阿尔茨海默病、肝癌与中国研究

大家好，欢迎收听《柳叶刀之声》。现在是2025年10月。我是主持人加文·克利弗，今天与我一同参与节目的有《柳叶刀》主编理查德·奥顿，以及《柳叶刀》高级执行编辑杰茜·巴格纳尔，我们正在《柳叶刀》录音室录制新一期节目。本期将讨论《柳叶刀》最新发布的阿尔茨海默病重大专题系列及其对诊断、治疗和医疗体系的影响，同时关注肝癌全球负担与中国科研格局演变，还将分享基因组学带来的长寿新见解。

Hello, and welcome to The Lancet Voice. It's October 2025. I'm your host, Gavin Cleaver, and I'm joined today by editor in chief of The Lancet, Richard Orton, and senior executive editor at The Lancet, Jessamy Bagnall, for another episode recorded here in The Lancet's studios. In this episode, we're gonna discuss the recent launch of a major Lancet series on Alzheimer's disease and its implications for diagnosis, treatment and health systems, and we also turn our attention to the global burden of liver cancer along with the evolving landscape of scientific research in China. We also have new insights into longevity via genomics.

非常感谢各位的参与，希望你们喜欢本期对话。理查德、杰茜，欢迎再次来到《柳叶刀之声》录音室。今天议程非常充实，我们将从阿尔茨海默病话题开始。理查德，听说你最近参加了新委员会成立的发布会？

Thanks so much for joining us and we hope you enjoy the conversation. Richard, Jessamy, welcome back for another episode of The Lancet Voice here in The Lancet recording studio in the offices. We've got a packed agenda today. We're gonna kick off by talking about Alzheimer's. Richard, I believe you were at the launch of this new commission recently.

不如和我们说说发布会的情况？

So why don't you tell us about how that went?

谢谢加文。我们上周确实在日内瓦大学附属医院发布了这套关于阿尔茨海默病的专题文章。首先要说明的是，这个系列由我的同事拜尔主导，她是项目的核心人物。过去两年她与乔瓦尼·弗里索内合作完成了三篇论文，统筹了所有作者团队。事实上《柳叶刀》多年来在痴呆症领域做了大量工作。

Well, thanks, Gavin. Yes, we launched this series of articles actually on Alzheimer's disease last week in Geneva at the University of Geneva, their main hospital. I should say, first of all, that it was my colleague, Bayer, who led this series, and she was the star of this show for us. And she's been working on this project now for a couple of years with this guy called Giovanni Frisone, who has put together these three papers, organized all the teams of authors. We've actually done a lot on dementia at The Lancet over the years.

追溯到六七年前，我们发布了首个痴呆症委员会报告，由吉尔·利文斯顿领导。那是个里程碑式的项目，首次确认了一系列风险因素——若能针对性干预，可避免未来三分之一的阿尔茨海默病例，虽然——

If you go back six, seven years ago, we published our first commission on dementia, was led by Jill Livingston. And that was a real landmark project because for the first time it identified a bunch of risk factors that if you address them, you could avert as much as a third of all future cases of Alzheimer's disease, which

即便听众没读过报告，也一定见过那张著名的示意图。

And even if our listeners haven't read that, they'll almost certainly have seen the very famous diagram.

没错。那张精美的图表完美诠释了如何用一张图展现3万字报告的核心成果——所有干预措施的影响效果一目了然。吉尔后来还更新过两次委员会报告，最新版去年刚发布。

Exactly. The beautiful diagram, and it's really an example of how one you know, you've got 30,000 words of text, but really it was that one figure which shows the impact of all those interventions. Really superb. And Jill has actually done two updates of the commission. The last one was published last year.

但如果我要对这项工作极度自我批评的话，它确实提出了预防干预措施，但我们尚未实施，且我们忽视了诊断和治疗领域。阿尔茨海默病科学中一些最重要的进展恰恰出现在这些诊断和治疗领域。拜耳和乔瓦尼·弗里斯尼所做的正是聚焦于此。我不断提及同事拜耳的原因是，在加入《柳叶刀》之前，她实际上是从事阿尔茨海默病研究的博士后科学家，她本人就在这些领域发表过论文。因此她不仅是专家级编辑，更是参与该项目的科学家专家。

But if I was being super self critical about that work, it does identify interventions for prevention, but we haven't done, and we have neglected areas around diagnosis and treatment. And some of the most important advances in the science of Alzheimer's disease have really come about in those areas of diagnosis and treatment. So what Bayer and Giovanni Frisone have done is to really focus on that. And and the reason why I keep mentioning my colleague Bayer is that before she joined the Lancet, she was actually a postdoc scientist doing research in Alzheimer's disease, and she has published papers herself in these very areas. So she is not just the editor who's an expert, but she's the scientist who's an expert working on this project.

