Also known as river blindness.

只要每年服用一到两次这种小小的药片。

One small tablet of ivermectin.

就能阻断传播，保护整个社区。

Taken once or twice a year helps stop transmission and protects entire communities.

这就是瘙痒停止的方式。

This is how itching stops.

这就是预防失明的方法。

This is how blindness is prevented.

这就是一代人远离河盲症成长起来的途径。

And this is how a generation grows up free from river blindness.

想象一下，你是一条蠕虫，一种特别的蠕虫——盘尾丝虫。

Imagine that you are a worm, a very specific kind of worm, unco cerca volvulus.

你一生的目标、使命、唯一的目的，就是钻进人体里。

Your goal in life, your mission, your only purpose is to worm your way into the human body.

你是个寄生虫。

You are a parasite.

你得靠人体才能活下来，才能繁衍。

You need the human body to survive and to thrive.

人类当然不会喜欢你。

Humans, perhaps understandably, do not care for you.

他们咒骂你和你的幼虫，尤其是幼虫，因为一旦进入人体，它们就会到处乱窜。

They curse you and your larvae, your larvae especially, because once they get into humans, they squirm everywhere.

它们钻进腿里，让人痒得受不了，那种痒简直让人发疯。

They crawl into legs, and they cause unbelievable itching, horrible, infernal itching.

一旦它们爬进眼睛，人就会失明。

And when they writhe into the eyes, humans go blind.

几个世纪以来，人类除了恨你，别无他法。

For centuries, there was nothing humans could do but spite you.

但后来，他们发现了一种药片，一种能杀死你宝贝的药。

But then they found a pill, a horrible pill that kills your darlings.

这种药，伊维菌素，让寄生虫的日子非常不好过。

This pill, ivermectin, makes life very difficult for a parasite.

欢迎来到《药物故事》。

Welcome to Drug Story.

我是托马斯·戈尔茨。

I'm Thomas Goetz.

今天要讲的药是伊维菌素，它真是一种神药，堪称奇迹般的疗法。

Today's drug is ivermectin, which truly is a wonder drug, a veritable miracle cure.

它对杀死引发河盲症或象皮病的寄生虫特别有效。

It is really, really good at killing parasites that cause diseases like river blindness or elephantiasis.

这些热带病主要发生在非洲、南美洲或亚洲部分地区。

These tropical diseases mostly happen in Africa or South America or parts of Asia.

伊维菌素对钩虫也有效，一个世纪前，钩虫病在美国南部非常普遍。

Ivermectin is also effective against hookworm, which a century ago was endemic in the Southern United States.

它对心丝虫也管用，能保护狗、猫等宠物，还能杀死马和其他家畜体内的寄生虫。

And it's good on heartworm, which affects pets, dogs, and cats, and it kills parasites in horses or other livestock.

但在美国，现在人们提到伊维菌素，大概不是因为它能治疗河盲症，而是别的用途。

But in The United States, these days, you have probably heard of ivermectin not as a treatment for river blindness, but for different purposes altogether.

我刚做了一次驱虫疗程。

I just did a parasite cleanse.

我真没想到自己会说出这种话。

I never thought those words would come out of me.

真有东西从我身体里排出来了。

Things literally came out of me.

我上次病得很重的时候，就用过伊维菌素。

I've used Ivermectin when I was really sick with

我得承认。

I have to.

是的。

Yeah.

说实话，我觉得吧，我看过不少研究。

And honestly, I actually think, you know, I've seen a lot of studies.

我觉得一年用一两次来清理身体，其实也没什么坏处。

I think that it's probably not a bad idea to use it once or twice a year to cleanse it out of your body.

对吧？

Right?

没错。

Right.

我的一些病人会用伊维菌素来预防病毒感染。

Some of my patients will take Ivermectin as a prevention for viral illnesses.

完全没问题。

Totally fine.

非常安全。

Totally safe.

我用的是每12小时一次，每次12毫克，连续七天。

I use Ivermectin for twelve by twelve, seven days, which is every twelve hours, twelve milligrams for seven days.

这么用是因为最近越来越多的研究都在说伊维菌素有抗癌作用。

And the reason is all the literature that's coming out about Ivermectin as an anticancer.

你知道自己体内可能有寄生虫吗？该怎么清除呢？

You know if you have a hidden parasite and how do you get rid of it?

他们建议做一次驱虫排毒，不过这事你得咨询自己的医生，因为我没有行医执照。但我自己确实会服用伊维菌素和苯并咪唑。

They recommend doing a parasitic detox, which you should talk to your own doctor about because I am not licensed to practice medicine, but I do take a form of ivermectin and venbendazole.

所以，没错，我查了下谷歌，现在YouTube上已经有成千上万条视频在大力推荐伊维菌素。

So, yeah, Google tells me that right now there are many tens of thousands of videos on YouTube raving about ivermectin.

但癌症、驱虫排毒、还有病毒？

But cancer, parasite cleanses, and viruses?

这到底是个什么药？

What is this drug?

伊维菌素到底起什么作用？

What does ivermectin do really?

