第15届伦德伯格研究所年度讲座：癌症共享

感谢您加入我们，收听联邦俱乐部的又一期播客节目。

Thank you for joining us for another podcast from the Commonwealth Club.

欢迎来到联邦俱乐部。我是乔治·哈蒙德，人文论坛和隆德伯格研究所的主席。人文论坛举办年度隆德伯格研究所讲座已有十五年历史。我想当我们开始时，我们以为，哦，我们会做几年。所以每年，隆德伯格博士都会召集一位演讲者或一组演讲者，讨论一系列议题。所有这些内容都以播客或视频形式提供，您可以回顾观看其他讲座。

Welcome to the Commonwealth Club. I'm George Hammond, chair of the Humanities Forum and the Lundberg Institute and the Humanities Forum has been putting on the annual Lundberg Institute lecture for fifteen years. I think when we started, we thought, oh, we'll do this for a couple of years. And, so every year, doctor Lundberg has gotten together, one speaker or a panel of speaker on a whole bunch of issues. All of them are on on either a podcast or video, that you can go back and watch the other ones.

在那段时间里，我们有很多关于疫情的讨论。所以今晚我们将讨论癌症共享（Cancer Commons）。而乔治，即乔治·隆德伯格博士，是癌症共享的主编。他还是Medscape的特约编辑。

We had a lot of them on the pandemic during that time. And so tonight we're going to do one on Cancer Commons. And George, Doctor. George Lundberg, that is, is the editor in chief of Cancer Commons. He's the editor at large for Medscape.

他是西北大学的临床病理学教授，同时也是隆德伯格研究所的主席和创始人。他还因在美国医学会杂志（AMA Journal）担任编辑的任期而极为知名。所以乔治，请告诉我们今晚的安排。

He is a clinical professor of pathology at Northwestern University, and he is also the president and founder of the Lundberg Institute. He's also extremely well known for his tenure, working for the AMA Journal, so as the editor. So George, let us know what we're gonna do tonight.

好的。非常感谢你，乔治·哈蒙德，感谢你连续十五年的友好介绍。感谢联邦俱乐部主办这场年度隆德伯格研究所讲座。同样十五年，三个不同的场地。这显然是最好的一个，比之前的两个都要好。

Okay. Thank you very much, George Hammond, for your kind introduction again for fifteen years in a row. Thank you, Commonwealth Club, for hosting this annual Lundberg Institute lecture. Again, fifteen year, three different venues. This is the best one, obviously, better than the two prior ones.

感谢现场和线上的各位出席并对我们的主题领域感兴趣。再次提醒，整个节目经过短暂编辑后将在YouTube上发布。所以您可以关注。您可以通过访问联邦俱乐部的活动页面找到它，或者通过访问lundberginstitute.org的活动页面找到。隆德伯格研究所是位于加利福尼亚州洛斯加托斯的一个501(c)(3)非营利组织。

Thank you all for in the studio and also online for for your attendance and your interest in our subject areas. And again, we're gonna be in YouTube with the entire program after there's been a little bit of time for editing. So you can look for that. You can find it if you go to the Commonwealth Club events page, or you can find it by going to the lundberginstitute.org events page. The Lundberg Institute is a five zero one c three not for profit organization in Los Gatos, California.

那就是我。正如乔治所说，我做过很多事。我是一名在加利福尼亚州执业的医生。我的前二十五年职业生涯是在学术机构担任临床解剖、法医和肿瘤病理学家，工作地点包括加州大学、加州大学戴维斯分校、南加州大学、哈佛和斯坦福。但后来，觉得还不够充实。

That's me. As George indicated, I've done a lot of stuff. I'm a physician licensed in the state of California. My first twenty five year career was as an academic clinical anatomic forensic and oncologic pathologist at places like UC, UC Davis, USC, Harvard, Stanford. But then, ready, not with enough of stuff.

所以，过去四十年里，我的第二职业是在多家机构担任全职医学编辑。最主要的是《美国医学会杂志》，我主持了十七年。今晚的讲座主题是'癌症公地'。这到底是什么？每年约有200万美国人被诊断出患有潜在致命性癌症。

So, the last forty years, my next career has been as a medical editor at a variety of places full time. The main one was the Journal of the American Medical Association, which I ran for seventeen years. Tonight's lecture is Cancer Commons. What on earth is that? Two million Americans are diagnosed Two million Americans thereabouts are diagnosed with a potentially lethal cancer every year.

采用标准疗法后，其中120万（约三分之二）患者能够治愈。但这意味着每年仍有约60万人无法治愈。虽然现有一些针对性治疗手段，但都只是零星的解决方案。这60万人超出了我们所谓的根治性医疗标准范围。

Using standard methods, one point two million or two thirds are cured. But that leaves about six hundred thousand who are not. And that's every year. Now, have some ways to get at those as well, but they're just little slices and dices. But that's the six hundred thousand people who are beyond what we would call the standard of curative care.

无论是否意识到，这些患者都属于'癌症公地'群体。这个庞大的患者群体该由谁来照料？这正是我们工作的意义所在。所有年份都重要，但某些年份尤为关键。2010年，我们创立了伦德伯格研究所，其信条是：一位患者，一位医师，一个瞬间，一项决策。

Those are cancer commons patients, whether they know it or not. That is the audience out there that, who's gonna take care of them? Well, that's where we are. All years are important, some years more than others. In 2010, we founded the Lundberg Institute and the credo was one patient, one physician, one moment, one decision.

让这项决策成为医患共同的选择，以最佳证据为依据，并充分考虑治疗成本。这是我们的董事会成员。最下面五位加上我，十五年来始终未变，去年新增了谢丽尔·格林。现场有三位董事——后排的帕特里夏·伦德伯格，以及艾伦和谢丽尔·格林，他们就在后方区域。

Let it be a decision shared by the patient and the physician, informed by the best evidence, and taking cost into consideration. This is our board of directors. The bottom five plus me have been there the entire fifteen years with no change, and we've added Cheryl Green within the last year. Three of the board are here, Patricia Lundberg back there, and Alan and Cheryl Green are here. They're in the back over here.

感谢各位莅临。同样在2010年，我们在帕洛阿尔托的营利性初创公司CollaborX内部启动了非营利项目'癌症公地'。该项目旨在通过非营利方式公开共享信息，逐个患者攻克癌症。今晚的活动正是关于'癌症公地'。

Thank you for coming. Also in 2010, we began a not for profit initiative in a for profit startup company called CollaborX in Palo Alto. And that initiative in 2010, we called Cancer Commons. It was intended to defeat cancer one patient at a time by openly sharing information in a not for profit way. Tonight's program is about Cancer Commons.

我们的首位演讲者是J·M·马蒂·特南鲍姆博士。马蒂拥有麻省理工学院电气工程学士和

Our first speaker will be Doctor. J. M. Marty Tenenbaum. Marty has a BS and

硕士学位，1972年获得斯坦福大学博士学位，当时他正从事人工智能早期阶段的研究工作

an MS in electrical engineering from MIT, a PhD from Stanford in 1972 when he was working in the early phases of artificial

人工智能。AI，从1972年开始。马蒂，这怎么样？时光飞逝，AI也是如此。马蒂被许多人公认为电子商务的发明者，他在九十年代初发明了它。

intelligence. AI, 1972 on. Marty, how about that? Time flies and so does AI. Marty is a recognized by many people as an inventor of ecommerce, inventor of it in early nineteen nineties.

他会告诉你他的故事，但他现在是一位晚期癌症患者的坚定倡导者，目前担任Cancer Commons董事会主席。艾玛·斯蒂贝尔曼，我在世界上最喜爱的人之一，可能比任何人都更了解这个主题，也比大多数AI系统所知道的更多，她最初在莫斯科接受教育，并在特拉维夫的魏茨曼研究所获得博士学位。来到旧金山后在UCSF做博士后，然后在工业界从事癌细胞生物学的先进研究。艾玛于2012年加入Cancer Commons，是我们的首席科学家。我们的第三位演讲者将通过远程方式出现，是一段约十一分钟的预录视频。

And he'll tell you his story, but he now is a fierce advocate for patients with advanced cancer, currently in his role as chairman of the board of directors of Cancer Commons. Emma Stibelman, one of my favorite people in the world, probably knows more about this subject than anybody there is, and more than most AI systems would ever know, Was educated originally in Moscow and got her PhD at the Weitzman Institute in Tel Aviv. Came to San Francisco as a post doctor at UCSF, and then did advanced work in cancer cell biology in industry. Emma joined Cancer Commons in 2012 and is our chief scientist. Our third speaker will be remote and it will be on a pre recorded video of about eleven minutes.

这是由我们的新CEO克利福德·里德博士录制的，他因先前的约定无法出席今晚的活动，所以改为录制视频。克利夫的教育背景包括MIT生物学学士、哈佛MBA，以及斯坦福博士学位。相当耀眼。他做过很多事情。

And his it is by doctor Clifford Reed, our new CEO at Cancer Commons, who had a prior engagement that took him away so he couldn't be here tonight. So he's done the video instead. Cliff's education was a BS in biology from MIT, an MBA from Harvard, and then his PhD from Stanford. Pretty glittery. He's done a lot of stuff.

他自称是技术和基因组学领域的连续创业者。他创立并运营的公司包括Complete Genomics和Travera。我们将通过视频看到他。与此同时，现在我希望马蒂和艾玛能上台进行分享。等他们两位都结束后，我会对克利夫做补充评论。

He describes himself as a serial entrepreneur in technology and genomics. Companies that he's founded and run include Complete Genomics and Travera. We will see him by video. Meanwhile, at this time, I hope we can have Marty and Emma on the stage and doing your thing. And after they're both finished, then I'll have additional comments to make about Cliff.

谢谢乔治。也感谢联邦俱乐部给予我们分享故事的机会。我是一名计算机科学家。我非常幸运能在计算机席卷世界的硅谷黄金时代成为一名计算机科学家。乔治提到我是AI领域的先驱。

Thank George. And thank you to the Commonwealth Club for the opportunity to share our story. I'm a computer scientist. I I was really fortunate enough to be a computer scientist in the heyday of computers taking over the world in Silicon Valley. George mentioned that I was a pioneer in AI.

实际上我是在1967年在斯坦福开始的，乔治。我在六七十年代建造的机器人曾被史密森尼博物馆和当地的计算机历史博物馆展出。所以当你是某个领域的第一个时，成为先驱很容易。这是个好建议。在九十年代，我确实在发明当今所知的互联网商务方面发挥了作用。

I actually started George, at Stanford in 1967. And the the robots that I built in the sixties and the seventies have been featured in the Smithsonian and locally in the computer history museum. So it's easy to be a pioneer when you're like first in anything. That's a good piece of advice. In the nineteen nineties, I really did play a role in inventing Internet commerce as you know it.

我创办了最早的互联网商务公司之一，我们做了一件非常关键的事情：开发了技术，使得在万维网上进行安全交易成为可能，当时万维网上只有大约30个物理实验室。我不知道我们当时在想什么，但我们喜欢这项技术。而这确实有机会改变了世界。在接下来的大约二十年里，我创办了五六家公司，主要都在电子商务领域。所有这些公司都很成功。

I started one of the first Internet commerce companies and we did something very crucial which was, to develop the technology that made it possible to do secure transactions on the World Wide Web at a time when there were like 30 physics labs on the World Wide Web. I don't know what we were thinking, but, we liked the technology. And this had a chance to it did change the world. And over the next, twenty years or so, I started a half a dozen companies in the largely in the e commerce space. All of them were successful.

