Does exercise lower your biological age?

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你平时挺爱运动的啊。

So you're a big exerciser.

今天有什么安排啊，Priya？

What are you up to today, Priya?

今天可真不怎么样，因为我一直在这儿陪着你。

Oh, today is not a good day, because I've been here with you.

真的吗？

Oh, really?

我算了算，来回都走到了电车站。

Well, I look, I've walked to the to the tram stop both ways.

那挺不错的。

Oh, that's pretty good.

是的。

Yeah.

我身体确实动了动。

There's some movement of my body.

不过你看，昨天我上了一节普拉提课。

But look, yesterday, I did a Pilates class.

再之前我打了心肺训练网球，你知道我有多喜欢这项运动。

The day before that, I did my cardio tennis, which you know I love.

是的。

Yeah.

我真怕你会邀请我一起去。

I'm terrified you're gonna invite me along to it.

我自己报的名。

Invited myself.

你还没答应呢。

You've you've said you've not said yes yet.

没答应。

No.

我故意不告诉你我什么时候在墨尔本。

I I deliberately don't tell you when I'm in Melbourne.

所以。

So

确实有这种感觉。

It feels like that.

确实有这种感觉。

It feels like that.

我躲着你。

I hide.

我躲着你。

I hide.

我骑车来的，感觉状态还不错。

I feel, you know, I've I've cycled in, so I feel pretty good.

但今天我们要聊的正是这类事。

But that's one of the stories we're looking at today.

骑自行车上班，像Priya那样保持运动，真能让人从生物学上变年轻吗？

Does in fact cycling into work, doing physical activity like Priya, does that make you younger biologically?

这不过是今天健康报告里的一个故事。

That's just one of the stories on today's health report.

我是Priya Alexander，现在在Wurundjeri土地上。

I'm Priya Alexander on Wurundjeri Land.

我是Norman Swan，现在在Gadigal土地上。

And I'm Norman Swan on Gadigal Land.

接下来节目中，妇科医生们对国内部分地区堕胎服务日益受限发出警告。

Also coming up on the show, gynaecologists are raising alarms about growing barriers to abortion access in parts of the country.

这情况确实令人担忧。

This is very concerning stuff.

没错。

Yeah.

妇科医生指出，这种趋势隐蔽而危险，可能预示着类似美国的未来走向。

It's claimed by the gynaecologists that this is insidious and the shape of things to come maybe like the American situation.

关于统一定价服务的障碍，政府政策又有了新调整，这次涉及的是某项关键医疗服务的根本性问题。

And more on bulk billing barriers with a change to government policy, this time quite existential in terms of a particular health service.

最近有什么新闻？

What's in news?

首先，我们来更新一下埃博拉疫情的最新情况，最近确实有一些变化。

First, we're covering in the news Ebola again, and we're just doing a little update here, and there have been some changes.

根据美国疾控中心6月2日发布的最新数据，目前已确认363例病例，62例死亡，乌干达也出现了15例确诊。不过我们都知道，实际数字很可能远高于此。

So as of the June 2, the latest data from the CDC in The United States says three hundred and sixty three confirmed cases, sixty two confirmed deaths, and Uganda now has fifteen confirmed cases as well, but we know that the numbers are likely much higher than that.

就在我们直播的时候，世界卫生组织表示，有迹象显示疫情似乎趋于平稳，但现在说疫情已经结束或得到控制还为时过早。

And as we go to air, the World Health Organization has said that there is some indication that it's leveling out, but it's too early to say that we're it's over or under control.

世卫组织还特别强调，不建议实施旅行限制或禁令，尤其是点名批评了美国——他们已禁止来自疫区的人入境。

The WHO have also said that they are really advising against travel restrictions and travel bans, and I think they're particularly calling out The US on this, who have banned anyone from affected areas from entering the country.

他们指出，这类措施反而严重阻碍了实地快速协同应对，也扰乱了物资供应链。

And they're saying that it's actually making it much more difficult to have a united and fast response on the ground, and it's also disrupting supply chains as well.

因此，世卫组织强烈警告各国不要采取这类做法，目前澳大利亚还没有实施任何禁令。

So they've really warned against countries doing that, and at the moment, Australia doesn't have a ban in place.

我知道很多人看到新闻标题都会很担心，但在澳大利亚的国际机场，来自疫区的旅客如果出现症状，都会有明确的标识提醒他们接受检测。

I know a lot of people feel quite worried seeing the news headlines, but at international airports in Australia, there is signage for people from affected places to get tested if they have symptoms.

我们在悉尼的韦斯特梅德医院确实设有隔离病房，一旦有疑虑就可以立即处理。

And we do have an isolation unit at Westmeath Hospital in Sydney if there is any question there.

还有一条好消息是关于疫苗的——回想起新冠疫情刚爆发时，我们之所以能这么快推出疫苗，是因为之前已经投入研发能快速应对新病毒的疫苗技术，现在这些技术正被用来加速开发针对这种埃博拉病毒的疫苗。

And some positive news on vaccines that, if you go right back to the beginning of COVID, one of the reasons we got vaccines so quickly is that there had been an effort to develop vaccine technologies which could turn around a vaccine very quickly after a new bug or virus has been identified, and they're using those technologies to try and turn around a vaccine against this particular form of Ebola as quickly as possible.

所以目前来看，成功研发出疫苗的可能性是相当大的。

So there's reasonable optimism that that will actually happen.

除此之外，联邦政府已经承诺提供五百万澳元支持全球应对行动，希望这笔资金能切实帮助到一线工作。

And I guess the only other update in this space is that the federal government has committed to $5,000,000 in support to the global response, and so hopefully, that is gonna help things on the ground.