在本期《药物故事》中，我们要讲讲伊维菌素——这种神奇的药物。

In this episode of Drug Story, we're going to tell the story of ivermectin, this amazing medicine.

我们会聊很多关于寄生虫的事，也会深入探究，为什么那么多人在YouTube和Instagram上热议伊维菌素，他们希望它能治什么，又相信它对什么有效。

We are going to talk about parasites a lot, and we will dig into what got all those people on YouTube and Instagram talking about Ivermectin, what they hope it could be, what they believe it works on.

不只是寄生虫病，连新冠这样的病毒性疾病，甚至癌症，如果真有证据表明它对这些病有效，那就太好了。

Not just parasitic diseases, but viral diseases like COVID or even cancer, which would be great if there's, you know, evidence that it actually works for those other diseases.

今天我们会以开放的心态、敞开的笔记本，以及对科学的开放态度，来探讨这个问题，接下来是《药物故事》。

We're going to explore that today with an open mind, an open notebook, and an open door to science in the drug story ahead.

我们每期节目都分三部分：诊断、处方和副作用。

We tell each episode in three parts, the diagnosis, the prescription, and side effects.

这是第一部分——诊断，我们会深入探讨这种药物背后的疾病，或者更准确地说，这些疾病。

This is part one, the diagnosis, where we explore the disease behind the drug, or in this case, the diseases.

因为伊维菌素已被证实对多种疾病有效，而这些疾病有一个共同点。

Because ivermectin is proven to work on many diseases, diseases with one thing in common.

它们不是由细菌或病毒引起的，而是由一种动物——寄生虫引起的。

They are caused not by a bacteria or a virus, but by an animal, a parasite.

很多时候，这是一种叫做蠕虫的生物。

Oftentimes, it's a type of worm called a helminth.

从技术上讲，寄生虫是指生活在其他生物体内或体表，并以它为生的生物。

Now technically speaking, a parasite is an organism that lives inside or on another creature and feeds off of it.

蜱虫是寄生虫，虱子也是，还有那种吃舌头的虱子。

A tick is a parasite, so are lice, as is the tongue eating louse.

就是这种小甲壳类动物。

That's this little crustacean.

它跟虾是近亲，会游进鱼的鳃里，然后钻进鱼嘴里，把鱼的舌头吃掉。

It's a relative of a shrimp that swims into a fish's gills, winds its way into the mouth, and then eats the fish's tongue.

是的。

Yeah.

你猜怎么着。

And get this.

然后它就取代了那条舌头的位置。

It then takes the place of that tongue.

它待在鱼嘴里，像舌头一样帮鱼吃东西，偶尔还自己偷吃一口。

It lives there in the mouth, helping the fish eat just as a tongue would, but taking a nibble of food every now and again.

这就是寄生虫，朋友们。

That, my friends, is a parasite.

地球上可能有成千上万，甚至上百万种寄生生物。

There are thousands, maybe millions of parasites on Earth.

是的。

Yeah.

光是想想就让人浑身发毛。

It just makes your skin crawl.

事实上，还真有一种病叫妄想性寄生症，也叫妄想性寄生感染，患者会坚信自己身上有寄生虫。

In fact, there's actually a condition called delusional infestation, also called delusional parasitosis, where people are convinced that they have parasites.

你现在可能就有点这种感觉，好像有什么东西在皮肤上爬，袜子底下，或者衬衫里面。

You might feel a bit of this right now, feeling like something is crawling on your skin, under your socks, maybe under your shirt.

有点发痒。

It's a little itchy.

不过，寄生虫排毒疗法根本没用。

And, no, a parasitic cleanse is not the answer.

根本没有证据表明这些疗法有效。

There is no evidence that those cleanses work.

如果你真觉得有寄生虫，赶紧去看医生。

If you really think you have parasites, go see a doctor.

别自己瞎折腾。

Do not DIY this.

其实，自从有了人类，寄生虫就一直在悄悄侵入我们的身体，甚至更早以前就有了。

Anyway, parasites have been warming their way into the human body for as long as there have been humans even before.

就像鱼、鸟、狗和马都会感染寄生虫一样，我们也不例外。

Just as fish and birds and dogs and horses all get parasitic infections, so do we.

很多寄生虫病最初都起源于热带地区。

Many of these parasitic diseases started in the tropics.

从大约1492年算起，过去六百年间，随着殖民、迁徙和奴隶贸易，寄生虫病已经蔓延到全球各地。

Since about 1492, basically, over the past six hundred years of conquest and migration and slavery, parasitic diseases have spread around the world.

寄生虫无处不在。

Parasites are everywhere.

给你说个冷知识。

Here's a factoid.

美国疾病控制与预防中心设在佐治亚州亚特兰大，因为七十五年前，美国南部地区寄生虫病十分普遍。

The US Centers for Disease Control and Prevention is based in Atlanta, Georgia because seventy five years ago, parasitic diseases were common in the Deep South.

当时主要是疟疾，还有钩虫病。

It was mostly malaria, but also hookworm.