但这段美好的生活在1998年被打断了，当时我发现腋下有个肿块，被诊断出黑色素瘤已转移到肝脏。那时还没有任何检查点抑制剂或靶向疗法——这些疗法后来因黑色素瘤如此棘手才被研发出来。于是，我被判定只剩九个月可活，而这正好发生在我将其中一家公司上市的途中。我本期待着拥有世界上所有的资源可供支配，却没有时间了。正如你所能想象的，我去咨询了所有当地的肿瘤医生，他们都告诉我同样的话。

But this wonderful life was interrupted in 1998 when I was discovered a lump under my arm and I was diagnosed with melanoma metastatic to liver. And this was before any of the checkpoint inhibitors or targeted therapies which were developed in melanoma because it was such a wicked disease. And so, given, nine months to live, this happened right in the middle of taking one of these companies public. And so I was looking forward to having all the resources in the world at my disposal, but no time. And I, went and talked to all of the local oncologists, as you might imagine, and they all told me the same thing.

我们无能为力。但我还有个秘密武器——里克·克劳斯纳，他当时四十出头，负责运营国家癌症研究所。我曾为他提供一些无偿咨询，他向我介绍了NCI资助的一批全新的医师科学家。这位是我的救命恩人，唐·莫顿，他拯救了我的生命。

There's not much we can do. But I went, to, I had an ace in the hole. Rick Klausner, who was in his early forties, he was running the National Cancer Institute. I was doing some pro bono consulting, with him, and he introduced me to a whole new tier of physician scientists that NCI was funding. This is my saint, Don Morton, the man who saved my life.

那些告诉我无能为力的医生显然不认识唐·莫顿，因为他是一位非凡的外科医生。他用最平静的语气说，你知道，你肝脏里有个肿瘤，我们会把它取出来。然后我还有一种实验性疫苗，正在临床试验中，它会清除所有残留的细胞。这一切的教训是，没有人应该有权告诉别人我们无能为力了。

And the physicians who told me there's nothing more that we can do obviously didn't know Don Morton, because this guy is a phenomenal surgeon. And he said, you know, with the calmest of voices, you know, you got a tumor in your liver. We'll take it out. And then I've got this experimental vaccine that I'm running a clinical trial on that will mop up all the residual cells. The the lesson of all of this is no one should be able to tell anyone that there's nothing more we can do.

他们无能为力，只是因为他们不知道唐·莫顿。所以，唐，你知道，做了这些事。然后有一天早上，我在临床试验中途醒来，在《纽约时报》上看到了这个头条。就像报纸上写的那样，我参加的试验的安全委员会阅读了结果和数据，说它没有效果。于是我打电话给唐，问道，就这样结束了吗？

There's nothing more they can do and they didn't know Don Morton. So, Don, you know, did these things. And then one morning, I woke up in the middle of the clinical trial and saw this headline on in the New York Times. And just like that in the paper, the trial I was on was the safety committee read it, the results, the data, and said it's not working. So I called Don up and I said, is that all there is?

你知道，我很幸运能与这个人建立关系。否则，我该打电话给谁呢？他说，是的，结束了。但事实证明，它帮助了一些患者，而我很幸运成为其中之一。而这已经是二十五年前的事了。

And this is you know, I was lucky enough to have a relationship with this man. Otherwise, who would I call? And he said, yeah, it's over. But, as it turns out, it helped a few patients and I was fortunate enough to be among them. And, this was twenty five years ago.

事实上，几个月前，我庆祝了最后一位告诉我只剩九个月的医生的离世。所以永远不要放弃。当我恢复健康后，正如乔治在2010年所说，我们两人有了一个想法，试图为其他人做唐和像他这样特别的医生为少数患者所做的事。我们想帮助每一个人。于是我们创立了Cancer Commons，帮助那些已经用尽所有标准方案但仍需要更多帮助的人。

In fact, a couple of months ago, I celebrated the demise of the last doc who told me that I had nine months. So never give up. And when I got my health back, as George said in 2010, the two of us, had this idea to try to do for other people what Don and very special doctors like him did for a few patients. We wanted to help everyone. And so we started cancer comments to help people who had exhausted all the standard options and needed more help.

下一张幻灯片。这是Cancer Commons早期的创立愿景。这张幻灯片实际上可能是2012年左右的原始幻灯片。从一开始，我们就设想了一个系统，帮助每位患者获得最佳可能的结果，然后跟踪该患者做了什么以及效果如何，这样我们可以从每一位患者身上持续学习。这一愿景吸引了一些杰出的人才。

Next slide. This was an early founding vision of Cancer Commons. And this slide may actually be a verbatim slide from 2012 or thereabouts. From the beginning, we envisioned a system that would help each patient get the best possible outcome and then track what that patient did and how well it worked so we could continuously learn from every patient. And this vision attracted some amazing people.

下一张幻灯片。角落里是当时的乔治·伦德伯格。他帮我组建了这个非凡的顾问委员会，成员大多是他的朋友。正如他所说，乔治曾是《美国医学会杂志》（JAMA）的主编。他旁边的是唐·肯尼迪，时任《科学》杂志主编，也是斯坦福大学的前校长。

Next slide. There's George Lundberg, at the time, up in the corner. He helped me assemble this extraordinary advisory board, mostly his friends. George, as he said, was the had been the editor of JAMA. Don Kennedy next to him was the editor of science at the time and former president of Stanford.

我们还有弗兰克·麦考密克，他当时负责加州大学旧金山分校的海伦·迪拉德中心，以及一些医学院的院长。但最重要的是，基本上涵盖了所有癌症领域的意见领袖，这些人都是乔治的朋友。他把他们请来，我们立刻行动起来，尽可能帮助更多患者。我们的患者会带着各种问题来找我们，我们会尽力解答。大多数情况下，他们是想确认当前的治疗方案是否合理。

We have on here Frank McCormick who had was running the Helen Dillard Center at the University of California, San Francisco, and, some deans of medicine. But most importantly, the thought leaders of basically every single cancer, these were all friends of George. And he brought them to the table, and we hit the ground running to help as many patients as we could. So our patients would come to us with all kinds of questions, and we'd answer, as best we could. Mostly, they were looking for sanity checks on their current line of treatment.

是否有其他可能的选择，特别是临床试验？他们会询问转诊给顶尖医生的推荐等等。我们都会帮助他们。但真正让'癌症公地'与众不同的是我们为这些患者所做的深度研究，以及传递这些结果时的清晰和同情心。请下一张幻灯片。

Were there any additional options that they might consider, especially clinical trials? They'd ask, for referrals to top docs and so forth. And we would help them. But what really set Cancer Commons apart was the depth of research that we would do on behalf of these patients and the clarity and compassion which with with which those results were delivered. Next slide, please.

这位坐在我旁边的非凡女性就是榜样——天使艾玛·斯蒂瓦尔曼，这些都是患者自发说的话。我们收到了成千上万条这样的自发赞誉。艾玛早期职业生涯曾是加州大学旧金山分校的实验室科学家，我想她与那里的一些杰出人士共事过，比如迈克·毕晓普、弗兰克·麦考密克等，从事基础科学研究。但后来，她希望为个体患者做更多事。

And those are the model of this extraordinary woman sitting here next to me, angel angel Emma Stivalman, who, through her patients, and these are all unsolicited words. We have thousands of unsolicited things like that. Emma was, previously, in her early career, a bench scientist at UCSF. I think she worked with some of the extraordinary people there, Mike Bishop, Frank McCormick, and so forth, doing some basic science. But at some point, she wanted to do more to help individual patients.

于是我们联系上了，她运用自己深厚的知识帮助这些患者找到新的选择。同样重要的是，她解释的方式让患者称她为'天才与天使的结合体'，因为她过去十多年里帮助了大约4000名患者。同样关键的是，她还招募并指导了几代科学家，其中一些人今晚就在观众席中，有些人则像散居各地一样走向世界。

And so, we connected, she used the amazing depth of, knowledge that she had to help these patients come up with new options. And, you know, equally important, explain them in a way that made her patients call her, you know, equal part genius and angel because she was there to help something like 4,000 patients over the last this one woman, 4,000 patients over the last, you know, dozen or so years. And equally important, what she did was that she recruited and mentored several generations of scientists that she's worked with. Some of them are in the audience tonight. Some of them, they've gone out like the diaspora.

对吧？是的。并且向世界展示了如何做我们正在做的事。下一张幻灯片。我想快速感谢一下目前在艾玛的科学领导和阿德里安·纽金特的操作领导下的团队科学家们。

Right? Yeah. And, and showed the world how to do what we're doing. Next slide. I'd just like to do a quick shout out to, the scientists that are on the team, today under Emma's scientific leadership and Adrian's, Nugent's operational re leadership.

我知道你们所有人今晚都在收听。非常感谢你们的服务。作为一个搞人工智能的人，我一直尝试——但可能不成功——用AI和我擅长的技术来复制这个团队的工作。多年来，他们作为一个团队可能已经服务了12000名患者。我为此感到无比自豪。

And I know all of you guys are out there listening in tonight. So thank you so very much for your service. I've been trying, and I might add unsuccessfully as, an AI guy, to try to replicate this team, using, AI, my go to talent to try to replicate what they do. Over the years, they've done probably 12,000 patients as a team. And I am so proud of that.

但这只是杯水车薪。每月需要帮助的患者数量高达12,000人。那么，我们如何以财务上可持续且能保持这种深切同情心的方式来扩大规模？有两件事让这成为可能：其一，正如各位所知，人工智能在过去几年取得了非凡成就。

But it's a drop in the bucket. The need is like 12,000 a month in terms of the patients who need help. So how can we scale this in such a way that is financially sustainable and is able to, keep this deep compassion. And there's two things that have made that now within the realm of possibility. One is, as you're all aware, AI has had a remarkable set of achievements over the last few years.

因此，过去不可能实现的事情现在成为可能。下一件大事——请翻到下一页幻灯片。我们成功邀请到了卓越的高管克里夫·里德（George刚才提到过），他放弃了漫长创业生涯中的又一次初创机会。这位先生创办过三家公司并推动上市，期间还完成了更多事业。顺带一提，Complete Genomics就是他带上市的。

And so things are possible now that weren't possible in the past. And the next big thing was the next slide, please. We somehow managed to recruit this extraordinary executive, Cliff Reed, that, George told you a bit about, to give up one more start up in his long chain. And this is a man who started three companies and took them public and did a bunch more things in between. Complete genomics, by the way, he took public.

他创办并推动上市后，将其出售给华大基因。如今它已成为仅次于Illumina的全球第二大测序公司。他最近从MIT分拆创立的Traverra公司专注于功能性检测——通过活体组织与药物相互作用测试，能较准确预测患者疗效。

He started. He took public. It's, he then sold it to Beijing genomics. It's now the second largest sequencing company in the world, after Illumina. And his most recent company, which he spun out of MIT, Traverra, does functional testing in which you take live tissue and, drugs and you, test them and predict pretty well how well patients are gonna do.

