The future of alcohol

这里是斯坦福工程，它代表着一切的未来，我是您的主持人奥尔特曼。

This is Stanford Engineering is the future of everything, and I'm your host, Altman.

我觉得有必要重新回顾一下这个节目的初衷。

I thought it would be good to revisit the original intent of this show.

2017年我们刚启动时，就想打造一个平台，深入探讨我的同事们在校园里从事的科学、技术、工程、医学及其他领域的研究与动力。

In 2017, when we started, we wanted to create a forum to dive into and discuss the motivations and the research that my colleagues do across the campus in science, technology, engineering, medicine, and other topics.

斯坦福大学，以及绝大多数高校，长期以来都在开展影响世界的重要工作。

Stanford University and all universities for the most part have a long history of doing important work that impacts the world.

能和大家分享这些工作背后，那些为创造更美好未来而不懈努力的人们的故事，真的令人欣慰。

And it's a joy to share with you how this work is motivated by humans who are working hard to create a better future for everybody.

本着这样的精神，我希望每期节目结束后，您都能更深入地理解这里正在进行的研究，并愿意把这些内容分享给您的朋友、家人、邻居和同事。

In that spirit, I hope you will walk away from every episode with a deeper understanding of the work that's in progress here, and that you'll share it with your friends, family, neighbors, coworkers as well.

当我们把所有数据整合起来看，确实能发现酒精是有害的。

When we put everything together, we do see that alcohol has a harm.

现在，我想坦诚地说一点。

Now, I wanna be honest here.

在饮酒量较低的情况下，这种伤害程度其实非常小。

That degree of harm at low levels of alcohol intake is pretty small.

不过话说回来，确实任何程度的饮酒可能都有一定危害。

And nonetheless, it it it remains true that any drink is probably harmful.

所谓存在一个安全的饮酒水平，这大概只是个神话。

And the idea that there's a safe level of alcohol use is probably mythology.

这里是斯坦福工程频道《万物未来》，我是主持人Russ Altman。

This is Stanford Engineering's The Future of Everything, and I'm your host Russ Altman.

对了，我们一直建议大家在你正在使用的播客应用里订阅我们的节目。

You know, we always ask you to follow the show in whatever app you're listening to.

为什么要这么做呢？

Why do we do that?

首先，这对你有好处，你会收到所有新节目的通知，这样就不会错过任何内容。

Well, first of all, for your benefit, you'll get told about all the new episodes so you won't miss anything.

同时这也对我们有帮助，毕竟我们得维持节目的运营嘛。

It also benefits us because we have to feed the beast.

算法特别喜欢用户关注特定节目，会把我们的节目推到推荐列表的更前面。

The algorithms like it when people are following a specific show, and they push our show up higher in the recommendations.

说白了，这有助于我们扩大听众群。

So, frankly, it helps us grow our audience.

所以，麻烦你考虑一下这一点。

So thanks for considering that.

今天，兰德尔·斯塔福德会告诉我们，从健康角度来说，酒精根本没有好处。

Today, Randall Stafford will tell us that from a health perspective, there really are no benefits to alcohol.

如果你非要喝，那也得是为了别的原因，而不是为了健康。

So if you're gonna drink it, you have to drink it for some other reason, not for your health.

这就是酒精的未来。

It's the future of alcohol.

今天我们会继续我们的特别环节——‘一分钟展望未来’，我会问兰德尔几个快速问题，他会在最后给出简短的回答。

Today, we're continuing our feature, the future in a minute, where I will ask Randall a few rapid fire questions and he'll give me some quick answers about alcohol in the end.

在开始之前，请记得我几分钟前说过的：在应用里关注我们，真的很有帮助。

And before we get started, please remember what I just said a few minutes ago, following us in the app is great.

这对你有帮助，我们也这么认为，而且对节目本身也有好处。

It helps you, we think, and it definitely helps the show.

人类喝酒已经有几千年的历史了。

So humans have been drinking alcohol for thousands of years.

我们大多数人对少量饮酒后的反应都很熟悉。

Most of us are pretty familiar with its effects, effects in small amounts.

我一喝就爱唠嗑，这估计不让你意外。

I get chatty, that might not surprise you.

喝得多了，就会出现典型的醉酒状态，中间各种程度都有。

And at larger doses, it has the traditional effects of being drunk and everything in between.

可几千年来，我们本该对酒精到底怎么影响健康了如指掌才对。

But for thousands of years, you would think we would be very aware of exactly what it does on our health.

但这么多年，关于酒精是利是弊，说法一直摇摆不定，公众也一直被搞得糊里糊涂，到底有没有健康好处？

And yet for years, that's been an up and down in terms of benefits and costs of alcohol and a very fuzzy signal to the public about are there health benefits or not?

这个问题很重要。

This is an important question.

你可以说，喝酒的好处并不全在健康上，比如在阳台上享受一个惬意的夜晚，吃顿好饭，再来一杯红酒。

There are benefits to alcohol, you could argue, that have nothing to do with health in terms of having a nice evening on a veranda, eating a nice meal and having a glass of wine.

有些人真的很享受这种感觉，这对他们来说就是一种收获。

Some people really enjoy that and that's a benefit to them.

但他们的健康呢？

But what about their health?

健康带来的好处，和别的方面的好处，是两码事。

That's different to consider the health benefits versus other potential benefits.

斯塔福德是斯坦福大学的医学教授，也是研究酒精对健康影响的专家。

Well, Stafford is a professor of medicine at Stanford University and an expert on the health influences of alcohol.

