美国的自闭症危机与人工智能如何通过NIH主任Jay Bhattacharya修复科学

美国人民并不愚蠢。事实上，他们相当聪明。当我们以尊重他们智慧的方式与他们交谈，用数据说话，允许人们持有不同意见，但同时将证据清晰地呈现在他们面前时，我认为人们会信任证据所指引的方向。我们需要那种硅谷精神。我们应该停止惩罚失败的科学家。

The American people are not stupid. In fact, they're quite smart. And when we talk to them in ways where we show respect for their intelligence with data, allow people to disagree, but then have the evidence right there front of people, I think people will with trust where the evidence actually leads. We need kind of that Silicon Valley spirit. We should stop punishing scientists who fail.

如果他们失败得有价值，就让他们在期刊上发表文章，解释他们从中学到了什么。我认为，这种硅谷精神需要更多地融入科学领域。

If they fail productively, let them publish in a journal to explain why they're what they learned from it. Like that Silicon Valley spirit, I think, needs come to science a little bit more.

自闭症资助、老药新希望与美国科学的重置。今天，我们邀请到了美国国立卫生研究院（NIH）主任杰伊·巴塔查里亚博士，以及A16Z健康与生物领域的普通合伙人维尼塔·阿加瓦尔和豪尔赫·康德。我们将探讨NIH新推出的5000万美元自闭症倡议、亚叶酸的潜力，以及对泰诺与妊娠关系的新审视。我们还将深入探讨复制危机、大胆的资助模式、重建公众信任，以及人工智能如何从药物发现到临床护理彻底改变医疗保健。

Autism funding, old drugs with new promise, and a reset on American science. Today, we're joined by Doctor. Jay Bhattacharya, Director of the NIH with A16Z Health and Bio general partners Vinita Agarwal and Jorge Conde. We cover the NIH's new $50,000,000 autism initiative, leucovorin's potential, and fresh scrutiny of Tylenol and pregnancy. We also dig into the replication crisis, bold funding models, rebuilding public trust, and how AI can transform health care from drug discovery to clinical care.

让我们开始吧。

Let's get into it.

嗯，班查德医生，非常感谢您来参加播客。我们非常高兴能邀请到您。

Well, doctor Banchard, thank you so much for coming on the podcast. We're stoked to have you.

我很高兴来到这里。和你们交谈真好。我有点嫉妒我没能在门洛帕克和你们一起录制。

I'm delighted to be here. So good to talk with you. I'm a little jealous I'm not in Menlo Park to be there with you on this.

没错。今天是9月22日星期一。今天有重大新闻发布。《泰晤士报》关于您的报道刚刚出炉。我希望您也能对此谈谈看法，但也许您可以先和我们分享这个重大新闻以及它为何如此具有影响力。

Exactly. And we're talking Monday, September 22. There's big news coming out today. The Times piece on on you just came out. I want you to reflect on that as well, but maybe you could share with us the big news and why it's so impactful.

当然。大约六个月前，我刚接手这份工作时，肯尼迪部长就向我提出挑战，要求我为自闭症儿童家庭寻找答案。我是说，患病率几十年来一直在上升，根据CDC的最新数据，大约是每31个孩子中就有一个。这个数字非常惊人。我们至今还没有找到答案。

Sure. So roughly six months ago, when I first started this job, Secretary Kennedy challenged me to help get answers for families with autistic kids. I mean, with there's, the prevalence has been rising for decades, like one in thirty one kids, I think is the CDC's latest numbers on this. That's an incredible number. I mean, we don't have answers.

很多时候，家庭使用的行为疗法对许多孩子效果并不理想。我们不知道病因，所以也不知道如何预防。因此我努力推出了这项新计划，投入5000万美元新资金，有250个团队申请了大额研究资助。今天我们将宣布，有13个团队将获得这项自闭症数据科学计划的资助。另外还有两件事也要在今天宣布，这些是在与医疗保险和医疗补助服务中心的Mehmet Oz、Marty Makary以及肯尼迪部长合作过程中产生的。

Lot of times families are, they have these behavioral therapies that don't really work very well for a lot of their kids. We don't know the cause, so we don't know how to prevent it. And so I'd launched, worked really hard to launch this new initiative, 50,000,000 new dollars, two fifty teams applied for large research grants. And we're going to announce today that 13 teams are going to be granted, you know, these grants for this autism data science initiative. The other thing, there's two other things that are going to get announced today that sort of came out of this process of working with Mehmet Oz at the Center for Medicare and Medicaid Services and Marty Makary and Secretary Kennedy.

Marty Makary是FDA局长。其中一项是一种药物，一种非常常见的旧药叫亚叶酸。它基本上就像是叶酸，但它的作用更像是将叶酸输送到大脑的方式，因为有些孩子存在叶酸处理问题 - 叶酸是从蔬菜中获取的，对吧？但有些孩子处理叶酸有困难。事实证明，很多医生有使用亚叶酸治疗自闭症儿童和大脑叶酸缺乏症患儿的经验，实际上很有效。

Marty Makary is the FDA Commissioner. One is a drug, a very common old drug called Leukovorim. It's basically like a it's folinic acid, called, but it's like it serves almost like a way to deliver folate to the brain where for when some kids have folate processing, folate is something you get in vegetables, right? But some kids have this difficulty processing folate. Turns out that a lot of doctors have experience using folinic acid, leucovorin, in treating autistic kids and kids who have this folate deficiency in their brains, it actually works.

大约20%的孩子，我认为，恢复了语言能力。高达60%的孩子情况大为改善。当然，不是每个自闭症孩子都会因此好转。必须要有这种特定的大脑状况。但让这种治疗更广泛地可用，我认为是件非常好的事情。

In twenty percent of the kids, I think, restore speech. Up to sixty percent of the kids, they get much better. Now, not every autistic kid is going to get better with this. You have to have this specific thing that's happening in your brain. But making that more widely available, I think, is a really good thing.

另一项是关于泰诺（对乙酰氨基酚）的警示。这显然是非常常见的止痛药。它是孕期唯一推荐使用的止痛退烧药。但最近出现了新的证据，实际上哈佛公共卫生学院院长刚刚发布的一项新研究也强调了这一点，表明孕期使用可能与孩子后来被诊断出自闭症有关。现在科学文献中对这个观点还存在很多争议。

The other one is a sort of a caution on Tylenol acetaminophen. That is obviously a very common pain reliever. It's the only sort of pain reliever and fever reducer used recommended during pregnancy. But there's been new evidence that's emerged and was actually highlighted by a new study put out by the dean of the Harvard School of Public Health just recently, actually, that suggests that use in pregnancy can correlate with subsequent autism diagnoses later on for the kids. Now, I think there's a lot of controversy still over that in the scientific literature.

但这足以提醒妈妈们：注意谨慎使用。我的意思是，不要经常使用。只有在发高烧真正需要时才使用。要慎重考虑。我不想引起任何人的恐慌。

But it's enough, I think, to say to moms, look, just be careful. I mean, you know, you don't use it all the time. Use it only really when you really need it for high fevers. Just think prudently about it. I don't want to panic anybody.

这不是那种应该让人恐慌的结果。只是提醒大家应该谨慎使用任何药物，尤其是在怀孕期间。

It's not the kind of result that should panic anybody. It's just a reminder that you should use any medicine carefully, especially during pregnancy.

是否会有关于孕期使用对乙酰氨基酚的修订指南，以帮助妈妈和父母们做出决定或判断该怎么做？

Will there be any revised guidelines around the use of acetaminophen in pregnancy to help moms and parents sort of make a decision or have a judgment call on what they should do?

会有的。这是FDA局长麦卡里博士正在努力推进的工作。同时，CMS医疗保险和医疗补助对亚叶酸钙的支付方式也将有所改变。所以这是一个跨机构的协作项目。

There will be. So that's something that Doctor. McCary, the FDA Commissioner, is working on. And there'll be also changes in how CMS Medicare and Medicaid pay for leucovorin. So it's a cross agency collaboration for all of that.

既包括给父母的指南，也包括药品支付方面的调整。然后还有我最枯燥的部分——我主要负责在未来几年启动那些有望带来答案的宏大而有趣的科研项目。

So both the guidelines for parents as well as sort of payment for drugs. And then we got the I'm the most boring part. I just get to launch vast, interesting science projects over the next that hopefully will produce answers over the next few years.

你们还关注早产问题。你们在那里启动了一个非常引人入胜的计划，不仅有望开展有趣的科研项目，更重要的是这些项目能带来对美国各地母亲发生早产的临床洞察。可以说，这是你们今天宣布的一些事项中另一个非常有趣的关联领域。

And you're also paying attention to preterm birth. And you've launched a really fascinating initiative there to, again, launch not only fascinating science projects, hopefully, but also science projects which lead to clinical insight into why that's happening to moms across America. And so, you know, that's another really interesting adjacency, if you will, to some of the announcements that you just made today.

是的。早产问题确实很有意思。比如，美国的早产结局比欧洲差。而我们并不完全清楚原因。当然，导致早产的因素有很多。

Yeah. I mean, the preterm birth thing is really interesting. Like, we have worse outcomes in The United States than Europe does. And, you know, we don't really have great answers for why. I mean, there's lots of contributors to preterm birth.

孕期产前护理非常重要，确保能够获得这些护理也至关重要。这是部分原因，但不是全部答案。我们需要为家庭解答所有这些令人担忧的问题。我听到全国各地很多人告诉我，向我询问这些问题的答案——没有优秀的科学研究是很难回答的。我的职责就是确保我们拥有严谨、优秀的科学来解答这些问题。

Of course, prenatal care is so important during pregnancy and making sure you have access to that is really important. So that's part of it, but it's not the whole answer. And we have to, we need to get answers to families on all these things that concern us. I've heard from so many people around the country telling me, asking me answers to these questions hard without excellent science. And that's my job is to make sure that we have rigorous, excellent science to address these questions.

这很困难，因为科学研究本身就很复杂，对吧？你以为得到了正确答案。比如我18岁时觉得鸡蛋有害，但后来发现鸡蛋其实对你有益。因为1985年的科学告诉我鸡蛋有害，我就一直不敢吃鸡蛋。当然，现在我们知道鸡蛋其实是有益的。

It's hard because, you know, like science is difficult, right? You get an answer you think is right. And then, you know, eggs were bad for me in, when I was 18, it turns out like it, but then like later it turns out eggs are great for you. And I, you know, I was fearful eating eggs forever because the science in 1985 told me that eggs are bad for you. And of course, now eggs are good for you.

你知道，科学确实很难，但我们必须对自己有更高的标准。我们谈论科学时必须严谨且可重复。作为NIH主任，我特别关注的一点是确保我们投资于重复验证。科学中的真理标准应该是可重复性。独立的团队——你不能仅仅因为我说某件事是真的就相信它。

Just, you know, it's one of those things where like science is difficult, but we have to hold ourselves to higher standards. We have to be we talk about people with science, it has to be rigorous and reproducible. Something I've been focused on really sharply as my time as NIH director is to make sure that we invest in replication. The standard for truth in science ought to be replication. Independent teens, you don't just don't believe me just because I haven't I say something is true.