稍后我们会详细讨论功能性检测。我们找到了这位拥有宏伟蓝图的卓越管理者，他计划将我们每年1,500名患者的服务规模，在十八个月内扩展到十万患者——至少是愿景目标，这正是我们努力的方向。

And we'll talk a little bit more about functional testing in a bit. So we've got the man with the plan, and he's an extraordinary executive. And he has a plan to take what we've done, you know, our 1,500 patients a year and, scale it to a 100,000 patients within eighteen months. At least aspirationally. That's what we're trying to do.

我们利用人工智能解读癌症文献、消化知识并向患者解释。我常说我们要把'艾玛'装进盒子里——系统的早期版本正是以这位杰出女士的名字命名的。克里夫同时正在招募一支护士导航员大军，目标召集千名肿瘤科护士（可利用业余时间或已退休），让需要人性化关怀的患者获得手握手的解释与陪伴。

And we've got AI to be able to read the cancer literature and digest it and explain it to patients. And I like to say that we're trying to put Emma in a box. And I actually called the early instance of the system Emma after this wonderful lady. We Cliff is also recruiting an army of nurse navigators. He'd like to get a thousand of them who will, oncology nurses, moonlighting or retired one, earn some extra bucks, that for people who want the human touch can be there to hold their hand and explain things to them.

他正在整合所有这些资源。Cancer Commons使命的第二部分（我提过但初期缺乏资源推进）是：持续从每位患者身上学习，以帮助下一位患者。克里夫与我将共同推进这项工作——我负责人工智能，他负责战略规划。

And, he's putting all that together. The second part of Cancer Commons mission, which I talked about, which we really didn't have the resources to work on at the beginning, was, being able to learn from every patient continuously in order to be able to help the next patient. And Cliff and I are gonna work on that together. I'm the AI guy. He's the guy with the plan.

请翻到下一页幻灯片，我有一个愿景目标（尚未征得克里夫同意，他作为优秀管理者可能不认同如此宏大的设想）。我大约只剩五年时间推进这些工作，强烈希望在此期间显著降低癌症死亡率。有几项措施我认为极有可能在这段时间产生重大影响：首先是实现最佳知识的全民共享。

And, if you go to the next slide, I have an aspirational goal. I haven't asked Cliff to buy into this yet, and I don't know whether he will because he's too good a manager to be so aspirational. I only have about five more years left to do this stuff, and I have a real desire to make a serious, hit on cancer mortality over that time period. And there's a few things that can be done that I think really have the potential to make an age major impact over that time period. The first is, getting universal access to the best knowledge.

第二点是，减少癌症治疗中的一些猜测。第三点是开发一些新的治疗方案。我将花一两分钟谈谈每一点。而克里夫在他的录音讲话中会更深入地探讨。众所周知，不同机构的治疗和结果差异很大，并且从主要的学术癌症中心向外延伸至社区医院，再到更偏远的农村社区、发展中社区，以及第三世界社区和弱势社区时，治疗效果往往会迅速下降。

The second is, taking some of the guesswork out of cancer treatments. And the third is developing some new treatment options. And I'm gonna speak just for a minute or two about each of these. And Cliff, in his recorded remarks, is gonna go, deeper on them. It's well known that treatments and outcomes vary widely across institutions, and they tend to decrease rapidly from major academic cancer centers as you move out into community hospitals and then further afield into, rural communities, developing communities, you know, third world communities and disadvantaged communities.

问题是，为什么在一个人人都应该能够知道所有知识的时代，这种情况还会发生？因此，如果我们能找出谁是最好的，并让所有人都达到最佳水平，就有机会拯救无数生命。重要的是，不需要新药或新知识，只需找出谁是最好的，然后提升所有人的水平。目前，我们正通过人工智能和我们的科学家进行大量深入研究，以确定什么是最好的。我们将编制指南，作为国家癌症中心NCCN指南（以早期癌症闻名）的补充。

And the question is, why does this happen today in an age where everyone should be able to know what everyone knows? And so there's an opportunity by just bringing everyone up to the level of the best if we can just figure out who is the best, to save countless lives. And importantly, with no new drugs or no new knowledge, Just find out who's the best and bring everyone up. Now we are doing, with AI and through our scientists, a lot of deep research to figure out what's the best. And we're going to be compiling guidelines that will be complementary to the National Cancer Center NCCN guidelines that are well known for early stage cancers.

但这些指南在某种程度上止步不前。它们说在一线和二线治疗后考虑临床试验，而这正是我们的起点。我们的患者需要的是系统性地捕捉这些专业知识，经过专家审查，然后进行社区评议，并持续跟踪数据，使其不断改进。如果需要，我们可以每月更新，甚至为每一位患者更新。

But they kind of bottom out. They say after first and second line therapy and consider a clinical trial, that's where we start. That's what our patients need is systematically to be able to capture that, expert vet it, and then put it out for community comment and continuously track the data so this gets better and better. And we can update it monthly if necessary. We can update it with every patient.

这就是人工智能的魔力。因此，在很短的时间内，我们确实有机会在这里产生影响。这位是悉达多·穆克吉，他写了《众病之王》，是一位非凡的医生和作家。

That's the magic of AI. And so there's a real opportunity to make a difference here on a very short time scale. That's Sid Mukherjee. He wrote The Emperor of All Maladies. And he was, is an extraordinary, doctor and writer.

他观察到，癌症治疗中存在很多试错。同一种药物可能对某些患有特定类型癌症的患者效果很好，但对另一组癌症患者却毫无作用，而对第三组患者，它只会引起一些严重的不良反应。我们可以做得比这好得多。

He made the observation there's a lot of trial and error in cancer. You can have the same drug that works well for some set of patients with a given type of cancer. It doesn't do anything for another set of can cancer patients. And for a third set, it just causes some severe adverse reactions. We can do a lot better than that.

请翻页。可悲的事实是，实际上只有不到五分之一的癌症药物对其处方患者效果良好，有时甚至不到十分之一。每位患者都承受着这些副作用。因此，如果我们能找到解决这个问题的方法，就能取得很大进展。这是Trevera的业务之一。

Turn the page, please. The, you know, sad truth is that fewer than one in five cancer drugs actually works well for the patients for whom it's prescribed, and sometimes it's fewer than one in ten. Every patient suffers the side effects of this. So if we can find a way to do something about that, we can make a lot of progress. That's one of the businesses of Trevera.

前排的克里夫·法普菲尔德，Sage Medic，另一家初创公司。有很多人正在做一些惊人的工作。这些测试的准确性，预测准确性，正在变得越来越好。我认为它们正接近75%或80%的阳性预测值，也就是说，如果测试显示它会有效，那么它很有可能有效。如果测试显示它不会有效，那就别浪费时间了。

Cliff Fappfeld in the front row here, Sage Medic, another start up. There's a bunch of people who are doing some amazing work. And the accuracy, the predictive accuracy of these tests are getting better and better. I I think they're approaching, like, 75 or 80% positive predictive value, namely if the test says it's gonna work, it has a good chance of working. If the test says it's not gonna work, don't bother wasting your time.

因此，Cancer Commons 可以与 Travera、Sagemedic 等公司合作，确定哪些检测最适合哪些类型的患者和癌症类型，并将这些纳入我们刚才讨论的指南中，使其广泛推广。这是三件事中的第二件。第三，我们需要新的疗法。目前开发一种新的抗癌药物需要十多年时间，耗资巨大，这不符合我的五年时间框架。但好消息是，FDA 已经批准了 300 种用于治疗癌症的药物。

So we can Cancer Commons can be in a position of working with, Travera and Sagemedic and companies like that to figure out which tests are the best for which types of patients and which types of cancer and build those into the guidelines that we just talked about so they become widespread. So that's the second of the three things. Third, we need new therapies. Now it takes over a decade to develop a new cancer drug at tremendous expense, and that doesn't fit my five year time frame. So, there is good news, however, which is there's 300 drugs that have already been approved by the FDA for treating cancer.

其中大多数药物只在少数患者和少数癌症类型中进行过测试。对吧？所以这个领域还是一片蓝海。这些药物可以并且已经被超适应症使用，用于需要的患者。

And most of these have been tested in a very small number of patients in a small number of cancers. Right? So the space is is greenfield. Right? These drugs can and have been used off label, for patients who need them.

甚至除此之外，有趣的是，没有人知道使用任何药物的最佳方式

And even beyond that, the interesting thing is that no one knows the optimal way to use any of

这些

these

药物，因为它们必须用于个体化的联合疗法和鸡尾酒疗法或随时间调整。那才是最佳方式。那么我们如何在这个领域导航呢？答案就是我们刚刚讨论过的所有那些功能性检测。我们可以消除猜测，帮助每位患者获得最佳治疗。

drugs because they have to be used in individualized combination therapies and cocktails or over time. That's the optimal way. So how can we navigate that space? And the answer is all of those, functional tests that we just got through talking about. We can take the guesswork out of it to help each patient get the optimal treatment.

然后，如果你愿意，我们可以创建一个“单例试验”，这为测试建立了一个框架，跟踪这些患者，观察他们的反应，看效果如何，然后自下而上地建立一个队列，而不是从一个假设开始并进行测试。这是一种非常快速地开发各种新疗法和联合方案的方法。我认为，如果我们做好这三件事，我们就有真正的机会在当今癌症患者的有生之年产生有意义的影响。这是一个非常雄心勃勃的议程，没有人能独自完成。当然，像 Cancer Commons 这样的非营利组织也不行。

And then we can create an end of one trial, if you like, which creates the framework for a test for following those patients, seeing what they do, seeing how well it worked, and then building a cohort from the bottom up as opposed to starting a trial with one hypothesis and testing it. This is a way to develop all kinds of new therapies and combination regimens very, very quickly. And I think if we do these three things, we have a real shot at making a meaningful difference in the lifetime of today's cancer patients. This is a very ambitious agenda, and no one can do it alone. Certainly not a nonprofit like Cancer Commons.

如果你在谈论试图修复基础设施，以便我们能弄清楚如何让人们自愿分享、汇集他们的数据并共享，如何能够建立必要的东西，以便功能性检测公司可以在 24 小时内正确地将肿瘤标本从社区医院病理实验室运送到他们的实验室并妥善保存。然后，如果我们需要获取我们进行过测试的药物，如何让人们同意通过制药公司的同情使用提供给我们，或者能够让保险公司报销，因为我们将开发数据，将这些疗法转变为获批的新疗法。所以我们需要……我现在不再日常运营 Cancer Commons 了，我将帮助 Cliff 从创办 Cancer Commons Labs 开始，与所有相关的组织合作，无论是营利性还是非营利性，这些组织是我们完成使命所必需的，并且让任何其他想与我们合作、分享我们价值观等的组织能够轻松地与我们互动。

If you're talking about trying to get the infrastructure fixed so that we can figure out how to get people to willingly share, pool their data and share it, how to be able to build what's necessary so that the functional testing companies can get, a tumor specimen out of a community hospital path lab and to, their lab properly preserved within twenty four hours. And then if we need access to the drugs that we've run tests on, how to get people to agree to give it to us either through, compassionate use from the drug companies or being able to get insurance companies to reimburse because we will develop the data that will turn these into approved new lines of therapy. So we need I I'm going to be, now that I'm not, running Cancer Commons day to day anymore, I'm gonna be helping Cliff start by starting Cancer Commons Labs and working with all of the organizations that are out there, both for profit and nonprofit, that we need in order to accomplish our mission and to make it easy for any other organizations that want to work with us that share our values and so forth to be able to, engage with us.

