人工智能能让个性化医疗变得可及吗？

ABC 听播客、广播、新闻、音乐等。

ABC Listen, podcasts, radio, news, music, and more.

如果离线生活不再是一种选择呢？

What if living offline isn't a choice anymore?

我是雷·约翰斯顿，在《退出》节目中，我正在探索我们的生活中有多少部分在线上，以及我们是否

I'm Ray Johnston, and in Opt Out, I'm finding out just how much of our lives are online and whether we

能够

can ever

真正地断开连接。

really unplug.

从隐私专家到黑客，我们探讨在一个始终监视的世界中消失意味着什么。

From privacy experts to hackers, we explore what it means to disappear in a world that's always watching.

退出。

Opt out.

要收听，请在您获取播客的任何平台搜索并下载本节目，或在 ABC 听应用中收听。

To hear it, search for download this show wherever you get your podcasts or hear it on the ABC Listen app.

所以普里亚，我们以前讨论过我们对宠物的共同偏好。

So Priya, we've discussed before our common preferences for pets.

是的，我们讨论过。

We have.

事实上，这引起了一些听众的不满，其中一些人甚至给我们写了实体信件，抱怨我们反猫的态度。

And in fact, this got a few listeners up in arms, some of whom have actually written physical letters to us complaining about our anticatism.

考虑到我们之前收到的那些信件，我不明白你为什么又提这个，但好吧，我们就接着说吧。

I don't know why you're bringing it up again, given the mail that we had, but alas, here we are.

你有

You have

狗吗？

a dog?

我有两只狗，叫乔克和沃利。

I have two dogs, Chook and Wally.

它们是漂亮的狗。

They're beautiful dogs.

它们都老了。

They're very old.

它们健康吗？

Are they well?

我们的小狗有白内障，另一只狗有脱毛症。

Our little one has cataracts, and our other dog has alopecia.

是的。

Right.

对。

Yes.

所以你是在全面了解病史。

So you're taking a full history.

所以你一直在给兽医花大笔钱。

So you're exsanguinating money into your veterinary surgeons

它们还好。

they're okay.

他们很好，我得说。

They're well, I have to say.

我们只是在支持他们。

We just support them.

今天我们要讨论的是一只得到主人极其精心照料的狗，而且即将出健康报告。

Well, we're gonna be talking today about a dog that's getting very exceptional service from his owner, and it's coming up on the health report.

这涉及到人工智能。

And it involves AI.

我很期待听一听。

I'm excited to listen.

我是Priya Alexander，来自Wirangiri土地。

I'm Priya Alexander on Wirangiri Land.

我是Norman Swan，来自Garrigal土地。

And I'm Norman Swan on Garrigal Land.

节目中还会提到，你的全科医生可能不会注意到你的肝功能正在下降，这是因为实验室报告血液检测结果的方式。

Also on the show, your GP might not notice your liver function is declining because of the way laboratories report blood test results.

我们将深入探讨这个问题。

We delve into that issue.

国家残障保险计划已经存在了几十年，但我们将听一位未能获得该支持的人讲述他如何在残疾状态下 navigating 生活。

The National Disability Insurance Scheme has been around for decades, but we're going to hear the story of someone who didn't have access to that support, and what it was like navigating life with disability.

你去年承认，有时我们可能会相当怀疑，也许在医疗保健领域，AI 就是其中之一，而我可能是迟来的采纳者，甚至根本没采纳。

You've admitted last year that sometimes we can be quite sceptical, and perhaps AI in health care is one of those places where I'm a late, if not no, adopter.

但是

But

这

it

是一个不断发展的领域。

is an evolving area.

人工智能正真正深入医疗保健领域，如果你还记得的话，去年我们曾采访过恩里科·奎拉教授，话题是医疗文书助手，当时引发了大量讨论。

AI is really getting its tentacles into health care, and we did do an interview with professor Enrico Cuera last year on scribes, if you recall, which generated a lot of discussion.

很多全科医生都在使用它们。

A lot of GPs are using them.

我们应当解释一下什么是医疗记录助手。

We should just explain what a scribe is.

是的。

Yes.

因此，在澳大利亚，现在有十分之四的全科医生在使用AI驱动的医疗记录助手。

So four in ten GPs are now using them in Australia, an AI powered scribe.

所谓医疗记录助手，就是安装在电脑软件中的一种设备，帮助全科医生或任何医疗专业人员记录病历。

And what that is is a device that's on the computer in the software that helps the GP or any medical professional take notes.

它会聆听问诊过程。

It listens to the consult.

它会自动生成病历记录。

It generates notes.

有些记录助手只会做这一件事。

Some scribes will just do that.

它们只会把一些笔记写下来。

They will just write some notes down.

有些系统甚至会提供诊断建议，可能影响问诊的方向。

Some will actually offer diagnostic input and potentially skew the direction of the consult.

有些系统还会自动生成信件并发送出去。

Some of them will actually generate letters and send a letter.

例如，如果是非全科医生的专科医生，比如外科医生，系统可能会给全科医生写一封回信。

For instance, if it's a non GP specialist, a surgeon, it might write a letter back to the GP.

所以它们能做很多事情。

So they can do a lot of things.

是的。

Yeah.

这是积极的一面。

And here's the good side.

积极的一面是，AI助手不可避免地会记录下更多与患者的对话内容，而这些内容在问诊结束后、需要接诊下一位患者前的短暂时间内，是无法全部写进病历的。

The good side is that inevitably, the AI scribes will record more of the conversation with the patient than would be taken down in notes in the short time you've got after the consultation before you need to see the next patient.

你通常只会记录下重要的内容，但有时那些重要的信息其实隐藏在对话本身中，而在下一次就诊时才会显现出来。

You'll tend to write down the important stuff, but sometimes the important stuff is buried in the conversation itself when it comes to the next visit.

例如，你可以通过患者在诊断前大约六到八个月内的全科医生就诊模式来预测胰腺癌。

For example, you can predict pancreatic cancer from the pattern of GP visits over a period of about six or eight months prior to the diagnosis.