你知道，其他人独立研究同一件事应该得出相同的答案。这样我们才能更有信心认为它是真实的，而不是仅仅因为某个权威人士这么说。

You know, other people independently looking at the same thing should arrive at the same answer. Then we know we're more likely we have more confidence that it's true rather than just, you know, high authority says so.

对于普通听众来说，科学失去活力或难以复现的原因是什么？导致这种趋势的根本原因是什么？

For the layperson listening to this, what's sort of been the cause for the loss, I'll say the loss of vigor in science or challenges around being able to replicate science? What is the underlying cause for this trend?

我的意思是，根本问题在于科学本身就很难。这确实是底线。其次的原因是科学研究的数量太多了，比过去多得多。比如回溯到1900年左右，每个科学家都认识其他科学家，基本上大家都互相监督。这本来是很正常的过程。

I mean, the underlying problem is just that science is hard. I mean, that's really the bottom line. And then the secondary cause is that there's just a lot of it, a lot more than there was. Like once upon a time, you know, you go back to 1900 or something, every scientist knew each other or very basically knew almost every other scientist, and everyone was checking each other. That was just a normal course.

现在有很多高度专业化的广阔领域，很难让人们去核查他人的工作。这样做没有回报。如果我整个职业生涯都在核查别人的工作，我就不可能在名牌大学获得教授职位。而且科学很难，对吧？科学家很容易固守一个想法并认为这是正确的。

Now you have vast fields where it's very specialized, and it's hard to get people to check other people's work. There's no return for it. If I spend my career checking other people's work, I'm not gonna get a professorship at a fancy university. And science is hard, right? It's very easy for a scientist to latch onto an idea and say, this is right.

我知道这是对的。但它可能并不正确。所以重要的是其他人研究后也能发现相同的结果。但往往当其他人研究时，他们并没有发现相同的结果，而我们却不知道这一点。对吧？

I know this is right. But it may not be right. And so what matters is other people looking at it find the same thing. But often when other people look at it, they don't find the same thing, but we don't learn about that. Right?

过去二十年来，科学界一直存在重复性危机，人们越来越意识到我们在确定真理时对科学持有的标准太低了。基本上，你可以在同行评审的期刊上发表论文——我自己就发表过180篇，为此我向大家道歉。但问题是，发表在期刊上并不代表它就是正确的，也不代表它就是真实的。

There's been the last two decades, there's been a replication crisis in science with increasing realization that the standards we hold ourselves to science in determining truth are too low. We basically, you can get a paper published in a peer reviewed journal. You know, I've had 180 of them myself, which I apologize for everyone. But, but the, but the thing is the fact that it's published in a journal doesn't mean it's right. It doesn't mean it's true.

这是有用的。那是我对那个科学观点的信念表达。我认为我发表的大部分内容都是真实的，但每个科学家都认为自己发表的每一样东西都是真实的。这还不够，必须要有重复验证。

It's useful. That's my expression of my belief about that scientific idea. I think most of my things are true, but every scientist thinks that every, everything they publish is true. That's not enough. You have to have replication.

必须要有其他人互相检查工作，因为在科学中很容易说服自己是对的。所以真正的问题在于这两点：科学体量太大导致人们过于专业化，没有动力去充分检查彼此的工作——我们应该做得更多。此外，发表标准也不够高，因为科学本身太难了，而发表标准确实还不够严格。

You have to have other people checking each other's work because it's so easy to convince yourself in science that you're right. And so it's really those two things. The volume of science means that people are so specialized, they don't and there's no returns. There's no there's no incentives to check each other's work as much as we ought to. And then the publication standards are too because science is too hard, science is so hard and publication standards are not high enough, really.

这确实是重复性危机的根源。

That's really the reason for the replication crisis.

首先，我想评论一下。昨天有个笑话在流传，算是推特上的一个引用推文，回应可能减少自闭症的讨论，有人说这是对硅谷初创公司生产力的直接打击。这对初创公司会有什么影响？不过，这确实是令人兴奋的消息。也许我们可以从更宏观的角度谈谈。

Well, first, I just wanna comment. There was a joke going around yesterday, sort of a quote tweet on Twitter in response to sort of any potential reduction in autism that someone said this is a direct attack on Silicon Valley startup productivity. What will this mean for startups? But yeah, exciting news there. Say more just in terms of maybe we could zoom out.

你提到你六个月前接手。到目前为止，你对自己的活动和成就有什么反思？接下来你希望实现什么目标？

You mentioned you took over six months ago. What are sort of your reflections so far in terms of your activity and achievements to date and then what you hope to achieve going forward?

嗯，我们做了很多事。比如我最初做的一件事是审视了我们资助国际合作的方式。结果发现，虽然我们资助国际合作，但NIH很难核查资金是否用在正确的地方。我们无法审计，比如武汉实验室。NIH曾向武汉实验室拨款，但我们无法进行审计。

Well, I mean, we've done a lot. So like one of the first things I did was we looked at, you know, the way we fund foreign collaborations, right? So it turns out that we fund foreign collaborations, but it's very difficult for the NIH to check that the money is going to the right things. We couldn't audit, like the Wuhan lab. The NIH had sent money to the Wuhan lab, but we couldn't audit it.

所以我们建立了一个新系统。我认为国际合作对科学非常重要，但我们需要以一种能够坦然面对美国民众的方式来进行，确保我们实际上在追踪资金，核查资金用途正确。我建立了一个新系统。令人沮丧的是，系统刚实施，我就看到报道说我想终止所有国际合作——这完全与事实不符。

So we put in a new system. Like, I think foreign collaborators are really important for science, but we need to do it in a way where I can look at the American people in the eye and say, look, we can we're we're actually tracking the money. We're checking to make sure things are going the right place, doing the right thing. I put in a new system. The frustrating thing about that is, like, we put that in, and all of a sudden, I'm seeing reports that I want to end all foreign collaborations, which is which is I mean, couldn't be further from the truth.

我只是想确保我们以一种可审计的方式进行。我可以站在国会面前说，是的，我知道我们给一个实验室拨了款，这是他们提交的实验室记录，记录了他们的工作内容，这在旧系统下是做不到的。我们已经改变了评估资助的方式。在NIH，我们有一个很棒的资助评估体系，叫做科学评审中心。它是世界上最好的同行评审组织。

I just wanna make sure that we do it in a way that's auditable. I can go in front of Congress and say, Yeah, I know we sent money to one lab, here's the lab notebooks that they sent, that they worked on, which we couldn't do under the old system. We've changed the way that we evaluate grants. So So, at the NIH, we have a great way of evaluating grants called the Center for Scientific Review. It's the world's best peer review organization.

结果发现，很多研究所——总共有27个研究所——都有自己并行的评审系统。所以我们将其集中化，确保每个人都以同样的方式被评估。另一件事，实际上这与硅谷有关，是我们目前正在努力的方向。好吧，你们可能会告诉我我对硅谷一无所知，尽管我没有在A16z工作过。

Turns out that a bunch of the institutes, there's 27 institutes, a bunch of the institutes had their own parallel review system. So we centralized that, made it so that everyone is viewed the same way. The other thing, actually, this is related to Silicon Valley, is something we're working on right now. Okay. You guys are going to tell me that I don't know anything about Silicon Valley, even though because I didn't work for A16z.

但我要说的是，在我看来，你们如此成功的原因在于，如果像A16Z这样的机构，你们有50个项目组合，资助了50个项目，其中49个失败了，而第五十个是谷歌之类的成功案例，你们会认为这个组合是巨大的成功。而那49家公司的团队，尤其是如果失败是有成效的，他们会得到第二次机会。你们不会过分惩罚失败。你们愿意拥有一个敢于大胆思考的组合。对吧？

But I'll just tell you my view of this is like the reason why you all are so successful is that if you, as a, an A16Z, you have a portfolio of 50 projects and you fund 50 of them and 49 of them fail and the fiftieth is, you know, Google or something, you view that portfolio as a tremendous success. And the people that that those those 49 companies, they're gonna get a second chance, especially if the failure was productive. You don't punish failure that much. You're willing to have a portfolio where you think big. Right?

我认为这种精神需要引入科学界。我在疫情前发表过研究，基本上是在问，NIH是否愿意大胆思考？而近几十年来，答案往往是否定的。如果你回顾1980年代和1990年代，NIH资助的想法大多是零到两年新的。而在2000年代初和2010年代，NIH资助的典型科学项目已经是六、七、八年旧的了。

That, I think that spirit needs to come to science. I did publish work before the pandemic asking essentially, is the NIH willing to think big? And too often the answer in recent decades has been no. If you look at back in the 1980s and 1990s, the NIH was funding ideas that were like zero, one, two years old. The typical scientific project funded by the NIH in the early 2000s and twenty teens was like six, seven, eight years old.

我们变得过于害怕尝试新想法。我们需要那种硅谷精神，这样我们就应该停止惩罚失败的科学家。如果他们的失败是有成效的，让他们在期刊上发表文章，解释他们从中学到了什么。我认为，硅谷的那种精神需要更多地融入科学界。

We just became too scared of trying new ideas out. We need kind of that Silicon Valley spirit so that we should stop punishing scientists who fail. If they fail productively, let them publish in a journal that explains what they learned from it. That Silicon Valley spirit, I think, needs to come to science a little bit more.

那么你认为评审资助的机制，比如NIH，是变得过于谨慎了，还是科学家们自己变得过于谨慎了？嗯，我的意思是，那些

And do you think that the mechanism for reviewing the grants, say, the NIH became overly cautious, or did the scientists themselves become overly cautious? Well, mean, those

是紧密相关的。这是一个同行评审组织。我的意思是，我在那些科学评审小组坐了十年、二十年，我目睹了发生的一切，对吧？所以，假设有一个新想法摆在我面前，好吧，我非常擅长方法，尤其是与旧想法相关的方法。

are closely linked. It's a peer review organization. Mean, I sat on those scientific view panels for a decade, two decades, and I watched what happens, right? So, let's suppose a new idea comes in front of me, right? Well, I'm really good at methods and especially methods related with the old idea.

这个新想法并不是在挑战我的想法，对吧？所以，我看着这个新想法，就觉得它根本不可能成功。我对同行评审小组这么说，大家也都同意，确实不可能成功。这么做太容易了。

That's this new idea is not competing with my idea. Right? And so, like, I look at the new idea, I go, this there's no way it can work. And I say that to this peer review panel, and everyone says, yeah, there's no way it can work. So easy to do.