总之，重点是这个由三篇论文组成的系列研究了阿尔茨海默病的诊断与治疗，进而展望未来，探讨了如何设计医疗体系来应对该疾病的若干场景。毫无疑问，随着社会老龄化，我们看到病例数量呈绝对爆发式增长，残疾调整生命年数持续上升，但我们的医疗体系适应速度远远跟不上——坦白说，在某些社会领域，这已然或将演变成一场护理危机。确实存在诊断方面的问题，也存在获取这些新型治疗手段（如清除大脑淀粉样蛋白的单克隆抗体）的问题，但这仍非治愈方案，阿尔茨海默病患者仍需要护理，这正是我们需要重构医疗体系的原因。上周在日内瓦发布的这组报告获得了极大关注，甚至登上了《每日快报》头版——要知道《柳叶刀》通常不会出现在那里，所以我们非常...

Anyway, the point is that this is a series of three papers that looks at the diagnosis and treatment of Alzheimer's disease, and then looks ahead and looks at some of the future scenarios about how you would design health systems to address Alzheimer's disease. Because there's no question we're seeing an absolute massive increase in numbers of cases with the older society, increase in number of disability adjusted life years, but we just are not adapting our health systems fast enough to deal with this, what will become, if it's not already, to be honest, in some some areas of society, a care crisis. So there are issues around, yes, diagnosis, issues around access to these new treatments these new monoclonal antibodies that strip the brain of amyloid, but still it's not a cure for Alzheimer's, and you're still gonna have people with Alzheimer's who are going to need care, and that's where our health systems need to be redesigned. So that was the launch last week in Geneva, and we got great coverage. It made the front page of The Daily Express, and The Lancet doesn't usually make front page of The Daily Express, so we were very

除非我们说了什么坏话。

Unless we've said something bad.

除非我们说了什么坏话——特别是关于奈杰尔·法拉奇的。总之我们获得了极佳的宣传效果。这是个非常乐观、充满希望的系列，其中的科学发现确实令人震撼。

Unless we've said something bad, especially about Nigel Farage. But so so we got we got great coverage. It's a very optimistic series. It's a very hopeful series. The science is really, really, really astonishing.

是的，上周确实是...是个非常棒的日子。

So, yes, it was it was a it was a great day last week. It

确实如此。我欣赏作者们——特别是拜耳带领的团队——严谨地梳理证据并探讨不同议题的方式。正如我们上期播客讨论的，这些新药及其实际疗效存在争议，领域内分歧严重。记得弗里斯尼来办公室时曾明确指出：阿尔茨海默病具有惊人的复杂性。

was. And I liked the way the authors and, you know, led by Bayer, really carefully laid out the evidence and explore the different issues. Because as we discussed in our last podcast, there is some controversy around these new drugs and whether they really work. There's a real divide in the field. And, you know, remember when Frisoni came into the office actually, and what they're really saying is that Alzheimer's is incredibly complex.

即使被确诊的患者中，约85%都伴有其他病理变化。我们不可能找到万能解药，必须将其视为需要整体应对的疾病，尝试针对不同领域。基于现有科学认知，我们知道淀粉样蛋白是因素之一，会利用这点也会结合其他手段——这远非终点，而是探索管理方法的重要进程。正如你所说，全球5700万患者到2050年将增长两倍。

Even those that are diagnosed with Alzheimer's, probably eighty five percent of them have some kind of other pathology going on. And we're not gonna find a silver bullet. And we have to look at it as a much more holistic disease where we try and target different areas. We look at the science and we say, okay, well, we know that amyloid is playing a part, we'll use that and we'll use other things that this isn't the end, but this is very much part of the story towards finding some way of managing this. And as you were saying, fifty seven million people globally set to triple by 2050.

