哪个国家的医疗最好？| 艾曼纽尔医生

因为最终，我上过学，也有朋友是考试能力最强、医学知识最渊博的人，能百分之百准确地背出克雷布斯循环的每一个步骤。

Because ultimately, I've went to school, and I've had friends that were the brightest minds in terms of test taking, medical knowledge, can quote you every sub step of the Krebs cycle with 100% accuracy.

但他们却成了糟糕的医生。

And they turn out to be crap doctors.

同意。

Agree.

所以我也有过类似的经历，当我当实习医生时，我曾休学四年攻读博士学位，因此我的实习技能有点生疏。我和一位来自约翰霍普金斯的实习医生一起轮转，都在肿瘤科工作。

So I had the same exact so when I was an intern, and I had taken four years off for a PhD, and so I was a bit of a rusty intern, I had a rotation with another, intern from Hopkins, and we were on the oncology war together.

我们去查房时遇到霍奇金淋巴瘤患者，我还在手忙脚乱地摸索，而他却直接引用《哈里森内科学》的内容。

We would go into a Hodgkin's disease, and I would fumble around a little about and he would just, like, report out Harrison's textbook.

你知道的吗？

You know?

这是鉴别诊断。

Here's a differential.

这是你要做的检查。

Here's a test you're doing.

如果真是霍奇金病，这就是化疗方案。

Here's a chemo if it really is Hodgkin.

啰啰嗦嗦的。

Blah blah blah.

我当时就想，天啊。

And I'm like, god.

这 guy 真厉害。

This guy's great.

后来我们一起值夜班。

Then we were on night call together.

你知道吧？

And he you know?

你知道夜班是怎么回事。

Well, you know what night call is.

有人撑不住了。

Someone goes south.

出事了。

Something happens.

你必须做出决定。

You've gotta make decisions.

你必须实施治疗。

You've gotta implement treatments.

blah blah blah。

Blah blah blah.

他僵住了。

He froze.

他就是无法承担在当下做出决定、分析这最可能是什么、我们应该如何干预、何时重新评估的全部责任。

He just couldn't take all that responsibility for having to make a decision in the moment, and analyze, you know, what's this most likely to be and what should our intervention be and when do we reassess.

他离开了内科，转去了病理科。

He left internal medicine and went into pathology.

减少与患者的互动

Less patient interaction

我不认为这是AI会面临的问题。

I don't think that's gonna be the problem with AI.

我不认为问题在于它们拥有全部书本知识却无法应用到实际情境中，因为它们将会

I don't think that is gonna be the problem that has all the book knowledge and can't apply to scenarios because they're gonna

嗯，不是的。

Well, no.

将这些应用到具体情境中。

Land it on scenarios.

我认为它们肯定能够应用，因为它们在共情点上表现得很明确。

I think that they can definitely apply it because it's clear with their winning empathy points.

它们显然能够应用。

They can clearly apply it.

问题是，人类长期来看是否能像信任同类一样信任机器人？

The question is, does the human trust the robot equally long term?

我来给你一个正在发生的现实案例，涉及行业领袖埃隆·马斯克，他有自己的大语言模型，非常流行，并已集成在X平台上。

And I'll present you a real life scenario that's happening right now with an industry leader, Elon Musk, who has his own LLM, very popular, integrated on X.

而且你知道，埃隆·马斯克一直很喜欢，或者至少历史上一直支持肯尼迪秘书。

And, you know, Elon Musk is a fan or at least has been a fan historically of secretary Kennedy.

他推动了对他的任命。

He pushed for his appointment.

他说肯尼迪秘书说的话很棒。

He says what he's saying is great.

但如果你问埃隆·马斯克自己的大语言模型，肯尼迪秘书在做出健康声明时的准确性百分比是多少？

But if you ask Elon Musk's own LLM, what are the percentages of accuracy of what secretary Kennedy, when he makes a health claim, what is the accuracy?

准确率是零，或者只有很低的百分比。

It's zero or, low percentage points.

但埃隆·马斯克似乎并不在意。

But Elon Musk doesn't seem to care.

那么，人类会在意人工智能说的话吗？

So will humans care about what the AI say?

我觉得会。

I think so.

大量咨询大型语言模型的情况都与医疗健康有关。

A great proportion of consulting LLMs relates to healthcare.

我认为人们是在寻求答案。

And I think people are looking for answers.

他们在医生无法提供服务的时候寻找答案。

They look for answers at times that doctors aren't available.

因此，我认为人们会信任那些经过医学信息训练并提供参考依据的大型语言模型，从而获得一定程度的信心。

So, I do think they're going to trust especially LLMs that are trained on medical information and give them references so that they can be somewhat confident.

在我们当前的AI时代，我们已经有了相当不错的大型语言模型来提供一般性信息。

So, in the era of AI that we have right now, we have pretty good LLMs to give us general information.

为什么反疫苗运动正在增长？

Why is the anti vaccine movement growing?

哦，我认为这并不是一个完美的意识形态压倒事实的例子。

Oh, because I don't think they this is a perfect case of ideology over Exactly.

所以，当人们咨询大型语言模型寻求医疗建议时，大多数人会充满信心，渴望得到答案。

So when they Well, I think most people, when they consult an LLM for a medical thing, are gonna be confident, want the answer.

他们没有意识形态

They don't have an ideology

哦，我明白了。

Oh, in see.

所以那些咨询的人

So the ones that are consulting

会，是的，完全满意。

will Yeah, be absolutely, happy with 100%.

所以，你认为会有患者说，我自豪地选择非AI医生吗？

So do you think there will be patients who say like, I'm proudly, I see a non AI physician.

然后一些患者会说，我不在乎，我选择

And then some patients will say, I don't care, I see an

AI，我认为是这样的。

AI I think that's right.

而且在定价上可能存在差异，在获取服务的时间上也可能有差异等等。

And there may be differential in pricing, there may be differential in time to access, etcetera.

我与一家公司合作，该公司开发了一个面向儿童的平台，专注于儿童，并尝试将各种治疗活动游戏化，以吸引儿童参与。

I work with a company that has developed a platform for children and focus on children and trying to make various therapeutic activities gamified that children will engage with.

例如，在作业治疗、物理治疗或心理健康治疗中，我们已经建立了一个游戏化系统。

So, for example, in occupational therapy, physical therapy, or mental health therapy, we've got a gamified system.

孩子们非常喜欢与之互动，这意味着他们可以减少面对面治疗的频率，因为在两次面对面干预之间，他们正在执行之前建议的物理治疗练习，而过去没有人会认真做这些，但现在有了游戏，他们真的在做了。

And kids love interacting with it, and it means that they can actually see the in person therapist less frequently because between in person interventions, they're doing these kind of physical therapy routines, which they were suggested before, but of course, Now no one with the game, they're actually like doing it.

我们限制了他们使用该系统的次数，以防止他们上瘾。

We've limited the number of times they can do it so that they don't get addicted to it.