对吧？我相信在A16你也面临这种诱惑。你看到一个项目，你会想，这个人显然是个天才，但他的想法根本不可能实现。这种诱惑非常强烈。在科学领域，尤其是在科研资助中，我们常常会说，是的，我们不想资助，不想尝试。

Right? I'm sure you face the temptation too at A16. So you you get you get a thing, like you look at the thing, you're like, this is a, this is, this guy's obviously a genius, but he has an idea that couldn't possibly work. And that temptation is very strong. And too often in science, we say, yeah, in scientific funding, we say, yeah, we don't want to give, we don't want to try it out.

是的，大多数新想法都会失败。这很正常。你预期会这样。但如果你不给人们尝试的空间，就永远无法取得重大进展。我认为这就是过去几十年生物医学科学文化中出现的问题。

And yeah, most new ideas are going to fail. That's just normal. You expect that to happen. But if you don't leave room for people to try them out, you're never going to make big advances. And I think that's what happened to the culture of biomedical science in the last few decades.

它太专注于渐进式的进步，而对重大突破关注不够。当然，确实有过重大的改进和科学发现，对吧？我不想贬低这一点。这是事实。但我们花了很多钱，许多研究这个问题的经济学家和科学学专家都指出，我们每花一美元所获得的进展太少了。

It's too focused on like incremental progress, not enough on enormous. Now, of course, there have been big improvements, scientific discoveries, right? I don't want to downplay that. That's true. But we spend a lot of money and per dollar we spend, a whole bunch of economists who have looked at this and the science of science folks who have looked at this say that we are getting too few advances per dollar that we spend.

这是因为文化太保守了。

That's because the culture is too conservative.

是的，这很有趣。这就是为什么许多优秀的风险投资伙伴关系，包括我们自己，都不是基于共识驱动的。你需要一致同意才能资助一个大胆的想法，因为总会有人说，嘿，这根本不可能成功。必须有人愿意下这个赌注。我很好奇，如果我的理解有误请纠正我，但在我看来，作为一个外部观察者，对于听众来说，NIH是我们国家最大的联邦生物医学研究资助机构，涵盖20个不同的研究所，资助金额超过350亿美元。

Yeah, it's interesting. It's sort of why many great venture partnerships, ourselves included, are not consensus driven. You require unanimous consent to fund a big, bold idea because someone's going to say, Hey, no way that's going to work. And someone has to be willing to take that bet. I'm curious and correct me if this is kind of not how you think about the NIH structurally, but it occurs to me, as an outside observer of the organization, again, for listeners, our country is the world's largest federal funder of biomedical research across 20 different institutes, over $35,000,000,000 in funding.

这是一个庞大的组织，基本上资助多个疾病子类别中我们认为最能推动全民健康的重要研究。在我看来，NIH必须在两个大类上做出正确的决策。一个是资金分配，如何决定免疫学、传染病、孕产妇健康、自闭症和行为健康等领域各获得多少资金。这涉及到基于基本价值观、人口输入、公民意见或其他因素的方法，你必须采用一些风险回报的方法来决定如何在这些不同领域分配资金。

There's a massive organization funding, essentially, across multiple sub disease categories the most important research that we believe will advance our health as a population. And it seems to me that there are two big categories in which the NIH has to get decision making right. One is allocation and how you decide, how much go to immunology versus infectious disease maternal health and versus autism and behavioral health. And there's this fundamental values based, population input based, citizenship input based, whatever it might be. There's some risk return based methods that you have to do to decide how do you allocate funds across these different areas.

然后还有执行层面的挑战。好吧，一旦你决定将这笔资金投入到该领域的研究资助中，你如何挑选合适的研究人员？如何确保他们诚实守信？如何推动数据回报？如何持续衡量生产力？

And then there's an execution challenge. Okay, once you've decided you're going to allocate this quantum of capital in research funding to this area, how do you pick the right investigators? How do you keep them honest? How do you drive data return? How do you measure productivity on an ongoing basis?

如何激励多年期项目中的持续风险承担？如何与国际资助研究伙伴明确协议？这些都属于执行层面的问题。这是人们思考NIH（美国国立卫生研究院）的合理方式吗？就像，你必须搞定资金分配，然后搞定执行，并且你致力于改革这两方面？

How do you incentivize ongoing risk taking in a multiple year project? How do you get your agreement straight with an international funding research partner? These are sort of all in the bucket of execution. Is that a reasonable way for people to think about the NIH? Like, you got to nail allocation and then nail execution, and you're in it to reform both?

所以，好吧，首先，你，就像你作为经济学家受过很好的训练。这很好，我很清楚，因为这正是经济学家会采用的正确方式。

So, okay, first of all, you are, like you're you're very well trained as an economist. That's very good very clear to me because that's exactly the right way how an economist would

这样思考。

think this.

我的意思是，不，我是说，这完全正确。对的。所以首先，有一个关于我们应该关注哪些疾病的决策。这不仅是科学问题，也是政治问题。

Mean, no, I mean, that's exactly right. Right. So first, there's a decision about where which diseases should we be focused on. That's it's not only a scientific problem. It's also a political problem.

就像它应该是一个政治问题，原因正如你刚才阐述的那样。对吧？我们关注的事情反映了资助我们的民众的真实需求。如果我们只是为了科学而做科学，只是漫无目的地徘徊，没有为人们的生活提供答案或改善，那么问题就是他们为什么要资助我们？而实际上是由国会来决定这一点的。

Like the it ought to be a political problem for the reasons you just articulated. Right? It's it's the the things that we focus on to reflect the, the the real needs of the people that fund us. If we're just doing science for science's sake and we're just, wandering around without producing answers or improvements for people's lives, well, the question is why should they fund us? And the, and it's actually Congress that decides this.

国会和总统一起在预算中决定资金流向，你知道，多少给传染病，多少给心脏病，多少给癌症，多少给儿科疾病。就像有一个整体的分配，既反映了人民的政治意愿，也反映了科学需求的机会。对吧？所以这是两者的结合决定了这一点。我认为这种情况完全合适。

Congress and the president together in the budget decide where does the money go, you know, how much to infectious diseases, how much to heart disease, how much to cancer, how much to pediatric conditions. You know, like there's a whole allocation that reflects the political will of the people as well as the scientific need opportunities. Right? So it's a mix of the two that decides that. And I think it's so completely appropriate that that be the case.

让我

Let me

让我推你

let me push you

回到那个问题上。为什么？为什么人们要对科学和我们改善重要疾病领域的能力有足够了解？他们可能连疾病的名字都不知道，对真实患病率也一无所知。

back on that. Why? Why do people know enough about science and our ability to make progress in important disease areas? They may not even know the names of the diseases. They may not know anything about the true prevalence.

我们让他们能够在完全非生物医学的领域发展事业，正是为了让专家们能持续评估科学发展将如何改善他们的健康。你可能会说，哦，这种观点过于家长式了。或者你也可以说，这就是人们决定想要的——他们不想操心具体需要做什么研究，决定将这种认知负担交给NIH的你们。

We've enabled them to be productive in careers entirely outside biomedical science, expressly so that the experts can weigh in on where science is going to improve their health on an ongoing basis. And so you may say, oh, that's an overly paternalistic view. Or you could say, well, that's what people decided they wanted. They didn't want to have to worry about exactly what research needed to be done. They decided to offload that cognitive load to you at the NIH.

而且他们可能不想在这方面有发言权。至少这是我对'资金分配应该政治化'观点的一种回应。你会如何回应？

And they may not want a voice in that. At least that's kind of one argument I'd make in response to the idea that allocation should be political. How would you respond to that?

让我回到你描述的后半部分，因为那里正是科学专业知识的用武之地。在每个领域内，科学家必须拥有发言权至关重要——他们可以说'这个应对阿尔茨海默病的思路很有前景'，'这个应对自闭症的想法很有希望'。然后科学家们可以自我审视：这真的可行吗？因此，NIH的角色就是协调这些科学意见，做出能真正推动这些领域健康发展的投资决策。

Let me get back to the second half of your characterization, because that's where the scientific expertise comes in. So within each area, it is absolutely vital that scientists have their say, that they can say, Well, this idea for addressing Alzheimer's is promising. This idea for addressing, you know, autism is promising. And then scientists can check themselves and say, well, is this actually promising? So, NIH's role is to mediate that, take that scientific input and make portfolio decisions that will actually advance health in those areas.

对，这基本上就是我的工作。所以我认为科学家确实有发言权。但关于资金应该投向何处的问题——让我以艾滋病疫情为例，说明可能出什么问题。

Right. That's basically my job. And so that, I think, scientists have their say. But in the question of where should the money go, right? So let me just go back to the HIV epidemic just to give us some sense of what can go wrong.

所以HIV早期的上升并未得到NIH的充分应对，我们说的是非常早期的80年代初，当时用于研究这一重要课题的资金不足。正是HIV患者团结起来的政治运动，呼吁我们必须重视这个问题，才促使NIH真正认真对待这一公共卫生威胁。如果把它完全交给科学家自己，或者我应该说我们自己，我要说两点。一是我们并不代表人民的意愿。我们并不擅长在不同人群之间进行调解。

So the early rise in HIV was not met with a sufficient response by the NIH, we're talking very early, in the early 80s, of money going to research on this vital topic. And it was the political movement of HIV patients coming together saying, look, it's really important that we address this, that led to the NIH actually taking that real public health threat seriously. If you leave it to scientists themselves, or I should say ourselves, I'll say two things. One is we don't reflect the will of the people. Like, we're not good at mediating between different population groups.

我的意思是，这样不对，对吧？没有哲学王能够决定，这么多钱应该用于HIV，这么多钱应该用于癌症，这么多钱应该用于儿科疾病。这是人民的意愿。所以，我真的看不到有其他方式可以做到这一点。

Mean, and it's it's not right. Right? There's no philosopher king that can decide, well, this much money should go to HIV, this much money should go to cancer, this much money should go to pediatric conditions. It's the will of the people. And so really, I don't see any other way to do it.

你知道，就像温斯顿·丘吉尔说的，民主是地球上最糟糕的政府制度，除了所有其他制度之外？我的意思是，我们没有哲学王。把它交给科学家并不是答案。我认为，人民确实应该在资金分配上有发言权。另一部分是，坦率地说，这与我们刚才讨论的内容有关。

Know, like, what was it like Winston Churchill said that democracy is the worst system of government on earth except for all the others? I mean, we don't have a Philosophy King. Leaving it to scientists is not an answer. The people really should have some say in where that allocation happens, I think. The other part of it is that, frankly, I mean, is something related to what we just talked about before.

