MAHA是否在影响健康政策？

本月早些时候，卫生部长小罗伯特·F·肯尼迪与副总统万斯在华盛顿特区会面，参加了'让美国再次健康'（MAHA）峰会。

Earlier this month, secretary of health Robert f Kennedy junior and vice president Vance met in Washington DC for a make America healthy again or MAHA summit.

峰会日程显示出向替代医学、健康养生和营养学的转向，而远离传统药物治疗。

The summit's agenda showed a shift towards alternative medicine, wellness, and nutrition, and away from conventional medications.

以下是万斯在峰会上的发言。

Here's Vance speaking at the summit.

我们只应该摄入那些真正必要的东西。

We should only be taking stuff.

我们只应该给孩子使用那些确实必要、安全且有效的东西。

We should only be giving our kids stuff if it's actually necessary, safe, and effective.

这是唯一公开的活动。

This was the only public event.

其他所有会议都是仅限受邀者参加的私人活动。

All the other sessions were invitation only private events.

不过《政客》杂志获得了峰会日程的副本，其中包括迷幻药物、食物即药物、抗衰老和生物黑客等议题。

Politico did though acquire a copy of the summit's agenda, which included topics like psychedelics, food as medicine, antiaging, and biohacking.

值得注意的是，大多数演讲者并非学术研究人员和医生。

Notably, most of the speakers were not academic researchers and doctors.

万斯还对医疗体系提出了批评。

Vance also criticized the medical establishment.

他们试图压制那些发表超出奥弗顿窗口言论的人。

They tried to silence the people who were saying things that were outside the Overton window.

而正如我们过去几年艰难发现的那样，往往是那些超出奥弗顿窗口的人才是正确的，而所有专家都错了。

And as we found out the hard way over the last few years, it was very often the people who were outside the Overton window who were actually right, and all the experts were wrong.

本周，美国食品药品监督管理局高层表示该机构将实施更严格的疫苗规定，这让美国国家公共电台采访的众多专家感到震惊。

And this week, the Food and Drug Administration's top leaders said the agency is vowing stricter vaccine rules, which alarmed numerous experts that NPR spoke with.

想想看。

Consider this.

特朗普政府正在边缘化科学家和研究人员。

The Trump administration is sidelining scientists and researchers.

这对美国民众的健康意味着什么？

What does that mean for the health of Americans?

这里是NPR，我是迈尔斯·帕克斯。

From NPR, I'm Miles Parks.

我想快速确认一下情况。

So I just wanna check-in really quick.

你还好吗？

Are you okay?

或者你正遭受睡眠不足、账单堆积或政治宣传的困扰？

Or are you suffering from sleep deprivation, a stack of bills, or political propaganda?

如果是这样，你可能陷入了父母陷阱。

If so, you may be stuck in the parent trap.

在《It's Been a Minute》播客中，我们将深入探讨现代育儿的焦虑，以及这些焦虑如何影响我们每个人——即使你没有孩子。

On the It's Been a Minute podcast, we're diving headfirst into the anxieties of modern parenting and how that trickles out to all of us even if you don't have children.

来寻找一些缓解吧。

Come find some relief.

请在NPR应用或你获取播客的任何平台收听《It's Been a Minute》播客。

Listen to the It's Been a Minute podcast on the NPR app or wherever you get your podcasts.

《Wildcard》让大牌访谈变得如同与朋友聊天般轻松自在。

Wildcard is where big name interviews feel like conversations with a friend.

我是说，我真不敢相信自己竟如此幸运。

I mean, I can't believe how lucky I've been.

你道别的方式不对，麦康纳。

You didn't say goodbye the right way, McConaughey.

她对我说，我觉得你不是普林斯顿的料。

She told me, I don't think you're Princeton material.

要说我有什么特点，大概就是坦率开放吧。

I'm nothing if not open, I guess.

我是瑞秋·马丁。

I'm Rachel Martin.

在NPR应用、YouTube或任何你获取播客的平台观看或收听《Wildcard》。

Watch or listen to Wildcard on the NPR app, YouTube, or wherever you get your podcasts.

这里是NPR的《Consider This》栏目。

It's Consider This from NPR.

副总统万斯在本月早些时候的MAHA峰会上对医学界提出了严厉批评。

Vice president Vance had strong criticism for the medical community in the MAHA summit earlier this month.

这些观点现在正影响着政府在疫苗、药物和健康方面的指导方针。

Those views are now affecting the administration's guidelines on vaccines, medication, and wellness.

那么当政府指导方针偏离科学共识时会发生什么？

So what happens when government guidance moves away from scientific consensus?