而这些信息往往隐藏在对话中，当患者前来就诊时，可能是因为其他原因，比如腹痛，听起来更像是溃疡或消化不良之类的症状。

And that's buried in the conversation when the person's come in maybe for something else, or tummy ache that sounds more like an ulcer or dyspepsia or whatever.

因此，你可能会错过这些模式，而AI速记员却能捕捉并指出这些线索。

And so you miss those patterns which the AI scribe can actually pick up and point out.

但问题是，AI在医学领域也可能带来一些问题，它的发展速度极快，已经渗透到诊断领域，以及面向消费者的网站，在这些网站上，理论上你可以自行诊断自己的病情，这已经超越了‘谷歌医生’的范畴，达到了以往难以想象的程度。

But the problem is, there are also problems with AI and medicine potentially, It's going at an enormous rate, so into diagnostics, into consumer facing websites where you can, in theory, diagnose your own condition, which goes beyond doctor Google to a level that you would have been hitherto unimaginable.

但问题在于AI的训练数据来源以及它所基于的内容。

But the problem is where it's been trained and what it's been trained on.

如果你使用的是基于美国医疗体系和美式英语训练的AI系统，那么它可能并不适用于澳大利亚的实际情况。

So if you've got an American system that's based on the American health care system, and also American English, you actually may not have an AI system that's fit for purpose in Australia.

甚至可能的情况是，一个在墨尔本训练的AI速记员，在本迪戈或其他小镇可能表现不佳，因为人们的说话方式和生活经历不同，而AI系统的效能完全取决于其训练数据的质量。

And it may even be that if you've got an AI scribe that's been trained in Melbourne, it might not work as well in Bendigo or another country town because the way people speak, their life experiences are different, and the AI system is really only as good as as the way it's trained.

我的意思是，里科在我们去年的访谈中也探讨过这一点，但当你提到它能记笔记，或许能捕捉更多细节时，我深有同感。

I mean, and Rico did delve into that in the interview that we did last year, but I think when you said it it takes notes and perhaps gets more detail.

问题是，诺曼，笔记中究竟需要哪些细节？

The question is, Norman, what detail is really needed in notes?

因为我听一些同事提到，他们收到的由助手生成的回信给全科医生中，包含了咨询时患者提到的所有额外信息，比如‘我刚失去了亲人，这段时间很难熬’。

Because I've had reports of some colleagues sharing with me that the scribe generated a letter back to the GP and it contained all of this extra information in the consult where the patient had said, you know, I've just had the death of loved one, and it's been a tricky time.

这些内容都被记录在笔记里，而患者并没有预料到会被记录下来。

And and it's all picked up in the note, and the patient hadn't necessarily anticipated that.

而且患者可能也不希望这些信息被分享。

And might not want it to be shared either.

没错。

That's right.

所以正如你之前所说，AI助手的发展速度非常快。

And so the the real thing with AI scribes, as you said before, it's rapidly evolved.

在某些方面，马已经跑出去了，而监管机构现在才开始追赶——TGA在AI已被广泛使用时就已经发布了相关监管框架。

The horse has almost bolted in some respects, and now the regulation is trying to catch up, the TGA released its kind of regulation of AI in July already when it was being widely used.

但让医疗专业人员征得每位患者的同意才是关键，不能只靠墙上贴一张告示，RECO确实提到过这一点，APRA指南也这么规定。

But it's on the onus of the health professionals to consent every single patient, not just a poster on the wall, and RECO did say that and the APRA guidelines say that too.

医疗委员会的规定指出，不能仅仅依靠在接待处张贴的海报或纸张。

The medical board's regulation says it can't just be a poster or a piece of paper that they see at reception.

你必须亲自问患者：你是否同意我使用它？

You must say to the patient, are you comfortable with me using it?

你必须仔细检查笔记，逐字核对，确保所有内容都准确无误。

And you must check the notes really carefully and and actually go through it and ensure that it's all accurate.

你用吗？

Do you use it?

我不用。

No, I don't.

我至今仍未使用，因为我需要在书写笔记时用来思考。

I still haven't because I I use the notes in my writing time to think.

对我来说，这种掌控感非常重要。

And for me, that level of control is important.

我认为我永远不会这么做，诺曼。

I don't think I'm gonna do it, Norman, ever.

这可能吗？

Is that possible?

是的。

Yes.

当然，这是可能的。

Of course, it's possible.

任何事情都是可能的。

Anything is possible.

有诺曼在我身边。

With Norman by my side.

无论有一天你是否会在办公室里看到一个类人机器人坐着，让你疑惑它是谁。

Whether or not you get a humanoid robot sitting in your office one day and you wonder who it is.

但你知道恩里科最近在一次会议上说了什么吗？我看到了他的评论，他说他非常希望这些AI文书公司能公开它们的性能数据，说明它们的错误率、幻觉率——也就是AI生成了一些与就诊内容无关、完全由AI自己编造的文本。

But do you know what Enrico recently said at a at a conference, and I saw his comment, was that he would really like these AI scribes companies to actually publish their performance data, to say what their error rates are, their rates of hallucination, which is where the AI actually generates text that's not based on anything in the consult, but actually generated by the AI itself.

但恩里科基本上是在呼吁这些产品的性能要有更高的透明度。

But Enrico's basically calling for far more transparency on the performance of these products.

它们有多好？

How good are they?

这正在不断演变。

So this is evolving.

它正在迅速发展。

It's rapidly evolving.

马可能在某种程度上已经跑掉了。

The horse probably has probably bolted to some extent.

我们今年可能会探讨人工智能对医学研究的影响，因为这种影响是巨大的，而且其中一些甚至令人担忧。

And what we might cover this year is what impact AI is having on medical research, because that is considerable, and some of it actually is worrying.

如果我们今年要策划一些内容，我非常感兴趣的是ChatGPT被用于人们咨询健康问题，因为最近的数据表明，高达百分之七十使用ChatGPT的人实际上是为健康问题去询问它。

And if we are pitching things for this year, I'm very interested in ChatGPT being used for people for their health questions, because recent data suggested up to seventy percent of people who use ChatGPT actually go to it for health queries.