科学家，如果你问我们，我们其实并不擅长预测未来，比如我们的投资是否会带来生产力？实际上，硅谷也不行，对吧？你不能保证你选择的每一个项目都会在你的投资组合中成功。这是不可能的，对吧？所以科学家在确定有哪些科学机会方面扮演着关键角色，告诉我们，然后我们可以做出决策。

Scientists, if you ask us, we're not actually good at predicting the future in terms of like our, will this investment result in productivity? I mean, actually, neither is Silicon Valley, right? You can't say, you can't promise me that every single project you pick is going to work for your portfolio. It cannot, right? And so scientists play a vital role in deciding what scientific opportunities there are, letting us know and then we can make decisions.

但投资组合的决策并不完全是科学决策。那是一种经济学的、微观经济学的、小写的e类型的决策。而宏观经济决策则是我们应该关注哪些疾病领域。这真的不应该仅仅由科学家来决定。当然，这其中存在互动，对吧？

But the portfolio decision, not exactly a scientific decision. That's an economic, microeconomic, small e kind of decision. And then the macroeconomic decision is where disease areas we should go to. It really shouldn't just be scientists that decide that. Of course, there's an interplay, right?

所以如果在某个特定领域有科学机会，我希望能够反馈给国会说，这是一个很好的领域。你们现在应该资助这个，因为你知道，镰状细胞病的细胞疗法取得了巨大进展。我们绝对需要资助它，对吧？然后国会可以根据这个科学机会采取行动。但这是人民和科学家之间的交流，而不是单向的。

So if there's a scientific opportunity in a particular area, I want to be able to reflect back to Congress and say, well, is a great area. You should fund this right now because, you know, there's huge advances in cell based therapy for sickle cell disease. We definitely need to fund that, right? And then Congress can move based on that scientific opportunity. But that's an exchange between, you know, the people and the scientists, not just a one way street.

我喜欢这个观点。很有见地。

I like that. That's insightful.

太棒了。

It's awesome.

是的。这似乎是一种更加跨学科的资源配置和执行方法，它包含了我们对支出规模、未来成本以及研究成功可能带来的经济影响的理解。不，感谢分享这一观点。我认为重要的是让人们明白，你正试图为资源配置问题引入更多声音，并为执行问题带来更严谨的态度。但这两者都不像表面看起来那么简单。

Yeah. It seems like a more interdisciplinary approach to allocation and execution that includes an understanding of how much we're spending, how much it costs on a go forward basis, what the economic impacts might be of getting the research right. No, thanks sharing that view. I think it's important for people to understand that you're trying to bring more voices to the allocation question and more rigor to the execution question. But both are not as straightforward as it may seem.

是啊。这是个异常复杂的工作。我以为当教授已经很复杂了，结果发现这个还要更复杂一些

Yeah. This is a weirdly complicated job. I thought being a professor was complicated, but this turns out it's a little more complicated

比那更复杂。

than that.

有没有哪些领域你觉得资源配置不足或过度？如果可以的话，你能大致指点一下吗？

There certain areas you feel were under allocated or over allocated, if you could, you know, just wave along?

哦，当然，每个领域都配置不足。我的意思是，关于配置不足的问题，我不确定是否只是资金问题。但如果你看看过去十五年的公共卫生趋势，美国的人均预期寿命没有任何增长。我们有大量积压的患者，患有心脏病的人，实际上癌症方面，我们在癌症治疗后的预期寿命有了很大改善，但癌症发病率却大幅上升。还有一型、二型糖尿病，自闭症。

Oh, we're all every area is under allocated, of course. Mean, I think, the thing is about the under allocation is I don't know if it's a question of money. But if you look at the trends in public health over the last decade and a half, The United States has seen no increase in life expectancy. We have enormous overhang of patients, people with heart disease, actually cancer, we've seen big improvements in life expectancy after getting cancer, huge increases in the incidence of cancer. Type one, type two diabetes, autism.

我们还讨论过一系列其他慢性病。在其他领域我们也取得了重大进展。所以问题在于，我们如何解决国家最紧迫的健康需求？对吧。看起来我们很擅长——而且我们应该擅长——处理一些患病率较低的疾病。

We've talked about a whole host of other chronic conditions. And we've made big advances in other places. So the question is like, how can we address the biggest health needs of the country? Right. It seems like we're really good at like and we should be good at some conditions that have lower prevalence.

就像我们在艾滋病防治方面取得了巨大进展。这确实值得大肆庆祝，对吧？但我们还有很长的路要走。去年仍有四万人感染了艾滋病毒。我们完全可以终结艾滋病疫情。

Like we've made tremendous advances in HIV. That's a huge cause for celebration, right? We still have some way to go. Forty thousand people got HIV last year. We can end the HIV epidemic.

我们仍然应该在这方面投入。但与此同时，那些死于心脏病发作的人呢？那些因二型糖尿病导致眼底或视网膜出血而失明的人呢？那些肾衰竭发病率不断上升的患者呢？我们必须关注国家实际存在的健康需求，关注人民的疾苦，并确保我们的科学研究能够针对这些问题。

We should still invest in that. But at the same time, what about all the people that died of heart attacks? What about all the people that have type two diabetes that are suffering from blindness because they have bleeding in their eyes or in their retinas? What about the people with kidney failure that the prevalence is rising? We have to look at the practical health needs of the country where people are suffering and make sure that we address our science to those things.

我认为我们在这方面做得还不够。只需看看宏观经济数据就知道了。这个国家的人均预期寿命在过去十多年里没有任何增长。科学并非唯一的原因。虽然NIH对此有所贡献，但它不是唯一的答案。

I don't think we've done that as much as we ought to. Just look at the macroeconomics. You don't have any increase in life expectancy in this country in over a decade. Science isn't the only reason why. The fact that the NIH contributes to that, but it's not the only answer.

显然，这非常复杂。但NIH理应为此做出贡献。我们所做的科学研究应该转化为人民更好的健康水平。因此，在那些人们受苦最深的领域，我认为资源分配确实不足。

Obviously, it's very complicated. But the NIH ought to contribute to that. The science we do should translate over to better health for people. And so really, those areas where people are suffering the most, that's where I want sort of, I would say, under allocated.

我很喜欢将NIH比作投资组合经理的这个想法，对吧？就像我们在硅谷做风险投资一样。如果我要滥用你的比喻——请允许我这么说——人民就像是你的有限合伙人。他们告诉你这些是我们希望你关注的基金主题和领域。而你们则是投资者，是风险投资家，需要进行投资组合管理和项目筛选等等。

I love this idea of comparing or analogizing the NIH to almost like a portfolio manager, right? Similar to what we do as venture capitalists in Silicon Valley. And if I really wanted to abuse your analogy, which I will if you'll allow me for a second, the people are almost like your limited partners. They're the ones that tell you these are the theses and the fund areas we want you to go after. And you all are the investors, the venture capital investors that have to do the portfolio management and picking and all of that.

你几分钟前提到，NIH的很多资助都流向了较陈旧的想法。而且有大量数据显示，这些资助也更多地流向了知名机构的资深科学家。这相当于如果我们只资助来自大型成熟公司的三十年资历高管，而忽视了刚从大学毕业、辍学或其他的年轻新秀。你已经稍微谈到了这个问题。如何改革这个过程，用Vanita的话来说，就是在执行层面如何选择那些自下而上涌现的创新？

You said a few minutes ago that a lot of the grants in the NIH are going to older ideas. And there's lots of data that shows they're also going to more established, older scientists at the very highly regarded institutions. The equivalent of that would be if we only funded thirty year executives that came out of large established companies and ignored the young up and comers coming right out of university or dropping out of school or whatever. You've talked a little bit about that question. How do you reform the process, the execution, to use Vanita's phrasing, on selecting for the innovation that, if you will, bubbles up from the bottom?

这其实是个难题。这正是我一直在思考的问题。实际上，你刚才描述的情况正是科学界长期以来的做法。NIH的数据显示，在1980年代，如果你35岁，实际上有机会获得NIH的大额资助。那时获得首个NIH大额资助的中位年龄就是35岁。

It's a hard question, actually. That's something that's at the top of my mind. Actually, you just described is exactly what we've been doing in science for a long time. The data out of the NIH is that in the 1980s, if you were 35, you actually had a chance of getting a large NIH grant. Like that was the median age of the first large NIH grant.

你当时35岁。现在你四十多岁了。我们告诉年轻的研究人员，你们必须快速行动，顺便说一句，快速意味着非常年轻。

You were 35 years old. Now you're in your mid forties. We tell young investigators, you got to do fast Which by way, fast super young. To

说清楚，四十多岁，非常年轻。只是想澄清这一点。

be clear, Mid forties, super young. Just wanna be clear about that.

我的意思是，我57岁了，所以，嗯，我不知道。我是说，他们对我来说就像婴儿一样。但问题是，就像硅谷一样，新想法来自更年轻的研究人员，对吧？所以，我几年前做了一项研究，发现你发表作品中的想法年龄会随着你的实际年龄每年增长一岁。所以我的想法每年都会随着我年龄增长而变老一岁。

I mean, I'm I'm 57, so, like, I don't know. Mean, that's they're seem like babies to me. But, but the but the thing is you have, the the just like as as in Silicon Valley, the new ideas come from younger, younger investigators, right? So, I did a study a few years back where I looked at, it turns out that the age of the ideas in your published work ages by every, by, by one year for every year of chronological age. So my ideas get one year older every year that I age.

最顶尖的科学家们拼命阻止这种情况。所以对于诺贝尔奖得主来说，每过两年实际年龄，他们论文中的想法只变老一岁。如果你想要最新的想法，你必须让年轻人尝试。而我们在这方面做得很差。比如，我们资助年轻人，然后他们退出，去了其他地方。

The very best scientists fight like crazy to stop that. So every two years of chronological age for Nobel Prize winners, their ideas in their papers age by a year. If you want the newest ideas, you have to let the young people have a try. And we just just bad at that. Like, young people, we fund we fund them, and then they drop out and they leave for for other places.

在七八十年代，情况并非如此。生物医学的文化要求你必须做一、二、三个博士后，才能有机会获得助理教授的职位。结果，我们支持的想法只是，它们只是更老了。我的意思是，这不一定是坏事。当然，在投资组合中，你应该支持一些仍有潜力的旧想法。

That wasn't true back like the back, back in the seventies and eighties. The culture of biomedicine says you have to have one, two, three postdocs before you get a shot at an assistant professor job. And as a result, the ideas that we support are just, they're just older. I mean, not necessarily a bad thing. I mean, course you should in the portfolio have some support for older ideas that are still promising.

但如果你不资助一些新想法，整个投资组合产生的进展就会比你资助时少。对吧？你必须在这方面进行多样化。解决这个问题很难。所以NIH二十年来一直在尝试解决这个问题，但我们没有取得任何进展。

But if you don't also fund some of the newer ideas, the portfolio is going to produce fewer advances as a whole than if you do. Right? You have to diversify in that sense. To solve that problem is hard. So the NIH has been trying to solve this now for two decades and we've made no progress.