但刚果及其邻国的情况依然令人非常担忧。

But still a very worrying time for Congo and its neighboring countries.

另一项研究揭示了一个令人不安的现象：越来越多的孩子在用人工智能聊天机器人来应对心理问题。

And another study suggesting quite disturbing levels of kids using AI Chatbots for their mental health systems.

这项研究发表在《儿科学杂志》上，调查对象是美国的青少年和成年人。

So this has been published in JAMA Pediatrics, and it's used US adolescents and adults.

所以这个年龄段跨度挺大的，从12岁到21岁。

So it's quite a broad age range, 12 to 21.

是的。

Yeah.

他们的研究规模其实不大。

What what they did it's not a huge study.

他们调查了大约一千名青少年，想了解他们使用AI的情况，以及这和心理健康问题之间有什么关联。

They they did a study of about a thousand adolescents and inquired about you know, to look at what their AI usage was in association with mental health issues.

然后他们把数据外推了。

Then they grossed it up.

如果这一千个孩子的情况属实，那全美国范围内，有多少孩子或年轻人会去寻求AI帮助呢？

If that was true for a thousand kids, how many children or young people would be consulting at a national level in The United States?

结果发现，如果原始数据准确，再推广到整个人口，数量可达数百万。

And it turned out to be millions, you know, if the original data were correct, and it was extrapolated to the whole population.

但即便在这么小的样本里，使用率也已经相当可观了。

But nonetheless, there was significant usage even in the small sample.

所以，将近五分之一的受访者表示，他们用人工智能来寻求心理健康方面的建议，这个比例比前一年上升了大约百分之五十，可见使用率正在迅速上升。

So almost a fifth of the people surveyed reported using AI for mental health reason for advice, and that was up about fifty percent from the year prior, so the the use is certainly escalating.

超过百分之四十的受访者每月都会使用，甚至更频繁。

Over forty percent of the Norman were doing it monthly or more often.

使用频率最高的是18到21岁的女性，以及过去六个月里曾向医生咨询过心理健康问题的人。

And the people who were doing this highest, who were going onto a onto a chatbot and using it for mental health advice, the highest use was amongst those were 18 21, women or females, and those who had spoken with their physician in the past six months about their mental health.

所以，并不是说他们没去找人寻求帮助。

So it's not as if they weren't seeing somebody for assistance.

对。

Yes.

他们确实有找人帮忙，但同时也去跟聊天机器人交流。

They were they were seeing somebody, but they also turned to the chatbot as well.

我们知道，聊天机器人通常都会尽量对你温柔体贴。

And what we know about chatbots is that they try and be nice to you.

虽然系统设置了防止自残的防护机制，但还是出现过一些著名案例，有人成功绕过了这些限制，结果AI聊天机器人反而鼓励了他们自残。

And although there are guardrails against self harm, there have been some notorious examples where somebody's learned to get around the guardrails, and the AI Chatbot hasn't actually encouraged them to self harm.

我觉得这非常令人担忧，我们之前已经讨论过这些内容，节目笔记里也能找到相关链接。

I think it's deeply concerning because we've covered, and we can link these episodes in the show notes.

我们之前也稍微聊过聊天机器人在心理健康和医疗建议方面的使用，它们到底安不安全，真的可能把人推向危险的境地。

We have done a little bit on the use of chatbots for mental health, for health advice, how safe they are, and it really can put people in troubling situations.

我看到这些数据时就想，我诊室里就有不少这样的病人，而且他们根本没有接受心理医生或家长的监督——很多人根本没告诉任何人，不告诉医生，不告诉朋友，也不告诉父母。

I think, for me, when I read this, I thought, I have a lot of these patients in my room, and without the oversight of a psychologist or a parent because a lot of these people did not disclose it to anybody, not their doctor, not a friend, not a parent.

这才是让我最担心的地方。

That's what makes me really nervous.

所以这确实值得我们多加留意。

So just something to be alert for.

还有一件让人不安的事，关于一种药物对乳腺癌女性患者的使用被部分取消了。

And then a troubling story about the removal of a drug, not entirely, but partly, for women who have breast cancer.

这种药的商品名叫佐雷德。

The brand name is Zoladex.

它的有效成分叫戈舍瑞林，能抑制雌激素，也常用于治疗子宫内膜异位症。

The the actual drug is called goserelin, and it blocks estrogen, and it's also used in endometriosis.

是的。

Yes.

这种药很多人都知道，因为它用于前列腺癌、乳腺癌，还有一些子宫内膜异位症患者。

So this is a drug that I think people would know it because it is used in prostate cancer, breast cancer, and for some patients with endometriosis.

它能抑制性激素。

It does suppress the sex hormones.

比如乳腺癌，有些肿瘤靠雌激素生长，如果阻断雌激素，就能帮助降低复发风险。

So if there is a tumor, like a breast cancer that relies on estrogen to actually grow, if you block the estrogen, it can help reduce the recurrence of breast cancer.

子宫内膜异位症呢，雌激素和正常生理周期会促进子宫内膜样组织在子宫外生长，导致疼痛和不适。

Endometriosis, where estrogen and the normal cycle can actually facilitate growth of this endometrial like tissue outside of the endometrial lining, cause problems, pain for people.

切断雌激素来源，能显著缓解患者的症状。

Cutting off the oestrogen can actually really help people with symptoms.

我们现在说的这家公司是阿斯利康。

Now, what we're talking about is AstraZeneca is the company.

他们生产的这种药叫佐利德克斯，有两种剂量。

They have this drug, Zoladex, and it comes in two doses.

有一种3.6毫克的植入剂，还有一种剂量更高的，是10毫克的。

There's a three point six milligram implant, and there's a higher dose one, which is ten milligrams.

对吗？

Is that correct?

是的。

Yep.