所以我就想知道，这种情况是什么样的？

So I just wanna know, what does that look like?

以及ChatGPT被用于心理治疗。

And ChatGPT being used for psychotherapy.

这是人们在与它交流，美国一名年轻男子自杀的案例已有明确记录。

That's People talking to it, and well documented case of suicide in a young man in The United States.

因此，这里确实存在实际问题。

So there are real problems there.

这些AI系统中设置的防护措施，是可以被绕过的。

The guardrails, which are there with some of these AI systems, can be got around.

如果您正在以任何形式使用AI来满足您的医疗需求，无论是用于心理支持还是咨询医疗问题，我们都非常希望听到您的经历，并可能在2026年对此进行深入探讨。

If there is anyone who's using AI in any form for addressing their health care needs, maybe you're the person using it for psychology support or asking it some medical questions, We would love to hear from you and potentially explore all of this for 2026.

我们的邮箱是 healthreport@abc.net.au。

Our address is healthreport@abc.net.au.

这里是ABC国家广播电台，您正在收听《健康报告》。

This is ABC Radio National, and you're listening to the health report.

我觉得你还有别的事情让我担心。

I believe that you have something else that I need to be worried about.

现在就直接告诉我吧。

Just just tell me here now.

你知道的，诚实点吧。

You know, just be honest.

你来诊所时，有一件事你迟早得做，就是查看所有的血液检查结果。

You come into the surgery, and one of the things you gotta do at some point is you gotta go through all the blood tests.

在会诊之前，我其实会提前一小时来做这件事。

Before I consult, actually, I'm in there an hour early to do this.

而且你做这个并没有报酬，但你还是要查看血液检查结果。

And you're not getting paid for it, but you're looking through the blood tests.

你在找什么？

What are you looking for?

所以不仅仅是血液检查。

So it's not just blood tests.

如果让我补充一点背景，我的收件箱里堆满了邮件。

So if I may give some context here, there's a full inbox

既然你想要回避刚才的问题

Since you're wriggling out of what

我说的是诺曼，我想回答这个问题，我当然会回答。

I'm saying Norman, I wanna answer the question, and I certainly will.

但通常我的收件箱里堆满了数百件事情，包括非全科医生的专业信件、X光片、病理报告，你必须逐一处理，决定谁需要来就诊、谁可以通过电话处理、谁是紧急情况，以及哪些可以直接处理掉。

But it is a full inbox often with hundreds of things, and it's non GP specialist letters, x rays, pathology, and you have to go through and decide who you're going to send a text to to come in, who you might deal with on the phone, who's an emergency, and what you can just clear.

你没有那么多时间，我会在病理报告中寻找加粗或高亮显示的内容，这些提示我结果超出了参考范围。

You don't have that much time, and I will look in the pathology realm for things that are bolded, highlighted, that tell me it's outside the reference range.

为了说明一下，你正在查看一长串数字，病理科医生会用加粗字体或在数字旁加星号标出你需要关注的地方。

So just to explain, you're looking down a list of numbers, and the pathologist will put something that you should pay attention to in bold lettering or numbers with an asterisk beside it.

没错。

That's right.

有时根据实验室的不同，会显示为红色，而且病理科医生常常会留下一段贴心的备注，帮助我解读结果，如果需要的话。

Sometimes it's red depending on the lab, and often the pathologist will leave a lovely note helping me interpret the result if it's ever needed.

对。

Right.

所以这就是你注意到的内容。

So that's what you notice.

其余的就都扔进桶里了。

And then the rest of it just goes in the bucket.

如果真的没有加粗或标星号，我认为大多数医疗专业人员在查看结果时都会说，如果不是这些情况，我可能会看看他们服用某些药物时的肾功能，但除此之外，我需要一个非常快速高效的系统。

Well, if it's not bolded truly, I think most health professionals checking results would say if it's not bolded, asterisked, yes, I might look for their renal function if they're on certain meds, but otherwise, I need to have a really quick efficient system.

这个故事实际上讲的就是一种严重的疾病——脂肪肝病引起的肝脏损伤。

And that's what this story is actually about, but about a very serious condition, is damage to the liver caused by fatty what we call fatty liver disease.

我们稍后会了解更多关于这方面的内容。

We'll find out more about that in a minute.

这种病在人群中非常普遍。

It's very common in the community.

这起事件最初源于一封邮件，实际上是一组来自我们听众的邮件，他们向我们讲述了关于肝功能检测的故事。

And this started off with an email, in fact, a set of emails from one of our listeners who was telling us this story about a liver function test.

这是一种肝脏血液检测，检测对象是她的伴侣，检测项目叫做ALT，即丙氨酸氨基转移酶。

So this is a liver blood test, and it was done on her partner, And it's called ALT, alanine aminotransferase.

当肝细胞受损或发炎时，这种酶就会泄漏到血液中。

So when your liver cells get damaged or inflamed, this spills out into your blood.

他的ALT值没有加粗或加星号。

And his ALTs were not bolded or asterisked.

它们处于该实验室的正常范围内。

They were within the normal range of that lab.

但事实上，这些数值是异常的。

But it turns out they were actually abnormal.

事实上，这个人的ALT值随着时间缓慢上升，但仍处于参考范围内。

So in fact, this person's ALT was actually increasing slowly over time, but still within the reference range.

是的。

Yep.

他最终患上了肝性脑病，即肝脏产生的毒素积聚在血液中，可能影响大脑功能。

And he ended up with what's called hepatic encephalopathy, where in fact the toxins from your liver gather in your bloodstream and could affect how your brain worked.

因此，这位听众一直在努力推动病理学家更加重视ALT检测的报告方式。

So this listener has been on a mission to actually get more attention paid to how pathologists report on this ALT test.