首先，我会让你了解一下我们在哪些方面倒退了。我们曾经有一个同行评审系统，要成为评审人，你必须有一个大额资助。现在想想看。我拿到了大额资助。我五十多岁了，我看到一个挑战我三十年工作的想法。

So first, I'll just give you some sense of where we've gone backwards. We used to have a system of peer review where in order to be a peer reviewer, you had to have a large grant. Now think about that. I got a large grant. I'm in my fifties and, I see an idea that challenges my thirty years of work.

我是一名评审小组成员。要真正敞开心扉承认自己可能错了确实很难。那个系统已经改变了。虽然我们现在不再有那条规则，但这是一种心态——你必须允许改变。所以我所做的就是授权给研究所所长，扩大他们在项目组合方面的权限。我不会像评判硅谷那样去评判他们，不会要求每一笔资助都必须成功。

And I'm a reviewer on a panel. It's really hard to like open your mind and say, well, I might've been wrong. That system, that got changed. But now that we no longer have that rule, but like it's mindset You have to allow, so what I've done is I've asked the, institute directors, I've given them the authority essentially to expand what they can do, in terms of the portfolio. I'm not going to judge them to make, just like with Silicon Valley, I'm not going to judge them on the, does every single grant succeed?

我会从整体上评估他们的项目组合。这些项目是否转化为对目标疾病患者更好的健康状况？是否带来了生物学知识的重大进步？对吧？我将从整体角度评估项目组合。

I'm going judge them on the portfolio as a whole. Does it translate over to a better health for the people that they're, for the disease that they're like trying to address or the diseases that they're trying to address? Does it result in big advances in biological knowledge? Right? I'm going to assess the portfolio as a whole.

另外还要看是否符合研究所的战略愿景。这些研究所都有非常出色的战略计划。当你阅读这些计划时，会被他们提出的科学构想所震撼。但根据同行评审结果实际获得资助的项目，往往在战略计划的某个部分有10个优秀提案，而另一部分却什么都没有。因此我会鼓励他们选择符合战略计划的项目组合。

And then the other thing is that does it match the strategic vision of the institute? The institutes, they have these like fantastic strategic plans. Like, you you go look at them and say, your eyes will get big with the science that they're proposing. And yet, what they actually end up funding based on their peer review panels is often you'll get 10 great proposals on one part of the strategic plan and like nothing on another part of the strategic plan. And so, I'm going to encourage them to be able to pick the portfolio so that it matches the strategic plan.

我会奖励那些更多奖励和赋能早期职业研究者的行为。没错。我将在研究所所长的决策中建立激励机制，让他们有动力解决这些长期存在的问题。我们必须解决新研究者的问题。同时我也会开始评估资深研究者，因为我确实认为他们仍然发挥着相当基础的作用。

I'm going to reward them for rewarding and empowering early career investigators more. Right. So, I'm going to build incentives into the decision making by the institute directors so that they have incentives to solve these long standing problems. We have to solve the new investigator problem. And I'm going to start to evaluate long established investigators because I do believe they play a pretty fundamental role still.

比如他们在推动共事的早期职业研究者职业发展方面做得如何？对吧？如果他们在指导和职业发展方面做得好，我将在他们的资助项目中给予奖励。我也会开始为此评估资助项目。因为从长远来看，资助组合必须能够持续产生新思想。

In like how well do they advance the careers of the early career investigators that work with them? Right? So if they're good at that kind of mentorship and career advances, I'm going reward them in their grants. I'm going to start evaluating the grants for that too. So because the grant portfolio has to be sustainable in the long run of producing new ideas.

我的意思是，如果早期职业研究者得不到所需的支持，我们就会开始停滞不前。

I mean, we don't have the early care investigators getting the support they need, we're going to start to stagnate.

我很高兴听到对推动早期职业研究者发展的兴趣。但讨论这个话题时不能不谈他们通常来自的大学。我是NIH MSTP资助的受益者，在NIH的慷慨支持下完成了MD-PhD学位。那么我的同班同学以及后来几十年通过这些资助项目接受培训的同行们呢？

I love to hear the interest in advancing early career investigators. But we can't have that conversation without talking about the universities from where they tend to come. And so I was a product of NIH MSTP funding. I did my MD PhD with the generous support of the NIH. And my peers and colleagues in my class and decades behind coming up get trained on those grants today?

您如何与行政部门合作，确保NIH确实认为将推动早期职业研究者培养渠道的培训资助的连续性？正如您所说，这些人最有可能带来变革、大胆的想法，并且敢于冒险尝试。

How can you work with the administration to ensure continuity for the training grants that NIH does believe are going to fuel the pipeline of early career investigators who, as you say, are perhaps most likely to bring change, big ideas, you know, and take big swings.

是的。我的意思是，您是生物物理学领域的，对吧？我们支持早期职业研究者的方式多种多样。有针对博士前学生的奖项，博士前指的是本科生。这一点非常重要。

Yeah. Mean, you know, you're biophysics, right? So we a range of ways that we support early care investigators. There are these awards for pre docs, pre docs meaning undergrads. And that's really important.

我们希望确保那些对生物医学和研究生物医学感兴趣且非常有才华的本科生有支持去做这件事。还有对博士后的支持，对吧？所以对于获得博士学位然后做博士后的人。这会很困难，但我们必须构建体系，使我们所做的各种投资真正转化为人们愿意留在生物医学领域。我的意思是，有很多人中途退出，但我认为RAIN问题不在于对早期的支持，我认为我们在很多项目组合上做得相当不错。

Like we want to make sure that the very talented undergraduates who are interested in biomedicine and research biomedicine have the support to do this. There's also like support for postdocs, right? So for people who are getting their PhD and then postdocs. It's going be hard, but we have to structure things so that the range of investments we make actually translate over to people wanting to stay in biomedicine. I mean, we have a lot of people who drop out, but I think the RAIN problem isn't that support for the early I think we have a lot of portfolios pretty good on that.

我们可以做得更好，目前已经相当不错了。问题在于，比如，在你拥有了生物医学领域的职业生涯之后，你如何，比如，凭借这段研究培训，是否有支持来，比如，实现下一个飞跃，获得助理教授的职位？而很多时候，这太难了。你无法获得所需的支持来实现这一点。我们有这些K奖项，但真的很难获得。

We could do better, it's pretty good. The problem is, like, after you've had this career in biomedicine, how do you, like, of this research training, do you have support to, like, make the next leap into an assistant professor job? And too often, it's too hard to do that. You can't get the support you need to do that. There's these K awards that we have that it's really difficult to get them.

我认为我们必须在这方面做得更好。我们必须奖励那些在这方面做得更好的大学。整个系统都存在各种问题，但我认为缺失的一环实际上是，你知道，你完成了医学博士和哲学博士学位后，能否获得那个助理教授的职位？还是你将被要求做17个不同的博士后，在那里你才有机会？目前，这个系统的设置使得这变得困难。

I think we have to do better at that. And we have to reward universities that are better at that. There's problems all across the system, but I think that missing link is really the, you know, you finish your MD and your PhD, and then can you get that assistant professor's job? Or are you going to be asked to do 17 different postdocs where you have a chance? Right now, that system is set up to make it difficult.

您之前提到我们在预期寿命方面没有取得进展。为什么我们落后了？为什么一些欧洲国家做得更好？您认为重新开始改善预期寿命的最高杠杆点是什么？

You mentioned earlier that we're not making advancements in life expectancy. Why are we lagging? Why are some European countries doing better? What are the highest leverage points you think to get back to improving there?

嗯，我认为关键是我们必须——我们的很多科学，你知道，我们之前讨论的这个复制问题非常重要。我们必须解决这个问题。那会很有帮助。然后是这个项目组合的事情，我认为这两件事实际上都将解决科学严谨性问题和某种保守主义问题。至于解决预期寿命问题，那实际上需要——在某种意义上，这不仅仅是一个科学问题。

Well, think the key thing is we have to A lot of our science is, you know, this replication question we talked about earlier is very important. We have to solve that. That will help a lot. And then this portfolio thing, I think both of those things actually will address the scientific rigor problem and the sort of conservatism problem. As far as addressing life expectancy, that that really needs to be it's in a sense not just a scientific problem.

就像，我们必须从根本上从我们想要的人群那里得到信息，表明他们希望科学家解决这些问题。就像我们之前讨论的，那种资源配置决策的政治性质。但你知道，这正是Mahaboo运动所代表的。Mahaboo运动基本上是来自美国人民的求助呼声，他们说，看啊。所有这些慢性病问题，我们孩子的所有这些问题，我们生病了，我们的健康状况比欧洲人差很多。

Like, we have to we have to essentially get a message from the people that we want that that they want scientists to address those problems. Like, that's just what we talked about earlier, the political political nature of of of that kind of allocation decision. But, you know, that's exactly what the Mahaboo movement represents. The Mahaboo movement is a it's basically a cry for help from the American people saying, look. All these chronic disease problems, all these problems with our kids, and we're sick, we're doing much worse than folks in Europe in terms of our health.

这本质上是对NIH进行改革以解决这些问题的呼吁。对我来说，这是一个巨大的机会。这就是为什么我同意接受这份工作。我本来当教授很开心的。但这是一生一次的机会，让NIH真正为美国人民服务。

That essentially is a call for the NIH to reform itself to address those problems. To me, it's a tremendous opportunity. And this is why I agreed to take this job. I was perfectly happy being a professor. But it's a once in a lifetime opportunity to make the NIH really work for the American people.

而且我认为，有那样的政治运动在我们背后支持，对实现这一点非常重要。

And I think having that political movement behind us is really important for that.

上周，你宣布了一些关于学术自由的有趣倡议。许多人知道你的声音登上全国舞台，部分原因是你热切希望看到学术自由在全国得到尊重和保护。听起来你正在寻找从根本上改善出版的方式，以便人们，包括早期职业研究者，在各个层面都能自由分享他们认为可能有趣的科学观点。并且，正如你之前提到的，我们需要弄清楚如何阐明，任何发表的内容不一定是事实，而是一种观点，由一套数据、一套分析和一套视角支持。你希望更多这样的观点在公共领域蓬勃发展。

Last week, you announced some really interesting initiatives around academic freedom. And many folks know your voice reached the national stage, in part because of your ardent desire to see academic freedom respected, protected across the country. And it sounds like you're looking for ways to improve publishing fundamentally so that people feel freedom at all levels, including early career investigators, to share their view on science that they think might be interesting. And we need to figure out, to your point earlier, how to make the point that anything published is not necessarily fact, but it's one opinion backed by one set of data and one set of analysis and one set of perspectives. And you'd like more of those to flourish in the public arena.

请多谈谈你希望NIH在保护学术自由方面扮演的角色。

Say more about the role that you want NIH to play in protecting academic freedom.