大约是10毫克，主要用于治疗前列腺癌男性患者。

It's around about ten milligrams, and it's approved for men with prostate cancer.

这个低剂量的，诺曼，我之前用过，因为阿斯利康说要把它从澳大利亚的PBS医保目录里撤掉。

This low dose one, Norman, I had a because what AstraZeneca have said is we are removing it off the PBS.

他们还要从澳大利亚的私人市场下架，所以3.6毫克的低剂量版本以后谁也买不到了，纯粹是商业考量。

We're removing it from the private market in Australia, so it will not be available, the low dose one, three point six milligrams, to anybody because of commercial reasons.

女性治疗乳腺癌时通常用的是这种低剂量笔剂。

The lower dose pen is the one that women will often use for breast cancer.

目前这种药在PBS医保里是覆盖子宫内膜异位症患者的。

It's currently on the PBS for people with endometriosis.

虽然有资格标准，但低剂量的用途更广泛。

There's eligibility criteria, but the lower dose one is the one that is for a wider range of uses.

高剂量的会继续保留，主要用于前列腺癌治疗。

The higher dose one, which is going to remain, is predominantly in prostate cancer.

药企表示，在今年十一月停售之后，会提供几个月的免费获取服务，并且会申请将大剂量版本纳入PBS，供乳腺癌和子宫内膜异位症女性使用。

So what the drug company has said, they'll have a free access service for a few months after for a while after they remove the drug in November of this year, and they're going to apply for PBS approval for the larger dose version for women with breast cancer and endometriosis.

我跟阿斯利康沟通过这事，因为有人提到，这其实是对他们定价政策的惩罚——我得说明一下，指的是制药福利咨询委员会的政策。

So I spoke to the AstraZeneca about this, Because there's been some reports that this is actually punishment to Australia for its pricing policy through the Pharmaceutical Benefits Advisory Council committee, I should say.

能解释一下吗？我觉得这个说法特别有意思。

Please explain that because it's I think it's always very interesting.

为什么要说是惩罚？

Punishment why?

为什么这么说？

Because?

因为我们国家的药价在国际上是最低的之一。

Because we achieve amongst the lowest prices for drugs internationally.

制药行业很讨厌这一点，因为其他国家都会跟着澳大利亚的做法。

And the pharmaceutical industry hates that because other countries follow Australia.

我们的药价虽然经常保密，但大家普遍觉得澳大利亚的定价做得不错。

So our our pricing although the pricing is often kept confidential, people have a sense that Australia is doing quite well.

所以我直接向阿斯利康提出了质疑。

So I I challenged Astra on this.

阿斯利康的说法是，可能还有其他国家也会受影响，但截至目前，只有澳大利亚收到了正式通知。

So what Astra has said is that they've implied that other countries might be involved with this, but in fact, Australia is the only country notified so far.

这是总部做出的全球性决定，但他们没法向我解释清楚为什么这么做，因为根本看不出其他国家也会跟进。

It's a global decision made by headquarters, and they were unable to explain to me why in fact it was done because it's not clear that in fact other country it will happen in other countries.

所以有种说法是，他们正在考虑通知其他国家，说这款药要下架。

So there's a a sense there that they are contemplating notifying other countries that it's gonna be removed.

我问他们：这跟药价有关系吗？

And when I said to them, well, is this because of pricing?

他们说：你可以自己去查一下澳大利亚药品协会的定价政策。

They said, well, feel free to refer to Medicines Australia's policy on pricing.

Medicines Australia 发起了一项运动，声称澳大利亚人因为药价太低、企业觉得不赚钱，而无法获得药物。

And Medicines Australia has come out with a campaign about Australians being denied medications because our pricing is too low and not commercial for these for these companies.

我和阿斯利康谈下来，唯一得到的信息就是：这是全球决策，我们不能说，但你可以去参考他们的定价政策——这让人不得不怀疑，事实就是如此。

So the only thing that I got out of the conversation with AstraZeneca was, well, we can't say because this is a global decision, but we will refer you to the policy on pricing, which makes one think that It is.

这分明是一种惩罚。

It is punishment.

别忘了，我们最近在讨论GOP一案时，也提到过类似的问题。

And don't forget that we actually covered this same issue in the context recently of GOP one.

当时他们想把Mounjaro纳入PBS，我们对价格的讨论不多，药企就直接说：我们不推进了。

It was Mounjaro that they were trying to get on the PBS, and there was a little bit of discourse about the price that we were willing to pay for it, and the drug company said, no, we're not proceeding.

是的。

Yep.

所以它只能留在私人市场了。

So we'll stay on the private market.

至于他们为什么连私人市场也要撤，这背后的原因也挺耐人寻味的。

So why the other thing is why they're removing from the private market as well is is also an interesting decision.

阿斯利康这边到底在搞什么，根本说不清楚。

So it's not transparent what, in fact, is going on here with AstraZeneca.

他们承诺过，如果有更多信息，会再向健康报告反馈。

They promised to get back to the health report if, in fact, they have more information that they can offer.

我觉得很多人会非常焦虑，我有些病人我都不知道他们接下来该怎么办。

And I think that there will be a lot of people who are quite anxious about this, and I have patients that I'm going I don't know what they're going to go on.

我得去联系他们的肿瘤科医生或者妇科医生，看看还有什么别的选择，但这肯定会伤害到很多人。

I'm gonna have to contact their medical oncologist or gynaecologist to see what our options are, but this will hurt a lot of people.

这真是个不幸的决定。

So an unfortunate decision.

您现在收听的是ABC国家广播电台，这里是健康报告。

On ABC Radio National, you're with the health report.