这不仅让他们进步得更快，还降低了成本。

And it both allows them to progress faster and lowers cost.

我认为，我们将会看到更多这类干预方式，它们并不一定取代医疗提供者，而是增强他们在治疗领域的工作。

That's the kind of intervention I think we're going to see more of that doesn't necessarily displace a healthcare provider, but augments what they're doing in the therapeutic realm.

我们对它非常兴奋。

We're very excited about it.

你也可以看到，它在行为健康方面可能很有用。

And you can also see how it might be useful for, well, we know it's useful for behavioral health.

我们已经将其应用于儿童的自我调节，以及焦虑等问题的干预。

We've done it, self regulation of kids and things like anxiety and working with them.

它对自闭症的诊断也会很有帮助，因为目前很多诊断过程都是先录像，然后再人工编码。

It'd be useful for diagnosing autism and things like that, where a lot of the diagnosis is already, we're gonna film you and then we're gonna code it.

但AI可以做得更好。

Well, the AI can do that better.

我担心私募股权过多地介入医疗领域，因为医疗与普通消费品不同，它关乎生死。

I worry about private equity being so involved within the healthcare space, Because I feel like the healthcare space, unlike a traditional consumable product, it's life or death.

人们并不是在选择是否要购买这种玩具或夹克这样的奢侈品。

So it's not a choice of whether or not people want the luxury of this toy or this jacket.

他们需要的是胰岛素。

It's their insulin that they need.

所以当有人开始干预这些核心医疗需求时，我会感到担忧，我已经看到过负面案例，比如远程医疗领域。

So when people start messing around with that, I get concerned, and I've seen it play out negatively, like even in the telemedicine space, as an example.

在我住院医师培训期间，远程医疗对我来说是绝佳的选择，特别适用于那些需要看专科医生、查看化验和影像结果、远程获得化疗建议的患者，他们不必请假，可以远程与我连接，我可以在线查看他们的糖化血红蛋白，远程管理糖尿病，调整胰岛素剂量。

Telemedicine was, to me, when I was studying in my residency, a great option for patients who needed to see a sub sub specialist to look over labs and imaging and give guidance about chemotherapy from a distance, from patients that didn't need to take a day off work and can remotely connect to me, and I could go over their hemoglobin A1c with them and manage their diabetes virtually, change their insulin dosage.

很好。

Great.

然后出现了很多公司，它们用远程医疗来处理一切，基本上变成了开药工厂，也许不是针对阿片类药物，而是针对非那雄胺、治疗脱发的药、伟哥、抗生素。

Then companies started popping up where they use telemedicine for everything, and they basically become a prescriber mill, maybe not for opioids, but for finasteride, for hair loss, for Viagra, for antibiotics.

现在有一些网站，你可以直接上去自我诊断，根本不和医生交流，就能申请任何你想要的处方药。

There's websites now you can go on and literally self diagnose without really talking to a physician and request whatever prescribed medication you want.

前几天我在福克斯新闻的《福克斯与朋友们》节目上看到一则广告，推销一种旅行套装，里面包含各种抗生素和抗寄生虫药，你只要打个电话就能直接拿到。

I saw a commercial playing when I was on Fox and Friends the other day for a travel kit that includes all sorts of antibiotics and antiparasitics that you could just call in and basically get now.

担心这种模式会全面接管

Any concerns that world taking over a

嗯，这里有两点。

Well, are two things there.

一是打电话就能拿到药物，我的意思是，抗生素和抗寄生虫药的问题在于，滥用会对其他人造成严重后果，比如抗生素耐药性；而私募股权的问题在某种程度上是另一个独立的问题。

One is calling in and getting medications, have I mean, the problem with antibiotics and antiparasitics is there's a lot of consequences for the rest of us, antibiotic The resistance when it's used incorrectly, issue of PE is in some ways a separate issue.

我认为这确实是个严重的问题。

I think that is a real problem.

我刚给我的学生讲过关于PE的课，我说：看吧，我找不到医疗领域中任何一个例子，说明PE的介入真正提升了质量并降低了成本。

And I just taught my class on PE, and I said, Look, I don't know of one area in healthcare where the entrance of PE has actually improved quality and reduced costs.

你找不到任何一个领域。

You can't point to a single area.

它们要么降低成本，要么推高成本。

They either reduce costs or they drive costs.

我的意思是，它们降低——

Mean, they reduce-

降低成本，增加利润。

Reduce costs, increase profits.

降低质量，增加成本。

Quality, reduce quality, increase costs.

有学生说：嗯，辅助生殖技术诊所算不算？

And some kids said, well, there's IVF clinics.

所以我们去查了相关数据。

So we looked into the data.

数据显示，私募股权并未改善辅助生殖技术。

The data are not that PE improves IVF.

改善——可及性。

Improve- Access.

嗯，它们进行了整合。

Well, they consolidate.

还存在非营利性的整合。

There's also not for profit consolidation.

事实证明，整合是有益的，因为它们带来了标准化的护理。

It turns out that consolidation is good because they bring the same standardized care.

它们还定量地衡量治疗结果。

They also quantitatively measure outcomes.

结果发现，在最终结果——是否成功生下孩子——方面，私募股权并不比私营非营利连锁机构更出色。

Turns out that PE is actually not better at the ultimate outcome, are you having a baby, than private, not for profit chains.

所以即使在这种情况中，这是我一位学生提出的例子，私募股权也没有改善整个系统。

So even in that scenario, which was raised to me by one of my students, not not improve the system.

所以我认为，任何私募股权公司都无法指出他们在哪个领域真正改善了医疗系统。

So I don't think anyone in PE can point to an area where they've actually improved the system.

是的，他们进行整合。

Yes, they consolidate.

他们把皮肤科医生、急诊科医生等聚集在一起。

They bring whether it's dermatologists, emergency room doctors, etc.

一起。

Together.

通常，他们会以多种方式提高价格。

Typically they raise the prices in multiple different ways.

他们改变患者的构成和就诊类型，以增加收入。

They change the patient mix, the kinds of visits that they're getting to raise more money.

因此，我对私募股权在医疗保健中扮演任何积极角色持高度怀疑态度。

So, I am quite skeptical that there's a place where PE has a good role in healthcare.

我认为他们的模式与医疗模式，正如你所指出的，并不兼容。

I think their model and the healthcare model, as you point out, don't mix.

所以，我真的很希望

So, I'd love to be

那么，你是否担心AI和私募股权融合，会创造出一个类似漫威的灭霸呢？

Well, are you concerned about that mixture of AI and PE merging to create a Marvel Thanos, if you will?

不担心。

No.

也许我应该担心，但我并不太在意。

Maybe I should be, but I'm not that concerned.

实际上，我认为许多大型科技公司必须在医疗健康领域取得成功。

I actually think many of the big tech companies have to make it in healthcare.

到目前为止，它们在医疗健康领域的业绩可以用一个词概括：糟糕。

Hitherto, their track record in healthcare can be summed up in one word, sucks.