我是说，当你想到其中百分之八十到九十的人被收容在机构里时，这些数字确实令人心惊。这对长期护理意味着什么？对护理人员又意味着什么？这其中有许多方面需要深入探讨和剖析。而我认为这个系列节目正是迈出了第一步。

I mean, those are scary figures when you think that ninety to eighty percent of those are institutionalized. What does that mean for long term care? What does that mean for carers? There's so many parts to this that need to be explored and broken down. And I really think this series is the sort of first step in doing that.

是的。你提到的争议，我们《周刊》编辑部当然已经进行了大量讨论。今年早些时候出版的那本名为《篡改》的书，作者是位备受尊敬的科普杂志记者——所以字面意义上...

Yeah. The the controversy that you're alluding to, of course, we've had a lot of discussions about that in the editorial office of of The Weekly Journal. This book that was published earlier this year called Doctored, by a science magazine journalist, a very respected science magazine So that's literally

我在笔记里记下这点，是因为我们上期播客开场就讨论了那本书。而且我知道你们后来还专门为此召开了峰会来研讨它。

what I put here on my notes is because we we started off last podcast by talking about that book. And I I'm aware that you have all had your summit since to discuss the book.

哦，读书会啊。

Oh, book club.

对。'峰会'这个词对读书会来说可能太隆重了，但我就是想营造点宏大的感觉。所以我很想听听你们的读书会——或者说峰会——进行得如何。

Yeah. Oh, club. Summit is possibly too grand a word for the book club, but I really wanted to give it some grandiose feel, you know. So I'm interested to hear how your book club stroke summit went.

确实分为两部分。上次我们可能讨论过研究诚信问题——没错。关于是否存在整体性的研究诚信危机，我们意见有些分歧。有人坚信危机确实存在，也有人持保留态度。但读书会的第一部分重点讨论了淀粉样蛋白假说，因为这位记者通过两个明显的研究不端案例，构建了一套旨在推翻阿尔茨海默病淀粉样蛋白级联假说的论证体系。

Yeah, well there were two parts to it, and I think the last time we might have talked about the research integrity We did. The general research integrity crisis, is there one or isn't there one? And we're a bit divided on that. Some people felt strongly that there was definitely a crisis, others felt less so. But the but the first part of our book club summit was devoted to this question of the amyloid hypothesis, because what what what this journalist does is to take two cases of clear clear examples of research misconduct, and from those cases, build this edifice of argument to undermine the amyloid cascade hypothesis of Alzheimer's disease.

读起来会觉得他的论证非常有力。但实际上经不起推敲——当你把他列举的案例放在过去二三十年阿尔茨海默病研究背景下看，就完全不能得出淀粉样蛋白与阿尔茨海默病毫无关系的结论。当然这并非否认其他相关病理因素的存在，比如感染、炎症等近年探索的方向。上周新书发布会上有位讲者提到个有趣现象：目前正在研发的100多种新药中，只有少数与淀粉样蛋白相关。这说明还存在其他可能影响疾病发生、发展进程的机制，只是我们尚未完全掌握。

And it's you read the book, and it's very compelling the way he's put it all together. But in fact, it doesn't convince because when you set what he's done against the past twenty, thirty years of work into Alzheimer's disease, it's just not right to conclude that amyloid has nothing to do with Alzheimer's at all. It's not to say that there aren't other associated pathologies, infection, inflammation, other things explored we lately. And what was very interesting at the launch last week was that one of the speakers said, well, there are over a 100 new drugs that are currently in development, and only a small proportion of those are related to amyloid. So there are other mechanisms involved which might be relevant for initiation, might accelerate or slow the disease process or exacerbate it, we don't know.

这远不止淀粉样蛋白那么简单，但淀粉样蛋白在病理学中仍至关重要。这正是我们讨论的核心。因为要在群体层面治疗早期阿尔茨海默病患者——这些新型单克隆药物的适应症群体——就必须实现极早期诊断。这些单克隆药物价格昂贵、给药复杂，其副作用还要求患者定期接受核磁共振检查。因此要整合初级、二级甚至三级医疗资源及诊断设施来承接这项计划，规模之庞大令人难以想象，而我们甚至还未真正开始考虑这个问题。

It's much more complicated than just amyloid, but amyloid is still pretty fundamental to the pathology. So that's what we were really talking about. Because to be able to treat on a population level the people who have got early Alzheimer's disease, because that's the indication for these new monoclonals, you've got to have very early diagnosis. These monoclonals are not cheap, they're not easy to administer, they have side effects which mean that you have to have regular MRI scans. So to organize your primary care, secondary care, and even tertiary care and diagnostic facilities to be able to take on this initiative is just huge, and we haven't really even begun to think about it.