目前澳大利亚的堕胎服务正面临巨大压力，人们在新闻推送里可能会看到南澳、新南威尔士和昆士兰这几个州都在酝酿政策调整。

Abortion care in Australia is currently under a lot of pressure, and people might see in their newsfeed that there are proposed changes for multiple states, South Australia, New South Wales, and Queensland.

很多医疗专业人士都十分担忧，本就难以获得的这项服务，本应是每个人基本的人权和医疗权利，现在却可能变得更加难 access。

And there are a lot of medical professionals who are really quite concerned that a service that is already difficult to access that should be a basic human and health care right for everybody is going to become much more difficult to access.

我采访了澳大利亚和新西兰妇产科学院院长尼莎·科特医生，聊聊这些变化可能是什么样子，以及会对女性造成什么影响。

I spoke to doctor Nisha Cott, who's the president of the Royal Australian and New Zealand College of Obstetrics and Gynaecology, to talk through what these changes might look like and how they will impact women.

所以，阿妮莎，我们先不谈南澳、昆士兰和新南威尔士可能发生的那些变动，你能先说说，目前女性在获取流产服务时面临哪些困难吗？

So, Anecia, can you just talk us through, before we go through any of these changes that are happening potentially in South Australia, Queensland, New South Wales, what kinds of barriers do women already face when it comes to abortion services?

我认为女性面临的一个关键障碍是获取服务的渠道。

I think a really important barrier that women face is access.

虽然流产在我们全国都是合法的，但实际能获得服务却很困难，尤其是在偏远和乡村地区，医生太少了。

So although abortion is legal everywhere in our country, access is a problem because we don't have providers, especially rural regional areas.

无论是药物流产还是手术流产，都缺乏提供服务的医疗人员。

We don't have providers for the medical abortions as well as surgical abortions.

而手术流产的障碍更多，因为需要手术室、外科医生和麻醉师，每多一个环节，难度就成倍增加。

And more women face barriers for surgical abortions because, again, surgical abortions mean you need to have a theater, you need to have a surgeon, you need to have an anesthetist, so those barriers just multiply.

费用也是一个障碍。

And cost can also be a barrier.

很多人不知道，很多女性接受流产服务时，还得自己掏不少钱。

I think a lot of people don't realize that many women who access abortion services are still paying quite a lot out of pocket often.

是的。

Yes.

当然。

Absolutely.

尽管获取途径有所改善，尤其是手术流产，但很多女性仍需自费承担手术费用。

So although that access has improved, especially again for surgical abortion, often women are paying out of pocket for the procedure.

费用可能高达数百澳元？

And that can be hundreds of dollars?

确实可能要花几百澳元。

That can definitely be hundreds of dollars.

我们先说说昆士兰州吧，那里拟议的变更涉及经认证的助产士和护士执业者，他们目前可以开具一种叫‘MS两步法’的药物，也就是人们熟知的药物流产所用的米非司酮和米索前列醇。

Let's start with Queensland then, where the proposed change is that endorsed midwives and nurse practitioners who can currently prescribe this thing called MS two step, which is the mifepristone and misoprostol, what people might know as a medical abortion.

拟议的变更是要取消经认证的助产士和护士执业者开具、发放和提供这种药物流产服务的资格。

The proposed change is to stop endorsed midwives and nurse practitioners from prescribing and dispensing and delivering this kind of medical abortion to women.

这项变更会带来什么影响？

What would that change cause?

这会带来很大影响，尤其是对偏远地区的女性。

That would change things, especially again for rural regional women.

因为偏远和农村地区的医疗服务通常依赖注册护士和认证助产士。

Because often rural and regional services rely on nurse practitioners and endorsed midwives.

那里往往没有医生能开这种药。

Often, don't have the doctors there to be able to prescribe it.

我们得记住，注册护士和助产士都受过专业训练，能完整评估病史，确保在合适的时间把药给对的人，不是随便开的，有严格的安全规范。

And we have to remember that nurse practitioners and midwives are trained to be able to get go through the history, make sure that they're, you know, prescribing the drugs to the right woman at the right time so it's not like, you know, there there are no guardrails around it.

时间点确实很关键，因为在澳大利亚，药物流产的时限是九周。

And right time is quite key because there's a cutoff for nine weeks Yes.

澳大利亚这个时限，有些人觉得有点保守。

For medical abortion in Australia, which some would argue is quite conservative.

在北半球，他们通常可以延得更晚一些。

In the Northern Hemisphere, they they certainly go a little bit later.

但这样一来，偏远和边远地区的女性会不会根本赶不上时间，失去获取机会？

But this is potentially going to mean some women in those regional and remote areas just don't get access in time?

没错。

Correct.

所以如果你没能及时获得药物流产，那接下来的选择就是手术流产。

So if you don't get access in time to medical abortion, then your next option is surgical abortion.

如果你所在的地方本来就很难拿到药物流产，那更不可能轻易做上手术流产。

If you live in a place where medical abortion is difficult to get, you are definitely not going to get a surgical abortion easily in that place.

这意味着你可能得长途跋涉几千公里，花大笔钱在交通和住宿上，再支付更高的手术费用，而且手术本身风险也更大。

So that means you're probably going to have to travel perhaps thousands of kilometers, spend the money on travel, spend the money on staying where you're going to, and then have your surgical procedure, which is also going to cost you more money and is going to be more risky.

而药物流产则避免了手术带来的各种风险。

Whereas a medical abortion doesn't have the surgical risks that go with having surgery.

那我们再来看看新南威尔士州。

So then we go to New South Wales.

那里提出了不同的修改方案。

Different proposed change there.

他们正试图禁止基于性别的选择性流产。

They're trying to ban sex selective abortions.

人们通常在怀孕十周后，通过无创产前检测就能知道胎儿的性别。

So people find out the gender of their baby, perhaps after ten weeks, if they've done the noninvasive prenatal test.