无论是谷歌的Verily，还是其他项目，都没有真正的成功。

Whatever it is, it's Verily at Google, no real successes.

亚马逊也是如此，没有任何真正的成功。

It's Amazon, no real successes.

不管怎样，Cigna已经收购了一些产品。

It's whatever, Cigna's bought some products.

微软也没有任何成功案例。

Microsoft doesn't have any successes.

但医疗和AI是不同的。

But healthcare and AI is different.

如果AI领域的数万亿美元估值要得到合理解释，它们必须在一个领域取得成功，而医疗正是它们能够成功并产生数千亿美元年收入的地方。

If the trillions of dollars of valuation are going to be justified in the AI space, they have to succeed in one place, and healthcare is the place that they can succeed and generate hundreds of billions of dollars in annual revenue.

我认为，它们必须专注于这个领域。

That, I think, they have to focus there.

你可以专注于法律领域，试图颠覆法律行业。

You can focus on law and trying to disrupt law.

法律行业有多大？

How big is law?

4000亿美元的医疗行业远超法律行业。

$400,000,000,000 Medicine dwarfs law.

它大了12倍。

It's 12 times bigger.

所以我认为，如果他们想要证明所有投资和热情是合理的，就必须在医疗领域取得成功。

So I think if they're going to justify all the investment and the excitement, they're going to have to succeed in healthcare.

尽管你对人工智能如此看好，却对生物黑客技术持相当悲观的态度。

Despite the fact that you're so bullish on AI, you're quite bearish on biohacking.

这看起来有点矛盾。

That seems a little paradoxical.

不，我觉得这两者其实没有关联。

No, I don't think they're related actually.

生物——我认为，如果你取一群对人工智能持悲观态度的人，几乎所有人都对生物黑客技术持悲观态度。

Bio- think I think if you were to take a subset of individuals who are bearish on AI, almost all of them are bearish on biohacking.

这可能是真的。

That's probably true.

这仅仅是因为他们完全不了解生物学。

And that's just because they don't understand biology at all.

是的，我的意思是，我认为这种想法——我们能超越身体的自然机制，比如认为Omega-3或者其他你最喜欢的补充剂有益，那越多就一定越好——是不对的。

Yeah, I mean, I I think this idea that we're gonna outsmart the body and, you know, if, omega threes or whatever, pick your best favorite supplement is good, more's gotta be better.

但你和我都清楚，在生物学中，这并不成立。

Well, you and I know in biology, that doesn't work.

通常情况下，越多反而越糟。

More often is worse.

对吧？

Right?

你会制造出问题。

You create problems.

我们从免疫系统的简单模型中就清楚这一点。

And we know this from the, you know, simple model of the immune system.

我们发现免疫系统功能不足。

Oh, we've got not enough immune system function.

明白吗？

Okay?

我们容易感染和其他问题。

We're liable to infections and other problems.

我们的免疫系统功能过强。

We've got too much immune system function.

我们容易患上自身免疫性疾病和其他各种问题。

We're liable to, you know, autoimmunity diseases, and other sorts of problem.

你知道，很多生物学都涉及一个非常复杂的平衡过程。

You know, a lot of biology is about a very, complicated balancing act.

因此，过度干预——这正是生物黑客主要追求的方向——并不是好主意。

And so overdoing it, which is mainly the direction biohacking goes, not a good idea.

所以我认为，他们再次采用了典型的科技思维模式。

And so I think they've got again, it's a typical tech approach.

他们用错了模型。

They've got the wrong model.

我的意思是，在人工智能领域，他们通过不断投入更多计算能力取得了成功。

I mean, in AI, throwing more and more compute power is how they've succeeded.

对吧？

Right?

向身体大量投喂补充剂或其他东西，并不是我们取得成功的正确方式。

Throwing more and more supplements or more and more stuff at the body is not how we're gonna succeed.

所以，如果你问很多大型语言模型，甚至是医学领域的模型，关于这些药物、补充剂和生物黑客技术。

So, if you ask a lot of the LLMs, even the medical ones, about these medications, supplement ones, biohacking.

它们会如实告诉你你刚才说的那些，因为它们是基于现有数据进行分析的。

They'll be honest and say what you said because they look at the available data.

但人工智能公司的创始人却采取了完全不同的做法。

But the founders of AI companies take a completely different approach.

那么，他们是不信任现有的证据，还是只是想急于求成？

So are they not trusting the current evidence that exists or they're just trying to jump ahead?

这是一场死亡危机吗？

Is it a mortality crisis?

我认为是两个方面的原因。

I think it's two things.

我认为这是自恋，以及对他们自身才华和无所不能的过度自信。

I think it's narcissism and a little excessive belief in their own brilliance and invallibility.

他们认为自己在LLM领域取得了成功，因此必定在所有领域都是天才。

They think they've succeeded in this area, LLMs, and therefore they must be a genius across the whole realm.

我的意思是，你见过这种亿万富翁。

I mean, you've met these kind of billionaires.

这就是他们的看法。

That's their view.

我在这里成功了。

I succeeded here.

我什么都知道。

I know everything.

所以，他们认为自己实际上并不关注，也没有时间去关注底层数据和根本理解。

And so, think they don't actually pay attention to the They don't really have the time to pay attention to the underlying data, the underlying understanding.

他们觉得，哦，我们还没测试过这个。

And they think, Oh, well, we haven't tested this.

没错，我们确实没有测试过。

That's right, we haven't tested it.

这并不意味着你关于更多剂量的假设是正确的，而且我们在补充剂领域确实知道，大多数补充剂——不是全部，但大多数——其实并无帮助。

That doesn't mean your hypothesis about more is And we do know in the supplement world that in fact, most supplements, I mean, not all, but most supplements are not helpful.

当然存在特定的情境和案例，你我都清楚，这些情况下补充剂至关重要。

There are context and cases, and you and I know them, where it's really important.

比如，准备怀孕、计划怀孕或已经怀孕的女性，必须确保摄入足够的叶酸、铁等营养素。

You know, woman who's trying to get pregnant, thinking about pregnant or is pregnant, you know, gotta make sure that she has folate, she has enough iron, etcetera.

素食者则很难摄取足够的维生素B12。

Vegans, well, they're unlikely to get enough vitamin B12.

他们必须服用补充剂。

They've got to take supplements.

还有其他情况。

There are other areas.

老年人也是如此。

Older people, same thing.

他们可能无法生成或吸收B12。

They might not be able to generate, absorb the B12.

所以我们确实需要一些人服用某些补充剂。

So, we do need people to take, or some people to take some supplements.

这与数十亿美元的复合维生素以及所有这些产品相去甚远，我每次走进CVS药店都感到震惊，那里卖得最多的恐怕就是补充剂了。

That is far from the billions of dollars in multivites and all the, I'm always shocked I go into CVS and probably the single biggest thing they're selling there, supplements.