所以，我的最后一张幻灯片是：我们需要听到您的声音。如果您或您认识并关爱的任何人正在应对严重的癌症，请联系我。我的邮箱在那里。我会亲自接听电话，或者请访问 cancercommons.org 为患者注册。我们能提供的帮助是无价的，而且我不知道还有哪里能获得我们提供给人们的这种建议。

So, my final slide is we need to hear from you. If you or anyone that you know and love is dealing with a serious cancer, please reach out to me. My email is there. I'll take the call personally or go to cancercommons.org and register the patient. It's, priceless what we can do, and I don't know any other place where you can get the kind of advice that we, provide people.

其次，如果您个人希望在这个特殊时刻作为一个志愿者或可能的慈善支持者，参与到一个非常有意义的癌症组织中，天哪，我真的很想听到您的消息。最后，如果您是一个与我们有着共同愿景和价值观的组织，我希望与您合作。请通过 Cancer Commons Labs 联系我。就这样，我将把讲台交给 Cancer Commons 的核心、灵魂和智慧——Emma Stivalman。

Secondly, if you're, an organ if you want, personally to engage at a very special time with a very meaningful cancer organization as a volunteer or possibly as a philanthropic supporter, boy, do I wanna hear from you. And finally, if you're an organization that shares our vision and values, I want to work with you. Come contact me through Cancer Commons Labs. And so with that, I'm going to turn over the podium to the heart, soul and brains of Cancer Commons, Emma Stivalman.

谢谢，Maritesh。我现在有点为难，因为我当然准备了一些开场白。但现在，一方面，我对 George 和 Marty 给予的赞誉感到非常尴尬；另一方面，在这些赞誉之后，我可以随心所欲地说任何话而不会被追究。但我不会这样做。

Thank you, Maritesh. I am in a quandary now because, of course, I had some prepared words to start with. But now, on one hand, I am very embarrassed by the accolades that I received from George and Marty. On the other hand, after these accolades, I can say whatever I want and get away with this. But I will not.

我想感谢 George，他是一位真正的灵感来源。自从十三年前我第一次见到他以来，我永远都听不够他的话。他太了不起了。我还要感谢他给予我在此演讲的荣誉。我可以说，Marty 当然是 Cancer Commons 的创始人和推动力，没有他，我不可能在 Cancer Commons 坚持十二年，实际上是十三年，努力做我所做的事情。

I want to thank George, who is a real inspiration. Since I met him first time thirteen years ago, I will never get enough of him. He's amazing. And I also want to thank him for giving me honor of presenting here. And I can say that Marty, of course, the founder and driving force behind Cancer Commons, without him, I wouldn't have lasted for twelve, actually thirteen years, with Cancer Commons trying to do what I do.

话虽如此，我们可以——哦，我现在可以移动它们了。是的。首先，我将简要介绍我们在 Cancer Commons 的工作。Marty 给出了很好的解释。我们为任何与我们联系的癌症患者提供免费服务。

Having said that, we can oh, I can move them now. Yes. So first, I will briefly talk about what we do at Cancer Commons. Marty gave a very good explanation. We offer free service to any cancer patients who connect with us.

再次如 Marti 所提到的，从一个科学家的运营，我们现在拥有五位具有癌症研究背景的博士科学家和两位专业的患者导航员。再次感谢 Marty。所有这一切，都归功于 Marty。那么，我们做什么？我们识别最相关的临床试验，我会稍详细谈谈这一点。

Again, as Marti mentioned, from one scientist operation, we now have five PhD scientists with backgrounds in cancer research and two professional patient navigators. And again, thanks to Marty. All this, thanks to Marty. So, what we do? We identify the most relevant clinical trials, and I will talk about it a little more.

我们还为治疗选择提供知情的支持，用患者能理解的通俗语言解释我们建议的理由。我们将患者转介给最相关的诊断服务，现在这类服务有很多。我们根据患者所患癌症类型及相关地理位置，推荐最佳专家。我们帮助处理治疗的副作用，并努力以同情心完成所有这一切。现在，为什么我强调试验？

We also provide informed support for treatment choices, explaining the rationale for our suggestions in lay terms that patients can understand. We refer patients to most relevant diagnostic services, of which there are many now. We provide recommendations for best experts in the particular type of cancer that a patient has in relevant geographical location. We help dealing with side effects of treatments, and we try to do all of that with compassion. Now, why do I emphasize trial?

因为现在的临床试验与二十年前已大不相同。过去使用的是老式化疗药物，可能通过不同剂量和不同组合给药。如今则有众多治疗癌症的新药——当然包括Marti提到的靶向药物和免疫检查点药物、癌症疫苗、细胞疗法、病毒疗法以及各种组合疗法。当然，化疗和放疗依然存在，但至少在我详细关注临床试验的这十二年来，进展令人惊叹。

Because trials now are not what they used to be, say, twenty years ago. In old days, it was old chemotherapy drugs that were given in different dosages and different combinations, maybe. Now there are so many new drugs to treat cancer. It's, of course, targeted drugs and immune checkpoint drugs that Marti mentioned, cancer vaccines, cell based treatment, virus based treatment, and various combinations thereof. Of course, there is still chemotherapy and there is radiation, but the progress has been amazing in at least twelve years that I've been looking in details at clinical trials.

其实之前有人提到，在加入Cancer Commons之前，我自称是

And before, actually, it was mentioned that before I came to Cancer Commons, I was what I call elaborate. I worked in industry and in UCSF. I ran labs, but I love to spend time in the lab, and I hope it gives me a somewhat different, not different, but maybe deeper look into the mechanisms of how the drugs may or may not work. And I learn every day just by looking at new trials and new drugs. So, why the other reason I think the trial is so important?

当然，当我向个体患者推荐试验时，我希望他们能加入试验并获得帮助。但更重要的是，所有药物的批准都基于临床试验结果。因此，每位参与试验的患者都在帮助其他类似病患。而且，许多药物组合往往只能在临床试验中获得——因为任何组合疗法，即使使用两种已批准药物，也会被视为新的研究性药物。组合疗法改变了艾滋病的治疗格局，同样正在癌症领域发生。

Of course, when I suggest trials to individual patients, I hope that they will enter the trials and it will help them. But also, all drugs are approved based on the results of clinical trials. So, each patient that enrolls in a trial benefits other patients, like her or him. And of course, drug combinations that could be a lot of time received only in clinical trials because any drug combination, even with two approved drugs, is considered to be a new investigational drug. So, combinations transform treatment of AIDS, and it happens in cancer.

为什么患者需要帮助寻找临床试验？肿瘤医生通常不会推荐患者参加试验，因为他们通常不了解或没时间了解诊所外开展的试验。如今许多诊所并不开展临床试验，而这些肿瘤医生——很多是全科肿瘤医生——根本没有时间筛选数百项试验来寻找适合患者的方案。患者自身则因多种原因难以找到相关试验。

Why patients need help finding clinical trials? Oncologists most often do not send people to clinical trials, because they usually don't know or don't have time to know much about trials that are run outside of their clinics. Now, a lot of clinics don't run clinical trials. And these oncologists, many of them general oncologists, have no time to investigate hundreds of clinical trials to find out ones that are suitable for their patients. Patients themselves cannot find relevant trials for many reasons.

我接触过一些擅长自主寻找试验的患者，但这极为罕见——大概只占我服务患者的千分之二。患者缺乏药物知识，而临床试验官网ClinicalTrials.gov说得委婉些也稍显复杂。因此我们通常会根据药物前景对推荐的试验进行排序。尽管如此，仅有2%-4%的癌症患者参与临床试验的现实仍令人扼腕。

I've worked with patients who are excellent at doing this, but it's a rarity. It's like, I don't know, zero point two percent of all patients that I worked with. Patients just don't have the knowledge about drugs, and the trial website, clinicaltrials.gov, could be a little confusing, to put it mildly. So we usually rank the trials that we suggest based on how promising we consider the drugs offered. Having said all that, it's pretty sad that only two to four percent of cancer patients enroll in clinical trials.

这只是我向患者展示试验的一个示例。通常推荐的不止一项试验，而是多项。我会提供试验网站链接供他们查阅信息（希望至少能理解部分内容），同时提供所涉及药物的资料。有时就像这个案例，已有关于该药物的临床数据，且结果非常乐观。

That's just an example of how I would present a trial to a patient. Usually, list is not one trial, but more. So, there is a trial website where they can see information, hopefully understand at least some of it. I provide information about the drug offered. Sometimes, like in this case, there is clinical data on this drug, which are very promising.

当然我也会说明试验开展的地理位置。很多时候患者不愿远行——甚至不愿前往300英里外的地方，更不用说乘飞机或跨海岸搬迁了。因此就近寻找试验至关重要。现在我将通过几个参与试验的患者案例（虽然发生频率不如我期望的那么高）来具体说明可能的情况。这个案例涉及一位患有侵袭性淋巴瘤（弥漫大B细胞淋巴瘤）且已接受多线治疗的患者。

And of course, I provide the geography of where the trials are run. A lot of time patients don't want to travel even 300 miles and don't want to fly or, God forbid, relocate to different coasts. So, it's very important to find trials nearby. And now I'll just illustrate what may happen sometimes, not quite as often as I would love to, with a couple of cases of patients who went into trials. This case is about a patient with a very aggressive type of lymphoma, diffuse large B cell lymphoma, who received several lines of treatment.

他们甚至没能让她达到符合骨髓移植条件的阶段。最终，经过大量化疗后达到了那个阶段，他们进行了骨髓移植，但几乎立即就失败了。因此，Cancer Commons鼓励她参加CAR T细胞疗法的试验，这在当时是一种全新的治疗方法。虽然有一些成果，但这还处于全面探索的初期阶段。这种治疗方式包括从患者体内分离出免疫T细胞，对其进行改造以识别癌细胞，然后重新输回患者体内。

They couldn't even get her to the point when she was eligible for bone marrow transplant. Finally, after extensive chemotherapy, got to that point and they could do bone marrow transplant, and it failed almost immediately. So, Cancer Commons encouraged her to go into trial with CAR T, which at this time was completely new treatment. There were some results, but it was really in the beginning stages of being, fully explored. It involves treatment because they isolate immune T cells from the patient, they modify them to recognize cancer cell, and reinfuse into the patient.

于是，这位患者参加了试验，治疗取得了成功。它消除了所有淋巴瘤，患者五年内无癌生存。更令人欣慰的是，这种名为Escarta的治疗方法在她试验中获得完全缓解一年半后，被批准用于DLBCL（弥漫大B细胞淋巴瘤）。如果她没有接受这个治疗，她可能活不到这个疗法获批的时候。第二个案例是关于一位前列腺癌患者，他在七年的患病期间接受了多种治疗方案。

So, this patient enrolled, and the treatment was successful. It eliminated all lymphoma, cancer free for five years. And the good thing that that treatment called Escarta was approved for DLBCL one and a half years after she had a complete response in the trial. If she didn't receive it, she wouldn't be alive to receive it after this time. Second case is about a patient with prostate cancer who received a lot of lines of treatment during seven years that he was suffering from it.