这引起了肝病专家西蒙·施特拉瑟教授的共鸣，他是肝脏基金会的主任，每天都在处理病理学家在ALT报告方面因脂肪肝疾病而存在的差异。

And this rang a bell with professor Simon Strasser, a hepatologist, a liver specialist, director of the Liver Foundation, who is dealing with this day by day, the variation between pathologists on ALT reporting in relation to fatty liver disease.

这是我们之间的对话。

Here's our conversation.

因此，我们看到了肝脏健康状况的显著变化，这与社区中肥胖和二型糖尿病的上升趋势相一致。

So we've seen a very dramatic change in liver health that parallels the rise in obesity and type two diabetes in the community.

因此，我们看到越来越多的人出现肝脏脂肪堆积的迹象，我们称之为脂肪肝疾病或代谢功能障碍相关性脂肪肝病。

So what we're seeing is more and more people with evidence of fat in their liver, and we call it fatty liver disease or metabolic dysfunction associated fatty liver disease.

因为这是一种与肥胖、高血压、高胆固醇和甘油三酯、二型糖尿病相关的肝脏疾病，而肝功能异常正是这些状况的表现。

Because it's a liver disease that's associated with having obesity, having high blood pressure, having high cholesterol and triglycerides, having type two diabetes, and the liver dysfunction is a manifestation of that.

我们通过超声检查可以看到肝脏中的脂肪，也通过肝功能检测发现轻度的肝功能异常。

And we see it both on ultrasounds where we see fat in the liver, and we see it on liver tests where we see mild derangement of liver test abnormalities.

在一些人身上，他们的肝脏只是有脂肪堆积，但其他肝功能仍然保持正常。

Now in some people, they just have fat in their liver and their liver function otherwise is maintained.

但在一些人身上，肝脏会逐渐出现炎症，随着时间推移，这种炎症还会导致瘢痕组织的形成。

But in some people, they actually will get inflammation in the liver building up, and over time, that inflammation will drive the development of scar tissue as well.

作为肝病专家，我担心脂肪肝的原因是多方面的。

Now the reason we, as a liver specialist, I worry about fatty liver is on a number of levels.

首先，它正成为肝癌最常见的原因之一，而在这个情况下，即使没有肝硬化，也可能发生肝癌。

One is it's becoming one of the commonest causes of liver cancer, and you don't have to have cirrhosis in this context to actually get liver cancer.

它也正成为人们需要肝移植的最常见原因之一，这是一个重大变化，因为我们现在已经有了针对乙型肝炎和丙型肝炎的有效治疗方法，这些疾病导致肝移植的需求正在减少。

It's also becoming one of the commonest reasons that people are needing liver transplantation, and that's a big change because now we've got good treatments for hepatitis b and for hepatitis c that they're becoming less of a reason for people needing a liver transplant.

而肥胖、糖尿病和脂肪肝疾病正成为人们需要肝移植的更常见原因。

And causes such as obesity, diabetes, and fatty liver disease are becoming the more common causes of people needing a liver transplant.

我的理解是，酒精的损害作用会被放大。

And my understanding is that the damaging effects of alcohol are multiplied.

换句话说，如果你有脂肪肝疾病，那么你只需要喝更少的酒，就会对肝脏造成严重损害，而如果没有脂肪肝，就需要喝更多。

In other words, you need to drink less alcohol to get serious effects on your liver if you've got fatty liver disease than if you don't.

是的。

Correct.

所有这些因素都会加剧肝脏瘢痕组织形成的风险，并增加肝硬化并发症甚至肝癌的风险。

All of that is compounded in terms of risk for developing more scar tissue in the liver and increasing the risk for complications with cirrhosis and even liver cancer.

没有肥胖也能得脂肪肝疾病吗？

Can you have fatty liver disease without obesity?

你可以有。

You can.

大约百分之二十的脂肪肝患者实际上并不肥胖。

So about twenty percent of people with fatty liver disease actually don't have obesity.

但他们确实存在代谢风险。

But they do have the metabolic risks.

他们通常缺乏运动。

They're often sedentary.

他们通常饮食不佳，而且往往腹部脂肪堆积，尽管他们的总体BMI（体重指数）可能并未达到我们认定为肥胖的标准，因为他们特别集中在腹部脂肪堆积。

They've usually got a poor diet, and they usually carry excess weight around their middles, although their overall BMI or body mass index may not get them into the range where we think they've got obesity because they're carrying it around their middle in particular.

当你腹部脂肪堆积时，也会在器官周围和肝脏内积累脂肪。

And when you carry fat around your middle, also carry fat around your organs and in your liver.

这就引出了血液检查。

Which brings us to the blood tests.

因此，当医生对你感到担忧，或者你进行常规体检时，通常会做一系列血液检查。

So often when your doctor's worried about you or you're getting a general checkup, they'll do a spectrum of blood tests.

他们会检测你的血红蛋白、红细胞和白细胞，而肝功能检查通常也包含在从单一样本中进行的这一系列检测中。

They'll do your hemoglobin, your red cells, and your white blood cells, and often liver tests are part of that spectrum of tests that they'll do off a single sample.

这里的问题是关于报告中提到的肝功能检测指标。

And the question here is about the liver function tests that are reported on.

我们健康报告的通讯员提到，其中一个关键的肝功能指标存在一些问题，那就是ALT，即丙氨酸氨基转移酶。

And our correspondent to the health report said there are issues to do with one of the key liver function tests, which is called ALT or alanine immunotransferase.

你只需告诉我们这个检测是什么，她的建议是，医生在看到ALT值偏高时似乎常常忽视，没有做出适当的反应。

You should just tell us what this test is, and her suggestion is that doctors seem to ignore it when it's high and don't respond appropriately.

这部分是因为ALT水平轻微升高非常常见。

Well, think partly that's because it's very common to have a slightly elevated ALT level.

ALT是一种存在于肝细胞内的酶。

And what ALT is, it's an enzyme that sits within the liver cells.

如果肝细胞受到任何损伤或发炎，这种酶就会释放到血液中。

And if the liver cells are damaged in any way or inflamed in any way, it will release out into the bloodstream.

问题的部分原因在于实验室报告ALT水平的方式。

Now the problem is partly how the laboratories report the ALT level.