这就像是医学界心照不宣的秘密：我们都知道必须行动，却没人敢率先迈出这一步，因为它带来的变革实在太过颠覆。

It's kind of this little secret that we have in medicine that we know we need to do it, but nobody can quite have the courage to step forward and do it because it's just so transformational.

那么诊断环节存在哪些问题？

So what are the issues around diagnosis?

首先，如何早期诊断阿尔茨海默病？哪些人群属于高危群体？很多人虽有轻度认知障碍，但他们会主动就医吗？即便就诊并主诉记忆问题——说实话谁没有过记忆模糊的时候呢？我自己就常忘事，总要向别人求证——这种普遍现象该如何界定？

Well, how do you diagnose Alzheimer's early and who's at risk of Alzheimer's? Because people often have mild cognitive impairments, but do they go and see their GP, and then even if they do go and see their GP and they've had a few memory issues, and I think we've all had sort of memory issues, I forget things, and have to ask people what happened with this, and and we I all do it, we all do it.

我们这个播客不得不重录了三次才成功。

We had we had to start this podcast three times.

哦，天啊。确实如此。

Oh, wow. Exactly.

那么判断某症状可能病理化的临界点是什么？即便怀疑患病，具体诊断依据又是什么？总不能靠脑部活检来检测淀粉样蛋白吧。现在涌现出一批令人振奋的新型生物标志物，不过...这确实很有意思。

So what's the threshold at which you say something becomes potentially pathological? And then even if you think it has, what's the actual diagnosis? You can't do a brain biopsy to see if somebody's got amyloid. So there are a whole load of new biomarkers that are coming along that are very, very exciting. But but it's quite interesting.

它们现在准备好投入主流应用了吗？这个问题存在很大争议。有些人更乐观地认为生物标志物已准备好用于临床。另一些人则提醒要谨慎。推动这些生物标志物背后涉及大量商业利益，这使得它们完全不适合临床应用。

Are they ready for prime time yet? There's a big controversy about that. Some people are more optimistic that biomarkers are ready for clinical use. Others say, be careful. There's a whole load of commercial interests involved in promoting these biomarkers, which renders them absolutely not ready for clinical application.

所以当前的问题在于，这些新的单克隆抗体正在试验中进行测试。在某些地区它们已可用于临床。但说实话，我们完全没做好大规模使用它们的准备。

So the the issue at the moment, these new monoclonals, they're being tested in trials. They are available in some geographies for use clinically. But to be honest, we're not set up for their widespread use at all.

是的，我有个家庭成员可以说是我们讨论话题的典型案例。他在70岁出头时被诊断出路易体痴呆，但从60岁中后期开始，他一直被当作睡眠障碍治疗——现在回想起来那显然是早发性痴呆的表现。但他住在相当偏远的地区，全科医生坚信是睡眠问题，他无法保持睡眠，经常处于类似梦游的状态。他只在那家专科睡眠诊所接受过治疗。有趣的是，他们后来搬到了牛津约翰·拉德克利夫医院的偏远区域。当他在睡眠研究随访时，医生给他做了认知评估后反应是'哦，好吧，实际上...'

Yeah, I I have family member who's a kind of perfect case study of what we're talking about, he was diagnosed with what turned out to be Lewy body dementia in his early 70s, but since his mid to late 60s, he'd been treated for a sleep disorder that now, in retrospect, was obviously part of early onset dementia, but he lived quite rurally and the GP was convinced it was a sleep issue, he couldn't stay asleep, he was constantly kind of like sleepwalking. He was only treated for that center specialist, sleep clinics, everything. And funnily enough, they moved rurally to the casement area of the John Radcliffe in Oxford. And as soon as he went in there for further follow-up with the sleep study, they gave him a cognitive assessment and they were like, oh, okay, actually, let's

这是

This is something

是的，这完全是另一回事。

Yeah, this is something completely different.