不如我们就从二十世纪初的美国南方开始讲起，说说钩虫的故事。

In fact, let's start our tale there in the Southern United States with a story about hookworms circa 1900.

查尔斯·斯蒂尔斯出生在纽约，曾在欧洲最顶尖的学府学习动物学。

Charles Stiles was born in New York and educated in the zoological sciences at the finest institutions in Europe.

斯蒂尔斯特别关注家畜身上的寄生虫，比如猪肉里的旋毛虫和牛体内的绦虫。

Stiles was particularly interested in parasites in livestock, like trichinosis in swine and tapeworm in cattle.

那时候，寄生虫研究——也就是寄生虫学——还是一门全新的医学领域。

At the time, the study of parasites, this is called parasitology, this was a brand new field of medicine.

人们发现，寄生虫会导致贾第虫病和疟疾这类疾病，而且相比细菌，寄生虫更容易被发现，有些甚至肉眼就能看到，不用显微镜。

Parasites, it was discovered, caused diseases like giardia and malaria, and compared to bacteria, parasites were easier to find, sometimes even visible to the naked eye without a microscope.

但这并不意味着它们更容易对付。

But that did not make them any easier to deal with.

大约在1900年，查尔斯·斯蒂尔斯受聘担任美国公共卫生服务局的首席动物学家。

So around 1900, Charles Stiles took a job as the chief zoologist for the US Public Health Service.

当他听说美国南方有人出现贫血、发育迟缓等问题时，他直觉这背后有寄生虫在作祟。

And when he heard about health problems in the American South, anemia, stunted growth, he had a hunch that parasites were involved.

于是斯蒂尔斯开始展开研究。

So Stiles began to research.

说实话，这事儿还真没别的说法。

Well, there's really no other way to say this.

他跑遍南方，挨家挨户收集人类粪便样本。

He went on a study of human shit across the South.

只要有人愿意配合，他就取样，很快他就确凿地证实了钩虫是导致广泛不适的元凶。

He took stool samples from everyone willing to let him, and soon he had definitively identified hookworms as a cause of widespread malaise.

根据这些粪便研究，他估算大约有百分之四十的南方人——无论黑白，几乎都是穷人——体内都携带着钩虫。

Based on his poop studies, he estimated that around forty percent of Southerners, whites and blacks, almost always poor, they carried hookworms.

他把这些寄生虫命名为美洲钩虫，意思是‘美洲杀手’。

He called these parasites, nekator americanus, which translates as American murderer.

这其实是个误称。

This was a misnomer, actually.

得钩虫病的人很少会死，但钩虫确实让日常生活变得糟糕透顶。

People rarely die of hookworm infections, but hookworms did make daily life much, much worse.

那时候，是二十世纪的最初几年。

At the time, this was the first years of the twentieth century.

在南方，穷就意味着几乎没有任何卫生条件。

To be poor in the South meant almost no sanitation.

没有自来水，没有厕所，连茅房都常常没有。

No running water, no toilets, often no outhouses.

人们随地大小便，哪儿方便就在哪儿，树林里、灌木丛后都行。

People pooped, well, wherever, in the woods, behind bushes.

大多数穷人不穿鞋，尤其是孩子。

And most poor people went without shoes, children especially.

那样做确实更省事。

It was just easier that way.

鞋子要花钱。

Shoes cost money.

这些条件最适合钩虫繁殖。

These were ideal conditions for the hookworm to prosper.

咱们从泥土说起。

Let's start in the dirt.

钩虫幼虫生活在土壤里，会钻进人的脚丫，迅速通过光脚的皮肤毛孔进入体内。

Hookworm larvae live in the soil and burrow through to reach their target, human feet, where they quickly slip into the pores of bare skin.

这可能会引起皮疹。

This might cause a rash.

当时叫它‘地痒’。

It was called ground itch.

但虫子已经进去了。

But the worm is in.

那些幼虫特别小，肉眼几乎看不见，接着就扭动着钻进毛细血管，进入血液循环。

The larvae, which are super tiny, scarcely visible to the human eye, they then wriggle their way into blood vessels and enter the bloodstream.

现在，旅程正式开始了。

And now the ride is on.

幼虫随着血液流到心脏，然后被泵送到肺部。

The larvae flow to the heart, and they are pumped out into the lungs.

这通常会引起咳嗽，而这正是钩虫所需要的。

This usually causes a cough, which is just what the hookworm needs.

因为每次咳嗽，钩虫都会被从肺部咳到嘴里，然后咕咚一声吞下去。

Because with every cough, the hookworm is forced out of the lungs into the mouth, and then, gulp, swallowed.

现在，钩虫总算安家了。

And now the worm is home free.

在小肠里，钩虫牢牢吸附在肠壁上。

In the small intestine, the worm latches onto the intestinal wall.

在那里，它靠吸血为生，最长也只能长到半英寸左右。

There, it feeds on blood and grows to just half an inch long at most.

成虫随后产下更多幼虫，随粪便排出体外，落在灌木丛附近的泥土里，等待下一双赤脚经过。

From there, the adult worm produces more larvae, which are expelled with a stool into the dirt past the bush where the worms wait for other feet to pass by.