我们之前谈到的脂肪肝疾病，至少有三分之一的澳大利亚成年人患有脂肪肝。

Now the fatty liver disease that we talked about, at least a third of the Australian adult population has fatty liver disease.

根据某些数据，这一比例甚至高达百分之四十。

And by some measures, it's up to forty percent.

所以这非常非常普遍。

So it's very, very common.

而脂肪肝的一个指标可能是ALT水平升高。

And one of the markers of that may be an elevated ALT levels.

实验室在报告ALT水平时会提供一个正常范围。

The laboratories report out ALT levels with a normal range.

这个范围有下限，尤其还有上限。

There'll be a lower end, and there'll be particularly a higher end of that range.

就连我在悉尼工作的地方，不同实验室的正常范围也不同，比如男性，一个实验室的上限是35，另一个实验室则可能是50甚至55。

And even around Sydney where I'm working, the ranges from one laboratory to another, for instance, for a man might be 35 in one laboratory and be up to 50 or even 55 in another laboratory.

但这些检测通常使用的是相同的仪器，只是它们根据当地人群的正常值来设定正常范围。

And yet they're done usually on the same machines, But they set the normal range based on a population normal.

所以，如果一个群体中很多人患有脂肪肝，那么就会有很多人的ALT水平被认定为正常，甚至高达50或55。

So if you've got a population where a lot of people have fatty liver, then there'll be a lot of people having what's thought to be a normal ALT level, and they'll report it out up to even 50 or 55.

抱歉。

Sorry.

所以，如果我能澄清一下，这看起来简直令人震惊：病理学家学会非常强调各实验室的标准，以及如何信任某个实验室而非另一个，但你所说的是，这完全是实验室自身的标准。

So so if I can just clarify there, I mean, it seems gobsmacking that you can have one laboratory, and the College of Pathologists makes a lot about their standards and how you can trust one laboratory versus another, and what you're saying is this is laboratory specific.

这已经够令人震惊的了。

Well, that's one gobsmacking thing.

更令人震惊的是，他们似乎默认了脂肪肝的存在，并因此调整了检测报告——因为他们所在的澳大利亚地区脂肪肝发病率很高，所以‘正常值’就被上调了。

The second gobsmacking thing is, well, they're kind of assuming fatty liver disease and adjusting their reporting because they might be in a part of Australia where there's a lot of fatty liver disease and therefore the normal has changed upwards.

但这就像说正常胆固醇是6，而我们知道健康胆固醇应该低于5一样。

But that's like saying a normal cholesterol is six when we know that a healthy cholesterol is below five.

我知道这对我来说毫无道理，因为我们清楚，女性的健康ALT值应该是19或更低，男性则是30或更低。

I know it makes no sense to me because we know that in fact, a healthy in a woman should be 19 or lower, and in a man, 30 or lower.

这比我们从实验室得到的正常范围要低得多。

That's a lot less than the normal ranges that we get from the laboratories.

作为一名肝病专家，当我查看肝功能检测时，我关注的水平远低于报告中标注星号或加粗的数值。

So as a liver specialist, when I look at liver tests, I'm looking for much lower levels than what will get an asterisk or a bold mark on a report.

比如，我们经常看到这种情况——在乙型肝炎患者中，我会遇到一位患有慢性乙型肝炎的年轻亚洲女性，这是一种肝脏病毒感染，她的ALT值从未超过正常范围，但可能在32左右，而正常上限是35。

So if I say, for instance and we see this all the time, for instance, in people with hepatitis b, I'll see a young Asian woman who has chronic hepatitis b, which is a virus infection of the liver, and her ALT will never be above normal, but it might be, say, 32 and now have the normal upper limit of 35.

我会给她服用抗病毒药物，以减轻炎症。

I give her antiviral treatment and settle down the inflammation.

下次她做血液检查时，ALT值会降到15或16。

The next time she has a blood test, it'll be 15 or 16.

因此，即使最初的ALT值在正常范围内，没有被标星号或加粗，但在我们仅用一片抗病毒药控制炎症后，它的数值就降低了一半。

So even though that ALT was originally in the normal range and didn't get an asterisk, didn't get a bold mark, it's halved by the time we've given just an antiviral tablet to reduce that inflammation.

我们在脂肪肝患者身上也看到同样的情况。

And we see the same thing happen in people with fatty liver disease.

他们肥胖，糖尿病控制不佳，服用药物后体重下降、血糖得到控制，ALT水平随之下降，尽管它一直处在所谓的实验室正常范围内。

We see they've got obesity, they've got poorly controlled diabetes, they go onto a medication, it drops their weight, controls their diabetes, and that ALT level will fall even though it's always been within the so called laboratory normal range.

那么，我们为何不能直接确定一个标准值，并据此报告结果呢？

So what's to stop us saying, here's the normal value and it's reported accordingly.

那为什么ALT没有这样的标准呢？

Why don't we have that for ALT?

在肝病专家的思维模式中，我们确实有这样的标准。

Well, we do within the liver specialist mindset.

难道不是我们应该遵循您的思维，而不是那些随意的病理学代表吗？

Isn't your mindset the one we should be following rather than random pathology reps?

我认为我们确实应该这么做。

I think we probably should be.

当我们开展教育并为全科实践制定指南时，我们会把这些数值纳入其中。

And when we do education and set out guidelines for general practice, we have those values incorporated.

在我们新的代谢相关脂肪性肝病共识声明中，这些数值已经被包含在内，但它们并不是实验室所设定的常规正常范围。

And in our new metabolic associated fatty liver disease consensus statement, those values are in there, but they're not the laboratory normal ranges that the laboratories are setting at.

因此，根据个体情况细致解读检测结果非常重要。

And so nuancing results for the actual individual is very, very important.

我想，当我们报告实验室结果时，也试图避免让整个群体感到恐慌。

I guess when we're reporting out of laboratories, we're also trying not to scare the entire population.

所以，如果你突然报告有三分之一甚至高达百分之四十的人群ALT异常，这会如何影响医疗资源的使用？

So if you suddenly reported abnormal ALT on a third or maybe forty percent of the population, what does that drive in terms of health utilization?