对，对，这很有意思。我是说，全科医生在早期诊断前必须要有这种意识——你得先想到这个诊断才能做出诊断。说实话，至少几十年前我学医时确实缺乏这种意识，可能你也是杰瑟敏，我们读医学院时阿尔茨海默病根本没得到如今这样的重视。部分原因在于当时...

Right, right, well, that's very interesting. So yeah, I mean, the awareness for a GP, you've got to, before early diagnosis, you've got to actually think of the diagnosis before you make the diagnosis. And if you're not fully aware, and to be honest, certainly when I was it was many decades ago, but it may have been the case for you too, Jessamine, when we were at medical school, Alzheimer's disease didn't get the attention that we're trying to give it today. And you know, part of the reason it wasn't given the attention was that there wasn't much that

束手无策。

Anybody could do.

医护人员对此无能为力。

Medics could do about it.

医护人员向来不喜欢那样。

Medics never like that.

不，不。过去既无法进行手术，也没有特效药可用。直到最近几年才真正有了应对手段。所以我们——整个医疗体系实际上并未做好应对阿尔茨海默病的准备。

No. No. There was you couldn't operate on it, and you couldn't give some fancy drug for it. So it's only been in in relatively recent years that you can actually do something. So we're not really the the health workforce isn't really set up to deal with Alzheimer's.

所以我们确实远远落后于形势。我是说，科学发展如此迅猛，但医疗行业却远远跟不上步伐。

So we're really, really behind the curve. I mean, the science is, you know, moving ahead so fast, but I think the health professions are really behind that.

我同意。具体数据记不清了，但报告里提到未确诊阿尔茨海默病就去世的患者比例很高。关于生物标志物的伦理问题很有意思——它带来了太多道德困境。

I agree. And I forget the figure, but there's a figure in here about the percentage of people that die without a diagnosis of Alzheimer's. And it's a very high proportion. There are a lot of people that have Alzheimer's that never get diagnosed. And I think that's interesting about the biomarkers because it comes with so many ethical questions.

究竟该如何运用这些标志物？用于监测病程发展？用于确诊？还是用于筛查？未来一二十年内，医疗行业和整个社会都必须直面这些问题。

Because how do you use them? Do you use them for disease, to monitor disease progression? Do you use them for diagnosis? Do you use them for screening? These are the types of questions that we're gonna have to grapple with as a medical profession, as a society, over the next ten to twenty years.

癌症和阿尔茨海默病有个本质区别：人们固然畏惧癌症这个可怕诊断，但对阿尔茨海默病还存在种普遍恐惧。你很难找到不这么认为的人

And there's something very different about cancer and Alzheimer's. People are scared of cancer and it's a terrible diagnosis, but there is also a generalized fear of Alzheimer's. And you'd struggle to meet someone who didn't say

但关于癌症的好消息——如果我能这么说的话——是已有非常完善且资金充足的医疗服务体系来应对癌症。本系列中使用的‘脑健康服务’这个概念，在NHS或其他地方都未被广泛提及。我们常讨论癌症医疗服务、心血管疾病服务或中风诊所，却很少谈及脑健康服务，甚至很少讨论脑健康本身。事实上，这也是编辑团队反复讨论的议题之一，因为脑健康是个新兴概念。

But the good thing about cancer, if I can put it as a good thing about cancer, is that there are health services that are very well designed to deal with cancer and very well funded. And there's a phrase used in this series, which we don't use widely in the NHS or anywhere, and it's brain health services. We talk about cancer health services, or services for cardiovascular disease or stroke clinics, but we don't talk about brain health services. We don't talk about brain health. And in fact, that's another one of those issues that we've had some discussion amongst the editors about, because brain health is an emerging concept.

再问一次：它究竟是什么？与哪些领域相关？是神经病学与精神医学的融合吗？还是更侧重于预防——通过特定干预措施预防脑部疾病？就像吉尔·利文斯顿委员会展示的那样？它到底是什么？

Again, what is it? How does it relate? Is it a fusion of neurology and psychiatry? Is it something that's more about prevention, having the capacity to prevent diseases of the brain by doing certain interventions, a little bit like Jill Livingston's commissions have shown? What is it?