于是，这个循环就这样持续下去。

And so the cycle continues.

不过咱们还是回到肠道里的成虫身上吧，抱歉，刚才跑题了。

But let's hook back, sorry, to the adult worms back in the intestines.

它们不断吸食宿主的血液，导致钩虫病引发贫血。

As they fester, sucking the blood out of their host, hookworms cause anemia.

这是一种因失血造成的严重且长期的缺铁状态。

That is a severe and chronic iron deficiency caused by blood loss.

贫血的症状包括乏力和极度疲倦。

Symptoms of anemia are weakness and extreme fatigue.

英语里有好多词来形容这种状态。

The English language is full of words to describe this.

怠惰、懒散、倦怠、萎靡、懒惰。

Indolence, sloth, lethargy, lassitude, laziness.

1902年，在华盛顿特区举行的泛美卫生大会上，查尔斯·斯蒂尔斯宣布了他的发现，并指出这种被称为‘美国杀手’的钩虫，可能与南方人特有的倦怠状态有关。

In nineteen o two, at the Pan American Sanitary Congress in Washington DC, Charles Stiles announced his discovery, and he noted that there might be a connection between this hookworm, the American killer, and the characteristic state of southern lassitude.

这事儿登上了头版头条。

And that became front page news.

《纽约太阳报》的标题赫然写着：懒惰的病原体被找到了。

The headline in the New York Sun screamed, germ of laziness found.

那时候，说南方人——尤其是白人南方人——懒惰，这种刻板印象很普遍。

At the time, this stereotype of a lazy southerner, especially white southerners, it was commonplace.

北方正疯狂工业化，南方却依然以农村为主。

As the North expanded in a frenzy of industrialization, the South was still overwhelmingly rural.

贫穷的白人南方人被看不起，说他们没干劲、反应慢，这种刻板印象正好和对黑人懒惰的种族歧视吻合。

Poor white southerners were scorned as unmotivated and slow, and the stereotype lined up neatly with racial slurs about lazy black people.

而这种污名化的影响更持久。

And that has been an even more enduring smear.

于是，查尔斯·斯蒂尔斯找到了他的使命。

So Charles Stiles had found his cause.

但治疗方案又在哪里呢？

But what about the cure?

一旦关于懒惰病菌的头条新闻过去，就没人再对跟进斯蒂尔斯的研究、解决钩虫问题感兴趣了。

Once the germ for laziness headlines faded, no one seemed that interested in following up on Stiles' work to do anything about the hookworms.

虽然可能有百分之四十的人口受影响，但钩虫病主要困扰的是最穷的人，尤其是黑人。

It may have affected forty percent of the population, sure, but hookworm was mostly an affliction of the very poor and often blacks.

别忘了，那是吉姆·克劳法时代的南方，根本谈不上什么进步。

Remember, this was the Jim Crow era South, not a time of great progress.

所以，这对刚起步的美国公共卫生服务和正在崛起的国家来说，根本不是优先事项。

So this was just not a priority for the fledgling US public health service or the growing nation.

于是，斯蒂尔斯开始四处奔走、演讲，宣传他觉得应该采取的措施。

So Stiles started stumping and lecturing about what he thought should be done.

他说，我的兴趣可以概括为两个字：清洁。

He said, my hobby may be summarized in the two words, clean up.

在我们美国人日常生活中那些肮脏的习惯里，我看到的可预防疾病和可预防死亡，比任何其他单一因素都要多。

In our filthy American habits of daily life, I see the cause of more preventable sickness and preventable death than I do in any other one factor.

最终，在1908年，斯蒂尔斯联系上了约翰·D·洛克菲勒的顾问团队——标准石油公司的创始人，当时美国最富有的人。

Eventually, in nineteen o eight, Stiles hooked up, sorry, with advisers to John d Rockefeller, the founder of the Standard Oil Company and the richest person in The United States at the time.

洛克菲勒愿意用他的财富投身公益事业，而斯蒂尔斯的工作正好契合这一目标。

Rockefeller was interested in putting his wealth towards philanthropy, and Stiles' work fit the bill.

很快，就成立了一个洛克菲勒卫生委员会，专门致力于根除美国南部的钩虫病。

Soon, there was a Rockefeller sanitary commission dedicated to eradicating hookworm in the Southern United States.

这个机构后来发展成了洛克菲勒基金会。

This would later become the Rockefeller Foundation.

斯蒂尔斯和洛克菲勒团队提出了三项对抗钩虫病的策略。

Stiles and the Rockefeller team identified three strategies to fight hookworm.

第一，感染的人要用百里香酚进行治疗。

First, infected people were to be treated with thymol.

这是一种天然存在的消毒剂，配合泻盐来杀死并排出体内的寄生虫。

This was a naturally occurring chemical used as a disinfectant, and Epsom salt to kill and purge the worms.

这个过程会让人大量呕吐和腹泻，但通常在24小时内就能清除体内的寄生虫。

This involved a lot of vomiting and diarrhea, but it usually worked to rid a body of worms within twenty four hours.