对于个体而言，这表明你的肝脏可能并不完全健康。

Well, for an individual, it would say there's something actually your liver's not completely healthy.

你应该采取措施评估肝脏是否存在纤维化，而我们已有方法可以进行评估。

You should be doing something to assess for whether there's scar tissue present in the liver, and we've got ways of assessing for that.

你还应该关注代谢风险，并设法降低这些风险，以预防未来发生心脏病或糖尿病。

And you should be looking at the metabolic risk and trying to lower that for the benefit of future heart disease or future diabetes development.

因此，我们看待肝脏的方式，就像矿井中的金丝雀一样。

So we look at the liver in a way as being sort of a canary in the coal mine.

它可能是最早提示某人代谢不健康的信号，如果他们开始采取措施改善自身状况——比如调整饮食、减少饱和脂肪和糖的摄入、减轻体重、增加运动，那么整体代谢健康将得到改善，未来患糖尿病和心脏病的风险也会降低。

It may be the first indication in somebody that metabolically they're not healthy and that if they start to introduce some ways of getting themselves better, improving their diet, reducing their saturated fats and their sugars in their diet, getting their weight down, exercising more, that overall metabolic health will benefit, and their chance of getting diabetes and heart disease in the future will reduce.

这种早期信号可能表现为ALT接近人群正常范围的上限，或者超声检查发现肝脏有轻微脂肪堆积。

That first hint of that might be from an ALT that's towards the upper limit of that population normal or that there's a bit of fat on an ultrasound.

所以，这与全科医生的对话会比较复杂。

So it's a complicated conversation with your GP.

我的意思是，你的全科医生说要给你做检查，而你却对此没有任何疑问。

I mean, your GP said, well, I'm gonna do a test on you, and you you don't ask any questions about it.

你知道，他们知道自己在做检查，而且是在做正确的事。

You know, they know they're doing the tests and they're doing the right thing.

但这里有一系列问题需要问。

But there's a series of questions.

我的意思是，你把样本送到哪家实验室？

I mean, which lab are you sending this to?

他们的正常值是多少？

What's their normal value?

你怎么知道我的数值是升高了，但还没到那个水平？

How are you gonna know that I'm raised but below that level?

我的意思是，当全科医生准备进行肝功能检查时，一个人应该和医生进行怎样的对话？

I mean, what do you think is the conversation a person should have with their GP when the GP is embarking on liver function tests?

我认为，一个人应该清楚自己的ALT值具体是多少。

Well, I think somebody should know what their ALT level actually is.

实验室的参考范围让我没那么担心，因为它们差异很大，但我认为真正重要的是ALT值本身。

The laboratory ranges worry me less because they vary so much, and yet I think that's the ALT level itself that's the important number.

抱歉，我想澄清一下，因为我可能误导了听我们对话的人，这里的假设是病理学家确实得出了准确的ALT值。

And sorry, just to clarify, because I might have misled people listening to our conversation, is the assumption here is that the pathologist is actually coming up with an accurate ALT level.

真正的问题在于对这个ALT值的解读。

It's the interpretation of that ALT level that's the issue.

没错。

That's right.

正常范围确实各不相同。

It's the normal ranges vary.

所以对于个人而言，如果他们担心肝脏健康，了解自己的ALT值可能是最重要的指标。

So for an individual person, if they're worried about their liver health, knowing their ALT value is actually probably what the important number is.

对于个人来说，也许第一个警示信号就是：我的肝脏似乎有点不对劲。

And for an individual, and maybe the first driver that says, actually, there's something not quite right with my liver.

我会努力减重、增加锻炼、调整饮食结构，吃得更健康，从而改善状况。

I'm going to work hard to get my weight down, to get my exercise levels up, to look at the components of my diet and start eating healthier, and that will improve things.

而个人如果坚持这些改变，他们的ALT水平实际上会下降。

And and an individual will see that ALT level will actually fall if they do those things.

目前，除了关注这些生活方式因素外，我们还没有针对脂肪肝的特定治疗方法。

Then at the moment, we have no specific treatments for fatty liver other than looking at those lifestyle things.

如果我们能更早介入，就可以预防这些不良后果。

If we get onto these earlier, we can prevent those outcomes.

斯蒂芬·斯特拉瑟教授来自悉尼大学，同时也是肝脏基金会的主任。

Professor Stephen Strasser is at University of Sydney and director of the Liver Foundation.

在国家广播电台，您正在收听健康报告。

On Radionational, you're with the health report.

现在我们回到之前承诺过的关于狗狗的故事。

So now to that story on dogs that we promised earlier.

这真是一个引人入胜的故事。

This is really a fascinating story.

这是一个关于一位非常特别的狗主人的故事，你会了解到这位主人为何特别——他正运用高科技手段，为爱犬争取更优质、更个性化的癌症治疗。

It's about a very special dog owner, and you'll find out why this dog owner is particularly special, who has been using high technology to try and get better and more personalized care for his dog's cancer.

这个故事的记者是我们可靠的制作人谢尔比·特雷纳。

Our reporter in this story is our trusty producer, Shelby Trainer.

她是一只挺有意思的狗，非常聪明、冷静沉着，但只要附近有猫，她就会不停地叫。

She's kind of an interesting dog, very intelligent, very calm and collected, but if there's a cat nearby, she'll love to bark at it.

非常非常亲昵。

Very, very affectionate.

就像大多数养狗的人会告诉你的那样，我这里有点偏颇——你对它们付出10%，它们就会回报你100%，罗斯伊就是这样。

As most dog owners will probably tell you, and I'm slightly biased here, is for every 10% you give them, they give you a 100% back, and it's like that with Rosie.

这是保罗·坎宁安，他在谈论他的收养狗罗斯伊。

This is Paul Cunningham, and he's talking about Rosie, his rescue dog.

我领养她的时候，她刚满两岁，现在她快要八岁了。

She had just turned two when I got her, and she's just about to hopefully get to eight.