他会告诉我们，目前来看，酒精并没有多少实际的健康益处。

He'll tell us that alcohol right now does not have many actual benefits.

兰德尔，人类用酒精已经有几千年了。

Randall, alcohol has been used for thousands of years by humans.

那为什么我们一直很难搞清楚酒精对健康到底有什么影响呢？

Why has it been so difficult to assess the health impacts and pin it down?

我觉得其中一个问题是，酒精是我们喜欢享用的东西。

Well, I think that one of the problems is that it's something we enjoy consuming.

而我们对喜欢的事物产生的情感依恋，有时候会干扰科学判断。

And I think our emotional attachment to what we enjoy sometimes does get in the way of science.

在我这一生中，我见证了公众对酒精健康建议的反复变化。

So now in my lifetime, I've seen an ebb and flow of public health advice about alcohol.

我相信你也很清楚，过去曾有说法认为少量饮酒其实有益健康。

As I'm sure you're well aware, it was small amounts are actually beneficial.

后来情况发生了一些转变。

There's been some changes.

你能给我们简要讲讲，人类对酒精健康影响的认识是如何演变的吗？

Can you give us a little abbreviated history of our understanding of the health impacts of alcohol?

是的，长期以来，人们对酒精的审查其实非常少。

Yeah, I think that, for a long time, there was really very little scrutiny about alcohol.

但一旦开始认真研究，很多成果都受到了一种倾向的影响——我们总想证明酒精是有益的，或者至少没那么有害。

And then once there was, I think quite a bit of the research was tainted by the idea that, you know, we really kind of want to show that alcohol is good or at least not bad for us.

所以，回顾过去五十年的发展，我们已经有了大量证据表明，饮酒确实会带来一些危害。

So as I map out kind of what's happened over the last fifty years, we have plenty of information that suggests that there are some harms with alcohol.

大部分研究都集中在身体健康上，却相对忽略了与饮酒相关的心理健康问题。

And a lot of the focus of research has been on physical health, somewhat leaving out the mental health aspects that go along with alcohol use.

单就身体健康而言，我们早期的一些数据表明，对于某些疾病，饮酒或许存在一定的益处。

But just in terms of physical, problems with alcohol, I think what we've seen is that very early on, some data that suggests that for some conditions, there may be some benefit.

比如，研究冠状动脉疾病——也就是导致心肌梗死的那类疾病——发现少量饮酒可能有助于降低该病的不良后果，我们也初步弄清了其中的部分机制。

So, for instance, if one looks at coronary artery disease, the problem that causes people to have heart attacks, there is some evidence that low levels of alcohol may actually be beneficial in terms of preventing bad outcomes from that particular disease, and we've worked out some of the mechanism as to why that might happen.

比如说，酒精对血液中的胆固醇和血脂有正面影响。

For instance, alcohol does have a favorable effect on our cholesterol and our lipids in our bloodstream.

因此，确实存在一些科学依据，说明酒精在某些情况下可能带来好处。

So there's a sign of a rationale for why alcohol might have some benefits in certain conditions.

但另一方面，我们从来没能全面地看待酒精的影响。

On the other hand, we've never really looked at alcohol in a very holistic way.

正如我提到的，我们常常忽视了酒精对心理健康的伤害。

As I mentioned, often we kind of discount the mental health aspects of alcohol's harm.

即使只看身体方面，我们也很少把所有因素综合起来考虑。

And even looking at just physical aspects, we often don't bundle everything together.

我觉得过去二三十年来的证据越来越清楚：一旦把所有因素都放在一起看，就能发现酒精确实有害。

So I think what we've seen over the last twenty or thirty years is increasing evidence that when we put everything together, we do see that alcohol has a harm.

但在这里，我想说句实话。

Now, I want to be honest here.

虽然在少量饮酒的情况下，这种危害很小，但事实仍然是，任何一杯酒都可能有害，所谓‘安全饮酒量’的说法，大概只是个迷思。

That degree of harm at low levels of alcohol intake is pretty small, and nonetheless, it remains true that any drink is probably harmful, and the idea that there's a safe level of alcohol use is probably mythology.

我想在我们的对话中特别强调的一点是，我不只关心酒精的流行病学数据或它对公共健康的影响，更想弄清楚：我们是怎么陷入这种状态的——明明有大量信息，却选择忽视，还说服自己少量饮酒是有益的。

And I think that's one of the things I want to stress during our talk is that I'm not only interested in kind of what is the epidemiology, what's the public health impact of alcohol, but how did we get into this situation of essentially ignoring a lot of information and convincing ourselves that low level alcohol use was beneficial.

这显然不对，而且早在三十年前，我们就已经有足够的证据能得出这个结论了。

It clearly isn't, and I think we have lots of information even available thirty years ago that would have said that.

过去几十年，证据一直在不断积累，现在我毫不怀疑这一点。

The evidence has accumulated more and more over the last few decades to the point where I don't think there's any doubt.

不过，这里有个难题：酒精在人们生活中时有时无，当我们研究人群时，必须非常谨慎地分析，为什么有些人会减少饮酒。

Now, one of the conundrums, one of the difficulties here is that alcohol is something that can come and go from people's lives, and when we look at populations, we need to be very careful about why people may have reduced their alcohol intake.

如果我们看一项针对全体人群的研究，可能会发现，曾经喝酒的人健康状况比现在还在喝的人更差。

So if we look at a study that looks at everybody in a population, what we may see are that former drinkers may have some health problems that are greater than those people who are drinking.