他们现在想禁止基于性别的选择性流产。

And they're attempting to say that sex selective abortion should be banned.

Nisha，有没有证据表明新南威尔士州的选择性流产问题特别严重？

Is there any evidence, Nisha, that there is an issue with sex selective abortion being higher in New South Wales?

那为什么还要提出这项修改？

Why the proposed change?

没有任何证据显示新南威尔士州，或者澳大利亚其他地方，存在这个问题。

There is no evidence to suggest that there is a problem in New South Wales or anywhere else in Australia.

推动这项修改的人，依赖的都是很老旧的数据。

The people who are pushing for this change are relying on data that is very old.

根本没有任何迹象表明这种情况真的会发生，而且现有的机制已经足够防止它发生。

There is no evidence that this is something that would be happening, and there are already guardrails again to make sure that that does not happen.

在这种情况下，我们得记住，有些遗传性疾病是和胎儿性别相关的。

It's important to remember in these situations that there are certain medical conditions, inherited conditions that go with the gender of the fetus.

所以当我们一刀切地禁止性别选择性流产时，实际上是在告诉女性：如果你携带了与性别相关的遗传疾病，你就永远不能选择流产，而这本应是你的权利，是否将这种疾病传给下一代，应该由你自己决定。

And so when we have this blanket thing of not having sex selective abortions, what we're saying to women is that if you are a carrier of a condition that is passed along because of gender or is related to gender, then you will never be able to have an abortion, which is your right to have, and it is your choice if that is a condition that you don't want to pass on to the fetus, to your next generation.

如果这项修改真的通过了，不仅会对患者造成严重影响，正如你所说，也会对提供医疗服务的医生带来巨大冲击。

And if this change went through, it would have serious implications for patients, as you mentioned, but also for the clinicians who are potentially delivering the care.

他们提议的处罚是高达四万四千澳元的罚款，以及最高五年的监禁。

They're suggesting a $44,000 final five year prison term.

我认为，把任何医疗程序都定为犯罪，根本不是解决问题的正确方向。

I think criminalisation of any healthcare procedure is not the way forward at all.

我们已经亲眼看到，刑事化会带来什么后果。

We have seen what happens with criminalization.

这花了我们很多年才扭转过来。

It has taken us many years.

直到2023年，我们才终于将堕胎非罪化。

It's only as recent as 2023 when we decriminalized abortion.

就在最近几个月，英国也刚刚完成了堕胎的非罪化。

It is only in the last few months that The UK has decriminalized abortion.

把医疗行为纳入刑法是非常危险的，这会让医生觉得干脆别干这行了。

It is very important that we don't put health care into any sort of criminal code because then that just makes practitioners who provide the service feel like they don't want to do it anymore.

所有这些讨论也都是在南澳大利亚的背景下进行的。

So, all of this is in the context of South Australia as well.

那里正有人推动禁止25周后的堕胎，而这类情况通常只发生在严重医疗问题的情况下。

There's a push there to ban abortions after twenty five weeks, which usually only occur if there's a really serious medical issue.

昆士兰、新南威尔士、南澳大利亚，这些地方的举动，是不是都在进一步限制女性的堕胎权利，设置更多障碍？

Is all of this Queensland, New South Wales, South Australia, is all of this really about restricting abortion care further for women and putting more barriers?

是的。

Yes.

毫无疑问。

100%.

只要听听那些推动这些政策的人说什么，就能明白，他们的最终目标就是把堕胎定为犯罪，让澳大利亚女性再也无法合法获得堕胎服务。

If you just listen to the people who are pushing for these things, you can hear them say that their ultimate aim is to criminalize abortion and to make abortion not available for women in Australia.

这正是他们的目的。

That is their aim.

这不过是绕着边儿打转，好实现那个目标。

And this is just tinkering around the edges to get to that aim.

我们必须立刻停止这一切，因为我们已经看到了证据。

And we have to stop this right now because we know we have seen the evidence.

我们已经看到了后果。

We have seen the the consequences.

看看美国得克萨斯州的情况。

We look at Texas in America.

由于女性无法获得堕胎服务，孕产妇死亡率上升了百分之五十。

Maternal death rates have increased by fifty percent because women cannot access abortion care.

但这不仅仅关乎堕胎服务。

But it's not just about abortion care.

连流产护理她们也得不到。

Then women cannot access miscarriage care.

连孕期护理也一样。

They cannot access pregnancy care.

这实际上是在救他们的命。

That is actually lifesaving for them.

我们必须对此采取行动。

We have to fight against this.

我想特别明确一点，这些流产案例只占澳大利亚所有流产的百分之一。

I think it's really important that we are very clear that those abortions form one percent percent of all of the abortions that happen in Australia.

这些决定往往是在极其痛苦和艰难的情况下做出的，女性原本是想要继续怀孕的，但胎儿却存在危及生命或严重限制生存的状况，她们在时间紧迫、支持极少的情况下做出这些选择。

And they are made in really traumatic, difficult situations where women often want the pregnancy, but they're faced with a situation where the baby has something that is life threatening, life limiting, and they're making these decisions in really difficult circumstances with very little time.

如果我们再增加她们的困难，只会让创伤更深。

If we make it even more difficult for them, that is only going to add to trauma.

这不会让她们的医疗照护变得更好。

It's not going to make care better for them.

我只是想知道，学院对一些基于宗教理由拒绝提供流产服务的医院有没有明确立场？现在这些医院正受到越来越多媒体关注。

I just wonder if you if the the college has a position on some hospitals, which is now getting a little bit more media attention, who don't provide abortion care on religious grounds.