而它们的价格都被大幅压低了，因为生产成本几乎为零，但他们却每瓶卖20.30美元。

And they're all always reduced because it costs nothing to make and they charge $20.30 bucks per bottle.

为了标签。

For the label.

是的。

Yeah.

对。

Yeah.

你认为有没有可能，FDA会介入补充剂领域？

Do you think there's ever a world where the FDA gets involved in the supplement space?

你什么意思？

What do you mean?

曾经有过那样的世界，但奥林·哈奇把那个世界拿走了，因为很多补充剂制造商都位于犹他州。

There was a world and then Orrin Hatch took that world away because a lot of the supplement makers were based in Utah.

我们能回到过去吗？

Could we go back?

我不知道。

I don't know.

也许作为全面医疗改革方案的一部分，这会相当重要。

Maybe as part of some comprehensive healthcare reform package, it would be kind of important.

我认为，如果我们遇到补充剂被污染、大量人员因此死亡并引起广泛关注的情况，这确实可能促使人们重新关注监管问题。

I do think if we had a situation where supplements were contaminated and a lot of people died from it in a visible way, that actually could generate interest in going back to regulation.

是的，前几天我和一个争论补充剂的人讨论时，他的论点是，死于药物的人远多于死于补充剂的人。

Yeah, well, a person I was debating supplements with the other day, their argument was way more people die as a result of pharmaceuticals than they do supplements.

但我说，这并不能说明全部情况。

And I'm like, but that doesn't tell you nearly the full picture.

对，对，对。

Right, right, right.

这取决于你想治疗什么疾病。

Depends what diseases you wanna treat.

而且大多数补充剂是给健康人用的，对吧？

And mostly supplements are for healthy people, right?

而大多数药物是给病人用的。

And mostly pharmaceuticals are for sick people.

是的。

Yeah.

而且这个观点，至少我的想法是，当人们试图向你推销补充剂时，他们会说这是天然的，所以很安全。

And the idea, at least my notion is, when people say supplements are fully safe, when they're trying to sell you, they're like, This is natural.

很安全。

It's safe.

在我看来，任何100%安全的东西都没有效果，因为在体内，每一个作用都会产生反作用。

To me, anything that's 100% safe has no action, because in the body, every action has a reaction.

所以如果它完全安全，那就意味着是胡说八道。

So if it's fully safe, that means it's bullshit.

它根本就没起任何作用。

It's not doing anything to begin with.

我对这一点的理解是，我所知道的任何医疗干预都有副作用。

So my version of that exact point is there's no medical intervention I know of that doesn't have side effects.

是的。

Yeah.

就连简单的抽血都可能有严重的副作用。

Just doesn't even a simple blood draw can have serious side effects.

明白吗？

Okay?

所以，虽然概率很低，但不是零。

So, it's low, low probability, but not zero probability.

这绝对是正确的。

And that is definitely true.

正如你所指出的，你试图通过身体引发某种反应，这本意是好的，但有时会出问题，可能是由于你的基因，或者是因为你注射药物时没有准确进入静脉。

You are as you point out, you're trying to provoke a reaction by the body for a good but sometimes it goes awry, either because of your genetics or because maybe you've injected that medication and it didn't get into the vein.

有各种各样的原因可能导致你出现这种情况。

There are all sorts of reasons you So could have a

我猜你有很多聪明的朋友，你有亿万富翁朋友，你的家人属于社会的上层。

I imagine you have really smart friends, you have billionaire friends, your family is in the upper echelons of society.

当有人真的来找你，说：‘拜托，你得承认，我喝完酒后做的那种静脉疗法，还有这些补充剂，真的有效。’你该怎么回应？

What do you do when someone comes to you really saying, Come on, you gotta say this IV therapy that I get after a night of drinking, or these supplements really work.

我想做一次全身核磁共振。

I wanna get a full body MRI.

你怎么劝他们打消这个念头？

How do you talk them out of it?

我不知道自己是否能说服那些亿万富翁，因为他们又觉得他们什么都知道。

I don't know that I succeed to the billionaires because again, they think they know everything.

他们很有钱。

They're rich.

但我确实经常被问到各种各样的问题。

But I do get asked questions about all sorts of things.

我会尽力解释相关数据。

And I try to explain the data.

首先，我会问：你为什么想要这个？

First of all, I say, why do you want that?

最重要的问题是，你担心什么？

The most important question is, what are you worried about?

明白吗？

Okay?

你才33岁，没有任何健康问题。

You're a 33 year old person, no health problems.

你却想要做一次全身核磁共振。

You want a full body MRI.

你疯了吗？

Are you crazy?

首先，那里什么都没有。

First of all, there's nothing there.

如果有什么显示出来，那很可能是假阳性。

If there's something that shows up, it's most likely to be a false positive.

所以你现在要为毫无意义的事情经历一堆其他检查。

So now you're gonna go through a bunch of other tests for nothing.

明白吗？

Alright?

你必须有针对性地行动，而盲目地随意做一堆所谓的预测性血液检查或基因标志物，根本不会告诉你任何信息。

You have to target what you're doing, and just shooting, you know, randomly getting a bunch of quote unquote predictive blood tests or gene markers doesn't tell you anything.

然后你还得知道，对于你发现的任何问题，我们是否有相应的治疗方法？

And then you have to know, do we have a treatment for whatever it is that you're coming up with?

我认为人们并不了解我的经验，很多问这些问题的人也不知道这些数据，这正是他们来找我的原因之一，这没问题。

And I think people don't think my experience is a lot of the people who ask me these questions don't either know the data, which is one reason they're coming to me, and that's fair.

我会告诉你我知道的，如果我不知道，我会去查。

I'll tell you what I know, and if I don't know, I'll look it up.

有人最近发给我一篇文章。

Someone actually recently sent me an article.

他们说，你不是说褪黑素对睡眠没用吗？但我有这些数据表明它可能对耐力有帮助。

They said, You said melatonin is no good for sleep, but I have these data that suggest it might be good for endurance.

你怎么看？

What do you think?

结果发现，它可能确实对耐力有帮助。

Well, turns out it might be good for endurance.

我刚看过一项研究，显示它会导致心力衰竭。

I just covered a study that it causes heart failure.

我想这取决于你研究的是什么。

I guess it depends on what you're studying.

但问题就在于，我们必须全面审视所有数据。

Well, but that's part of the issue is we've got to actually look at the comprehensive set of data.

所以我尽量把数据提供给人们。

So I try to give people the data.

我会根据他们的具体情况和年龄，给出我最好的建议，判断这是否对他们有益。

I try to give them my best recommendation about whether this is a good idea for them given their situation, their age.

总的来说，我们往往做得过头了。

In general, we overdo it.

我想说两点。

And for, I would say two things.

很多人，尤其是可能正在听你播客的人，本身已经很健康了，他们只是需要被确认自己正在做对的事情，方向是正确的。

A lot of people, especially probably people listening to your podcast, are probably already healthy, And they just need to be reassured you're doing the right thing, you're going in the right direction.