但我们需要弄清楚的是，这些人为什么会变成这样，他们的健康问题是否促使他们决定戒酒。

But what we need to understand is how those people got in that situation and whether perhaps their health issues contributed to their decision to stop drinking.

理想情况下，我们可以通过随机对照试验来研究这个问题。

Now, ideally, we might look at this through a randomized clinical trial.

我们可以把人群随机分成三组：一组完全不喝，一组少量喝，另一组喝得多一点。

We might randomize people in the population to drink nothing, drink a little bit, and then drink a little bit more for a third part of the population.

可惜的是，我们做不到这一点。

Unfortunately, we can't do that.

这不仅严重违背伦理，而且让参与者长期遵守这种分配方案，在实际操作上也几乎不可能。

Really unethical, and the logistical barriers to actually having people adhere to that particular assignment would be problematic.

所以我们只能依赖所谓的观察性数据来分析。

So we really are left in this situation where we need to use what's called observational information.

但很明显，这类数据并不是最理想的。

And clearly, that's not the ideal type of information.

如果有随机对照试验当然更好，但现实就是做不到。

It would be much better to have the randomized clinical trial, but we simply can't do that.

所以，正如我之前说的，一个问题是，那些已经戒酒的人可能本身就有一些行为模式或健康问题，这些反而让他们看起来像是不喝酒才导致了问题。

So one of the problems, as I said, is that people who have stopped drinking may have behaviors and may have other health problems that cause them to look like their lack of alcohol in some senses caused their problems.

对，没错。

Right, right.

但实际上，情况可能恰恰相反。

When in fact, it may be just the opposite.

我想深入聊聊最近对心理健康方面的认识，还有它对生活、生活方式以及社会影响的广泛作用。

So let me, I do want to get into the recent understanding of, especially the mental health things, which you mentioned, but also affects broadly on life and lifestyle and social implications.

不过你之前提到一个关键点，我猜你面临的挑战之一是：人们到底在追求什么？

But you made a point earlier that one of the challenges I'm guessing that you face is what are people rooting for?

这跟其他疾病的流行病学不一样，别的病大家都一致认为：我可不想得这病，只要能告诉我怎么避开就行。

Like, is a, this is different kind of epidemiology, like for, than from other diseases where everybody agrees, I don't want to get that disease and anything you can tell me about how to avoid it.

但我觉得，这里的一个关键在于，很多人心里其实有很强的认同感：我喜欢周五或周六晚上喝一杯葡萄酒，或者来杯威士忌——当然不是每天，这个我们待会儿再说。

But I think one, and I think one of the dynamics going on here is there's a strong feeling in the population that like, I enjoy my glass of wine or my drink of whiskey on a Friday night or a Saturday night, not every night, but we'll get to that.

所以，社会并不仅仅是一个旁观者，你该怎么形容呢？

And therefore, society is not just a, what would you call it?

他们不是对研究结果持中立态度的听众。

They're not just a neutral listener to the findings.

他们有自己的看法，甚至基于自身的生活方式、喜好或不喜好，形成了自己的‘数据’，这会影响他们对结果的理解。

They have opinions and in fact, they have their own data from their own lifestyle and their own enjoyment or lack of enjoyment, which kind of affects how they interpret.

我知道你还写过，这背后是一个庞大的产业，牵涉到巨额利益。

And then I know you've also written about this is an industry and there's a lot of money at stake here.

所以在我们聊最新研究发现之前，你能说说这种局面吗？当一个领域里人人都有观点，都带着自己的生活经验，而且背后还有巨额利益在运作的时候。

So before we go into what the latest findings are, tell me about that dynamic of when you're working in a field where everybody has an opinion and a primary data from their own life and there's a lot of money at stake.

是的。

Yeah.

我觉得这其实是人性的一部分——我们看待世界的方式本身就带着偏见。

And I think this is part of the the human condition is that the way we see the world does have certain biases.

而我们的一种偏见就是：那些我们喜欢做的事，我们希望它们至少是无害的，最好是对我们有益的。

And one of our biases is that those things we enjoy doing, we want to be at least neutral, if not beneficial for our lives.

我很喜欢把饮酒和开车作比较这个说法。

Really like the analogy between alcohol use and driving.

某种程度上，开车已经融入了我们的文化。

So in some sense, driving is part of our culture.

饮酒也是我们文化的一部分。

Alcohol is part of our culture.

但我们要意识到，开车的方式有很多种。

But we should realize that there are different ways to drive.

喝酒的方式也同样多种多样。

There are different ways to drink.

而且任何驾驶都伴随着一定的受伤风险。

And also that any driving really does carry with it some risk of injury.

如果我们不认清这一点，就很难真正好好照顾自己。

And that unless we recognize that, we're not going to take care of ourselves in the most appropriate way.

我不是在说每个人都该戒酒，但重要的是，即使少量饮酒也有风险，而且喝得越多，风险就越大，也就是剂量越高风险越高，尤其是短时间内大量饮酒，危害特别大。

So, you know, I'm not making an argument here that everybody should stop drinking, but I think what's really important is that even low levels of alcohol do carry some risk and that those risks magnify as we increase the amount of alcohol that people are taking in, in other words, their dosage, and that certain types of drinking, particularly multiple drinks in a single episode, are particularly harmful.

所以我想把这一点放在其他行为的背景下说清楚：酒精使用没有任何益处。

So I want to just put this in the context of other sorts of behaviors and really say there is no benefit of alcohol use.