但都没有效果。他的PSA（前列腺癌进展的标志物）持续上升。骨转移带来的疼痛越来越严重。在这七年中，他从未接受过突变检测，而这种检测现在几乎已成为大多数转移性癌症患者的常规检查。我们建议他做了这个检测，结果发现他的癌症有一个在前列腺癌中非常罕见的特征。

Nothing worked. His PSA, which is a marker for prostate cancer progression, kept rising. His bone metastases were becoming more and more painful. And throughout these seven years he didn't receive mutational testing, which is something that is now almost routine for, well, let's say most metastatic cancer patients. So we suggested that he does it, and the testing revealed a feature of his cancer that is very rare in prostate cancer.

这被称为肿瘤突变负荷，在他的案例中非常高，在前列腺癌中很少见。因此，他有资格接受免疫检查点抑制剂治疗，反应非常显著，至今仍无癌生存。第三个案例，如果时间允许，有点类似我刚才讨论的前列腺癌案例。同样，一位患有非常侵袭性乳腺癌的女性也没有被提供突变检测。一旦进行了检测——她最终说服了她的肿瘤医生去做——结果发现她有一个突变，甚至不是普通的突变，而是一种在癌症中罕见的基因扩增。

It's called tumor mutational burden, which in his case was very high, rarely seen in prostate cancer. And therefore, he qualified for treatment with an immune checkpoint drug, and his response was amazing, and he's still cancer free. Third case, if I have time, it's a little similar to the prostate cancer case that I was discussing. Again, no mutational testing was offered to that woman with a very aggressive type of breast cancer. Once it was done, once she was finally able to convince her oncologist to do it, it turned out that she has a mutation that was it's not even a mutation, it's called gene amplification that's rarely seen in cancers.

我在科学文献中找到了一篇关于这种改变的病例报告，该报告引导医生给这些患者使用了免疫检查点药物，并且患者反应良好。她也这么做了。她参加了附近的一项试验，并且反应极佳。现在，我们不仅提供试验机会（Marti也提到了这一点），还努力提供临床支持的证据，说明如何增强药物的活性。具体的建议总是因患者接受的药物不同而异。

And I found one case report in the scientific literature about that alteration that led the doctors on these cases to give these patients immune checkpoint drugs, and they had a good response. That's what she did. She went into a trial nearby and she had an excellent response. Now, we not only offer trials, and Marti mentioned it, we try to provide clinically supported evidence on how to enhance activity of drugs. And the suggestion is always different depending on what drugs patients receive.

接受免疫检查点药物治疗的患者会收到一份长长的清单，大约有八到九条建议，关于如何调整饮食、生活方式，以及一天中何时接受免疫检查点药物的输注。显然，这很重要。此外，还有一些有益的补充剂和需要避免的事项。不幸的是，我们工作中重要的一部分是劝阻患者不要被社交媒体等地方众多的虚假治疗所诱惑。这只是试图向患者解释为什么这种治疗对他们有益是多么重要的一个例子。

Patients who receive immune checkpoint drugs receive a long list of about eight to nine suggestions on how to modify their diet, their lifestyle, what time of the day to receive the infusion of immune checkpoint drug. Apparently, that's important. And also, there are certain supplements that help and certain things that should be avoided. And unfortunately, an important part of what you do is to discourage patients from being lured into fake treatments, of which there are many out there on the social media, etcetera. This is just an example of how important it would be to try and explain to patients why this treatment is good for them.

这是一封邮件中的引用：‘要是这些护士和医生能像你这样解释事情就好了。’ 是的，我们在肿瘤学方面的时间比护士和医生稍多一些，但知道这一点很好。知道我们的工作受到赞赏很好。我们也努力解释对治疗结果的预期，因为这些结果可能非常不同。

And it's a citation from one email. If only these nurses and doctors could explain things the way you do. Yeah, we have a little more time than nurses and doctors in oncology, but that's good to know. Good to know that it's appreciated. We also try to expect to explain what to expect as treatment outcomes because they're very different.

大多数求助于癌症共享组织的患者都患有转移性癌症，但有时他们处于癌症早期阶段，我们会尽力安抚他们——如果确实如此——他们将有望获得治愈。我之前提到过这一点。不幸的是，这构成了我们工作的很大一部分。我们交换或制定了或多或少的标准声明，劝阻人们前往某些诊所并为未经证实的治疗支付高额费用。这可能会非常令人难过。

Most of patients who turn to cancer commons have metastatic cancers, but sometimes they have early stage cancers, and we try to reassure them, if it is indeed so, that they will be they're looking at the cure. I mentioned that. This is unfortunately a big part of what we do. We exchanged or developed more or less standard statements that discourage people to go to certain clinics and to pay a lot of money for unproven treatments. It could be very sad.

有时人们很难被说服，因为他们随时准备抓住任何希望。我将在此结束，并再次向马蒂和其他优秀的人士表达我个人的感谢。我在此列出了我们的两位护士导航员，劳伦和安莎，以及四位科学家，阿曼达、阿德里安、苏尼塔和萨曼莎。但我也想提一下，癌症共享组织里还有许多让这一切成为可能的人。我也提到了他们。

And sometimes people are difficult to convince because they are ready to grab any hope. And I will finish here with my personal thanks again to Marty and to other wonderful people. I listed here our two nurse navigators, Lauren and Ansha, and four scientists, Amanda, Adrian, Sunita, and Samantha. But I also want to mention that there are people at Cancer Commons that help it to be. And I did mention them.

正子在这里，还有雪莉。他们都对我们的使命非常投入。谢谢。

Masako is here, Shelly. And it's they're all very dedicated to our mission. Thank you.

随后大约二十五年前遭遇了互联网泡沫破灭。你们中的许多人像我一样曾在硅谷工作。我当时在所谓的“硅巷”工作，也就是我们称呼曼哈顿中城和市中心这片区域的名字。我们，包括今晚在座的比尔·西尔伯格，帮助WebMD将Meds打造成它后来的样子。二十五年前我们在讲座中经常引用的一本流行书籍叫《基业长青》，那是一本很棒的书。

Followed by the dot com bust like twenty five years ago. Many of you like me worked in the Silicon Valley. I worked then in Silicon Alley, which is what we call this area in Manhattan, Midtown Manhattan and downtown. We, including Bill Silberg, who's here tonight, helped WebMD build Meds into what it was. A popular book back then that we used to refer to a lot in lectures twenty five years ago was called Built to Last, a wonderful book.

它至今仍是一本值得一读的好书。书里有一个变得很有名的缩写词：BHAG。Big, Hairy, Audacious Goal（宏大、艰难、大胆的目标）。接下来你们将看到一个视频，它会告诉你们这就是我们的宏大、艰难、大胆的目标。请记住，我们谈论的是每年六十万落入这个境地的美国人。

It's still a good book to read. And in that was an acronym that was became famous, b h a g. Big, hairy, audacious goal. Now you're gonna see a video which tells you this is our big, hairy, audacious goal. Remember, we're talking about six hundred thousand Americans every year who fall into this bucket.

非常感谢。请播放视频。

Thank you very much. Video, please.

大家好。我是克里夫·里德，癌症共享组织的首席执行官，我将向各位描述癌症共享组织未来的发展方向。第一个新方向是大幅增加我们能够服务的患者数量。原因如下。

Hi. I'm Cliff Reed. I'm the CEO of Cancer Commons, and I'm going to describe for you the future directions of Cancer Commons. The first new direction Cancer Commons is to dramatically increase the number of patients that we can serve. And here's why.

美国每年大约有180万新增癌症患者，其中120万（约三分之二）患者情况相当不错。他们被早期发现，接受了手术、放疗，要么被治愈，要么进入长期缓解期。但另外60万患者，即另外三分之一，情况则完全不乐观。他们要么是在癌症晚期才被发现，要么因某种原因进展为晚期患者。最终这些患者会从肿瘤医生那里听到，根据NCCN指南，我们已经无能为力了。

There are approximately one point eight million new cancer patients every year in The United States and one point two million of them, about two thirds, do quite well. They're detected early, they get surgery, radiation, they're either cured or they're put into a durable remission. But the other six hundred thousand, the other third of the patients don't do well at all. They're either caught late in their cancer or they progress for some reason to become late stage patients. And eventually those patients hear from their oncologists, under the NCCN guidelines, there's nothing more we can do.

这些就是癌症共享计划的患者。我们了解到的是，除了NCCN指南之外，我们还能为这些患者做更多事情。但由于我们团队规模小，每年只能服务约一千名患者。而我们即将改变这一现状。以下是我们将如何实现。

Those are cancer commons patients. And what we've learned is there's a lot more that we can do with those patients beyond the NCCN guidelines. But with our small team, we're only able to serve about a thousand patients a year. And we're about to change that. And here's how we're going to do it.

我们正在创建一个名为PCCN指南的新信息资源。与NCCN指南的对应是刻意为之——NCCN指南描述的是临床医学，即临床癌症医学。而PCCN指南（代表临床后癌症网络）则描述了癌症患者在耗尽NCCN指南中的所有选项后还可获得的所有选择。因此我们说NCCN加PCCN才是完整的癌症护理。这就是患者的全程旅程。

We're creating a new information resource called the PCCN guidelines. And the parallel to the NCCN guidelines is intentional, where the NCCN guidelines describes clinical medicine, clinical cancer medicine. The PCCN guidelines, which stands for post clinical cancer network, describe all of the options available to cancer patients after they've exhausted the options in the NCCN guidelines. So we say NCCN plus PCCN is complete cancer care. That's the total patient journey.

PCCN指南将提供全面、持续更新的超越标准护理的癌症治疗指导，作为NCCN指南的自然补充。那么我们将如何实现呢？PCCN指南包含三个部分：首先是内容，其次是策展，第三是交付。在内容方面，我们的领域专家、博士们已经花费数年时间浏览互联网上所有海量信息，以了解临床后癌症患者的可选方案。

And the PCCN guidelines will offer comprehensive, continuously updated guidance on the cancer care beyond standard of care as the natural complement to the NCCN guidelines. Now, how are we going to do this? Well, PCCN guidelines come in three parts. The first is content, second is curation, and the third is delivery. On the content side, our subject matter experts, our PhDs, have spent years now browsing through all of the enormous information on the internet available to understand options for post clinical cancer patients.

我们现在要做的是利用AI技术自动为他们完成这项工作。也就是说，我们将告诉大型语言模型（LLM）需要寻找什么，因为我们知道如何做到这一点。LLM将出去阅读数百万页各种格式的网络材料，进行整理、总结，并将其纳入PCCN指南。这里包含的信息将包括新兴临床试验、指南外药物（尽管这些大多不可用，我稍后会再谈这一点）。

Well, what we're going to do is now use AI technology to automatically do that for them. That is we're going to tell an LLM what to look for because we know how to do that. The LLM will then go out and read millions of pages of internet materials in all different formats, organize it, summarize it, and bring it back into the PCCN guidelines. The kind of information in here will be the emerging clinical trials, off guideline drugs, although those are largely unavailable. I'll come back to that in just a moment.

先进诊断技术、整合医学以及许多其他可以帮助临床后癌症患者的内容。但这种方法的问题是，LLM生成的这些材料会充满错误。它会充满幻觉，因为LLM会编造内容。而且还会充满不良信息，因为存在一些旨在欺骗晚期癌症患者的信息。有很多人试图利用晚期癌症患者。

Advanced diagnostics, integrative medicine, and many other things that can help post clinical cancer patients. But the problem with this approach is that this material that's generated by the LLMs will be full of errors. It'll be full of hallucinations because LLMs make things up. And it'll be full of bad information because there is information for advanced cancer patients that intended to deceive. Are a lot of people that try to prey on advanced cancer patients.