不要被其他各种信息分散注意力。

Don't get diverted by all this other stuff.

我认为这一点非常重要。

And I think that's very important.

作为人类，我们面临的一个问题是，有一些有趣的研究表明，我们的本能倾向是：遇到问题，就想解决它，于是就添加点什么。

One of the problems we have as human beings, and there's some interesting research, our natural tendency is we got a problem, we want to solve a problem, let's add something.

所以我们添加了一种补充剂。

So, we add a supplement.

我们增加锻炼。

We add an exercise.

我们增加助眠产品。

We add a sleeping aid.

我发现，在当前的健康领域，我们最需要做的是减少。

I find that in wellness at this moment, what we mostly have to do is take away.

停止做那些坏事，因为我们的生活中有很多不良因素，无论是饮食营养，还是那些危险行为，还有一些人们一直都在做但风险现在变得更加明显的事情，比如酒精。

Stop doing the bad stuff because we have a lot of bad stuff in our lives, whether it's food and nutrition, it's risky behaviors that are out there, it's things that people have been doing forever, but the risks have become much more obvious like alcohol.

所以，我认为我在健康领域试图说服人们的一点是，放松下来，真正专注于消除不良习惯。

So, I think part of what I try to convince people in the wellness space is chill out and actually focus on getting rid of bad stuff.

有一些非常好的事情你应该去做，然后我们可以简化几步。

There's some really good stuff you should do, and then we can make it easy a few steps.

我还想向人们强调的另一点是，我们都知道单靠意志力是做不到的。

The other thing I like to emphasize to people is we know that you can't do this by willpower.

你必须养成习惯，并且能够坚持下去。

You have to develop a habit, and you have to be able to stick to it.

其中一个问题是，你必须终身坚持下去。

And one of the problems is you've got to stick to it for life.

所以，如果这是一种极端的自我压抑，你是不可能坚持下去的。

So someone that it's extreme self denial, you're not gonna stick to that.

或者即使你坚持了，你的生活也会变得非常不愉快、不快乐。

Or if you do stick to it, you're gonna have a very unpleasant, unhappy life.

这并不是成功的秘诀。

That's not a formula for success.

你知道，你希望享受你在地球上拥有的七十五到八十五年时光。

You know, you wanna enjoy the seventy five, eighty five years you have on the planet.

所以，我会试着说，让我们找出那些你可以做到、正在努力培养，并且会享受、不会让你受苦的习惯。

So, I try to say, let's figure out what the habits are that you can do or work towards and that you're gonna enjoy and you're not gonna suffer.

这也是我特别强调健康领域中社交互动的原因之一。

That's one of the reasons I really like to emphasize for wellness, social interaction.

社交互动对你有益，对他人也有益，而且你不仅能立即获得成效，还能在健康和长寿方面获得长期回报。

Social interaction is good for you, it's good for the other person, and you get the results today, immediately, as well as long term results in terms of health and longevity.

所以，我认为人们现在感到紧张。

So, you gotta I I think people are nervous at this moment.

他们觉得世界失去了控制，而事实确实如此。

They're feeling like the world's out of control, which it is.

他们会努力掌控自己能控制的部分，也就是自己的健康。

And they're gonna control the part they can in terms of their own wellness.

这很好，但别太过头。

Well, that's good, but don't go overboard.

是的，我认为过度优化才是问题所在。

Yeah, the hyper optimization of it all is where I think it goes wrong.

适当尝试优化健康是可以的。

Like it's all right to try and optimize your health.

但一旦进入过度优化的状态，你就走向了稳态的反面，会带来负面后果。

But once you're in that hyper stage, that's where you're getting into now the opposite end of homeostasis, where you're getting the negative repercussions of it.

是的，没错。

Yeah, yeah.

我记得曾有一位急诊科医生，我跟他实习时，我们正在为一位病人进行鼻出血的电凝止血。

I remember there was an ER doc that I trained under where we were doing some cautery of a nosebleed for a patient.

我们基本把血止住了。

And we got it to mostly stop.

我说：但还不算完美。

And I said, But it's not perfect.

我们得让它完美。

Let's get it perfect.

他却说：在医疗领域，追求完美会破坏良好效果。

He said, The enemy of good is trying for perfect in healthcare.

这句话深深印在我心里，因为我觉得这在很多这类情况下都适用。

And that really stuck with me because I think it applies in a lot of these Totally.

生物黑客

Biohacking

完全正确。

Totally.

我同意你的观点。

I agree with you.

而且，我们可能了解人群层面的优化，但在个体层面，我们并不知道对你或我来说，基于基因的最优状态是什么。

And also, we might know optimization on a population basis, but in an individual, yeah, we don't know what optimal for you is or me given our genetics.

现在你可以购买一个检测套件，它会告诉你什么对你最合适。

Well, now you could buy a kit and it'll tell you what's right for you.

它会检测你的粪便中的微生物。

It'll check your stool for the microbes.

我最喜欢的是，许多这类公司会检测你的粪便或微生物组，然后告诉你：你应该多吃纤维。

And my favorite is what a lot of these companies do is they'll check your stool or your microbiome, and they'll say, You should eat more fiber.

我心想：嘿，这个建议我本来可以免费告诉你。

I'm like, Hey, I could've sold you that for free.

是的，没错。

Yeah, exactly.

只有百分之七的美国人摄入了足够的纤维。

Seven percent of Americans get enough fiber.

我喜欢覆盆子和抱子甘蓝。

I love those raspberries and brussels sprouts.

没错。

Exactly.

我有一个担忧。

I have a concern.

我想知道你是否也有同样的担忧。

I'm curious if you share it.

如果你看看年轻医生想选择的专业方向，通常来说，虽然不是一对一的对应，但规律是：收入更高的专业往往获得最多的关注，而初级保健、精神科、儿科——这些在我看来真正构成良好医疗体系基础的专业——却获得最少的报酬和最少的关注。

If you look at the specialties that young doctors wanna enter, usually, and it's not one to one, but the pattern is higher paying specialties end up receiving the most attention, primary care, psychiatry, pediatrics, the most important specialties really, if you ask me, the foundation of a good healthcare system, get reimbursed the least, least amount of attention.

我想到了这一点在当今的体现，我看到哪些医生和专家能获得良好的经济回报。

And I think about how that's playing out today, and I see what kind of physicians and gurus are making good financial outcomes.

我担心这将如何影响未来学生的教育，他们会在哪里看到我们所谈论的这种模式——那种枯燥、老套、对着空气呐喊的观念， versus Brian Johnson 的‘活到150岁’模式？他们会说，即使他的说法有点夸张，但他至少在告诉人们要健康，而我靠这个还能赚大钱。

And I worry how this is gonna impact the future education of students, where are they going to see the model we're talking about, this boring, old yell at the clouds mantra that we're doing versus Brian Johnson's live to 150 model and say, even if his is a little off, he's still telling people to be healthy, and I could become a millionaire doing that.