低剂量饮酒的伤害可能不大，但对某些特别容易患上特定疾病的人来说，这点伤害就足以给生活带来实际问题，或许有一部分人根本就不该喝酒。

The harm at low levels of use may be small, but for some people who are particularly susceptible to certain diseases, it may be enough to cause some real problems in people's lives, and perhaps there is a subpopulation who really shouldn't be drinking at all.

没错，说得很好。

Right, very good.

当你说到没有益处时，我觉得得稍微补充一下：指的是没有健康益处，因为有人可能会说，‘可它让我的意大利餐厅周五晚上特别愉快’。

And then when you say there is no benefit, I think, is it fair to say we have to decorate that a little bit with, there is no health benefit because people may say, well, it made my Friday night at the Italian restaurant very lovely.

那种是另一种类型的益处，而我们其实已经把它排除在外了，毕竟我们是医生，关注的是健康方面的利与弊，这正是我们的专业所在。

And that's a different kind of benefit, which we're kind of taking that off the table, I think, because we're doctors, we're thinking about health benefits and negatives, and that's what we're kind of paid to think about.

影响一个人是否喝酒、喝多少的因素有很多，但核心是，我们要认清：这些因素带来的都不是健康上的好处，尽管作为人类，我们多希望它能有点好处。

So there are lots of factors that might play into whether somebody drinks and how much, but I think just the idea is to put that in as something that's real, something that isn't a benefit, although clearly we as humans wish there were a benefit.

对，没错。

Right, right.

这有点像我们讨论黑巧克力和它的抗氧化成分时的情形。

You know, some of this is similar to when we start talking about dark chocolate and its antioxidants.

希望它对健康有益。

Please let it be healthy.

希望它能

Please let

对健康有益。

it be healthy.

我认为目前积累的证据表明，如果它确实没有害处，甚至可能通过可可和巧克力中的植物化学物质带来一些好处。

I I think we have the accumulated information that if it's certainly doing no harm and maybe doing some benefit through some of the compounds, the phytochemicals that are in cocoa and chocolate.

是的。

Yes.

但我觉得我们得退一步说，如果我们从头设计一种最健康的生活方式，大概会把饮酒列为需要适度控制的一项。

But I think we need to kind of step back and just say, if we were designing the most appropriate life, we probably would put in alcohol as one thing we need to moderate.

对。

Right.

好的，那我们来看看最近的一些研究发现。

Okay, so let's go a little bit into the recent findings.

你之前提到一个很有意思的观点，说人们长期以来一直在研究酒精对身体的影响，但过去几十年却很少关注它对心理健康的影响。

You said something very intriguing early on about the, people have been studying the physical effects of alcohol, but maybe over the last several decades, haven't been focusing on the mental health issues.

我从身边朋友和家人的经历中明显看到，当人患上抑郁症时，尤其是得不到足够医疗帮助的情况下，往往就会用喝酒来自我缓解——我不知道这有没有数据支持，但我觉得很明显。

And I know from just seeing friends and family, it is very clear that when people suffer from depression, it's clear to me, and you can tell me if this is supported by the data, people who suffer from depression, especially if they're not getting adequate healthcare, often is kind of what we call self medicate with alcohol.

这种现象太明显了，你亲眼看着它一点一点发生，根本躲不开。

It's very obvious and you see it and you can kind of see it happening in real time before you.

那我们现在对心理健康和酒精之间的相互作用，到底了解多少？

What is the state of our understanding of the interactions between mental health?

你可以认为，是因为抑郁才让人喝酒，也可能是喝酒导致了抑郁。

You know, you could say the alcohol is there because of the depression or the depression is resulting from the alcohol.

作为流行病学家，你怎么去理清这种因果关系？

How do you untangle that as an epidemiologist?

是的，这个问题确实涉及双向的因果关系。

Yeah, so this issue of bidirectional causing or causality.

实际上，我们已经知道，饮酒会引发抑郁，也会让已有的抑郁症状变得更严重。

So we actually do know that alcohol consumption will lead to depression, will lead to worsening depression.

同时，人类行为中确实存在自我疗愈的倾向。

At the same time, you know, part of human behavior is this process of self medication.

所以，一方面我们说酒精会引发或加重抑郁，另一方面，抑郁本身及其相关症状也会导致人们饮酒。

So at the same time as we say that alcohol has a causal effect of causing depression, we can also say that depression itself and the symptoms that go along with it cause alcohol use.

这一点已经得到细致研究，很清楚的是，这两种方向都在同时发生，这就让厘清酒精对心理健康的确切因果影响变得相当困难。

So this has been very carefully looked at, and it's really clear that both of these directions are working, which makes it fairly difficult to disentangle kind of what is the causal effect of alcohol on people's mental health.

不过，我们确实有长期追踪的研究发现，饮酒量的增加往往早于抑郁发作的发生。

But we do have good studies that look longitudinally and find that increases in alcohol use seem to predate people having episodes of depression.

但这并不适用于每个人，情况没那么绝对。

Now, that applies to every single person in the population, not clear.

但抑郁在我们人群中极为普遍，而在我看来，这个问题却远未得到应有的重视。

But depression is an incredibly common problem in our population, one that really is not recognized and not given enough, emphasis, in my opinion.

酒精使用和抑郁之间的任何关联都值得警惕，尤其是当我们已有证据表明酒精可能直接引发抑郁时。

And any correlation between alcohol use and depression, I think, is problematic, but even more so when we have evidence that alcohol can be a causative effect in depression.

我认为，关于因果关系和双向影响的这个问题，正是研究酒精使用时的一大难点。

And I would say this issue of causes and bidirectional causality is one thing that's problematic in looking at alcohol use.