第二，他们发起了一场建造厕所的运动。

Second, they went on an outhouse building campaign.

当时有估计称，35%的白人家庭和75%的黑人家庭连厕所都没有。

One estimate at the time held that 35% of white households and 75% of black households had no privies.

这种情况必须改变。

That would have to change.

目标是为每户人家建一个带至少四英尺深坑的厕所。

The goal was to build an outhouse for every home with a pit at least four feet deep.

第三点，穿鞋。

Third, shoes.

这可是个不小的观念转变。

Now this was a big cultural change.

南方的孩子平时很少穿鞋，夏天尤其如此，但鞋子能防止寄生虫入侵。

Children in the South rarely wore shoes, especially in the summer, but shoes keep the worms out.

灭钩虫运动很快取得了进展。

The hookworm campaign quickly took off.

各州政府也参与了进来。

State governments got engaged.

在洛克菲勒资金的支持下，许多南方州成立了卫生委员会，并加强了公共卫生部门。

With Rockefeller money, many Southern states established sanitary commissions and better state departments of health.

很快，人们开始讨论建立一个更广泛的国家级公共卫生服务体系，借由钩虫运动的成功经验，推动全国范围内的卫生与医疗改善。

Soon, there was talk of an expanded national public health service, one that could build on the success of the hookworm campaign and advance sanitation and health care across the land.

洛克菲勒联盟把这包装成一场拯救乡村生活方式的运动，但其实他们是在要求人们改变生活方式、居住环境、穿着习惯和饮食方式。

The Rockefeller coalition framed this as a movement for the conservation of country life, but they were really demanding that people change how they lived, where they lived, what they wore, how they ate.

唯有改变才能遏制疾病，但很多人并不喜欢这么多改变。

Change was the only way to keep disease at bay, and many people did not like all that change.

这时，国家医疗自由联盟出现了。

Enter the National League of Medical Freedom.

这个反对组织抨击科学医学，主张人们应该有自由选择任何他们认为有效的疗法，联邦政府不该偏袒某种医学而贬低其他形式。

This opposition group condemned scientific medicine, arguing that people should be free to pursue whatever form of treatment they believed best and that the federal government should steer clear of endorsing certain kinds of medicine as more worthy than others.

该联盟的资金来自顺势疗法医生、整骨疗法医生以及其他替代医学从业者。

The league was funded by homeopaths, osteopaths, and others in the alternative medicine business.

起初，他们的策略确实奏效了。

At first, it worked.

该联盟及其后续组织——美国医学自由联盟，成功拖延了所谓‘医学章鱼’——一个更强大的全国性卫生机构——的成立。

The league and a successor group, the American Medical Liberty League, they managed to delay approval of what was called the medical octopus, a stronger national health organization.

但到了新政时期，加上20世纪30年代更有效的药物和疗法出现，反对声音逐渐减弱，尽管并未完全消失。

But by the time of the New Deal and more effective drugs and treatments in the nineteen thirties, the opposition faded, though it did not disappear.

那种以维护医疗自由为名，对抗主流医学的理念，听起来是不是有点耳熟？

That idea of defending medical freedoms against mainstream medicine, does that sound familiar?

这种想法从未真正消亡。

That idea would not die.

它至今依然存在。

It has not died.

现在，我们再回到钩虫病的话题。

So now back to hookworm.

到20世纪50年代左右，美国南部的钩虫病基本被消灭了，虽然南方部分地区仍偶有发生，而且在全国各地的狗、猫和马身上依然可见。

That was eliminated in the Southern US more or less by the nineteen fifties, though it's not entirely gone from the South, and it still appears in dogs and cats and horses nationwide.

遗憾的是，钩虫病在世界许多地方依然普遍，这让我们不得不谈到另一种寄生虫。

And hookworm is still sadly common around the world, which takes us to another worm.

让我们把目光转向非洲，来看看另一种寄生虫病——河盲症。

Let's follow our drug story to Africa to meet another parasitic disease, river blindness.

在撒哈拉以南非洲的村庄里，像加纳、尼日利亚和喀麦隆这些国家的人们，生活离不开河流，因为吃的、喝的、干活的地方都在河边。

In the villages of Sub Saharan Africa, in countries like Ghana, Nigeria, and Cameroon, people depend on rivers because that is where the food is, where the water is, that's where the work is.

河水确实珍贵，但这些河流也暗藏危险。

The water from the rivers is precious indeed, but the rivers are treacherous.

它们滋生了一种黑蝇，正是这种蝇导致失明。

They produce the black fly that brings blindness.

这段话出自1983年一部关于河盲症的纪录片。

That's from a 1983 documentary about river blindness.

黑蝇叮咬人的时候，会把一种叫盘尾丝虫的幼虫传入人体。

The black flies bite, and when they bite, they transmit the larvae of worm called Oncocerca volvulus.

这种寄生虫会在皮肤底下生长繁殖。

The worm grows and breeds under the skin.