学院是否明确支持流产应被视为基本医疗保障或基本人权？

Does the college have a clear position on that where, you know, abortion should be a basic health care or human right?

也就是说，是否应该允许拒绝为女性提供这类医疗服务？

Should it you know, should there be the ability to deny this kind of care for women?

学会的立场非常明确，Priya。

The college's position is very clear, Priya.

个别医生可以成为良心拒服者。

Individual practitioners can be objectors, conscientious objectors.

这是他们的权利。

That is their right.

他们有义务将寻求堕胎服务的女性转介给其他能够提供相关医疗服务的机构。

They have a duty to refer women who approach them for abortion to another provider who should be able to provide them with abortion care.

公共财政纳税人的钱应该用于提供澳大利亚境内所有合法的医疗服务，这当然包括堕胎、避孕、绝育等所有女性依法享有的医疗选项。

And publicly funded taxpayer money should be used to provide the full gamut of legal health care in Australia, and that should include abortion care, contraception, sterilization, every single thing that is legally available to women in Australia.

限制堕胎权从来就没有真正减少过女性堕胎的数量。

Removing abortion rights has never ever reduced the number of abortions that women have.

它只会让堕胎变得不安全，甚至会导致女性死亡。

It has just made abortion unsafe for women, and it will kill women.

所以我们必须把这一点说清楚。

So it's really important for us to be clear about that.

剥夺合法堕胎权并不会减少堕胎的数量。

Taking away legal abortion rights will not reduce the number of abortions that happen.

只会让堕胎变得更危险。

It will only reduce the safety of of abortions.

妮莎·科特医生，妇产科医生，澳大利亚和新西兰皇家妇产科学院院长。

Doctor Neisha Cott, obstetrician and president of the Royal Australian New Zealand College of Obstetricians and Gynecologists.

在ABC国家广播电台，您正在收听她的报道。

On ABC Radio National, you're with her report.

所以，普里亚，接下来这个故事，我得先跟你打个底，你知道的，你可是个运动狂人。

So, Priya, this next story, just to sit you down to the ground, you know, because, you know, you're a fanatic exerciser.

运动狂人啊。

Oh, fanatic.

运动真能让你变年轻吗？

Does it make you younger?

这才是问题所在。

Is the question.

没错，这正是关键。

Well, that is the question.

不过我不太会说自己是狂热运动者。

I wouldn't say fanatic exerciser, though.

真的吗？

No?

我只是特别喜欢活动身体，而且一动起来，感觉就明显好很多。

I just I really enjoy moving the body, and I know I feel better when I do it.

现在我更有依据了，知道运动对我真的有好处。

And now I have even more evidence that it's good for me.

那你确实可以从这篇论文里找到依据，它讲的是生物年龄和体力活动的关系。

Well, you do from this paper, which is about biological age and physical activity.

在介绍我们的嘉宾——来自新加坡国立大学的安德里亚·迈耶——之前，我们得先解释一下生物年龄这个概念。

So there's a bit of explaining to do before we come to our guest who's Andrea Meyer from National University of Singapore about biological age.

现在任何关注长寿话题的人都会听到有人说：‘我早就开始做这些事了。’

Now anybody who's reading the the stuff about longevity at the moment, well, you'll you'll hear people saying, oh, I've been doing all this stuff.

比如布莱恩·约翰逊就是个典型，他说自己实际年龄比生理年龄小好几岁。

You know, Brian Johnson's the classic one, and I'm x number of years younger than my chronological age.

他们用的衡量方法有很多。

There's lots of measures they use.

但其中一种核心方法——我不确定布莱恩·约翰逊用得多不多——就是所谓的表观遗传时钟。

But one of the core measures, I don't know whether how much Brian Johnson uses it, is based on what's called epigenetic clocks.

这听起来有点专业，但如果你对那些让人看起来比实际年龄年轻的技术感兴趣，表观遗传时钟真的值得了解一下。

So this gets a bit technical, but if you are interested in all this information about people making themselves younger than they actually are, epigenetic clocks are really worth understanding.

随着我们变老，DNA双螺旋结构的外层会不断发生化学反应。

So as we age, chemical reactions occur around the outside of our, you know, the the double helix of our genes in the DNA.

这些是发生在外部的化学变化，内部也有，但并不是DNA序列本身的突变。

So it's chemical reactions, if you like, on the outside there and on the inside too, but it's not mutations in our DNA.

就是围绕在DNA外层的这些化学变化。

It's chemical reactions around the outside.

从技术上讲，这叫DNA甲基化。

It's called DNA methylation to be technical.

在我们的基因组里，这类反应其实经常发生。

Now it happens fairly regularly in our genome that these reactions happen.

有一点是确定的：生物钟，也就是这些表观遗传时钟，如果你说自己35岁，你的情况是34岁，但假设我的年龄

And what's definitely known is that biological clocks, these epigenetic clocks, if you say my age is 35, in your case, 34, but if you if my age

39岁。

39.

你不用说实话，别觉得尴尬。

You don't need to be honest, uncomfortable.

随口说个数就行。

Lie on air.

但如果你说自己34岁，表观遗传时钟通常能很准确地对应上。

But if you say your age is 34, epigenetic clocks usually can be quite reliably tallied with that.

换句话说，如果他们不知道你的真实年龄，他们更可能判断你是34岁。

In other words, if they don't know your age, they're much more likely to say you're 34.

关于表观遗传时钟的一大争议是，如果它显示你比实际年龄更老或更年轻，这到底准不准？

The big debate around epigenetic clocks is if it shows something else, whether it's older or younger, is that an accurate measure?

而且，这真的意味着你会活得更久吗？

And does it actually mean you're gonna live longer?