因此我们必须从LLM生成的指南中清除所有这些错误信息。这就是策展步骤的作用所在。我们计划采用与NCCN指南完全相同的方式来完成这项工作。我们将组建专家委员会来审阅LLM的输出，阅读原始的PCCN指南，编辑和修正所有幻觉内容，消除所有不良信息。而他们编辑的方式实际上不是删除内容，而是通过编写新文档来教导LLM如何纠正其错误。

So we have to get all of that misinformation out of the LLM generated guidelines. And that's where the curation step comes in. We plan to do this in just really the same fashion that the NCCN guidelines does it. We're going to stand up committees of experts to read the output of the LLM, to read the raw PCCN guidelines and edit and correct all the hallucinations, eliminate all the bad information. And the way they edit actually isn't by actually deleting things, it's by just writing new documents that teach the LLM how to correct its mistakes.

我们计划每月进行一次更新。因此，我们将每月重新发布PCCN指南，以保持其完全最新。最后，向晚期癌症患者提供PCCN指南。首先，我们将在我们的网站上免费发布，任何想要阅读的人都可以直接访问。如果你熟悉NCCN指南网站，你会发现它看起来会非常相似。

And we plan to do this on a monthly basis. So we'll re release the PCCN guidelines every month to keep it fully up to date. And then finally delivery of the PCCN guidelines to advanced cancer patients. First, we'll publish our website free of charge and anyone who wants to could just go read it. It'll look a lot like the NCCN guidelines website if you're familiar with that.

我们还将创建一个个性化应用程序，该程序将接收患者的医疗记录，然后根据该医疗记录的视角来查看PCCN指南，仅限于他们的癌症类型、已接受的治疗以及他们希望采取的未来方向。但我们在Cancer Commons了解到，相当多的癌症患者并不想阅读网站，可能也不想与手机对话。他们需要的是人性化的接触，希望有人可以交谈，帮助他们在选择治疗方案这一艰难过程中导航。Cancer Commons将继续提供这项服务，但我们每年最多只能服务大约一千名患者。

We'll also create a personalized application that will take the patient's medical record in and then view the PCCN guidelines through the lens of that medical record, limited to their cancer, given their treatments, given their desires and future directions that they wanna take. But we've learned at Cancer Commons that an awful lot of cancer patients don't wanna read a website and they probably don't wanna talk to their phones either. What they want is a human touch. They want someone to talk to, to help them through the very difficult process of navigating their options. Now, Cancer Commons will continue to do that, but we just can't scale beyond around a thousand patients a year.

因此，我们想出了一个扩大服务规模的方法，即我们所谓的独立患者导航员。我们将组建一支肿瘤科护士队伍，为晚期癌症患者提供一对一的人工患者导航服务。我们将对这些独立患者导航员进行PCCN指南的培训并予以认证。然后，我们将做一件非常重要的事情：建立一个计费系统，使这些肿瘤科护士能够向医疗保险和其他保险公司收取服务时间的费用，这样他们就不必学习如何操作计费。

So we've come up with a method for scaling up our services, and that is what we call independent patient navigators. We are going to stand up an army of oncology nurses to provide patient navigation services humanly, one on one with advanced cancer patients. And so we are going to train these independent patient navigators on the PCCN guidelines and we'll certify them. And then we are going to do a very important thing, which is set up the billing system that enables these oncology nurses to bill Medicare and other insurers for their time. So they don't have to learn how to do that billing.

我们将为他们处理所有计费事宜。这就是向10万名癌症患者（而非1千名）提供这些信息访问的方法，同时继续提供Cancer Commons过去十年来所提供的人性化界面。现在，我提到过，指南外药物大多对癌症患者不可用。这是Cancer Commons的第二个新方向，因为我们将设立一项临床研究，使这些患者能够获得指南外药物。让我解释一下什么是指南外药物。

We'll do all that billing for them. So this is the method of providing access to this information to 100,000 cancer patients, not 1,000, but also continuing to provide that human interface that Cancer Commons has provided over this past decade. Now, I mentioned that off guideline drugs are largely not available to cancer patients. And this is the second new direction of Cancer Commons because what we're doing is we are going to stand up a clinical study that makes off guideline drugs available to these patients. And let me describe what I mean by off guideline drugs.

如果你查看NCCN指南，其中有39种癌症。每种癌症都有一组被批准用于该癌症的药物。我最近重新查阅了NCCN指南并进行了统计，计算了每种癌症有多少种获批药物。结果发现，拥有最多获批药物的癌症是乳腺癌。

If you go into the NCCN guidelines, there are 39 cancers in the NCCN guidelines. And each of those cancers has a set of drugs that are approved for that cancer. And I just recently went back to the NCCN guidelines and I counted. I counted how many drugs are approved for each cancer. And it turns out the cancer with the most approved drugs is breast cancer.

乳腺癌有61种获批的癌症药物。药物最少的癌症是胰腺癌，只有15种获批药物。但如果你看这张图表，你会意识到，天啊，FDA批准了300种药物，而实际出现在NCCN指南中所有癌症的药物数量只占约百分之十。

And there's 61 approved cancer drugs in breast cancer. The cancer with the fewest number of drugs is pancreatic cancer. There are 15 approved drugs. But if you look at this chart, you can kind of realize, gee, there are 300 FDA approved drugs. And the number of drugs that actually appear in the NCCN guidelines across all the cancers is about ten percent.

因此，百分之九十的FDA批准药物只是闲置在架子上，没有被使用。这是因为我们知道这些药物对特定癌症无效吗？不，并非如此。药物通过临床试验进入NCCN指南。如果一种药物从未针对某种癌症进行过临床试验，它就不会被纳入NCCN指南。

So ninety percent of the FDA approved drugs are just sitting on a shelf and they're not being used. And is that because we know that those drugs are ineffective for that particular cancer? No, that's not why. Drugs get into the NCCN Guidelines through clinical trials. And if a drug has never been run-in a clinical trial against a cancer, it's not in the NCCN Guidelines.

所以这90%不在指南中的药物，并不意味着它们对患者无效。这只是意味着从未进行过临床试验。我们可以改变这一点。我们能做的是使用新的诊断测试，让这90%的药物能够用于晚期癌症患者。这些新的诊断测试被称为功能测试，它们在实验室中测试一组非指南药物对患者活体癌细胞的反应。

So these 90% of drugs that aren't in the guidelines, it doesn't mean that they don't work for a patient. It just means that no clinical trial has ever been run. So we can change that. What we can do is use new diagnostic tests to make these 90% of drugs available to advanced cancer patients. So these new diagnostic tests, they're called functional tests, test a set of off guideline drugs against a patient's live cancer cells in the laboratory.

对于那些对患者活体癌细胞有效的药物，我们会撰写报告并发送给肿瘤科医生。这样肿瘤科医生就有了可能对该患者有效的非指南药物。如果这种方法有效，它将改变癌症治疗的范式，因为每个晚期癌症患者都可以通过测试多种非指南药物，找到一两种或三种有效的药物，由他们的肿瘤科医生使用这些药物，希望能抑制癌症，使其进入缓解期——虽然不太可能完全治愈，但实现缓解是我们能够达到的目标。如果患者获得一年的缓解期后癌症复发，我们就重新进行测试，找到一组新的有效非指南药物并应用于患者。

And for the drugs that work against that patient's live cancer cells, you write up a report and send it to the oncologist. And the oncologist now has off guideline drugs that are likely to work in that patient. If this works well, it will change the paradigm of cancer care because then every advanced cancer patient can run a test against multiple off guideline drugs, find the one or two or three that work, have their oncologist give them those drugs, which hopefully knocks their cancer down, puts them into remission, very unlikely due to any kind of a cure, but knocking it into remission is what we can get. And if we get to a year of remission and then the cancer comes back, we rerun the test. We find a new set of off guideline drugs that work and apply those to the patient.

如果我们能够这样年复一年地持续二十年，而患者最终死于其他原因，那我们就成功地将癌症从死刑判决转变为一种慢性疾病。我们正在开展一项临床研究来实现这个目标。研究从测试开始，理想情况下包括基因组测试和功能测试。测试结果交给我们的博士团队，他们根据这些结果查阅科学文献，撰写科学报告，为应用这些FDA批准的药物提供科学依据。这些药物对人体是安全的，但需要让那些不在NCCN指南中的患者也能使用。

And if we can just do that, you know, year after year for twenty years and the patient dies of something else, we succeeded at reducing cancer from a death sentence to a chronic disease. So we are standing up a clinical study to do exactly that. It starts with testing, a genomic test and a functional test ideally. The test results go to our PhDs who then go through the scientific literature with those test results on hand and create a scientific report, a scientific basis for applying these FDA approved drugs. They're safe in humans, but for allowing these FDA approved drugs to patients who are not in the NCCN guidelines.

但我们有真实证据相信这些药物会对这些患者有效。有了这份科学报告，我们需要获得三方面的同意：患者的同意（通常比较容易），患者肿瘤科医生的同意（他们愿意将这些药物应用于患者——这些药物是安全的，只是不在NCCN指南中）。

But we have real evidence that we believe these drugs are going to work for these patients. With that scientific report, we have to get three consents. The patient's consent, which is typically quite easy. The patient's oncologist consent that they're willing to apply to these drugs to these patients. They're safe, but they're not in the NCCN guidelines.

第三是支付方的同意。这些是市面可得的商业药物，它们在NCCN指南中针对的是其他癌症，而不是该患者所患的癌症。因此我们需要支付方愿意为这些药物付费。获得这三方面同意后，肿瘤科医生就用这些药物治疗患者，我们则收集数据。

And then thirdly, the payer's consent. These are commercially available drugs. They're in the NCCN guidelines for a different cancer, not just for this patient's cancer. And so we need a payer to be willing to pay for those drugs. So we get those three consents, then the oncologist treats the patient with the drug and we get the data.

我们实际上按诊断测试来组织这项临床研究。随着时间的推移，当我们有足够的数据时，我们将能够计算并报告每种不同诊断测试在选择非指南药物方面的预测准确性。如果我们发现一个或多个测试在选择非指南药物方面表现优异，这将改变晚期癌症患者的治疗方式。目前我们正在为我们的Cancer Commons患者进行这项研究，但我们希望这个研究设计能够广泛传播。我们希望每个患者权益组织都能为自己的患者开展这项研究，让他们的晚期癌症患者能够获得那90%目前根本无法获得的超适应症药物。

And we have actually organized this clinical study by diagnostic test. And over time, when we have enough data, we'll be able to calculate and report the predictive accuracy of each of the different diagnostic tests that select off guideline drugs for patients. And if we find one or more tests that do an excellent job of selecting off guideline drugs for patients, that will change the way advanced cancer patients are treated. Now we're running this study for our Cancer Commons patients, but we're hoping the study design goes viral. We'd like every patient advocacy to be running the study for their patients, providing their advanced cancer patients with access to that 90% of off label drugs that they simply have no access to today.