人体通常对成虫的反应比较轻微，不会强烈排斥。

The human body generally tolerates the adult worms with a low immune response.

但当幼虫进入眼睛时，身体会产生更强烈的免疫反应，引发炎症，最终导致失明。

But when the baby worms, the larvae, get into the eye, a more intense immune reaction can cause inflammation, and that leads to blindness.

河盲症本身很少直接致死，但它可能摧毁整个家庭或村庄，因为失明通常发生在人们最富生产力的年纪。

River blindness itself is rarely deadly to individuals, but it can prove fatal to a family or to a village because blindness often comes to men and women in their prime productive years.

子女不得不放弃工作，回家照顾失明的父母。

Sons or daughters must drop out of the workforce to care for a blind parent.

结婚和生育变得越来越少。

Marriages and parenthood are less common.

最终，年轻人纷纷离开村庄。

Eventually, young people flee the village.

几十年来，人们对盘尾丝虫病几乎无能为力。

For decades, there was little to be done for oncocerecysis.

全球有高达两千万人感染了这种寄生虫，数十万人因此失明或视力严重受损。

As many as twenty million people were infected with the parasite worldwide, and hundreds of thousands were blinded or had impaired vision because of the disease.

上世纪七十年代，世界银行开始在西非使用滴滴涕和其他杀虫剂来消灭黑蝇种群。

In the nineteen seventies, the World Bank began using DDT and other insecticides to kill black fly populations in West Africa.

这在某些地方有效，但对环境和人类健康造成了极大的危害。

This worked in places, but it was terrifically dangerous to the environment and to human health.

到了1981年，一种新药出现了，它不仅能治疗河盲症，还能对付其他寄生虫病，比如钩虫病。

And then in 1981, a new drug appeared that might work for river blindness and for other parasitic diseases too, including hookworm.

这种药叫伊维菌素，关于它的故事，我们将在第二部分的后半段详细讲。

This was Ivermectin, and we'll get into that after a break in part two.

欢迎回到《药物故事》。

Welcome back to Drug Story.

这里是第二部分——处方篇，我们将探讨一种治疗疾病的药物是如何研发和使用的。

This is part two, the prescription, where we explore the creation and the use of a drug to treat disease.

今天要讲的药物，当然是伊维菌素。

And today's drug is, of course, ivermectin.

伊维菌素的诞生，始于1973年日本东京以南的一个高尔夫球场。

The creation of ivermectin begins, of all places, on a golf course south of Tokyo, Japan in 1973.

在球场边缘，朝相模湾东面望去的地方，一位名叫大村智的年轻科学家正在挖土。

On the edge of the course looking east over Sagami Bay, a young scientist named Satoshi Omura was digging up dirt.

当时人们早就知道，土壤里充满了生命和微生物。

Now at the time, it was well known that soil, dirt, was full of life and full of microbes.

任何一块土地里，都在上演着一场战争。

In any patch of earth, a war is going on.

各种细菌释放化学物质，消灭竞争对手，只为争夺食物和生存空间。

With various bacteria producing chemical agents to kill off rival bacteria in the quest for food and survival.

自1943年起，人们就发现，有些微生物可以被分离出来，制成药物。

Since 1943, it was known that some of those microbes could be isolated and turned into medicines.

最早的抗生素之一——链霉素，就是从土壤中提取出来的。

One of the first antibiotics, streptomycin, was isolated out of soil.

四环素、雷帕霉素，还有十几种其他药物，最初都源自泥土。

Tetracycline, rapamycin, and a dozen other medicines started in dirt.

大村智是北里研究所的负责人，他刚刚与总部位于新泽西的默克公司启动了一项合作研究。

Omura was a director at the Kita Sato Institute, and he had just begun a research project with Merck, the New Jersey based pharma company.

大村智有个习惯，随身带着采样袋，一有兴致，就随手挖一铲土，留着回去化验。

Part of Omura's habit was to carry sample bags with him so that when the mood struck him, he could shovel up a soil sample for testing later.

那个高尔夫球场取来的样本，只是大村智实验室里四万种菌株中的一例。

The sample from that golf course was just one of 40,000 cultures isolated in Oumura's lab.

其中最有希望的菌株被送往美国新泽西州，最终只有一种显示出抗寄生虫的效果。

The promising ones were then sent overseas to New Jersey, and exactly one turned out to have an antiparasitic effect.

它能杀死蠕虫。

It killed worms.

接下来的几年里，由威廉·坎贝尔带领的默克团队不断优化这种微生物的培养，试图提炼出更强效的版本。

For the next few years, the Merck team led by William Campbell, they sweated the stuff, trying to create a stronger brew of this microbe.

他们用它测试了从细菌到寄生虫等多种病原体。

They tested it against various pathogens from bacteria to parasites.

经过无数次实验，他们最终得到了伊维菌素——一种能稳定有效杀灭家畜体内寄生虫的药物。

And after countless experiments, they had ivermectin, a drug that worked reliably and consistently to kill parasites in livestock.