你知道，我们可以用类似看待抑郁的方式来分析自杀倾向，因为抑郁往往会导向自杀行为。

You know, we could look at things like suicidality in some of the same way that, you know, depression is going to lead to suicidality.

酒精常常是导致人们试图自杀的直接原因。

Alcohol is often a proximal cause of people's attempted suicides.

这并不意味着酒精是影响一个人心理健康和自杀企图的唯一因素，但酒精使用和自杀行为之间确实存在很强的关联。

Now, that doesn't mean that alcohol is the only thing that's contributing to a person's mental health and the attempt at suicide, but But there is a strong link between alcohol use and suicidal behavior.

而自杀，同样也是个被严重忽视的问题。

And suicide, likewise, is one of those problems that I think is under recognized.

我们平时很少讨论它，但它其实非常普遍，更是年轻人死亡的主要原因之一。

We don't talk about it enough, but it's very common and really is one of the more common causes of death in young people.

我们真该正视这个问题，从多个角度去深入分析。

And we ought to, you know, we ought to face up to that and look at that from multiple angles.

当然，酒精只是其中一个角度，但我们必须以更全面、更整体的方式来看待这些社会问题。

And of course, in some sense, alcohol is only one of those angles, but we need to think about these social problems in a much more comprehensive and a whole person sort of way.

除了抑郁这个主要因素外，我知道，还有没有其他心理健康方面的问题，也和酒精有着类似的复杂关系？

So in addition to depression, which is a big one, I know, are there other aspects of mental health where we're seeing alcohol have these complex relationships?

确实，在双相情感障碍中，我们也能看到类似的双向作用机制：躁狂发作会引发饮酒，反过来，饮酒在发作前也很常见。

Yeah, certainly in bipolar affective disorder, we see some of the same bidirectional mechanisms at work, both an episode of mania will cause alcohol, but also on the other hand, alcohol use preceding an episode is quite common.

所以，这背后是一张复杂的因果网络，而酒精正处在中心位置——它既是某些心理问题的诱因，也是这些心理问题的结果。

So, you know, we have this complex kind of web of causality, and we know that alcohol kind of sits in the middle of this, both as a cause and as something that's caused by various mental conditions.

我觉得还有一个领域研究得还不够，那就是酒精使用的其他社会因素。

One area that I think has not yet been studied enough are some of the other social dynamics of alcohol use.

如果我们仔细观察，虽然这方面研究远不如健康影响那么充分，但也能看到失业和饮酒之间同样的双向模式。

And we see, if we look carefully, and this isn't nearly as well researched as health effects, but we see the same bidirectional kind of pattern with unemployment.

失业的人确实更容易增加饮酒量。

So people who are unemployed, yes, that is a cause of increased alcohol consumption.

但另一方面，数据表明，很多人的就业困难其实发生在饮酒量上升之后。

But on the other hand, we have data suggesting that increased alcohol consumption precedes many people's difficulties with employment.

这已经超出了健康范畴，进入了社会问题的领域——我们真该认真看待，因为失业本身又和抑郁以及其他社会问题紧密相关。

So, you know, this is beyond kind of the health realm and getting into kind of a, you know, one of the social problems that that we really ought to be looking at because unemployment itself is then linked to depression and other social harms.

这是与拉塞尔·阿尔特曼探讨的未来一切。

This is the future of everything with Russ Altman.

接下来，我们继续与兰德尔·斯塔福德的对话。

We'll have more with Randall Stafford next.

欢迎回到《一切的未来》。

Welcome back to The Future of Everything.

我是拉塞尔·阿尔特曼，今天对话的是来自斯坦福大学的兰德尔·斯塔福德。

I'm Russ Altman, and I'm speaking with Randall Stafford from Stanford University.

在上一部分，我们讨论了酒精，以及为什么很难确定它到底对人是有益还是有害。

In the first segment, we discussed alcohol and what is the evidence and why is it so hard to get evidence about whether alcohol is good for us or not?

目前的证据显示，除了极少数例外，酒精总体上弊大于利。

The current evidence shows that with very few exceptions, it's mostly not good.

在这一部分，我想问问兰德尔，为什么我们对酒精的认知总是这么混乱？在个人层面上，我们该怎么判断它到底是在帮我们还是害我们？

In this segment, I'm gonna ask Randall why we get so confused about alcohol and what can we do on a personal level to assess whether alcohol is helping or hurting us?

别忘了，本部分快结束时，我会让兰德尔回答几个快速问答，他会给出自己的即时看法。

Don't forget, we will end this segment with a future in a minute where I'll ask Randall a few rapid fire questions and he's gonna give me his quick answers.

这一部分我想问你，兰德尔，我们是怎么走到这一步的？

In this segment, I wanna ask you, Randall, how did we get here?

我们是怎么走到这一步的？居然还在纠结酒精到底是不是对我们有益，还信着这些说法。

How did we get to this position of kind of trying to grapple with all of these issues of alcohol, the mythologies about it being good for us?

你怎么看？

What's your assessment?

我觉得我们之所以走到这一步，是有几个合理的原因的。

Well, I think we got here for a few good reasons.

就像我们之前说的，作为人类，我们总是希望自己的行为是没问题的，所以跟这相矛盾的信息，往往就被忽略了。

I think as we've talked about, as humans, you know, we want to believe that what we're doing is okay, and information that contradicts that tends to be dismissed.

在酒精对健康影响的科学研究中，这种情况确实存在。

And I think we have some of that happening in the area of the science of alcohol's effect on health.