这也就是这项研究的背景——它综合了全球数千项研究、数以千计的参与者，来探讨身体活动是否与生物年龄变年轻有关。

So that's a bit of background to this study, which looked at research around the world, thousands of articles, thousands of participants as to whether physical activity is associated with a shift in the biological clock to a younger stage.

我这样解释清楚了吗，安德里亚·梅耶？

Have I explained that okay, Andrea Mayer?

非常清楚。

Absolutely.

谢谢你邀请我。

Thank you for having me.

身体活动非常重要，现在我们不仅能测量它，还能把它转化为生物年龄。

Physical activity is very important, and now we can measure it and express it as the biological age.

没错。

Yes.

所以你做了这项综述。

So you did this review.

你发现了什么？

What did you find?

因为结果有点不一致。

Because it was a bit of a mixed picture.

你没发现运动让人变老，但在多大程度上能让人生物年龄更年轻，结果并不明确。

You didn't find it made you older, but it was a bit of a mixed picture to the extent to which it showed you you were biologically younger.

是的。

Yes.

我们有很多表观遗传时钟，可以根据表观遗传特征测量大量指标。

So we have many epigenetic clocks, we can measure based on the epigenetic makeup lots of markers.

通常我们用的时钟要么是预测死亡风险，要么是预测疾病，而我们发现，步数越多的人，使用Horvath时钟和GrimAge时钟时，他们的生物年龄也更年轻。

Very often, we are using clocks, which either are trained to predict mortality or diseases, and what we were able to find, if somebody has more steps, it's very likely that that person these individuals also have a biologically younger age using the Horvath clock and the GrimAge clock.

这两个时钟都被广泛使用，并且在大量人群中经过训练，我们成功展示了步数与生物年龄之间的关联。

So these are two clocks which are very often being used and have been trained in in many participants, and we were able to showcase the association with steps.

不过，其他的表观遗传时钟并没有显示出这种效果。

However, other clocks did not showcase that.

所以大家最想知道的是，到底要运动多少，才能让生物年龄明显变年轻？

So what people wanna know is how much physical activity for how much benefit in terms of biological age getting younger?

是的。

Yes.

这确实有点难，因为我们得把所有这些研究队列的数据统一起来，而每个人对体力活动的衡量方式都不太一样。

And that's a little bit difficult because we had to standardize all these cohorts, and because everybody looked at physical activity a little bit differently.

所以我们只能证明两者之间存在关联。

So what we were only able to showcase is that there is an association.

这种关联还挺强的。

It's a strong association.

统计上是显著的，但我们没法说清楚具体走多少步对应多大的变化——因为我谈的是横断面研究，也就是说，只是发现更活跃的人生物年龄更低。

It's statistically significant, but we were not able to showcase of how many steps are associated with what kind of not even change, because I'm talking about cross sectional studies, which only means that if people are are being more active, that they have a lower biological age.

所以我现在面临的问题是，很多问题都指向一个点：你没法告诉我，如果一个人从一开始就非常活跃，到底需要多少运动量才能带来效果。

So the question that I've got I've got a couple lots of questions is so what you can't tell me is about dose, with a priori doing a highly active

普拉提课。

Pilates class.

普拉提课。

Pilates class.

托恩，你知道，一周六天运动的人，虽然她自己并不这么做，但你只是拍了个瞬间，他们看起来生物年龄更小。

Thank On, you know, six days of the week, which she doesn't do, but, you know, six days of the week is going to have a younger age than somebody else because you've just taken a snapshot in time.

但因为你只是拍了个瞬间，可能像普里亚这样的人本来就经常练普拉提，而那些不练的人，问题出在人本身，而不是运动本身。

But because you've taken a snapshot in time, it could be that people like Priya do Pilates on a regular basis, and people who don't so in other words, it's something about the people who do exercise rather than being the exercise itself.

是的。

Yes.

完全正确。

Absolutely.

因为有很多混杂因素，我们叫它们。

Because there are lots of confounding factors, we call them.

步数多的人，可能本来就更注重健康，饮食更好，睡眠更佳，关心身体，会做预防措施，所以他们的生物年龄天然就更低。

People who have more steps, it might be that they are more health conscious, that they have a better diet, that they have better sleep, that they're caring about their health, they do preventative measures, and they always have a lower biological age.

没错。

Absolutely.

所以从横断面研究来看，我们根本不能推断出因果关系。

So out of cross sectional studies, we call them we cannot actually refer to any causality.

明白了。

Okay.

换句话说，你观察到一个有趣的现象：经常锻炼的人可能生物年龄更年轻，但还需要更多研究来确认这一点。

So in other words, what you've got is an an interesting indication that you might be biologically younger if you do exercise, but that needs more work to nail it.

安德莉亚，我想问一下，从更宏观的角度来看，你在论文中提到‘抗衰老保护’，意思是身体活跃能延缓衰老过程。

Andrea, I'm just wondering, just zooming out for people, you talk in the paper about gero protective, that if you are physically active, that it protects against the aging process.

你能具体说说吗？

Can you just give us how?

身体活动到底是怎么在抗衰老层面起作用的？

How does physical activity actually help the body at that kind of antiaging process level?

给我们多一点动力去动起来吧。

Give us some more motivation to move.

哦，当然。

Oh, yes.

你已经有动力了，这太棒了，我们都该动起来。

So you already have the motivation, heard, which is absolutely great, and we should all move.

运动特别好，因为你一活动，血液循环就会好很多。

So physical activity is is very nice because if you are physically active, your, circulation is much, much better.

你的心脏也会跳得更有力。

Your heart is pumping much, much more.

我们不仅知道它在全身层面有作用，比如你运动的时候。

And what we know not only on systemic levels so for example, you are physically active.

你真能感受到心跳在加快。

You you really feel your heart.