她一半是斯塔福郡斗牛梗，一半是谢帕德犬。

She's half staffy and half Sharpay.

这两个犬种都容易患上她这种类型的癌症。

Both of those breeds are predispositioned to getting the kind of cancer that she has.

大约一年前，Rosie被诊断出患有肥大细胞癌。

About a year ago, Rosie was diagnosed with mast cell cancer.

肥大细胞是免疫系统的一部分。

Mast cells are part of the immune system.

当你流鼻涕时，那实际上是肥大细胞在让你的鼻子流涕。

When you get a runny nose, that's actually the mast cells making your nose run.

肥大细胞肿瘤是狗最常见的恶性皮肤肿瘤。

And mast cell tumors are the most common malignant skin tumor in dogs.

当肥大细胞癌发生基因突变时，它们会持续接收到不断生长的信号。

Mast cell cancers, when there's been a genetic mutation, they're constantly receiving the signal to just keep growing.

Rosie已经接受了多次手术、免疫疗法和靶向抗癌治疗。

Rosie has undergone several surgeries, immunotherapy and targeted anticancer therapy.

不幸的是，尽管这些治疗延长了她的生命，但癌症仍在继续发展。

Unfortunately, while it has extended her life, the cancer continues to grow.

因此，Paul亲自着手寻找一种能针对她基因突变的疗法，这种突变已被证实与细胞无限制生长有关。

And so Paul took matters into his own hands to find a treatment that targets her genetic mutation, which is known to be implicated in unfettered cell growth.

因为如果我不去尝试，我会知道我还没有竭尽全力。

Because if I didn't try, I'd know that I hadn't tried everything, essentially.

保罗并不是肿瘤学家、遗传学家或生物学家。

Paul isn't an oncologist or a geneticist or a biologist.

然而，他拥有一家人工智能公司。

He does, however, own an AI company.

这意味着他能够使用许多人都无法接触到的工具。

And that means he has access to tools that many people don't.

基于我对这些最新突破的了解，我想，为什么不试试呢？

With some of the knowledge that I knew about these recent breakthroughs, I thought, like, why not give it a crack?

哦，我最初的想法是，这可能并没有被正确地实现过。

Oh, my initial thoughts were this had probably hasn't been done properly.

你知道，这是一门非常困难的科学。

You know, this is really difficult science.

这是来自新南威尔士大学的结构生物学家凯特·米基医生。

This is doctor Kate Micky, a structural biologist at the University of New South Wales.

她看到了保罗后续的工作，关于他是如何做到的，稍后会提到，但她对他的成就感到惊叹。

She saw Paul's work down the line, more on how he did it shortly, but she was amazed at what he was able to achieve.

真的非常惊讶，他做得太棒了。

Genuinely surprised, like, he's done an amazing job.

我认为这让我感到非常激动和鼓舞，看到一位没有接受过正式科学训练的普通人，能够几乎完全独立地走这么远，这反映了我们当前所处的阶段，非常有趣。

And I think that's something that's really exciting and inspirational to me to see a member of the lay public, you know, without formal scientific training, being able to get so far down the pipeline essentially unaided, which I think is a really interesting reflection of where we are.

我在2024年11月开始使用ChatGPT。

I jumped on ChatGPT in November 2024.

你会花两到三个小时深入与ChatGPT探讨，就在其中一次对话中，我制定了一份行动步骤计划。

You know, there's like two to three hour deep dive sessions you have with ChatGPT, one of those sessions, and came up with a plan on steps to take.

第一步是提取罗斯的DNA。

The first step was to get Rosie's DNA extracted.

这一操作是在罗斯接受手术时完成的。

This was done during one of Rosie's surgeries.

兽医很贴心地从肿瘤组织和健康组织中分别取了样本。

The veterinarian kindly took a sample from the cancer and a healthy sample.

保罗随后联系了一家研究机构，该机构同意从这两个样本中提取罗西的DNA。

Paul then reached out to a research institute that agreed to extract Rosie's DNA from both of these samples.

这是一个多步骤的过程，DNA需要被分离和纯化。

It's a multistep process where the DNA is isolated and purified.

下一步是将DNA进行测序。

The next step was to get the DNA sequenced.

DNA由四种化学碱基组成：腺嘌呤、鸟嘌呤、胞嘧啶和胸腺嘧啶，简单来说就是A、G、C和T。

DNA is made up of four chemical bases adenine, guanine, cytosine, and thymine, or simply put, A, G, C, and T.

正是这些碱基的排列顺序，决定了你是像保罗这样的人，还是像罗西这样的狗。

It's the order of these bases that essentially determines whether you're a person, like Paul, or a dog, like Rosie.

特定的DNA片段包含构建蛋白质的指令，而蛋白质在体内执行重要功能，包括激活肥大细胞。

Specific strings of DNA contain instructions for building things like proteins, which carry out vital jobs in the body, including activating mast cells.

在DNA被提取后，是新南威尔士大学对它进行了测序，将罗西的DNA从生物样本转化为数据。

After the DNA had been extracted, it was the University of New South Wales that sequenced it, turning Rosie's DNA from a biological specimen into data.

现在我们有了这些数据。

Now we have the data.

这些数据大约有350吉字节。

The data was about 350 gigabytes.

你可能会认为基因测序是一门精确的科学，但其实并不是。

You might think of genetic sequencing as an exact science, but it isn't.

这350吉字节的数据需要被仔细筛选，去除DNA链的重复读取，并重新排列，以反映一只典型狗的基因组模样。

This 350 gigabytes of data has to be sifted through for duplicate readings of DNA strands and rearranged to reflect what a typical dog genome would look like.

在进行比较之前，这一过程分别对罗斯的癌组织样本和健康组织样本都执行了一遍。

This was done on both Rosie's cancer sample and her healthy sample before the two could be compared.

我们进行了所谓的变异检测，寻找两者之间的差异。

We ran what's called variant calling, looking for differences between the two.

而正是在这里，你可以找到突变。

And this is where you can find the mutations.