我们向公共卫生领域杰出教授、密苏里州圣路易斯华盛顿大学公共卫生学院院长桑德罗·加利亚博士提出了这个问题。

We pose this question to doctor Sandro Galea, a distinguished professor in public health and dean of the Washington University School of Public Health in Saint Louis, Missouri.

我想首先请您对副总统的言论作出回应。

I wanna start by having you respond to the vice president.

医疗体系是否过于僵化或官僚化，以至于阻碍了创新？

Is the health system too rigid or bureaucratic to actually allow for innovation?

嗯，总体而言，我认为并非如此。

Well, think in general, I would like to think it's not.

要知道，副总统说的很多话确实有让人认同之处。

You know, there there's much that the vice president said that one agrees with.

我是说，他提出我们不应服用药物，除非它们确有必要、安全且有效，这一点我完全赞同。

I mean, he said that we should not take medications unless they're necessary, safe, and effective, and I agree with that completely.

我认为副总统言下之意——从刚才播放的片段和其他言论中可以看出——是由于这些挑战，我们就该抛弃科学和医学的贡献。

I I think the extension of that, that the Vice President implied, certainly in his clips that you just aired and in other comments, is that as a result of these challenges, we should discard science and discard what medicine has to offer.

这种延伸观点实际上并没有事实依据。

Mean, that extension is not really grounded in fact.

他还提到了过度开药的问题，确实有同行评议的研究指出，某些药物如抗生素和部分抗酸剂存在过量处方现象。

Well, he also brought up this idea of overprescription, and there are peer reviewed studies that note that some medications, things like antibiotics and in some cases, antacid medications, They have been found to be overprescribed.

还有其他案例表明，商业利益驱使医生过度开具如睡眠呼吸暂停用的CPAP设备。

There's been other cases where people have said that business incentives motivate doctors to overprescribe things like CPAP machines for sleep apnea.

我想请教，您能否稍作解释？或者您是否认为当前确实存在某些药物过度处方的倾向？

I guess I wonder, can you explain that a little bit, or do you think there is a tendency to overprescribe some medications?

是的，MAHA议程中的过度处方问题很有意思，它某种程度上反映了更广泛的MAHA主张——确实存在抗生素等多种药物的过度使用现象。

Yeah, think the issue of overprescribing in the MAHA agenda is an interesting one, and it is a little bit of a piece of the larger MAHA agenda, meaning that it is correct, there is overprescribing, there is overprescribing of a number of medications, there is overprescribing of antibiotics.

这些复杂的医疗体系内含对从业者的处方激励，我们社会需要做的是通过科学研究记录处方行为，让科研机构与政府部门协作确保激励指向精准处方而非盲目开药。

These are really complex systems that embed incentives for practitioners, incentives for prescribing, and what we need to be doing as a society is doing the science to document your prescribing, to work in partnership between science and government agencies to make sure that the incentives are not for prescribing, but for prescribing accurately.

因此，MAHA议程虽然基于许多重要且正确的观察，却被过度引申，暗示科学毫无贡献，我们应该转向诸如迷幻药物和生物黑客等未经严谨证据验证的替代方式，无法确保你我使用的药物或方法真正安全有效，能实现其延长寿命、促进健康的本意。

So the MAHA agenda, which is founded on a number of important and correct observations, ends up being taken too far to suggest that science has nothing to offer and that we should move to some other alternate way of embracing things like psychedelics and biohacking that is not grounded in rigorous evidence that can make sure that medications or approaches that you and I use are indeed safe, they're effective, and can do what they're supposed to be doing, which is helping us live longer, healthier lives.

我们确实应该投资于‘让美国再次健康’这一目标。

It is correct that we should invest in making America healthy again.

但错误在于实现这一目标的方式不应是抛弃科学，放弃全球最成功的科研机构与政府合作体系——正是这种合作让我国取得了突飞猛进的发展。

It is not correct that the way to do that is by throwing away science, by disinvesting from the most successful partnership between the science establishment and government of anywhere in the world that has allowed us to advance by leaps and bounds in this country.

我们需要做的是揭露这些挑战，记录这些挑战，而判断利弊则需要依靠科学。

What we need to be doing is exposing these challenges, writing about these challenges, and it's going to take science to determine what is beneficial and what is harmful.

你认为

Do you think

我们是否正在进入一种新的政治常态——每当新政党上台执政，科学指导方针就会发生根本性转变？

that we are entering a new political normal here where basically every time a new party enters power, takes over the presidency, that scientific guidance is just going to shift radically?