我觉得，要理清酒精在这些复杂关系中的双向因果作用，本身就很困难。

I think that some of the teasing apart these bidirectional causing and alcohol being at the middle of some of these things is difficult.

但我想说的是，很长一段时间里，我们一直用非常简单的分析方式，直到后来才意识到：也许我们得考虑这些双向的因果关系。

But I think what I would say is that we stuck with very simplistic analyses for a long time before we kind of got to the point of saying, well, maybe we need to account for this bidirectional, causation.

所以，我觉得这其中一部分原因，就是我们太想相信它有益了。

So I think that part of this is wishful thinking.

一部分原因在于，我们长期停留在简单粗暴的研究方式和结论上。

Part of it is stopping research in simple ways and using simple results.

我觉得还存在一定程度的选择性使用数据。

I think also there's a certain amount of cherry picking.

比如谈到心脏病，确实低剂量饮酒可能对冠状动脉疾病有点好处，但一旦把范围扩大到所有类型的心脏病，危害就很明显了。

So for instance, when we think about heart disease, yes, there may be a benefit of low levels of alcohol use for coronary artery disease, but when we expand that category to all heart disease, there clearly is a harm.

酒精与心房颤动和心力衰竭密切相关，而这两种病在我国都是很严重的问题。

Alcohol is quite involved with the causation of atrial fibrillation and with heart failure, and those are two very serious problems in our nation.

虽然心肌梗死是最常见的心脏病，但如果从整体来看心脏病，酒精的影响是负面的。

And while heart attacks are, you know, the most common heart disease, if we take heart disease as a whole, alcohol has a negative effect.

再看其他健康问题，几乎找不到哪种疾病会说酒精对它没坏处。

And if we look at other health conditions, there are very few health conditions where you would say that health is not negatively impacted.

目前我们新信息最多的一个领域是癌症，尤其是世界卫生组织下属的国际癌症研究机构，他们找到了充分证据，证明即使是适量饮酒，也会增加患癌风险，特别是乳腺癌。

One of the areas where we have a lot of new information is on cancer, and part of this is the International Agency for Research on Cancer, a part of the WHO, and they found very good evidence that even moderate levels of alcohol are implicated in the causation of cancer, and this is particularly true for breast cancer.

这其实很多人早就有怀疑，但过去十年才真正被证实并牢固确立下来。

So this is something that I think people suspected for a long time, but it's really been proven and solidified over the last decade.

你称它为一种迷思，这让我很感兴趣，因为它突显了这是一种高度社会化、几乎像病毒一样传播的现象。

You've referred to it as a mythology, which I find intriguing because it really stresses that this is a highly social, it's almost like a viral phenomenon.

人们会交流，你通过社交媒体或跟朋友聊天，既能传播真相，也能传播谬误。

People talk, you can spread both truth and untruths through social media, through conversations with your friends.

有没有教育方面的努力？你对教育这件事持乐观态度吗？

Is there an educational component and are you optimistic about educating?

应该跟年轻人讨论这个问题吗？还是说他们这个年纪还太小，理解不了这些？

Should discussing this with youth or is this just not the right age and the right time for them to understand these issues?

你怎么看这个问题？

How do you think about that?

我很受鼓舞。

Well, I'm very encouraged.

现在大家对酒精以及它该扮演什么角色，讨论得越来越多了。

I think there is a lot more discussion about kind of alcohol and what role it should have.

酒精不再被理所当然地当成每个人非做不可的事了，尤其是年轻人，他们开始流行暂时戒酒，这让我特别感兴趣。

I think it's no longer taken for granted as something that every person needs to do, and I'm very intrigued by, particularly among young people, you know, the idea of taking a break from alcohol.

我觉得每个人都值得一试。

And this is something that I would recommend for everybody.

我觉得自己去探索一下，看看没有酒精的生活是什么样子，观察其中的变化，也许会发现，其实我并没有自己以为的那么需要酒精。

I think that having our own kind of capabilities of experimenting, seeing what life is without alcohol, looking at differences, and, you know, perhaps deciding that maybe I don't need alcohol as much as I thought I did.

说实话，我还是喜欢喝酒的，但我的饮酒量已经从每周七杯左右降到了两三杯，这完全是基于这些数据做出的调整。

Now, I enjoy alcohol, you know, but my intake has gone from somewhere around seven drinks per week to maybe two or three, and that's on the basis of, of these data.

一开始我确实挺难做到的，但最后发现，这么做真的很有好处。

But, you know, I I, had trouble doing that and found, however, that in the end it's beneficial.

我觉得我现在更健康了，喝酒也少多了，而且这么低的饮酒量，带来的危害几乎可以忽略不计。

I actually think that I'm healthier and not drinking as much, and that very low level of alcohol, I think, presents a harm that's fairly negligible.

是的，可能有点害处，但程度微乎其微。

Yes, it may be harmful, but only minimally so.

没错，没错。

Right, right.

所以我真心建议大家好好审视自己的饮酒习惯，像对待开车一样认真思考，看看是否值得做一些调整，而且别着急，慢慢来。

So I really encourage people to look at their own alcohol use, think about it in the way they think about driving, and think about whether they want to kind of make some changes and go slow on those changes.

我觉得作为消费者，看到无酒精啤酒、无酒精香槟，甚至其他无酒精饮品的数量增长，真的让人惊讶，因为在我过去的生活里，这些东西根本不存在。

And I do think my understanding, and just being a consumer, the amount of, for example, non alcoholic beer, non alcoholic, even non alcoholic champagne and other spirits has been stunning because in my life, this was not a thing.