嗯，首先，在NIH，我发现很多内部研究人员为了发表他们的工作，必须获得上级的许可。我改变了这一点。不再需要许可。如果你是NIH的研究人员，你有科学论文，你不需要得到我的许可。人们会发表我不同意的研究。

Well, first, at the NIH, I found out that a lot of folks at the internal investigators at the NIH, in order to publish their work, had to seek permission from their supervisors. I changed that. Like no more permission. If you're an NIH researcher, you have a scientific paper, you don't have to get permission from me. People are going to publish research that I don't agree with.

这很棒。他们应该能够这样做。此外，像大学这样的地方，我认为必须绝对致力于学术自由，才能产生优秀的科学。而且，你知道，过去几个月，政府在大学行动上有很多争议，关于要求它们达到高标准，比如反犹太主义等等。但同时也传递了一个信息，即我们确实希望大学拥有学术自由。

It's wonderful. They should be able to do that. Also, places that, like the universities, I think, need to be absolutely committed to academic freedom for some excellent science to happen. And, you know, like there's been a lot of like bangs over the administration's actions with universities over the last few months regarding holding them to high standards regarding, you know, anti Semitism and so on. But there's also been a message that we really do want academic freedom at the universities.

科学家应当能够畅所欲言并自由探索，否则就不是良好的研究环境。至于期刊，这是个复杂的问题，但当前症结在于科学期刊实质上存在双头垄断。少数几家营利性公司控制了大量期刊，它们对并非由自己完成、由美国纳税人资助的研究每篇文章收取上万美元费用。他们曾有这样的政策：普通人想查阅科学论文必须付费——存在一道付费墙，需支付50或100美元。我们已为NIH资助的研究取消了这堵付费墙。

Scientists are really able to say what they think and explore where they will, or else they're not good environments for research. As far as journals, that's a complicated question, but the problem right now is that the scientific journals, there's essentially a duopoly. A very few number of companies, for profit companies control very large number of journals and they charge tens of thousand, $10,000 per article for science that they didn't do, that the American people paid for. They actually had a sort of a policy where, if a regular person wanted to go find a scientific article, they had to go. There was a paywall where they pay like $50 $100 We got rid of that paywall for NIH funded research.

这方面还有很多工作要做。我们需要更多学术自由，需要更开放的科研出版体系，我正在制定相关政策来实现这一目标。所以杰伊，

There's still a lot to do in this area. We need more academic freedom. We need more openness and scientific publishing, and I'm working on policies to do that. So Jay, one

美国公众关注的核心问题之一是追求更好的健康结果。这个国家过去一直引以为傲的重要途径就是拥有卓越的公共卫生基础设施。但过去几年间确实出现了许多对公共卫生的不信任。如何重建公众信任？因为显然，如果没有信任，卫生信息的传播效果就会大打折扣。

of the key questions for the American public, they're looking for better outcomes, better health. One of the big avenues that, of course, this country uses and it's really had as a gold standard in the past is having this extraordinary public health infrastructure. But I think what's also true is over the course of the last several years, there's a lot of mistrust now in terms of public health. How do you rebuild that trust for the public? Because obviously, if there's no trust, the message can only be so effective.

那么我们应该如何重建这些桥梁——在您认为需要重建的范围内？

So how do we build those bridges back to the extent that you think they need rebuilding?

我认为公共卫生问题及其信任缺失必须追溯到疫情时期。如果你回顾疫情阶段，记得到处设置的有机玻璃隔板——现在每次看到这些隔板都让我怒火中烧，不过这又是另一回事了。这些措施根本没有科学依据，对吧？

I think the problem with public health and the lack of trust in it, you have to point to the pandemic. You have no choice. If you look at you just think back to the the pandemic and you remember the plexiglass that was everywhere, that's there's still every time they see a plexiglass, it makes me fills me with rage, but that's another story. And there was no science behind that. Right?

还有比如进餐厅要戴口罩，坐下就能摘掉。明白吗？这同样没有科学依据。诸如此类的一系列措施。特别是关闭学校这种危害极大的决策——其科学依据如此薄弱，导致现在孩子们的教育进度落后数年，他们未来多年都要为此付出代价。

There was the there was, like, the you wear a mask when you walk into a restaurant and you take it off when you sit down. You know? You again, no science behind it. A whole host of, like, things. And they were really damaging things like closing schools, where again, the science was so weak that it's now kids are like years behind in education as a result, and they'll be paying the price for that for years.

因此很多美国人对公共卫生失去信任，我完全理解其原因。那么问题在于我们该如何应对？在我看来关键有两点，两个宏观层面的举措：第一是必须恢复黄金标准的科学研究。总统关于黄金标准科学的行政令非常重要，因为它明确了我们原以为所有科学家都已认知并恪守的原则。

And so a lot of American people have lost trust in public health for reasons I can completely understand. And so the question then is, what can we do about it? And to me, the key thing is there's two things that have to happen, like two very broad things. Like one, think we have to restore gold standard science. Like that presidential EO on gold standard science is so important because what it says is it articulates things that we thought all scientists already knew and are committed to.

比如可重复性非常重要，无偏见的同行评审，以及在讨论我们科学发现局限性时的谦逊态度。有很多事情你读到时会感叹，哇，我以为科学早就做到了。所以如果我们真的做到这些，我认为这是其中的主要部分。第二件事是，就像我们之前谈到的，必须明确人民政治在决定资助哪些科学优先领域中的作用，然后由科学家在投资组合分析中决定科学领域内的优先资助事项。我们必须向人们传达，我们是他们在科学研究和公共卫生领域的合作伙伴。

Like replication is really important, unbiased peer review, humility in how we talk about the limitations of our scientific findings. There's a whole host of things where you read it and go, Wow, I thought science already did that. So And if we actually do that, I think that's a major part of this. The second thing is we have to just like we talked about earlier, the role of the people politics in deciding what scientific priorities, areas of science to fund, and then scientists to decide what priorities within the science areas to fund in the portfolio analysis. We have to convey to people that we are their partners in scientific investigation and in public health.

公共卫生工作者是人民的公仆。但在疫情期间，很多时候给人的感觉是我们高高在上，对吧，告诉你们该做什么，告诉你们如果不接种疫苗就不能上班，不能找工作。看到这些令人心碎，因为我深信，当科学以合作伙伴的身份与人民协作，并怀着近乎仆人的态度对待人民时，就能做很多好事。真的能做很多好事。但我认为，这种谦逊和回归某种黄金标准的科学，才是解决信任问题的方法。

Folks in public health are servants of the people. And too often during the pandemic, it came across like we sitting above people, right, telling you what to do, telling you if you don't take this vaccine, you can't go to work, you can't get a job. It heartbreaking to watch because I believe very fundamentally that when science works as partners with people and has this almost servant attitude toward people, you can do a lot of good. You can do a lot of good. But I think really that kind of humility and the return to sort of gold standard science, that's the way to solve the problem of trust.

不过，这将需要很长时间，因为我的意思是，我和全国各地很多人谈过，我们离解决公众信任问题还差得很远。

It's going to take a long time, though, because I mean, I've talked to so many people around the country and it's not we're nowhere near solving that public trust problem.

丹，我认为展望未来，这是一个特别具有挑战性的事情。我很想听听你的想法，如何在面对不确定性和信息不完整的情况下传达建议和指导。因为回到你的观点，在理想情况下，你总是依赖于黄金标准的科学。但很多时候，科学中存在很多未知。科学是艰难的，正如你之前所说的。

Dan, I think it's an especially challenging thing as you look forward. I'd love to hear your thoughts on how do you convey recommendations and guidance in the face of uncertainty and incomplete information. Because going back to your point, in an ideal world, you're always resting on top of gold standard science. But a lot of times, science there's a lot of unknowns in the science. Science is hard, going back to what you were saying earlier.

那么，在一个你自己也信息不全的世界里，你如何向一个紧张的民众传达一种建议甚至指导呢？

And so how do you communicate to a population, a nervous populace, a sense a recommendation or even guidance in a world where you yourself have incomplete information?

我认为你只需要诚实。如果我被问到一个问题，比如，天哪，但愿不要在我任内再发生一次大流行。然后我被问，好吧，我们应该如何应对？戴口罩是否正确之类的？没有确凿的科学证据。

I think you just have to be honest. If I asked a question about mean, God forbid, there's another pandemic during my watch. Then I'm asked, Okay, how should we manage? Is it right to wear masks or something? There's no good scientific evidence.

我会直接这么说。我曾经是一名医学生，拥有医学博士学位，所以我可以根据亲身经历告诉你。医学院的前两年，你上一堆课。第三年，你终于能见到病人了。所以你走进病房，穿着白大褂，但你一无所知或知之甚少。

I'm going to just say that. I was a medical student once, I was an MD, so I can tell you this from firsthand experience. The first two years of med school, you do a bunch of classwork. The third year, you finally get to see patients. So you walk into a patient room and you're wearing a white coat and you know nothing or very little.

你可以用生物化学知识填满自己，可以写化学方程式写到手指发酸。但你做不到的是理解病人真正需要什么。于是你坐在病人面前，听他们讲述自己的故事。这很美妙。

You can fill with knowledge about biochemistry. You can write chemical equations so your fingers get tired. But what you can't do is understand what a patient really needs. And so you sit down in front of the patient, they tell you their stories. Wonderful.

就像他们把信任托付给你。而你忍不住想告诉他们一些事情来满足他们的需求。但你并不知道答案。你只是不知道，因为你只是个三年级医学生。当然不知道答案。

Like they put their trust in you. And you are tempted to tell them things to answer their needs that they're asking you. But you don't know the answer. You just don't because you're a third year med student. Of course, don't know the answer.

因为穿着白大褂，因为有人看着你期待答案，把信任交给你，你会感到一种冲动，想说些自己并不了解的事情。你知道，就像开始自由发挥。但这是个可怕的错误，对吧？作为三年级医学生，你学到的是应该说：我不知道。我会去查一下。

And there's a like because you're wearing the white coat and because you have someone looking at you wanting the answer, putting their trust in you, you could feel this urge to like say things you don't know. You know, start like freelancing. And that's just a terrible mistake, right? As a third year mastering, you learn that you should just say, I don't know. I'm going to look it up.

我会为你查找答案。我会回来告诉你。我会咨询比我懂得更多的人。你必须保持谦逊。尤其是在面对新事物、新疫情或真正的科学不确定性时，我们公共卫生领域的人必须谦逊地说：看，我们不确定，但这是我们努力寻找答案的方式。

They'll look the answer for you. I'll get back to you. I'll consult with people who know more than I do. You have to be humble. And especially in face of new things, new pandemic or genuine scientific uncertainty, we in public health have to be humble and say, look, we're not sure, but here's how we're working to try to get an answer.