1981年，伊维菌素获得批准，用于治疗牲畜体内的各种寄生虫、螨虫、蜱虫、蛔虫、钩虫和心丝虫。

In 1981, ivermectin was approved for use in animals to kill various kinds of parasites, mites and ticks and roundworms and hookworms and heartworms.

默克公司因此赚得盆满钵满。

Merck would make a lot of money this way.

但寄生虫也是人类的难题，尤其在欠发达地区。

But parasites were also a problem in humans, particularly in less developed countries.

因此，同年在塞内加尔，默克公司开始在人体上测试伊维菌素，用于预防和治疗河盲症。

So that same year in Senegal, Merck began testing ivermectin in people for the prevention and treatment of river blindness.

这些试验也取得了成功。

And those experiments worked too.

1987年，伊维菌素获准用于人类。

Ivermectin was approved for use in humans in 1987.

但谁来承担这笔药费呢？

But who would pay for the drug?

要为全球数亿人生产和分发这种药物，开销可不是小数目。

It would be no small expense to manufacture and distribute the drug to hundreds of millions of people worldwide.

于是，默克做了一件非同寻常的事。

So Merck did something remarkable.

公司承诺，只要需要，就免费提供这种药物，正如当时公司董事长所说。

The company agreed to give away the drug for free as much as needed and as long as needed, as the company's chairman said at the time.

几年内，伊维菌素就开始供应给整个村庄、整个国家。

Within a few years, ivermectin was being distributed to whole villages, whole countries.

很快，人们重新回到河边，像一场迁徙热潮，村庄和社区重燃希望，焕然新生。

Soon, people started returning to the rivers in a land rush as villages and communities were reborn with hope.

接着又传来一个好消息。

And then another triumph.

二十世纪九十年代中期，伊维菌素被证实对淋巴丝虫病同样有效，这是一种广泛流行的寄生虫病。

In the mid nineteen nineties, ivermectin was proven effective for treating lymphatic filariasis, another widespread parasitic disease.

这种病是通过蚊子叮咬传播的线虫引起的。

In this case, worms delivered by a mosquito bite.

这种疾病影响着一亿人，会导致四肢和生殖器长期肿胀，甚至引发象皮病等严重后果。

This disease afflicts a hundred million people and causes chronic swelling in the limbs and genitals, leading to horrible conditions like elephantiasis.

同样，默克公司免费捐赠了这种药物。

Again, Merck donated the drug for free.

距离这些成就已经四十年了，我们现在知道，伊维菌素对多种寄生虫都有效，而且每年只需服用一到两片药即可。

Forty years after these triumphs, we now know that ivermectin works against a great many parasites, and it is easy to take just one or two pills a year.

它让各国有了对抗疾病、夺回被寄生虫肆虐而荒废土地的机会。

It gives countries a fighting chance to push back on disease and to reclaim land that has been abandoned due to infestation.

截至目前，已有五个国家彻底根除了河盲症，还有好几个国家也快实现了。

To date, five countries have eliminated river blindness outright, and several more are really close.

与此同时，默克公司还以品牌名“Heartgard”销售一种药物，用于预防狗狗的心丝虫和钩虫感染。

And all along, Merck has sold a drug under the brand name Heartgard to prevent heartworms and hookworms in dogs.

这些产品迅速成为全球销量最高的兽药，年收入超过十亿美元。

These products quickly became the top selling veterinary medicines in the world, earning more than $1,000,000,000 annually.

所以，默克公司赚取利润，完全是应得的。

So, yeah, Merck made their money as they deserve to.

2015年，大村智和威廉·坎贝尔因发现伊维菌素而荣获诺贝尔生理学或医学奖。

And in 2015, Satoshi Amora and Merx William Campbell were awarded the Nobel Prize in medicine for their discovery of ivermectin.

寄生虫通常不被认为是可爱的生物。

Parasites are not generally regarded as being lovable.

当我们说某人是寄生虫时，绝不是在夸奖他。

When we refer to people as parasites, we are not being complimentary.

这是坎贝尔在接受荣誉时的画面。

Here is Campbell accepting the honor.

我们总以为，寄生虫就是那种靠别人推着才能通过旋转门的人。

We tend to think that a parasite is the sort of person who goes through a revolving door on somebody else's push.

这种说法不公平。

This is unfair.

这对自然界中无数重要又常见的寄生生物来说，是极大的不公。

It's unfair to real parasites, to the innumerable and influential parasites from the world of nature.

各位陛下、皇室成员、阁下，女士们、先生们，是时候给寄生生物多一点尊重了。

Your majesties, your royal highnesses, your excellencies, ladies and gentlemen, it is time for parasites to get a little more respect.

我们

We

我们的故事本可以在这里结束。

could end our story here.

一种神奇的药物，一项诺贝尔奖，数百万生命得到改善，数十亿美元收入入账。

A miracle drug, a Nobel Prize, millions of lives improved, billions of dollars earned.

不知怎么的，每个人都是赢家。

Somehow, everyone is a winner.

真是个精彩的故事。

What a story.

但这个药物的故事还没结束。

But that is not where this drug story ends.