直到最近几年，你至少可以为此感到欣慰。

And until the last few years, you must take some heart in that.

这背后一定存在一股独立于科学之外的社会潮流。

And there must be a movement separate from the science.

人们一定是用实际行动在投票，真切感受到了这些产品的好处。

People must be kind of voting with their feet and must be sensing the benefits of these.

你有没有想过，这种无酒精啤酒、无酒精饮品的潮流，到底是从哪儿来的？

Are you aware of why this, NA, non alcoholic beer, NA, spirits, where did this movement come from?

它是不是源于……

Did it know, come from I'm

我没法确切说它起源于哪里，但我知道，文化上人们对酒精的态度越来越怀疑了，我觉得这种怀疑是合理的。

sure of its origin, but you know, what I have noticed is just culturally, there are more, skeptical there's more skepticism in the media about alcohol, and I think that's a reasonable skepticism.

我们每个人都该对广告传递的信息保持警惕，更深入地反思自己那些习以为常的行为。

I think we all should be very skeptical of the messages that we get from advertisements, for instance, and that we ought to think more deeply about the sort of behaviors that we engage in.

传统上，如果你问人们酒精有什么害处，大家普遍觉得主要是伤肝，尤其是长期大量饮酒的人。

So one of the very traditional things, think if you ask people what's wrong with alcohol, think it's generally understood in population that impacts on your liver, especially with heavy alcohol use.

咱们先聊聊肝脏吧。

So let's just talk about the liver for a minute.

当然，大家都知道长期大量喝酒会导致肝病，但除了酗酒之外，还有很多其他类型的肝病。

So of course it's well known that if you have heavy, heavy alcohol use, you're going to have liver disease, but there are a lot of other liver diseases other than heavy alcohol use.

比如肝炎，还有各种与脂肪肝相关的综合征。

There's hepatitis, there's various syndromes associated with fatty liver.

那么，除了大量饮酒之外，普通饮酒对肝脏到底有什么影响？我们现在了解多少？

What's the status of our understanding of the effects of alcohol on the liver when it's not just from huge amounts of alcohol intake perhaps?

是的，我们知道，即使是适量饮酒，也可能导致肝硬化，也就是肝脏组织出现瘢痕。

Yeah, so what we know is that even moderate amounts can contribute to cirrhosis, in other words, scarring of the liver.

虽然这种情况在重度饮酒者中更常见，但我们也发现，当肝脏本身已经受到刺激时，酒精会加剧这种损伤。

It's less common than in people with very high levels of alcohol consumption, but we also know that when situations induce the liver to be irritated, there's this additive effect.

很多人其实已经有代谢性肝病，原因可能是前期糖尿病或者糖尿病。

So many people do have metabolic liver disease on the basis of having prediabetes or diabetes.

跟酒精没关系。

Unrelated to alcohol.

跟酒精没关系。

Unrelated to alcohol.

对。

Yeah.

但当酒精加入其中时，肝脏损伤会更严重。

But when we add alcohol into that mix, we have even worsening liver disease.

那对于肝炎这类情况也一样吗？

Okay, and is that true for things like hepatitis?

酒精会让肝炎变得更糟吗？

Does it make a hepatitis worse?

有一些研究支持这个说法，不过就丙型肝炎的进展而言，酒精的影响其实相对有限。

There is some evidence there, but you know, the amount of effect that let's say alcohol use has in progression of hepatitis C seems to be relatively minimal.

最后一个问题，趁着还有点时间，你刚才提到并鼓励大家去尝试调整饮酒习惯，我想听听，如果有人正在听我们对话，想着‘也许我该改一改’，那他们具体该怎么做？

Okay, and so the final thing I wanted to ask you just as we wrap up in the last minute, you've already mentioned and encouraged people to experiment with alcohol, but I would like to hear more about what could somebody who's sitting, listening to our conversation saying, Hey, I might want to change.

你有什么建议可以告诉他们，该怎么调整饮酒习惯，或者怎么追踪自己的饮酒量吗？

Are there any tips that you can give them about how to modify their alcohol use or even how to track their alcohol use?

很多人其实根本没认真想过，自己每周到底喝了多少杯酒？

People might not be very intentional about even realizing how many drinks a week am I taking?

是的。

Yeah.

我觉得确实应该记录下来，把每次喝酒的数量都写清楚。

Well, I think it does make sense to track, to actually write down your alcohol consumption.

我们之前没提到过一点，我觉得关于饮酒量的指南很快就要调整了。

One point that we haven't mentioned before is that I believe the guidelines around alcohol consumption are going to be changing.

目前美国的建议是，男性每天最多两杯，女性每天一杯。

Right now we have in The United States this idea that men can drink up to two, drinks per day, women one drink per day.

但我觉得这个量实在太多了，尤其是对男性来说。

That's way more than I think we ought to be drinking, particularly for men.

我预计未来的指南可能会把推荐量降到每周三到五杯。

So I see those guidelines changing maybe to the level of three to five drinks per week.

至于你能做的，我觉得避免一次喝超过两杯的情况非常明智。

Now, in terms of what you can do, I think avoiding those instances where you drink more than two drinks at a time, I think, is very wise.

我们知道，酗酒会带来特别大的伤害。

We know that binge drinking causes particular harms.

所以我会从这一点入手。

So that's where I would start.

然后试着思考一下，我为什么会喝酒？

And then I think trying to think about, well, what are the reasons why I drink?

也许可以把饮酒限制在和别人一起社交的场合。

And perhaps limiting alcohol to those situations where there's social alcohol use with other people.