我们必须传达这种不确定性，不能责怪公众。我走访并与许多公共卫生和科学界人士交谈，他们说：我们需要做的是教公众更多科学知识，确保他们理解科学并不总是完美的，科学是不断发展的。比如今天说鸡蛋很好，明天又说鸡蛋很糟糕。那是因为有了新的科学发现。在我看来，这就像在责怪公众。

And we have to convey that uncertainty and we can't blame the public. I've gone around and talked to lots of folks in public health and science, they're like, well, what we have to do is we have to teach the public more about science and to make sure they understand that science isn't always perfect and science like moves. Know, may have eggs are great one day and eggs are terrible one another day. That's because we have new science. To me, that's like blaming the public.

不是公众不理解科学很难。他们从根本上明白。这不是什么复杂的事情，我的意思是，公众都知道科学是困难的。问题在于科学家们对那些本不该确定的事情表达了确定性，然后在疫情期间因此改变了人们的生活，使其变得更糟。

It's not the public doesn't understand that science is hard. They understand it fundamentally. Like they just this is not a complicated thing in the sense of like, I mean, everyone knows within the public that science is hard. The problem is that scientists conveyed certainty about things they had no business conveying certainty about and then changed people's lives for the worst as a result of it during the pandemic.

我承认疫情在沟通和不确定性中的确定性方面带来了特殊挑战。但我们如何承认这一挑战，同时不失去对过去几十年公共卫生进步基石的信任，无论是新生儿疫苗接种，HHS就婴儿乙肝疫苗接种举行了倾听之旅和咨询更新。我们全面审视所有数据很好。但在某些情况下，有人会认为，与新病毒、无数据、全新感染的新疫情相比，像乙肝这样的背景下不确定性要小得多。请不要觉得必须回应那个具体的疫苗例子，但我们如何确保即使在你拥有相对确定性时站出来说：嘿，这不完美，但我们非常确定这是个好主意。

I acknowledge that the pandemic was a particular challenge with respect to both communication and certainty in the midst of uncertainty. But how do we acknowledge that challenge and not lose trust in some of the bedrocks of public health advancement that we've made over the last several decades, whether that's newborn vaccinations, HHS held a listening tour and an advisory update on hep B vaccination in babies. And it's great that we're looking at all of the data holistically there. But in some of those cases, some folks would argue there is substantially less uncertainty than there was in the wake of a new pandemic with a new virus, with no data, with completely new infections than there is in the context of something like a hep B. And please don't feel the need to respond to that specific vaccine example, but how do we not make it so that even when you do have relative certainty and you come out and say, Hey, this is not perfect, but we were pretty darn sure this is a good idea.

那你如何让人们不会说，'你看，上次你说你不知道，所以我现在也不知道'。

How do you then make it so that people don't say, Well, you know, last time you said you didn't know, so I don't know.

对。所以我认为，当你不知道时，说'我不知道'是个好答案。但当你有更多证据，比如麻疹疫苗（MMR）。如果你想预防麻疹，就打MMR疫苗。这是预防麻疹的最佳方式，而麻疹可能是致命的疾病。

Right. So I think, I don't know is a good answer when you don't know. When when you have a a little more evidence, a lot more evidence, like just take the MMR vaccine. Like, mean, if you wanna prevent measles, take the MMR vaccine. I mean, it's the best way to prevent measles, and measles can be a deadly disease.

比如，我给孩子们打了MMR疫苗。很高兴我这么做了。

Like, I vaccinated my kids with MMR. Was really happy I did.

我也是。

Me too.

我认为那种确定性是科学的，对吧？没有什么是绝对已知的，比如明天可能有人推翻牛顿物理学，突然你就在讨论相对论之类的。你总要保留那种可能性。但有些事情我们确实更确定。我不是说我们都该假装谦虚。

And I think that that, you know, I think that that kind of, certainty, it's, you know, it's science, right? So nothing is known, like tomorrow that someone might come along and they overturn, you know, Newtonian physics and all of a sudden you're talking about relativity or something, right? That, that, it's, you'll always leave open that possibility. But some things we do know with certain, with like much more certainty. I, I'm, I'm not saying that we should all have false humility.

我认为我们应该对真正需要谦虚的事情保持谦逊。但同时，在科学确定性较高的领域，我们必须为学术自由留出空间，让人们可以表达不同观点。我们不取消他们，我们与他们理性讨论。

I think we should have humility for the things we just should actually have humility about. Right? But at the same time, when we have an area of more scientific certainty, we have to leave open room for academic freedom so that people can have their say, that they think differently. We don't cancel them. We don't, we just, we reason with them.

我们说，看，你说了XYZ，但看看所有这些其他证据，MMR就是个好例子。看看这些显示不同结果的证据。他们可以进行公开讨论。有这种矛盾是可以的。

And we say, look, you say X, Y, Z, but look at all this other evidence, MMR is a good example. Look at all the evidence that that, that that shows you differently. And they'll just have a public discussion. It's okay. I mean, it's okay to have that contradiction.

然后，然后，然后我认为当真正优秀的科学被复现时，人们会明白的，也许我太天真了，但我不这么认为。我认为科学辩论中胜出的是证据。你可以看看，有证据支持这一点，对吧？所以在这个国家，MMR疫苗的接种率，大约95%的美国父母给孩子接种了MMR疫苗。而COVID疫苗的接种率，我认为只有13%的美国父母给孩子接种。

And then and then, and then I think what will come across is when there is actual excellent science replicated, maybe I'm naive, but I don't think so. I think that wins scientific debates. And you can look, there's evidence for this, right? So the uptake of MMR in this country, the MMR vaccine is like ninety five percent of American parents vaccinate their kids for the MMR. And think it's like thirteen percent of American parents vaccinate their kids for the COVID vaccine.

我认为这反映了关于这些疫苗相对优点的科学证据。美国人民并不愚蠢。事实上，他们相当聪明。当我们以尊重他们智慧的方式与他们交谈，用数据说话，允许人们有不同意见，但将证据摆在人们面前时，我认为人们会以信任回应，跟随证据的指引。我的意思是，我只是，也许这只是我的一种信念，但我看不到其他前进的道路。

I think that reflects the scientific evidence regarding the relative merits of those vaccines. The American people are not stupid. In fact, they're quite smart. And when we talk to them in ways where we show respect for their intelligence with data, allow people to disagree, but then have the evidence right there in front of people, I think people will respond with trust, where the evidence actually leads. I mean, I just, I got, maybe that's just a matter of faith for me, but I don't see any other way forward.

你提到NIH的三个优先事项是营养、慢性病和整合人工智能。也许你能详细谈谈后两个，你认为在减轻疾病负担和整合人工智能方面，哪些最有前景？

You mentioned that the three priorities of NIH that you have are nutrition, chronic disease, and integrating AI. Maybe can you flesh out a little bit on the last two, where you see as most promising in terms of reducing the disease burden and then also in terms of integrating AI?

我见过一些关于阿尔茨海默病的绝妙新想法。例如，我在斯坦福的一位同事发表了一系列出色的论文，使用了一种名为Zostavax的旧带状疱疹疫苗。他发现在优秀的观察性研究中，如果你接种了Zostavax，可以将患阿尔茨海默病认知衰退的可能性降低高达20%到30%。我的意思是，对于一种相当无害且安全的疫苗来说，这相当可观，尽管它实际上不再使用，因为它对带状疱疹无效。我的意思是，如果你有一种简单、廉价的方法来预防30%的阿尔茨海默病例或延缓阿尔茨海默病数年。

I've seen some like fantastic new ideas regarding, Alzheimer's disease, for instance. A colleague of mine at Stanford did, has this like fantastic set of papers he published using an old shingles vaccine called Zostavax. He found that in excellent observational studies that if you had Zostavax, it reduces the likelihood of developing cognitive decline for Alzheimer's disease by up to twenty percent, thirty percent. I mean, it's pretty substantial for a pretty innocuous safe vaccine that's no longer used actually because it didn't work for shingles. I mean, if you had a very simple, cheap way to prevent thirty percent of Alzheimer's cases or delay Alzheimer's for years.

我见过所有这些巨大的进展，你知道，它们只需要一点科学的关爱。我认为我们只需要专注于这些，让我们的投资组合聚焦于此，愿意承担风险，比如尝试那些看起来是新颖的想法。我们将取得很大进展。顺便说一下，人工智能我认为将在这方面发挥巨大作用。就像每个人都知道的蛋白质折叠和AlphaFold。

There's all these like huge advances, I've seen, that, you know, just need a little bit of scientific love. I I think we just need to focus on those, have the make our portfolios focused on those, be willing to take risks in terms of, like, on things that look like they're they're new ideas. And we're going to make a lot of progress. And AI, by the way, I think is going play a tremendous role in that. Just, you know, everyone knows about the protein folding and AlphaFold.

它在加速生物医学药物开发方面做得非常出色，因为现在你不需要坐在那里等待，你可以进行计算，弄清楚蛋白质如何折叠，靶点会是什么样子，然后问哪些药物产品更可能真正有效，而不必进行非常昂贵的生物实验室工作。你仍然需要进行实验室工作，但它们以更有前景的方式进行。在我们提供医疗服务的方式上，对吧？所以你可以让人工智能帮助放射科医生更好地确保他们发现一切，让我捕捉到所有东西。甚至简单的事情，比如你去看医生，医生整个时间都坐在那里看电脑而不是看你，因为他们正在填写电子健康记录。

That has done an amazing job in turbocharging biomedical drug development, because now you don't need to sit there and wait, you can just do your computations, figure out how the protein folds, what the target sites will look like, and then ask which of these drug products are more likely to actually work without having to do very expensive biologic, you know, lab work. You still have to do the lab work, but they focus on lab work in more promising ways. In the way that we deliver medicine, right? So you can have AIs help radiologists do a better job at making sure they catch things, make me catch everything. Even simple things like, you you go to your doctor, the doctor sits there looking at the computer the entire time rather than you because they're like filling out their electronic health records.

让人工智能助手听取对话，为医生填写表格。所以他们只需事后检查，花几分钟时间，而他们把全部注意力都放在你身上，对吧？所有这些都需要研究，顺便说一句。我的意思是，这会帮助患者吗？我们必须问这些问题。

Have an AI assistant listen to the conversation, fill out the form for the doctor. So they're just checking afterwards, takes them a couple of minutes, and they're spending all their attention on you, right? All of this needs research, by way. I mean, this going to help patients? We have to ask those questions.

但对我来说，这是一个巨大的承诺。就像那些简单的东西可以改变生物医学研究以及患者的治疗方式。这就是为什么人工智能作为潜在工具对我如此重要。它确实需要研究。我的意思是，我不想，我们不能让人工智能对我们产生幻觉，然后基于幻觉来治疗患者。

But to me, that's a tremendous promise. Like those simple things can transform biomedical research and how patients are treated. So that's why AI is so important to me as a potential tool. It does need research. Mean, I don't want to, we can't have AI hallucinating on us and then treating patients based on hallucinations.

但是，你知道，解决这类问题是一个研究课题。

But, you know, that's a matter of research to fix those kinds of problems.