我们在Heptocarbons作为New正在做的第三件事是收集我们产生的所有数据。我们所有的PCCN患者都将被要求将他们的治疗结果数据贡献到PCCN患者注册库中。如果我们每年真能收集10万例这样的数据，这将成为一个巨大的数据源，帮助我们了解哪些标准治疗后的选项最有效。我们将继续从我们的专家指导系统收集数据，从中了解哪些标准治疗前、NCCN指南前的创新最有效。最后，我们还将从我们的N-of-one临床研究中收集数据，以了解哪些诊断测试最能有效识别对晚期癌症患者有效的非指南药物。

And the third thing we're doing at Heptocarbons as New is that we're gathering all of the data that generate. So all of our PCCN patients are going to be asked to contribute their data, treatment outcome data into a PCCN patient registry. And if we can really do 100,000 of these a year, it will be a tremendous data source for understanding which post standard of care options are most effective. We'll continue to gather the data from our expert guidance system, and there we can learn which pre standard of care, pre NCCN guidelines innovations are most effective. And finally, we'll gather the data from our N of one clinical study to understand which diagnostic tests are best at identifying effective off guideline drugs for advanced cancer patients.

因此，我们在此收集的所有数据将为患者提供治疗路径的指导。同时，我们也希望这些数据能为研究者和投资者提供关于晚期癌症护理中有前景的新方法的指引。Cancer Commons正在为有需求的晚期癌症患者提供个性化指导，并实现超越标准护理的个性化治疗，这是首次大规模实施此类服务。NCCN加PCCN构成了完整的癌症护理体系。这种方法的患者获益很高，但遗憾的是，盈利机会较低。

So this, all of the data that we're capturing here will provide guidance for patients onto what treatments to follow. But also, we hope it'll provide guidance for researchers and investors about promising new approaches in advanced cancer care. So Cancer Commons is offering personalized guidance and enabling personalized treatments beyond standard of care for advanced cancer patients in need and doing it at scale for the first time. NCCN plus PCCN is complete cancer care. The patient benefit of this approach is high, but unfortunately, the profit opportunity is low.

因此，Cancer Commons得到了感恩的患者和各位慈善捐助的支持。我们也在持续探索自我维持的财务模式。非常感谢大家。

So Cancer Commons is supported by grateful patients and by your philanthropy. We're also continuously exploring self sustaining financial models. Thank you very much.

好的，现在我们可能有十到十五分钟的问答时间。Marty和Emma可以上台来。那么，我先来问第一个问题。Marty，你从转移性黑色素瘤中存活了这么多年，这非常不寻常。

All right, now we can, have maybe ten, fifteen minutes of Q and A. Marty and Emma can go on stage. Well, we'll start with one myself. So, Marty, you have survived so many years from metastatic melanoma. Highly unusual.

在最初的治疗之后，你是否还需要接受其他治疗，还是之后就一直没有再进行任何治疗？

Did you have to take anything else after the original, treatment or has it just stayed without any future treatment?

那个——抱歉。在五年半之后有一次复发。

There there excuse me. There was a recurrence, five and a half years out.

你

You

知道吗，他们通常说五年就没事了。别信这个。Don Morton之所以名声显赫，正是因为他非常了解这些疾病的运作方式。他让我在好几年里每六个月做一次扫描，之后变成每年一次。而我自己当时是想停掉的。

know, they normally say five years you're done. Don't believe it. Don Morton made his reputation by just knowing so well how these diseases work. And he made me get scans every six months for quite a few years and then it was every year. And I wanted to stop.

他说，不，你不能停止检查。所以他及早发现了复发，我们及时处理了。大概是2004年2月左右吧。之后我一直坚持检查，直到唐不幸因手术去世——他得的是一种无法手术的癌症。

And he said, no, you're not stopping. So he caught a recurrence early and we took care of it. Think it was 02/2004, something like that. And then I continued to get testing until Don unfortunately passed away from surgery, from a cancer that he couldn't do surgery on.

然后

And

我个人实在无法承受扫描带来的焦虑，更不用说做了40次左右扫描后，我可能已经带有放射性，甚至增加了百分之一二患继发癌症的风险。但这绝对是值得的。所以你看，在我那个时代，一旦进入缓解期，就是靠扫描监测；而现在有了非常灵敏的分子检测手段可以发现复发。坚持监测、保持领先至关重要。

I just couldn't personally take the scan anxiety, not to mention after 40 scans or something like that, I was probably radioactive and maybe increased my chance of, you know, a follow on cancer by a percent or two. But it certainly was worth it. So that, you know, the experience is once you've gotten yourself into remission in my era, it was scans, but nowadays, they're very sensitive molecular tests that can detect recurrence. It's very important to keep on that thing and just stay ahead of it.

是的。而且现在的新检测方法没那么大放射性了。

Yeah. And now the new tests aren't so radioactive.

没错。虽然部分PET CT被PET MRI取代，但辐射量仍然很大。但我一直认为——也坚信这一点——其实可以不必常规进行扫描，而是只在有迹象表明可能出现问题、通过分子检测发现某种生物学复发时才做。

Yeah. Well, they replaced some of the PET CTs with PET MRIs, which is still a lot of radiation. But I always thought that it was possible and I certainly believe this, that one could in fact not routinely do the scans but to do the scans only when they're indicated that something might be going on because there's some kind of a biological recurrence that you can pick up molecularly.

真了不起。这么多年了。艾玛，从情感角度来说，玛西说你接触过4000名患者？你是怎么保持力量坚持下来的？

Amazing. That many years. Emma, so from an emotional point of view, you've dealt with 4,000 patients, Marci said. Right? How how do you have the the the strength to do that?

有时候我也不知道。有时候我会哭。

Sometimes I don't know. Sometimes I cry.

嗯哼。

Uh-huh.

是的。你知道，这令人悲伤的原因不止一个。病人去世了。他们患有转移性癌症。而当病人拒绝理性治疗时，我会感到非常难过。

Yeah. I you know, it's very sad for more than one reason. Patients die. They have metastatic cancers. And I get very sad when patients refuse to be rational.

嗯。

Mhmm.

然后开始服用羟氯喹或伊维菌素。

And go and start taking hydroxychloroquine or ivermectin.

是啊。有没有哪个病人，你知道，你为之付出很多努力的，反而责怪你？没有。从没遇到过这种情况吗？

Yeah. Has has any patient, you know, that you worked really hard for, blamed you? No. Never run into that?

没有发生过，伊恩。我很少遇到不愉快的经历。我可以举一个例子，但也许我不应该。

That didn't happen, Ian. I had very few unpleasant encounters. I can cite one, but maybe I shouldn't.

别。别说了。

No. No.

不。翻转因为

No. The flip Because

我没有，我甚至没和这位病人共事过。病人。是第二封邮件。

I didn't I didn't even work with this patient. Patient. Was the second email.

乔治，反面更常见。艾玛会形成这些依恋

George, the flip side is more common. Emma forms these attachments

对。

Right.

与她的病人多年相处。失去这样的病人对她来说非常非常难受。

With her patients over many years. And it's very, very hard on her to lose a patient like that.

嗯。是的。是的。我认为总的来说，大家都看到从事肿瘤学工作的医生们，觉得这一定是个情感上非常困难的领域。当然，有人能做这份工作对每个人来说都非常宝贵。

Mhmm. Yeah. Yeah. I think in general, everyone sees people, doctors who work in oncology and finds it must be a very difficult field emotionally to do. And, of course, that's really valuable for everybody that someone can do it.

但请继续。

But go ahead.

你好，我是保罗·比林斯。我是一名内科医生和医学遗传学家，也是癌症共享组织的副主席。我实际上有一个评论，然后想向艾玛提一个问题。

Hi. I'm Paul Billings. I'm an internist and medical geneticist. I'm also the vice chairman of the Cancer Commons. I actually have a comment and then a question for Emma.

我的评论是，我们正生活在一个特殊的时代，现在有很多对科学证据的敌意。例如，我们几十年来积累的所有关于疫苗的证据都受到了质疑。是的。我认为非常重要的一点是，随着癌症共享组织这个新项目的发展，虽然它并非完全基于证据，而是在收集证据的过程中，不应削弱我们对科学过程以及在美国和全球范围内进行的科学质量的信任。这是一个新事物，是正在发展的证据，也是良好科学传统的一部分。

My comment is that we're living in a time, a unique time right now, where there's a lot of hostility about scientific evidence. For instance, all the evidence that we have over decades about vaccines is being called into question. Yeah. And I think it's very important as this new program at Cancer Commons becomes not fully evidence based, but gathers evidence that it doesn't erode the trust we have in the scientific process and in the quality of science that's occurring in The United States and around the world. This is a new this is developing evidence and it is a part of a good scientific tradition.

它不应该引发更多，我们可以说是社交媒体上非基于数据的臆想。但我想问艾玛的问题是，我的家庭一直密切参与姑息治疗的发展

It's not shouldn't give rise to more, shall we say non data based hallucinations by social network. But the question I have for Emma is my family has been intimately involved in the development of palliative care

在

in

美国。我想知道您如何看待这个在过去几十年里兴起的运动，以及您认为它与您提供的科学导航服务是融合的还是分离的。

The United States. And I wonder about how you've seen that movement which has come up you know very much over the last couple of decades and how it's how you see it as either integrated or separated from the kinds of scientific navigation that you provide.

我认为姑息治疗非常重要。不幸的是，很多患者听到姑息治疗这个词时，会认为这是临终治疗，但事实并非如此。姑息治疗也可以是对副作用或癌症导致的某些衰弱后果的护理，不一定与死亡相关。所以我总是建议那些经常因癌症本身或治疗而承受巨大痛苦的患者，去咨询姑息治疗诊所、护士和医生，并努力让他们明白，不，

I think palliative care is extremely important. Unfortunately, lot of patients when they hear the word palliative, they think it's the end of life treatment, which is not true. Palliative care could be also care for side effects or some debilitating consequences of cancer, not necessarily death. So I always suggest to patients to consult patients who are in a lot of pain that happens frequently because of the cancer itself or because of the treatment. I always suggest to consult palliative care clinics, nurses, doctors, and try to convince them that, no.

我建议这样做并不是因为你一个月内就会去世。这只是为了让你的生活更轻松。我希望这一领域能继续发展。

It I'm not suggesting it because you're going to die in a month. It's just something to make your life easier. And I hope it will continue to be developed.

我是Magdalena Yashil。Emma，我个人想感谢你，因为在黑暗时刻我们需要帮助时，你为我和我的家人提供了支持。我的问题是，为什么那些最终会因患者获得治愈或某种缓解而节省开支的支付方——我认为应该是这样——为什么他们不那么感兴趣？或者人寿保险公司呢？

I'm Magdalena Yashil. Emma, I personally want to thank you because you were there for me and my family when we needed help in the dark hours. My question is, why aren't the payers who ultimately, I would think, would have savings with individuals who get either cure or some sort of remission. Why would they not be more interested? Or life insurance companies?

为什么没有其他真正受益于Cancer Commons工作的群体呢？

Why aren't there other constituencies that are actually the beneficiaries of the work that Cancer Commons does?

是的。我真希望我能对这个合理且非常好的问题有个好答案。很多保险公司都是利润驱动的，他们看不到超出当月或当年利润目标之外的东西。所以他们不愿意为真正有效的药物投入资金。有时候，我甚至见过像医疗补助这样的保险公司不批准一种便宜的化疗药物。

Yeah. I wish I wish I had a good answer to this legitimate and very good question. There are a lot of insurance companies are profit driven, and they can't see beyond whatever the profit goals for that month or year. So they are unwilling to sell out money for the drugs that actually work. And sometimes for even I've seen cases where insurance companies like Medicaid will not approve a cheap chemotherapy drug.