你认为这可能会改变年轻聪明人才进入医疗领域的方式吗？

Do you think that might shift the way young brilliant minds might, end up entering the health sphere?

哦，我认为这不是未来的事，而是现在正在发生的事。

Oh, I I don't think it's a future thing, it's a current thing.

当我们查看进入儿科、内科或精神科的学生人数时，正如你所指出的，你不需要追求财富最大化就能明白，骨科医生和全科医生每年收入相差五倍，这种差距会在三十年或四十年的职业生涯中不断累积，这必然会驱使人们做出选择，尤其是当他们带着二十万、三十万美元的债务入学时。

When we look at the number of students going into pediatrics, or the number of students going into internal medicine, or going into psychiatry, as you point out, you don't have to be a wealth maximizer to say that the 5x difference between an orthopedic surgeon and a primary care doctor per year, which is going be compounded over thirty or forty years of an entire career, that's going to drive people, especially if they come in with two hundred thousand, three hundred thousand deaths.

我们必须改变这种模式。

We have to change the model.

在我所在的费城地区，保险公司将每一块钱医疗费用中的四分钱支付给全科医生。

In the Philadelphia area where I'm at, the insurers are paying $04 of every healthcare dollar to primary care.

我一直在批评他们。

And I keep chastising them.

这太荒谬了。

That is absurd.

你们这样下去会掏空整个体系，然后又抱怨说，哎呀，我们没有全科医生了。

You are going to hollow out and then you're going to bemoan, Oh, we have no primary care doctors.

是的，这正是你们自己造成的。

Yeah, you caused it.

我们必须改变这种支付体系。

And we have to change that reimbursement system.

我长期以来一直主张我们需要一种不同的模式。

And I've been arguing for a long time that we need a different model.

如果我们从医院拿走百分之二到三，再从专科医生那里拿走百分之二到三，就可以将全科医生的薪酬翻倍。

If we took just two or 3% from hospitals and we took another two or 3% from specialists, we could double primary care doctor pay.

那样的话，你就会看到一个完全不同的局面。

And then you would see a very different scenario.

不仅仅是内科，正如你所指出的，儿科的薪酬严重偏低，尤其是儿科专科医生更是如此。

And not just internal medicine, but as you point out, pediatrics is way underpaid, especially pediatric specialists are way underpaid.

这些问题现在就已经存在，十年后将会变成巨大的危机。

And those are things where it's a problem now, it's gonna be a huge problem in ten years.

有些问题不可能一夜之间解决。

And there's problems you can't fix overnight.

由于医学培训的周期很长，解决这些问题需要几十年的时间。

It takes decades to fix that because of the long pipeline of medical training.

所以，我完全同意你的观点。

So, I totally agree with you.

有充分的证据表明，增加社区中的全科医生数量可以延长寿命、降低死亡率。

There's good evidence adding more primary care doctors to a community increases longevity, decreases mortality.

增加专科医生数量则会产生相反的效果，实际上会提高死亡率。

Adding more specialists does the reverse, actually increases mortality.

这不是一个好局面。

Not a good scenario.

因此，我们需要更多的全科医生。

And so, we need more primary care doctors.

而且，他们不必追求财富最大化，也明白我们必须缩小我们与骨科医生、泌尿科医生、护士或其他任何人之间的收入差距，得让他们更接近那笔钱。

And again, they don't have to be wealth maximizers to say, We've got to narrow this gap between us and the orthopedic surgeons, the urologist, or the nurse, or whoever, you gotta get them closer to that money.

所以，也许差距是两倍，而不是五倍。

So maybe the difference is two times, not five times.

是的。

Yeah.

保险公司希望专注于初级保健，这个想法对我来说非常合理。

The idea of insurers wanting to focus on primary care to me makes so much sense.

因为如果你投资初级保健，就是在投资预防性医疗。

Because if you invest in primary care, you're investing in preventive care.

从长远来看，这能帮你节省保险成本。

You're saving yourself as an insurer money down the line.

然而，我看到的情况是，很少有人在五年后仍由同一家保险公司承保。

However, what I've seen happen is that rarely the same person is covered by the same insurer after five years.

因此，当你知道这个人迟早会转到其他计划时，就没有动力去投资预防性医疗了。

So as a result, there is no incentive to invest in prevention when you know you're gonna lose this person to another plan.

有没有人讨论过在后台制定某种政策，不一定是对个人的终身计划，但让保险公司必须长期陪伴一个人？

Has there ever been talk on the back end of making, not maybe a lifetime plan for an individual, but some kind of policy where insurers have to stick around with a person?

是的，我写过很多关于这个话题的内容。

So, yeah, I've written a lot about this.

你完全正确。

You're a 100% right.

这种频繁更换保险公司的情况，完全削弱了保险公司的财务激励，不仅不利于投资于预防保健，也不利于投资于任何需要一两年后才能见效的举措。

This churn, you switching insurance companies, totally undermines the financial incentive of an insurance company, not just to invest in prevention, primary prevention, but to invest in anything where the payoff is gonna be a year or two down the line.

计划之间的更换率相当高，每年达到15%。

The rotation among plans is pretty high, 15% per year.

你完全正确。

So you're absolutely right.

客户流失是个问题。

Churn is a problem.

我的解决方案是，你不可能获得终身保险计划，但可以签订五年期合同，让参保人与一家保险公司绑定五年。

My solution to that is you're not gonna get a lifetime plan, but you could get five year contracts where someone signs up for an insurance company for five years.

如果你换工作、搬家、结婚或遇到其他情况，仍然可以更换计划。

And if you change, you lose a job, you move, you get married, whatever, you can change plans.

这会如你所指出的那样，改变长期投资的财务激励。

That changes the financial incentives, as you point out, to invest longer term.

不是永久的，但至少是更长期的。

Not forever, but for longer term.

我认为这是一个对我们非常重要的模式。

And I think that's a very important model for us.

我同意你的看法。

I agree with you.

为什么我们要每年重新参保？

Why do we have annual re enrollment?

这看起来太疯狂了。

It seems crazy.

简直不可思议。

Seems wild.

没错，太离谱了。

Exactly, wild.

他们通常不会和医生签订年度合同。

They don't sign annual contracts with docs typically.

他们签订的是三年或五年的合同。

They sign three years or five year contracts.

我们也应该这样做。

We should do the same.

顺便说一下，既然我们谈到这个，也许我们可以五年内保持相同的保费。

And by the way, as we're at it, maybe what we do is same premium for five years.

我们在五年内不会提高保费。

We're not gonna increase the premium for five years.

这样每个人都有了可预测性。

So, everyone's got some predictability.

你为人们创造了激励。

You create an incentive for people.

但如果你告诉他们保费不能变，他们就会提高共付额或其他费用。

Well, you'll tell them you can't change the premium, they'll just raise the copay or whatever.