你还会发现皮肤变得更有光泽，这都是运动带来的。

You you see that your your skin is going to glow because of the physical activity.

我们还知道，它对细胞层面也有非常积极的影响。

We also know that it has very positive effects on cellular level.

如果我们经常运动，肌肉就能产生一些物质，比如肌因子。

If we are physically active, our muscle is able to produce, for example, myokines.

肌细胞其实就是骨骼肌，而肌因子就是

So myos is nothing else than skeletal muscle, and then myokines are

肌肉组织分泌的激素。

hormones produced by the muscle tissue.

没错。

Yeah.

肌因子也不全是好事，它们有时也可能是促炎分子。

It's not so much myokines can also be inflammatory molecules.

它们是一类能正向调节细胞活动的分子，比如提升大脑功能。

So it's a group of molecules which are positively regulating cellular activity, for example, your brain activity.

我们还知道，当一个人从久坐不动变得经常运动时，细胞里的线粒体——也就是为细胞和身体供能的关键结构——会变得活跃得多。

What we also know is that if somebody is physically active and going from a non active to an active state, that the mitochondria in a cell, which is actually essential to to build energy of your cell and there with the body, is much, much better.

所以说，运动对延缓衰老的几乎所有关键机制都有积极影响。

So physical activity is influencing positively nearly all hallmarks of aging.

衰老的特征就是导致我们变老的机制，比如头发变白、脂肪增加而肌肉减少，还有各种年龄相关的疾病。

Hallmarks of aging are the mechanisms why we age, why we have gray hair, why we have more fat in the end compared to muscle, why we have age related diseases.

体育锻炼是最好的神经保护方式，当然，还有像改善饮食、保证睡眠这样的生活方式调整也很重要。

So physical activity is the best neuroprotective interventions anybody can do, and, of course, next to lifestyle interventions like a better diet and sleep, for example.

所以，安德里亚，根据这些研究，是个不错的初步消息。

So, Andrea, based on this research, good preliminary news.

敬请关注后续进展。

Watch this space.

非常感谢你。

Thank you very much indeed.

谢谢。

Thank you.

安德鲁·马赫教授来自新加坡国立大学。

Professor Andrew Maher, is at the National University of Singapore.

这里是ABC国家广播电台，您正在收听《健康报告》。

On ABC Radio National, you're with the health report.

上周我们聊了关于统付制度可能的调整，以及从七月一日起，医疗专业人员必须获得患者的明确同意，光是口头同意就不够了。

Last week, Norman, we talked about potential changes to bulk billing and the need for health care professionals from the July 1 to actually attain consent from patients, and verbal consent will not cut it anymore.

是的。

It

这些变动确实有可能发生。

will be So they're potential.

这些是真的变动，对吧？

They're real changes, aren't they?

嗯，你刚才说的是‘有可能’。

Well You

你刚才说‘有可能’。

said potential.

你是希望这些能变成现实。

You're hoping you'll make a change.

我确实希望如此。

I do.

我现在活了这么久了，觉得能明白一件事：有时候事情就是推进不了，但我希望我们发出的这些声音，能对做决策的人产生一些影响。

I've lived enough now, I feel, to know that sometimes things don't go ahead, and I'm hoping all the noise that we're making is doing something to people who make decisions.

从7月1日起，你不能靠口头同意来接受统付服务。

But you can't verbally consent to being bulk billed from July 1.

任何替你申请医保服务的人，都必须有你每项服务的电子签名记录，而且这个签名必须来自患者本人，或者照护者。

Whoever is claiming the Medicare service from you needs an electronic stored signature from you from every single service, and it either needs to be from the patient or from a caregiver.

你上周就预示过，这会带来很大问题，我当时还专门问过你。

And you, last week, foreshadowed that this was going to create great problems, and I questioned you on that.

一位忠实听众、悉尼大学呼吸医学教授保罗·托尔齐洛，同时也是原住民医疗服务领域的资深从业者，还是阿利斯斯普林斯努南帕健康委员会的医疗主管，他刚刚给部长马克·巴特勒写了一封信，谈到了这项服务一个非常严重的问题。

But a faithful listener to the health report, who's professor Paul Torzillo, who's professor of respiratory medicine at the University of Sydney, but he's also a long standing practitioner in Aboriginal medical services in the policy area as well, is medical director of the Nunampa Health Council in Alice Springs, and has written to the minister, Mark Butler, about a really serious issue with this particular service.

欢迎收听健康报道，

Welcome to the health report,

保罗。

Paul.

谢谢。

Thanks.

我来简单说明一下努南帕健康委员会面临的问题。

So just to outline what the problem is for Nunampa Health Council.

努南帕健康委员会的服务范围覆盖南澳大利亚西北部整整十二万平方公里的区域，就在国家的正中央。

Nunampala Health Council services people who live across a 120,000 square kilometers in the Northwest Of South Australia, right in the middle of the country.

我们一共有六个主要诊所。

We've got six main clinics.

这些诊所都没有前台人员，也没有行政人员。

They're staffed without reception staff, without admin officers.

我们服务的人群中，据最乐观的估计，家里能说英语的还不到4%，更别提在社区里了。

They service a population where, on best estimates, less than 4% of people speak English in their home, let alone in their community.

要我们弄一份表格——不管是电子的还是纸质的，先解释什么是医保，再解释医保权益转让是什么意思，然后让人签字同意，再给他们一份列明医保报销项目的文件——这根本不可能做到。

And the idea that we would somehow be able to produce a form, either digital or written, explain what Medicare is, then explain what assignment of Medicare benefit means, then get a person to consent, then give them a document about the items for which Medicare will be billed, it just can't happen.

我们不是不想做这些事。

It's not that we don't want to do this.

而是我们根本做不到。

It's that we can't do it.