我们重点关注了一种名为cKIT的蛋白质。

We focused in on a protein called cKIT.

它是导致罗斯所患癌症类型的一个已知原因。

It's a known cause of the type of cancer that Rosie has.

一旦我们获得了cKIT蛋白的正常版本和突变版本，我们就使用了一种我所知道的新技术，叫做AlphaFold。

Once we got the cKIT protein, the healthy one and the mutated one, we used this new technology which I was aware of called AlphaFold.

这是一个由谷歌DeepMind团队开发的计算机程序。

So it's a computer program that was written by the DeepMind team at Google.

当保罗说他们得到了c蛋白时，他的意思是他们找到了编码cKIT蛋白的化学碱基序列，也就是那串特定的A、G、C、T的组合，它们指导身体如何制造cKIT蛋白。

When Paul says they got the c protein, what he means is they found the sequence of chemical bases, the specific jumble of a, g, c and t that instructs the body on how to make the c kit protein.

然而，蛋白质并不是一堆字母。

However, proteins aren't a jumble of letters.

它们是三维结构。

They're three-dimensional structures.

长期以来一直存在一个问题：我们知道蛋白质内部化学物质的组成。

An age old problem has always been we know what the chemicals inside the proteins look like.

这就像一条长链，但我们从未理解它们是如何折叠成三维形状，从而执行其功能的。

It's like a long string, but we've never understood how they fold up into a three-dimensional shape that carries out the machine task that they do.

这一点对我们非常重要，因为如果你想开发药物，几乎所有的药物都靶向蛋白质，并通过选择性结合目标蛋白的特定结构来阻止其发挥作用。

And that's important for us to understand because if you want to make a drug, almost all drugs target proteins, and they target the protein by binding selectively to the particular machine protein they're looking for that stops it working.

这就是AlphaFold的用武之地。

That's where AlphaFold comes in.

它是一个人工智能程序，能够根据输入的化学碱基序列预测蛋白质的结构。

It's an AI program that's able to predict the structure of a protein based on the sequence of chemical bases that it's fed.

在这一时刻之前，过去六十年里，我们一直依赖实验方法来解决这个问题。

Prior to this moment, so for the last sixty years, we've had to do it by experimental methods.

我一生都在致力于解决蛋白质结构问题，曾花了四年时间试图确定一种蛋白质的结构，但最终未能成功。

I personally have spent my life working on solving protein structures, and I've worked for four years to try to get the structure of one protein and not being able to achieve it.

它们非常难以测定。

They're very difficult.

因此，AlphaFold软件对于理解蛋白质结构的人来说，是一项能极大加速研究的惊人工具。

So AlphaFold software, it's an amazing tool in the hands of someone who understands protein structures to really accelerate research.

这不是你能在普通电脑上运行的软件。

This isn't software you can run on your average computer.

它非常昂贵，计算过程需要数小时。

It's very expensive, and calculations run for hours.

尽管有如此强大的计算能力，米基医生表示AlphaFold远非完美。

Despite this computing power, doctor Mickey says AlphaFold is far from perfect.

它会出错。

It makes mistakes.

当AlphaFold给出预测时，它还会提供一些指标，告诉你它认为自己的表现如何。

When AlphaFold gives predictions, it also provides metrics to tell you how well it thinks it's performed.

这就像是把电钻交到我手里。

It's a bit like putting the power drill in my hand.

对吧？

Right?

我并不擅长，也没有接受过工匠训练。

I'm not a very good I'm not trained as a tradesman.

如果你给我一把电钻，我确实能钻出一个洞。

If you give me a power drill, I can drill a hole.

但可能看起来很丑。

It's probably pretty ugly.

电钻最好的使用方式是掌握在大师级工匠手中，他们能极大地提升工作效率。

The best place for the power drill is in the hands of a master craftsman who really accelerates their job.

作为一名结构生物学家，我可以查看这个程序的结果，判断哪些部分是可信的、哪些是有用的、哪些我们相信是正确的，以及哪些它可能并没有做好。

So as a structural biologist, I can look at the results of the program and understand the things that we can trust and the things we believe and the things that are useful and the things that it's probably not doing a good job at.

无论AlphaFold是否准确，它已经给出了Rosie突变型cKIT蛋白的结构预测。

Whether or not AlphaFold has done a good job, it has given a prediction of what Rosie's mutated c kit protein looks like.

之所以查明这一点至关重要，是因为它能帮助Paul为Rosie找到一种有效的靶向治疗方法。

The reason this was so important to find out is because it could help Paul find a targeted treatment for Rosie's cancer that works.

因为这种药物能与她独特的突变型cKIT蛋白结合，从而阻止其过度活跃。

Because it binds to her uniquely mutated cKIT protein and can stop it from running in overdrive.

肥大细胞瘤在狗身上非常常见。

Mast cell tumors are very common in dogs.

但在人类中却很罕见。

They're rare in people.

因此，医学研究不太可能投入大量时间去深入探索这个领域。

So it's not an area that medical research is gonna spend a lot of time investigating.

彼得·贝内特是墨尔本大学兽医肿瘤学的副教授。

Peter Bennett is an associate professor in veterinary oncology at the University of Melbourne.

目前已有两种药物专门针对导致肥大细胞失控生长的突变cKIT蛋白，适用于狗狗。

There are two drugs for dogs that already do target the mutated c kit protein responsible for out of control mast cell growth.

然而

However

即使是有这些突变的狗狗，也并不总是对这种抑制剂有反应。

Even the dogs with those mutations don't always respond to that inhibitor.

罗斯的情况就是如此。

Which was the case in Rosie.

于是，保罗开始寻找一种可能对罗斯的特定突变有效的药物，这是一种通常不为狗狗提供的个性化治疗方式。

So Paul went in search of a drug that might work on her exact mutation, a kind of personalized approach that isn't usually available to dogs.

他发现了一种在美国已用于人类的有前景的化合物。

And he has found a promising compound that is in use in humans in The United States.

而他正是借助了更多人工智能程序才做到了这一点。

And he did that with the help of even more AI programs.