关于这一点，我还有其他想法。

Well, I have other ideas about that too.

因为你可以说，每年看三次初级保健医生，共付额为零。

Because you could say copay for visiting primary care doc, zero for three visits a year.

但这又改变了人们使用其医疗计划的动机。

Well, that again changes the incentive of people about how they're going to use their healthcare plan.

但我认为你说得完全对。

But I think you're absolutely right.

如果我们相信预防很重要，我们就得思考为什么我们做不到这一点？

If we believe prevention's important, we have to think about why aren't we getting it?

人员流动是主要因素之一。

Churn is one of the major factors.

我在推动《平价医疗法案》时特别喜欢政客们说的话。

I love politicians when we were doing the ACA.

他们会说：我们有的是一个治病系统，而不是医疗保健系统。

They would say, We have a sick care system, not a healthcare system.

我说：你们明白为什么你们为疾病付费，却不为健康付费吗？

I said, Do you understand why you pay for sickness, you don't pay for health?

是的。

Yeah.

这正是我想说的。

Well, that's what I was gonna say.

我对当前的‘让美国再次健康’运动感到沮丧，我不太明白‘再次’是什么意思，因为我们什么时候曾经健康过且没有问题呢？

My frustration with the current Make America Healthy Again movement, which I don't quite understand what again means, because when were we healthy and not having issues?

如果我们真要讨论改善健康成果，就应该投资于初级医疗。

If we're gonna talk about improving outcomes, we would be investing in primary care.

我们会投资于研究，但目前对ALS、HIV等所有疾病的NIH预算却都在削减。

We'd be investing in research, yet NIH budgets for ALS, HIV, you could name all the conditions across the board are being cut.

凯文·霍尔，一位杰出的代谢研究者，这位嘉宾在被解雇后曾做客这个播客。

Kevin Hall, phenomenal metabolism researcher, metabolic researcher, a guest on this podcast after he was fired.

嗯，算是被间接解雇吧，我想他是辞职了。

Well, indirectly fired, I guess he resigned.

但因为他们试图篡改他的研究成果，这些本应负责开发预防项目、提供营养指导、帮助我们消除经常被指责为社会顽疾的垃圾食品的人，正面临困境。

But because of them trying to alter his work, These are the people that are gonna be doing the work to create preventive programs, to give us guidance on nutrition, to help us get rid of junk food that we so often call out as what ails our society.

但我们却没有这样做。

But we're not doing that.

也许是因为我太天真了。

And maybe because I'm naive.

我们为什么不做这些呢？

Why aren't we doing that?

因为看起来我们的国家预算负债累累，我们想省钱，而这是确保能省钱的方法。

Because it seems like we have this national budget that is in debt, and we wanna save money, And this is a surefire way to do it.

虽然没有明确的方法，但我们本可以采取一些基本步骤，可我们却没有做。

And while there are not clear ways of doing it, there are some basic steps we can take, but we're not doing it.

我同意。

I agree.

我不认为MAHA，但我认为他们的一些目标相当可敬，比如减少超加工食品，关注慢性病。

I don't think MAHA I think some of their goals are quite admirable, less ultra processed foods, focus on chronic conditions.

完全正确——但说这些话和付诸行动是两回事。

Totally- But to say those things and then put something into action are two different things.

啊，你知道我接下来要说什么。

Ah, you knew exactly where I was going.

我认为他们在实现100%目标的过程中所倡导的政策并不一致。

I don't think they're consistent in the policies that they're advocating to get there 100%.

我的意思是，如果你想改变食品体系和人们的饮食习惯，就必须改变我们对超加工食品原料的补贴政策。

I mean, look, if you wanna change the food system and what people eat, you gotta change the subsidies we have for the ingredients that go into ultra processed foods.

我们对玉米、大豆、大米和小麦提供了巨额补贴。

We have huge subsidies for corn and soybeans and rice and wheat.

那么这些补贴都在起什么作用呢？

Well, what are those doing?

是的，它们让超加工食品变得便宜，从而促使人们购买。

Yes, they're making ultra processed foods cheap and inducing people to buy them.

我们对开心果、树莓、蓝莓、苹果也有同样的补贴吗？

Do we have the same kind of subsidies for your pistachios, your raspberries, your blueberries, your apples?

绝对没有。

Absolutely not.

我们知道这些食物非常有营养。

We know those are very nutritious.

它们富含膳食纤维。

They have good fiber.

回到你刚才说的纤维问题。

Go back to your fiber point.

它们有助于改善肠道菌群。

They enhance the microbiome.

但我们对这些作物没有良好的补贴。

We don't have good subsidies for those.

所以，他们的做法并不一致。

So, they are not being consistent.

同样，我们使用了大量农药和添加剂。

Similarly, we have a lot of pesticides and a lot of additives.

你想让人们更健康。

You wanna make people healthy.

我们需要一个强有力的环境保护署。

We need a robust, environmental protection agency.

但事实上，我们正在自我削弱。

But in fact, we're undercutting.

所以我认为你完全正确。

So I think you're a 100% right.

理念与实施脱节了，这是一个严重的问题。

The idea and the implementation are divorced, and that is a major problem here.

现在我明白了。

Now I understand.

我不是MAHA运动的专家，但我了解到该运动内部有些人对此感到不满。

I'm no expert on the MAHA movement, but I understand that there are people within the movement who are upset about that.

嗯，这很好，但他们必须推动政府在行动上更加一致。

Well, that is good, but they have to push for more consistency in what the government does.

其中一些可能是他们普遍的怀疑态度。

Some of it may be their general suspicion.

哦，如果政府在做这件事，那肯定不会是好事。

Oh, if the government's doing it, it can't be good.

这是错误的。

That's wrong.

很多这类事情，只有政府才能做。

A lot of this stuff, only the government can do.

你知道，谁愿意花所有时间去检查水槽下面的每一个瓶子呢？

You know, who wants to spend all their time looking at every bottle under their sink?

它有没有毒？

Is it got a toxic or not?

我宁愿政府把它们收走，系统性地处理，哪怕稍微过度一点，也不愿我自己花大量时间 obsessively 地去处理这些事。

I'd rather the government take them out and do it systematically and maybe overreach a little bit that than my having to take a lot of time and be obsessive about that.

每个人各自去做，不是正确的做法。

Every person doing it individually is not the way to go.

这正是我们设立政府的原因之一。

That's one of the reasons we have a government.

他们可以做到。

They can do it.

他们有专业知识，能够有效完成。

They've got the expertise, and they can do it effectively.

我们没有

We don't have

去做的必要，大规模处理应该更便宜。

to do And doing it at scale should be cheaper.

是的。

Yes.

为了

For

当然。

sure.

所以那里应该能节省资金。

So there should be financial savings there.

对。

Yeah.

我很好奇，如果你今天必须出生，你会选择哪个国家，因为它的医疗体系？

I'm curious, if you had to be born today, nation would you be born in because of their healthcare system?