因为接下来，故事出现了转折。

Because here, our story takes a turn.

人们越来越担心一种新型罕见的肺炎样病毒，它已导致至少两人死亡，并从中国传播到了亚洲其他国家。

Growing concern about a new and rare pneumonia like virus that has caused at least two deaths and has spread from China to other countries in Asia.

美国疾病控制与预防中心确认，美国首例病例已在华盛顿州发现。

The Centers for Disease Control and Prevention has confirmed the first US case has been detected in Washington state.

这真是前所未有的情况。

This is truly an unprecedented situation.

这种病毒不分人种，一视同仁。

This virus doesn't discriminate.

它谁都不放过。

It attacks everyone.

我希望每个美国人都做好准备。

I want every American to be prepared.

2019年底，一种新疾病出现了，就是新冠。

In late twenty nineteen, a new disease emerged, COVID.

突然间，伊维菌素成了头版新闻。

And suddenly, Ivermectin was front page news.

今天，我宣布新冠病毒在美国构成公共卫生紧急状态。

I have today declared that the coronavirus presents a public health emergency in The United States.

公共卫生紧急状态。

Public health emergency.

宣布进入紧急状态。

A declaration of emergency.

紧急状态。

State of emergency.

新冠可以被定义为一场大流行。

COVID nineteen can be characterized as a pandemic.

我们将暂停所有来自欧洲的旅行。

We will be suspending all travel from Europe.

我正式宣布进入国家紧急状态。

I am officially declaring a national emergency.

当时人很多，我们不得不在外面等了大约二十分钟才被允许进去。

It was quite crowded, and we had to wait outside for about twenty minutes before they let us in.

我们跳到三月十六号。

Jumping to March 16.

这是第三部分，关于副作用。

This is part three, side effects.

通常来说，副作用是药物带来的不希望出现的反应。

Now usually, side effects are unwanted or undesired consequences of a drug.

但有时候，这些意外的反应反而为药物开辟了新的用途。

But sometimes those unintended consequences actually open the door to new uses for the drug.

这叫药物再利用。

It's called repurposing.

药物再利用通常是指，一种药原本是为某种疾病研发的，却意外对其他疾病产生了作用。

Repurposing for medicines is oftentimes a medicine may be developed for one reason, one indication, and it may have off target effects for a different disease process.

伟哥，大家都听说过伟哥。

So Viagra, everyone knows about Viagra.

伟哥最初是作为降压药开发的。

So Viagra was initially, developed as a blood pressure medicine.

这位是医生。

This is Doctor.

大卫·布卢瓦尔，明尼苏达大学的医学教授，同时也是传染病专家。

David Bulware, a professor of medicine and infectious disease physician at the University of Minnesota.

医生。

Doctor.

作为降压药，它的效果并不太理想，但出现了一些意想不到的副作用。

It didn't really work that great as blood pressure medicine, but it had some off target side effects.

所以这些副作用一出来，大家都说：这玩意儿有意思。

So the side effects, people were like, Oh, this is a thing.

于是它就被重新用于治疗勃起功能障碍，尽管它最初是作为降压药开发的。

So it was then repurposed for sort of erectile dysfunction, even though it was originally developed as a blood pressure medicine.

这就是一个被成功再利用的著名例子。

So that's a famous example of something that's repurposed.

记得2020年新冠疫情刚在美国爆发时，没人知道该怎么办。

Now remember when COVID hit The US in 2020, nobody knew anything.

当时根本找不到明确有效的治疗方法。

There was no obvious treatment.

于是各种想法都冒出来了，有些简直荒唐可笑。

So there were a lot of ideas, some absurd ideas about what would work.

有人甚至说漂白剂能杀灭病毒，或者二氯甲烷。

Some people said bleach would kill the virus or methylene chloride.

二氯甲烷就是俗称的油漆去除剂。

That's also known as paint stripper.

紫外线据说能起作用。

Ultraviolet light was supposed to work.

在印度，有一位政客办了一场喝牛尿的聚会，来了两百多人。

In India, one politician held a cow urine drinking party, and 200 people showed up.

各种茶饮、药膏和提取物多得数不清。

There were so many teas and salves and extracts.

还有各种膳食补充剂。

And then there were supplements.

人们疯狂抢购，争着买各种补充剂。

People were crushing the store, trying to get their hands on various supplements.

这是西蒙妮。

This is Simone.

她在俄勒冈州波特兰的一家超市负责补充剂货架。

She worked in a grocery store in Portland, Oregon in the supplements section.

她亲眼目睹了这场疯狂的抢购潮。

She had a front row seat to the frenzy.

维生素C、维生素D、锌、接骨木莓和NAC。

Vitamin c, vitamin d, zinc, elderberry, and NAC.

哦，还有槲皮素。

Oh, quercetin also.

没错。

Right.

这些理论上都能增强免疫力。

And these all, like, help the immune system in theory.

对。

Yes.

当时气氛特别混乱。

And the energy was very chaotic.

是啊。

Yeah.

那真是段特别古怪的时光。

It was just a really weird time.