相信我，我永远无法接受这一点。而每年花费5万到10万美元的昂贵靶向药物，医生们必须非常努力地说服保险公司承担这些费用。他们没有长远的眼光。他们不认为那个病人会活得更久。坦率地说，也许他们不在乎，因为他们是利润驱动的。

Believe me, I can never accept it. And expensive targeted drugs that cost between 50 to 100,000 a year, doctors have to work really hard to convince insurance company to cover their expense. There is no long term vision. They don't think that that patient will live longer. And frankly, maybe they don't care because they're profit driven.

这非常令人悲伤。

It's very sad.

事实上，你知道，医疗保险支付方有一个增加业务的机会，通过销售癌症保险产品来获得利润机会。你听到Cliff Reed说过，他一直在寻找可持续资助Cancer Commons所能做事情的方法。Cancer Commons与医疗支付方合作可能会非常富有成效，以便在他们覆盖的人中有人生病时能够提供我们提供的服务——这对患者有益，也对利润底线有益。我还想说，Magdalena，你刚才顺便提到，为什么不是健康保险或人寿保险？

There is, in fact, you know, an opportunity for medical insurance payers to make added business to actually have profit opportunity by selling a cancer insurance product. And you heard Cliff Reed saying that he's continuously looking for ways to finance sustainably the kinds of things that Cancer Commons can do. It could be very productive for Cancer Commons to partner with health and payers in order to be able to provide if one of their covered people get sick. Services The that we provide which are good for the patient and good for the profit bottom line. I'd also say, Magdalena, that in passing you just said, you know, why don't health insurance or life insurance?

对人寿保险公司来说，情况要清晰得多，冲突也少得多。他们有非常强烈的愿望让病人活下去。而且，Cancer Commons与人寿保险公司合作也是一个机会。

The situation is much clearer and less conflicted for life insurance. They have a very strong desire to keep a patient alive. And, they, there's an opportunity for Cancer Commons to partner with life insurance companies as well.

还有另一个因素。我恰好曾在保险领域的法律方面工作过，也就是说，如果关于新事物或正在进行的测试存在责任法律，公司会得到一些保护。但如果情况明确，他们更有可能投入资金，因为一旦出错，责任可能会极其严重。

There's a there's another element too. I happen to have worked as lawyer in that field of insurance, and that is, if if the law of liability on something new or something, that's being done as a test where there is some protection for the companies. But if it was clear, they would be a little bit more likely to to put out the money for it because the liability can be so extreme if it goes wrong.

嗯。

Mhmm.

这是另一个利润原因，但很令人痛苦。

That's another profit reason, but it's a painful one.

是的。或许我也可以对此发表评论。我是Chris Apfel医生，Sagemedic的创始人兼CEO。我们是一个功能性精准肿瘤学平台，能够获取患者组织样本，在实验室内仅用一天时间创建微肿瘤复制体，然后对其进行药物测试，以了解哪种疗法最可能有效或无效。这实际上非常有趣。

Yeah. And perhaps I can comment on that as well. So I'm doctor Chris Apfel, the founder and CEO of Sagemedic. So one of those functional precision oncology platforms where we can actually take a patient tissue sample, create micro tumor replicates in the lab within just one day, and then we drug them to understand which therapy is most likely to work or not. And it's actually very interesting.

我们从其他工作以及自身工作中了解到，相对容易且完全可能以较高准确性预测哪些方法不会奏效。因此，如果你在体外对这些微肿瘤用药，而它们在患者无法耐受的剂量下仍然存活，你就知道这不会有效。在这些治疗上花费资金不仅会给患者带来更多伤害，可能缩短生命，还会产生不必要的成本。我认为保险公司面临的挑战在于，如果你能找到一种药物，确实能提高生存率，比如对于二期或三期结直肠癌或卵巢癌患者，通过提前识别最有效的药物，将长期生存率提高10%、20%或30%，这实际上能节省大量资金。嗯。

We know that from other work as well and our work that it's very easy or it's relatively it's very well possible to really predict what cannot work with relatively high accuracy. So if you drug those microtumors in vitro and they still are viable at dosages that a patient can't tolerate, you know this is not going to work. And spending this money on those treatments would not only cause more harm for those patients and possibly shorten the lives, it would also create unnecessary costs. The challenge, I think what the insurance companies have is if you can actually find a drug where you can actually increase your survival, let's say a patient that is a stage two or stage three colorectal or ovarian cancer patient, and by identifying the most effective drug right ahead of time, you actually increase long term survival by, let's say, ten or twenty percent or thirty percent, that actually saves a ton of money. Mhmm.

挑战在于，在那60万患者中，有许多是四期患者。但很多时候，找到治愈方法要困难得多，你只能延长生命，比如一年、两年或三年。但最终，医疗保健的总成本实际上比患者早逝更高。这就是保险公司所处的矛盾境地。这就是为什么有‘三个D’的说法：延迟、拒绝、死亡。

The challenge becomes on those six hundred thousand patients, there are stage four. But very often, you actually it's much harder to find a cure and you extend life, let's say, for another year, for another two years, for another three years. But at the end of the day, the total cost for the health care is then actually higher as opposed to the patient dying earlier. And that's the conflict situation where insurance companies are in. That's the reason why there is this the saying of the the three d's, delay, deny death.

因此，如果患者无法治愈，找到能让他们多活一、二、三年的方法通常会增加医疗成本，这对保险公司来说，可以理解是一个挑战。

So if the patient cannot be cured, finding something that gives this patient another one, two, three more years of life usually increase health care costs, and that is for insurance companies, understandably a challenge.

现在我很抱歉。我们我们已经没有问题了。我的意思是，时间到了。不幸的是，我们并不是没有问题可问了。但十五年来，我一直想问乔治这个问题，所以我想我们就以这个问题来结束吧。

And now I'm sorry. We we've run out of questions. I mean, we've run out of time. We haven't run out of questions, unfortunately. But I've for fifteen years, I wanted to ask George this question, so I thought we would end with this one.

那么，乔治，你你曾经，你当了执业医师十五、二十五年，然后转行做了编辑。你对这个转变感到高兴吗？还有，从执业医师转变为审阅他人工作的学者，这个过程中有什么困难？

So so, George, you you have, you were a practicing physician for in in, for for fifteen, twenty five years, and then you switched to being an editor. Do you are you happy that you made that switch? And and and what was the what was the, you know, difficulty to go from a practicing physician to an academic, reviewer of other people's work?

我喜欢解决问题，喜欢研究复杂、困难的问题。然后，我喜欢能够说这是一个解决方案，并让人们从中学习。我认为从执业病理学家转变过来——如今的病理学家很大程度上是大型实验室中众多人员的管理者——而大型期刊的编辑则是众多作者和编辑的管理者。他们都在努力做同样的事情。

I like to solve problems, and I like to look at complicated, difficult problems. And then, I like to be able to say this is a solution and let people learn from that. And I think going from being a practicing pathologist, in which pathologists these days are largely managers of large numbers of people in large laboratories. Editors of large journals are managers of large numbers of writers and editors. And they're all trying to do the same thing.

所以，只要你保持坚实的科学基础，临床同理心和理解力，真正重视伦理并无论身在何处都正确践行伦理，这种转变并不那么困难。其实相当容易，特别是如果你保持一只脚留在原来的领域，不迷失方向。所以没问题，没什么大不了的。

So, really isn't all that different as long as you retain a solid scientific base. Clinical empathy and understanding are really serious about ethics and doing ethics right no matter where you are, that transition is not that hard. It's rather easy, especially if you keep one foot back where you were don't lose track of that. So not a problem. No big deal.

嗯，我们非常高兴你做出了这个转变。多年来，你在这个领域做出了巨大贡献。最后我只想简单评论一下当前困扰我们社会的对科学缺乏兴趣的担忧。当然，有各种各样的人，他们的经验告诉他们不能信任科学。但这并不是很多。

Well, we're we're very glad that you did. You've you've made a great contribution for so many years in the field. And I just wanted to end with one small comment about the worry about the lack of interest in science that's currently afflicting our society. There's, of course, all kinds of people who whose experience tells them that they can't trust science. That's not very much.

并不是很多人。但我认为，我们正在经历的事情将会强化这个观念，因为不幸的是，由此产生的结果将会强化科学作为推动前进、改善我们生活质量的方式。我认为这必然会在五年内发生。对于那些认为这不可能的人，当坏事发生时，只需记住，如果你在1944年的柏林，当一切都在你周围崩溃时，你可能无法想象到1960年，它会再次成为一个中产阶级城市。

Not very many people. But I think that what we're going through right now is going to reinforce reinforce the the idea idea because because of of the the outcomes outcomes that that are are gonna gonna result unfortunately. That's gonna reinforce science as as the way to move forward to improve the quality of our lives. I I think that's bound to happen within five years. And for those of you who think that that's impossible when something's bad is happening, just remember if you were in Berlin in 1944, you probably would not have imagined as everything was crashing around you that by 1960, it would be a middle class city again.

你知道，这就是我们人类的方式。我们受过太多教育，无法长期忍受这种情况。即使某个群体对此非常兴奋，它已经在分裂了。你知道共产主义发生了什么，斯大林、托洛茨基，你知道，很快大家就开始互相争吵，接下来就是他们分崩离析。

You know, it's just that's the way we are as humans. We're we're way too educated to put up with this for very long. Even if some group is very excited about it, it's already splintering. You know what happened to the communist, you know. Stalin, Trotsky, you know, and pretty soon everybody's all arguing with each other and the next thing is they they they fall apart.

这是一个非常痛苦的转型过程，但我认为毫无疑问会朝着科学的方向发展。这一点毋庸置疑。总之，非常感谢乔治带来第十五届伦德伯格研究所讲座。马蒂、艾玛，非常感谢你们前来与我们分享这一切。至此，联邦俱乐部世界事务部在其第123年的启迪性讨论中又一场活动圆满结束。

It's very painful transition, but I I think it's undoubtedly gonna go science's way. No question about it. So anyway, thank you very much, George for the fifteenth annual Lundberg Institute lecture. Marty, Emma, thank you so much for coming here and sharing this with us. And so ends another event at the Commonwealth Club World Affairs in its one hundred and twenty third year of enlightened discussion.

非常感谢。明年再见，乔治。

Thank you very much. See you again next year, George.

您正在收听的是加州联邦俱乐部的节目。您可以在苹果播客、Google Play和Stitcher上收听我们数千期播客节目。如果您喜欢我们的内容，请考虑支持我们的工作，帮助我们每年为像您这样的听众带来500场节目。请访问commonwealthclub.org/donate。通过我们的旅行项目，以思维畅游世界，探索精彩的国内外目的地。

You've been listening to the Commonwealth Club of California. Hear thousands of our podcasts on Apple Podcast, Google Play, and Stitcher. If you like what you've heard, please consider supporting our work and help us bring 500 programs a year to listeners like you. Go to commonwealthclub.org/donate. Think your way around the world with our travel programs to exciting domestic and international destinations.

当您在湾区时，请亲临我们的活动现场参与。感谢您的收听与支持。

And when you're in the Bay Area, please join us live at our events. Thank you for listening and for your support.