我们听说卫生与公众服务部（HHS）在整个机构范围内推出了企业级安全版的ChatGPT，从HHS乃至NIH内部运营的角度来看，这似乎是一项了不起的成就，能够内部查询一个想法的新颖程度。这类简单的查询和数据流动性似乎很重要。未来会怎样？人工智能会撰写研究所的战略路线图吗？人工智能会提交拨款申请吗？人工智能评审小组会评审拨款吗？而我们科学家将在其中扮演什么角色？

We heard that HHS rolled out across agency wide an enterprise secure version of ChatGPT, which seems like a terrific achievement from the perspective of internal HHS and NIH operations even, to be able to look up internally how new is an idea. Simple queries and data fluidity of that kind seems important. What's the future? Is an AI going to write the institute's strategic roadmap and an AI submit a grant and an AI review panel review the grant? And where are we going to play a role as scientists?

我的意思是，我不...好吧。这个问题涉及很多方面。

I mean, I don't. Okay. So, there's a lot to that question.

答案是否定的。是的。

The answer is no. Yeah.

我的意思是，我认为人工智能非常擅长总结现有知识。你给它的训练数据会帮助它。它在这方面非常出色。但要真正开发出挑战现有范式的新颖想法。我的意思是，我不知道你对人工智能的体验如何，它们在这方面还不太行。

Mean, I think AIs are really good at summarizing existing knowledge. The training data you give it helps it. It's fantastic at that kind of thing. Really developing brand new ideas that challenge existing paradigms. Mean, I don't know your experience with AIs, they're not quite as good at that.

我刚出台了一项新政策，限制你可以提交的新公共申请数量，比如一个周期最多六份之类。我们有写了60份申请的人，很明显是人工智能生成的。然后我们就有，你知道，这是个问题，这不是...是的。所以，我的意思是，我认为人工智能非常重要，正如我所说，我认为它是，但它必须，我们必须进行研究来了解如何用它来帮助人们。而且我认为人们，科学家们，仍然将扮演极其重要的角色。

I've just put a new policy in place where I'm limiting the number of new public applications you can have, like can have six a cycle or something. We have people writing 60 applications and very clearly AI generated. And then we have, you know, it's, mean, it's the problem that's not the Yeah. So, I mean, I think AI is really important, as I said, I think it's, but it has to, we have to do research to understand how it can be used to help people. And I think people, scientists are still going to have a tremendously important role.

NIH推出的新AI系统确实令人振奋。我们其实也一直在开发一个专门为NIH定制的新系统，同样是为了以保护患者隐私等方式进行防护，但在整个NIH范围内推广，让人们能够以有助于NIH特定任务的方式与之互动。所以我认为这一切都非常令人兴奋。但这是一种能力的增强，而不是替代。它将让人们的生产力大大提高。

The new AI system rollout at NIH is just exciting. We've actually been working on a new system also specific to NIH, again, to protect in ways that protect patient privacy and all that, but rolled out across the NIH so that people can like interact with it in ways that help NIH specific tasks as well. So I mean, I think that's all very exciting. But it's an augmentation of capacity rather than a substitution of capacity. It'll make people way more productive.

它将帮助我们解决一些关键问题。但科学家们仍然需要——我的意思是，作为科学家，我们仍然有工作要做。

It'll help us address some of the key problems. But scientists are still going to I mean, we still have work to do as scientists.

确实如此。如果我能以最后一个问题结束。如果你有一个信息要给那些正在考虑投身科学事业的新星科学家，让他们能够充分发挥自己的能力，使科学变得更好、更智能、更快速——无论是刚开始攻读新领域博士学位的科学家，还是考虑创办新公司以推进他们工作的科学家，或是在NIH运营实验室的科学家。对于那位希望尽其所能产生最大影响的个体科学家，你有什么信息要传达？

We do. If I could just end on one last question. If you had one message for the rising star scientist contemplating a career in science where they can bring the best of their abilities to making science better, smarter, faster, a scientist embarking on a new PhD in a brave new field, a scientist thinking about starting a new company to advance the work that they're doing, a scientist at the NIH running a lab. What is your one message to the individual scientist who's out there you know, hoping to make the biggest impact they can.

科学是不可思议的。它几乎拥有无限的能力来促进人类福祉。而正是那些相信自己的想法、即使门关着也一次又一次敲门直到它打开的个体科学家，才能真正在这个世界上产生重大影响。我会说，请留在科学领域，继续敲门并用它改变世界，因为这是科学家们能做到这一点的唯一途径。

Science is incredible. Like, it has almost limited capacity to advance human well-being. And it's the individual scientist who believes in their idea, keeps knocking on the door even when the door is closed over and over again until it opens. That's who really makes a big difference in this world. I would say, please stay in science, keep knocking that door and change the world with it, because that's the only way that scientists can do that.

我喜欢马克斯·佩鲁茨的故事。不知道你听说过他没有。他是剑桥大学的研究员，我想当时他五十多岁。他有一个想法，认为可以弄清楚肌红蛋白的结构，这听起来像是一件很极客的事情。但在那时，其实还没有蛋白质折叠这个领域。

I love the story of Max Perotz. I don't if you've heard of him. He's a University of Cambridge researcher in, I think, his fifties. And he had this idea that he could figure out the structure of myoglobin, which sounds like a very geeky kind of thing. It's like, but it's, but back then there was no protein folding field really.

我的意思是，他当时还是个学生，他所有的教授都不断告诉他，选一个更容易的问题吧，马克斯。这太疯狂了。你为什么把所有时间都花在这上面？你永远完成不了的。在剑桥大学的十年里，他四处游荡，每个人都知道他是个天才，但他似乎一无所获。

I mean, it was like, he was a student and all his professors kept telling him, pick an easier problem, Max. This is crazy. Why are you spending all your time? You're never gonna finish. And for a decade at the University of Cambridge, you wandered around, everyone knew he was a genius, but he was like, got nowhere.

他坚持不懈地工作，直到最终解决了这个问题。这彻底改变了生物医学领域的许多方面。最终他赢得了诺贝尔奖。我在想，我们今天是否有一个科学基础设施，能让像马克斯·佩鲁茨那样的人做出他当时的成就。我希望能通过NIH的力量实现这一点，让世界上的新马克斯·佩鲁茨们——那些现在怀揣伟大想法的人——能够尝试它们并用它们改变世界。

He's not just working at it until finally he figured it out. And it's just transformed like a whole host of things in biomedicine. And, you know, eventually won the Nobel Prize. It's, you know, it's the kind of thing where I ask myself, do we have a scientific, sort of infrastructure today that would allow a Max Perutz to do what he did back then. And I would love to make that happen through the of the power of the NIH, to allow the Max Pervertz of the world, the new ones who are now sitting there with great ideas, to be able to try them out and change the world with them.

太棒了。

Fantastic.

那么也许就此展望未来，如果我们回到最初的话题，您提到NIH的最高目标是改善美国人民的健康，无论是通过预期寿命还是美国人慢性病发病率来衡量。如果您必须猜测我们将在哪个领域看到最大最好的进展，是会来自我们如何管理患者——也就是疾病管理、治疗疾病的新分子，还是我们生活方式的改变？

So maybe on that note, just looking to the future, if we end where we started, you talked about the NIH's highest ambition is to improve the health of the American people, whether that's measured in life expectancy or the rate of chronic disease that Americans suffer from. If you had to guess where we're going to see the biggest and best gains, is that going to come from how we manage patients? So the management of disease, you know, new molecules for treating disease, or modifications in terms of how we all live?

是的。是的，没错。以上所有方面都是。我的意思是，你知道，在不确定的情况下，我非常相信投资组合的理念。所以我无法确切回答你的问题，因为在这三个领域我都看到了有希望的进展。

Yes. Yes, yes. Yes to all of the above. I mean, you know, I am a big believer in portfolios when I have uncertainty. So I don't know how to answer your question, because I see promising advances in all three of those topics.

我认为我们必须对以上所有领域进行投资，才能看到哪些方向最有前景。就像，谁能预测到GLP-1类药物——你知道吗，去年因为这个神奇分子，美国人均体重出现了几十年来的首次下降，这完全是因为我们坚持了正确的生物学研究。

And I think we have to invest in all of the above in order to see where the most promising things go. Like, who would have predicted that the GLP-1s, know, that would actually we saw a reduction in average body weight in this country the first time in, you know, decades last year because of a monster molecule that somehow turns out to, you know, when you, if you just do the right biology.

是有科学家在敲某扇门才让这成为可能的，对吧？

There was a scientist knocking on some kind of door to make that happen, right?

是的。这就是科学的特点——很难预测最大的突破会出现在哪里。所以你必须像投资组合一样分散投入。但对我来说，所有这些领域都显得非常有前景。

Yeah. Mean, that's the only thing about science. It's hard to predict where the best things are going to happen. So you have to, like, have a portfolio. But all of those areas to me look like they're very promising.

在我走遍全国与人们交流的过程中，我对所有这一切都感到兴奋。所以我迫不及待想看到我们的成果。

As I've gone around the country, talked to people, I'm excited about all of it. So I can't wait to see what we produce.

你们两位对这个问题有什么预测吗？还是说也是，嗯，

Do either of you have a prediction to that question? Or is it also Well,

这是我们每周都会讨论的话题，关于我们想在哪里投资。你知道，

this is the debate we have every week in terms of where we want to invest. Know,

我们的答案是是的，是的，是的，也是。

Our answer is yes, yes, yes, too.

正确。以上所有都是。

Correct. All of the above.

嗯，这是

Well, it's

一个很好的结束点。Bhattacharya 博士，非常感谢您来参加播客。

a great place to close. Doctor. Bhattacharya, thank you so much for coming on the podcast.

谢谢。

Thank you.

非常感谢。祝您有美好的一天。

Thank you so much. Have a great day.

感谢您收听A16Z播客。如果您喜欢这期节目，请在ratethispodcast.com/a16z留下评论告诉我们。我们还有更多精彩的对话即将呈现。下次再见。提醒一下，此处内容仅供信息参考，不应被视为法律、商业、税务或投资建议，也不应用于评估任何投资或证券，且不针对任何a16z基金的投资者或潜在投资者。

Thanks for listening to the A16Z Podcast. If you enjoyed the episode, let us know by leaving a review at ratethispodcast.com/a16z. We've got more great conversations coming your way. See you next time. As a reminder, the content here is for informational purposes only, should not be taken as legal business, tax, or investment advice, or be used to evaluate any investment or security, and is not directed at any investors or potential investors in any a16z fund.

请注意，a16z及其关联公司可能也持有本播客讨论公司的投资。更多详情及投资信息，请参见a16z.com/disclosures。

Please note that a16z and its affiliates may also maintain investments in the companies discussed in this podcast. For more details, investments, please see a16z.com/disclosures.