哦，这个问题不公平。

Oh, that's not a fair question.

我不会仅仅因为一个国家的医疗体系而选择出生在那里。

I wouldn't wanna be born in a country only because of their healthcare system.

好吧，这是个假设性的问题，你必须

Well, this Based hypothetical, you have to

根据医疗体系来选择吗？

on the healthcare system?

嗯，首先，我写过一本书叫《世界上医疗最好的国家是哪个？》

Well, look, first of all, let's be I do have a book called Which Country is the World's Best Healthcare?

哦，原来如此。

Oh, there you go.

我只去了11个国家。

I only went to 11 countries.

我并没有去世界上每一个国家。

I didn't go to every country in the world.

所以表现最好的国家是荷兰、德国和挪威。

So the big winners were The Netherlands, Germany, and Norway.

他们做得好的地方是什么？

What are they doing well?

他们做得好的地方是什么？

What are they doing well?

他们 definitely 强调初级医疗，尤其是荷兰和挪威。

They're definitely emphasizing, especially The Netherlands and Norway, emphasizing primary care.

要想看专科医生，你必须先通过全科医生。

To get to a specialist, you really have to go through a primary care doctor.

他们对价格进行了管控。

They put controls on prices.

他们确实会给你选择，尤其是在荷兰，他们会提供不同的医疗保险机构供你选择。

They do give you, especially in The Netherlands, they give you choices of different sickness funds they call their insurers.

他们让初级保健医生管理心理健康问题，因此几乎所有的医生都配备有专门负责心理健康护理的护士。

They make their primary care doctors manage mental health conditions, so almost all of them have nurses who manage mental health.

他们有医生或护士提供全天候服务，并能访问您的医疗记录。

They have doctors or nurses who are accessible 20 fourseven, who have access to your medical records.

所以他们做了很多正确的事情，却只花费了预算的10%到12%。

So they have a lot of things that are going in the and they only spend eleven, ten 12% of budget.

因此，他们还有大量资金可以用于改善学校、基础设施、环境以及其他有助于人们健康的方面。

So they have a lot of other money that can be spent on enhancing schools, infrastructure, environment, and other things that make people, healthy.

我经常去挪威，因为我正在与挪威的一所大学开展研究项目。

I spend a lot of time in Norway because I have a research project with, Norwegian University.

所以我非常喜欢挪威。

So, I love Norway.

那是一个非常美丽的地方。

It's a beautiful, beautiful country.

如果你还没去过那里

If you haven't been there

我没去过。

I haven't.

我得去看看。

I gotta go check it out.

哦，你真得去看看。

Oh, you gotta go check it out.

我有个不错的公寓，你可以住。

I've got a good apartment you can stay in.

是个很棒的地方，而且大多数人会说英语。

A wonderful place and most everyone speaks English.

他们的食物很棒。

They have great food.

挪威有什么饮食建议吗？

What's a food tip in Norway?

饮食建议是什么？

What's the food tip?

他们有很多鱼，同时也非常重视传统美食。

They have a lot of fish for one They also have really invested in heritage food.

比如，人们仍然按照古老的方法制作山羊奶酪。

So, people doing the old way of getting goat cheese.

他们大力支持那些想从事这种传统方式的人，而且很多食材都非常新鲜。

They've got lot they they invest in people who wanna do that, and a lot of it's fresh.

你知道吗？

You know?

渔民出海打捞，当天晚上就能上桌。

The the, fishermen went out, and it's on your plate at dinner.

这真的非常特别。

And so that's a pretty pretty special.

这很不错。

That's a good one.

你之前提到，避免坏习惯比试图用生物黑客手段弥补坏习惯更重要。

You mentioned earlier that avoiding bad habits is more important than trying to biohack your way out of bad habits.

现在人们最糟糕的三个损害健康的习惯是什么？

What are the three worst habits that folks have these days that are harming their health?

我们先聚焦在饮食上吧，因为还有其他很多习惯。

Well, let's just focus on food for a second because there are lots of other habits.

还有与吸烟有关的习惯，与枪支有关的习惯。

There's habits related to smoking, habits related to guns.

但如果你关注饮食，我在书里提出的饮食建议是三个不要。

But if you focus on food so my suggestions on food, in my book are, one, three don'ts.

不要喝含糖饮料。

No sugary sweetened beverages.

比如苏打水，你知道，一瓶含有140卡路里。

Sodas, for example, you know, have a 140 calories.

这大约相当于十茶匙的糖。

That's about 10 teaspoons of sugar.

等一下。

Just a minute.

那小小一罐里就有十茶匙的糖。

10 teaspoons of sugar in that little can.

没有任何营养益处。

No nutritional benefit.

好消息是，美国人实际上正在减少摄入量。

Now the good thing is Americans are actually decreasing

但他们却在增加星巴克的星冰乐和弗拉普奇诺的摄入。

But then they're increasing their Starbucks frappe frappuccinos.

是的。

Yeah.

问题是，它的热量远超140卡路里，大约有400卡路里。

And that problem is it's way more than a 140 calories, about 400 calories.

因为你不仅摄入了糖，还摄入了脂肪。

Because then you're getting fat in as well as the sugar in there.

第二点是减少盐分零食、包装蛋糕、松饼和饼干的摄入。

The second is to decrease your salty snacks, your packaged cakes, your muffins, your cookies.

在过去三十年里，我们食用的包装零食和甜食的量增加到了每天约500卡路里。

We have over the last thirty years increased the amount of those packaged snacks and sweets that we're eating to be about 500 calories a day.

占成年人推荐饮食的25%到20%。

25% to 20% of an adult's recommended diet.

这是一个巨大的错误。

That is a big mistake.

你可以选择一些健康又有营养的零食，比如坚果、水果或鹰嘴豆泥。

There are good, nutritious snacks you can have, whether they're nuts or fruit or hummus.

太多包装零食和超加工食品了。

Too many packaged snacks, ultra processed foods.

还有更广泛的超加工食品。

And then there's the more general ultra processed foods.

我们摄入的卡路里中，接近60%来自超加工食品。

Just shy of 60% of all our calories are ultra processed foods.

我们必须大幅减少这类食品的摄入。

We have to reduce that substantially.

这需要一场全社会的变革。

That requires a whole social change.

你能买到和负担得起什么，你能做什么饭。

What you can buy and afford, what you can cook.

我从刚毕业的研究助理那里学到的一件事是，他们根本不会做饭。

One of the things I learned from my research assistants who are just fresh out of college is they have no idea how to cook.

他们连锅碗瓢盆都没有。

They have no pots and pans.

他们的父母从未教过他们做饭。

Their parents never taught them how to cook.

他们的课堂上没有家政课。

There's no home economics in their classrooms.

他们根本不知道。

They didn't know.

他们甚至不会，我曾因沮丧而给了我的一位研究助理一些指导。

They they can't even I I gave one of my research assistants in frustration.