我们常常忽略了自己在什么情况下喝酒。

I think we often don't think enough about the situations in which we're consuming alcohol.

是的。

Yes.

我还注意到，现在这些设备——比如手表、戒指，能追踪睡眠的——让你很容易看出哪些行为影响了睡眠。即使数据不是百分百精确，也常常能揭示那些你以为无害的事，比如晚上喝咖啡或喝酒，其实严重降低了睡眠质量。

I'm also struck that with all of these devices, you know, the watches and the rings and the things that can track your sleep, it's very easy to see if something that you're doing is messing with your sleep because the data, even if it's not totally perfect, often shows you that the things you think are benign, like caffeine at night or alcohol at night are actually affecting the quality of your sleep.

是的，我同意。

Yeah, I agree.

非常感谢。

Thank you very much.

如果可以的话，我想接下来进入我们的新环节——未来速问速答，我会问你几个快速问题，期待你的快速回答。

And if it's okay, I'd like to move to our new feature, the future in a minute, where I ask you a few rapid fire questions and we get your rapid fire answers.

你准备好了吗？

Are you ready to go?

开始吧。

Shoot.

好的，太好了。

Okay, great.

有一件事，最让你对未来的前景感到希望的是什么？

What is one thing that gives you the most hope about the future?

我觉得是看到年轻人尝试戒酒，比如参加无酒月或无酒周。

I think it's seeing young people experimenting with stopping alcohol, having an alcohol free month or an alcohol free week.

你希望听众听完这一期后，最想记住的一件事是什么？

What's one thing you want people to walk away from this episode remembering?

酒精没有安全摄入量。

That there's no safe level of alcohol use.

除了钱之外，你做研究最需要的是什么？

Aside from money, what is the one thing you need to succeed in your research?

我最需要的是人们能相信科学，真正理解科学告诉我们：关于行为，我们其实有很多值得重视的发现。

The thing I need is for people to believe the science and to really take away from science the fact that we have insights about behavior that we ought to be paying attention to.

如果一切顺利，未来会是什么样子？

If all goes well, what does the future look like?

我觉得人们会更清醒、更谨慎地饮酒。

Well, I think that we will have much more conscious or mindful use of alcohol.

我不指望完全不喝，但我觉得暴饮的情况会减少，饮酒量也会降到对大多数人几乎不造成伤害的水平。

I don't expect that it's gonna be zero, but I think we'll have less bingeing and we'll have levels of use which get us into the point of kind of negligible harm, at least for most people.

而且我觉得，会有一些人需要彻底戒酒。

And I think that we will have people who need to stop drinking entirely.

如果你从头再来，想转行去拿另一个领域的学位或认证，你会选哪个？

If you were starting all over again and you needed to get your degree or your certification in a different discipline, what would that be?

这问题真不好答。

Well, that's a hard one.

我觉得我会专注肝病，因为再过二十年，这国家肯定会爆发一场危机。

I think I would focus on liver disease cause it really is gonna be a crisis in this country, you know, within the next, twenty years.

感谢兰德尔·斯塔福德。

Thanks to Randall Stafford.

以上就是酒精的未来。

That was the future of alcohol.

感谢收听本期节目。

Thank you for listening to this show.

我们的往期节目已经超过三百期了，如果你还没听过，强烈推荐你去听听。

We have more than 300 episodes in our back catalog and I really wanna encourage you to go listen to them if you haven't.

内容都很精彩，几乎可以无限循环地听下去。

It's good stuff and you can binge listen it forever, pretty much.

另外，如果你喜欢这个节目，别忘了给个评分和评论。

And also, of course, if you're enjoying the show, please rate and review.

我们经常说这话。

We say this all the time.

我们得喂饱这个算法机器。

We have to feed the beast.

算法就是那个机器，我们需要提供数据，让它向大家证明我们做得不错。

The algorithm is the beast, and we have to give it the data to show people that we're doing a pretty good job.

如果配得上五分，我们当然希望拿到五分，也希望大家在评论里分享对节目的看法和反馈。

We like to get a five point o if we deserve it, and that people have thoughts and responses to the quality of our show in the comments.

所以，感谢你考虑这么做，这真的很有帮助。

So thanks for considering that it really does help.

你可以在很多社交媒体上找到我。

You can connect with me on many social media platforms.

我在 Bluesky、Threads、Mastodon 和 LinkedIn 上的账号都是 Russ b Altman 或 RB Altman。

I'm at Russ b Altman or at RB Altman on Bluesky, Threads, Mastodon, and LinkedIn.

你也可以关注斯坦福工程学院，搜索方式是 Stanford School of Engineering 或 Stanford ENG。

You can follow the Stanford School of Engineering at Stanford School of Engineering or at Stanford ENG.

如果你对本集或之前的任何一集有疑问，欢迎通过邮件发送文字问题或语音留言给我们。

If you'd like to ask a question about this episode or a previous episode, please email us a written question or a voice memo question.

我们可能会在未来的节目中选用你的问题。

We might feature it in a future episode.

邮件地址是 thefutureofeverything@Stanford.edu，全部连在一起，不要空格。

You can send it to thefutureofeverything@Stanford.edu, all one word, the future of everything.

不要用空格、下划线或者连字符。

No spaces, no underscores, no dashes.

thefutureofeverything@Stanford.edu。

The future ofeverything@Stanford.edu.

再次感谢你的收听。

Thanks again for tuning in.

希望你喜欢这个播客。

We hope you're enjoying the podcast.