你知道，我真的希望不会如此。

You know, I really hope not.

我真心希望我们作为一个国家能达成平衡，即认识到我们共同秉持的一些核心价值观。

I I really hope that we, as a country, refine their equilibrium, meaning that we recognize that there are some core values that we hold as a country.

我的意思是，这些原则一直是美国实验共和国在过去250年发展进步的核心，我们依据数据而非信仰来决定做什么以及如何做。

I mean, these principles have been at the core of the advance of the republic of the American experiment for the past two hundred and fifty years, that we use data and not belief to inform what we do and how we do what we do.

但如果这一过程受到挑战或被破坏，我们将失去数据和证据，只剩下信仰、观点和主观看法。

But that process, if it's challenged or if it's dismantled, leaves us with no data, no evidence, and leaves us only with belief and opinion and perspective.

而信仰、观点和主观看法可能会将我们引向毁灭之路。

And belief, opinion, perspective can lead us down the road to perdition.

我们可能会犯下许多错误，并影响许多人的生活。

We can make a lot of mistakes, and we can affect a lot of people's lives.

当你的亲友向你咨询他们做决定时应该去哪里获取信息时——我特别想到的是有孩子的家长关于疫苗及其潜在风险收益的问题。

When people in your own life ask you where they should go for information on decisions they have to make, I'm thinking specifically as somebody with a child in terms of vaccines and the potential risk reward of getting those vaccines.

现在很多人对此都有很多疑问。

A lot of people have a lot of questions about that right now.

你会告诉人们去哪里获取可靠信息？

What do you tell people about whether where to go for good information?

还是说CDC（疾控中心）吗？或者你有什么建议？

Is it still the CDC, or what do you tell them?

我首先会建议从个人的医生、主治医师开始咨询。

I would first of all start with one's doctor, one's physician.

医生应当具备足够的智慧来指导患者——也就是我们所有人——了解现有的最佳证据。

Physicians should have the wisdom to be able to guide patients, all of us, in what the best available evidence is.

除此之外，我们的公共卫生机构确实是全球最优秀的机构之一。

Outside of that, our public health agencies are really among the best in the world.

当然我们都意识到，这些机构目前正经历着政治分歧带来的冲击，对其公布的数据以及不再公布的数据都存在质疑。

Now I think we all recognize that there has been some sweeping up of those agencies and some of these political divides of the moment, and there have been some challenges to the data that are being presented by those agencies and conversely the data that are no longer being presented.

因此我认为需要谨慎对待，但疾病控制中心、国立卫生研究院、食品药品监督管理局里的科学家们，都是毕生追求真理的杰出人才。

So I think one has to be careful there, but the scientists inside the Centers for Disease Control, the National Institutes of Health, the Food and Drug Administration, These are outstanding people who have spent a career in the pursuit of truth.

我不希望在这个政治敏感时期，当这些问题被用来推进党派议程时，我们忽视了这一点。

I I do not want us to lose sight of that in the heat of this political moment when these issues have really become used to advance partisan agendas.

这位是

That was Doctor.

桑德罗·加利亚博士，一位杰出的公共卫生学教授。

Sandro Galea, a distinguished professor in public health.

感谢您的到来。

Thank you for being here.

谢谢邀请我参加。

Thank you for having me on.

本期节目由乔丹·玛丽·史密斯和艾弗里·基特利制作，汉娜·格洛文纳负责音频工程，艾哈迈德·达曼负责剪辑。

This episode was produced by Jordan Marie Smith and Avery Keatley, with audio engineering by Hannah Glovena, who was edited by Ahmad Daman.

我们的执行制作人是萨米·耶尼根。

Our executive producer is Sammy Yenigan.

这里是NPR的《Consider This》节目。

It's Consider This from NPR.

我是迈尔斯·帕克斯。

I'm Miles Parks.

有没有什么问题是你懒得去谷歌搜索的？

Do you have a question you just don't feel like googling?

我们是伊恩和迈克，《How To Do Everything》的主持人。

We're Ian and Mike, hosts of How To Do Everything.

我们能帮你解答所有最紧迫的问题，比如：我可以用洗碗机做千层面吗？

We can help answer all of your most pressing questions, like, can I cook lasagna in my dishwasher?

飞艇该停在哪里？

Where do you park your blimp?

还有永恒的经典问题：那是什么味道？

Or the timeless classic, what's that smell?

我哦。

I oh.

请在NPR应用或你获取播客的任何平台收听《如何搞定一切》播客节目。

Listen to the how to do everything podcast on the NPR app or wherever you get your podcasts.