因此我们正在启动一个脑健康委员会来解析这个概念。当人们谈论心血管健康时，对健康心脏有明确认知。但人们对健康大脑却毫无概念，医疗体系也绝非为处理健康或亚健康大脑而设计。以英国为例，我能指出NHS记忆诊所的旧址，但它们现在基本都转入私营领域，在公立医疗体系中分布极其有限。

So we're we're actually launching a commission on brain health to try and understand what this concept is. We know when you talk about cardiovascular health, people have a clear idea of what a healthy heart is. But I don't think we have any idea of what a healthy brain is, and we certainly don't design our health systems to deal with a healthy or slightly unhealthy brain. For example, we don't have many, at least in The UK, I can tell you where an NHS memory clinic was. You know, they're in the private sector, but they're not very widely distributed in the NHS sector.

正如我们所说，这条路任重道远。本系列报道试图鸣响发令枪以激发公众兴趣。但需要后续行动——就像我们常说的，这个系列必须要有‘来世’。很幸运在日内瓦时，我们有世卫组织成员参与发布工作。我已致信询问能否在明年世界卫生大会上举办活动，向成员国推介本系列并展开深入讨论，因为这些宝贵成果值得更积极的推广。

So I think there's as as we're saying, there's a long way to go here, and this series is trying to fire a little bit of a starting gun to get people interested in these questions. And we but we need to follow-up. As we always say, this series needs to have an afterlife, and we were very fortunate to have somebody from the World Health Organization since we were in Geneva as part of the team launching this. And I've already written to a following up to see, could we have an event at next year's World Health Assembly to represent this series to member states to have some further discussion, because there's so much good work in here that we really need to promote it more assertively.

我认为公众对心血管健康与脑健康的认知差异巨大。前者已形成完整体系——知道要运动、健康饮食、保持良好生活习惯。而脑健康呢？数独问号。

I'd say the public perception of cardiovascular health versus brain health is quite different. One's developed cardiovascular health, know that you have to exercise, eat healthy, generally treat yourself well, brain health, sudoku question marks.

没错，等效措施是什么？阅读？不看无脑电视？不沉迷手机？但相关科学依据很少，多是主观意见。而关于健康心脏或肝脏的研究却浩如烟海。

Right, exactly, what's the equivalent? What's the equivalent? I know, that's I don't know the answer Reading, to not watching inane television, not doom scrolling on your phone? But there's really not much science, there's a lot of opinion, but there isn't much science, whereas there's an enormous amount of science about whether a healthy heart or a healthy liver is, so.

我妻子是神经科学家，现在可能正听着这段对话叹气呢。

My wife is a neuroscientist, probably listening to this and groaning, so Yeah.

她应该参加

She should be on

这个播客节目。

the podcast.

她可以

She can

花时间详细告诉我们，确切地说，

take time and tell us about Exactly, the

什么是健康的

what is I a healthy

我认为这是裙带关系，不是吗？所以我们要从一个非常难治疗的部位转到另一个历史上也相当难治疗的部位——肝脏。

think that's nepotism, isn't it? So we'll we'll move on from one thing that's very difficult to treat to another thing that's historically been quite difficult to treat, to the liver.

我们非常重视肝脏。肝脏曾经是——如果让我回顾的话——

We we love the liver. The liver was my was, if if I go back

你的初恋。

you first love.

那是我的初恋。肝脏无疑是人体中最美丽的器官。许多年前，我就想成为一名肝脏医生。人们总认为肝脏是个可怕的器官，只与肝硬化相关。但实际上，它绝对是身体里最美丽的器官——唯一能自我再生的器官。

It was my first love. It is the most beautiful organ in the human body by a long, long way. And so I I wanted to be a liver doctor many, many years ago, and people think the liver is this horrible organ, and it's all about cirrhosis. And, you know, in fact, it's it's absolutely the most beautiful organ in the body. It's the only organ that can regenerate itself.

你知道吗，多么神奇，多么惊人

You know, what an amazing, astonishing

你写过这类主题的文章吗？我绝对会读的，比如理查德写的《被低估的肝脏之美》

Have you written an article along these lines? Because I would definitely read it, you know, The Underappreciated Beauty Okay, of the Liver by Richard

我会考虑的，一定会认真考虑。我确实深爱着肝脏，千真万确。当你凝视它时，那种美令人心醉。

I will think about it, I will think about that. I definitely am in love with the liver, definitely, definitely. And it's beautiful when you look at it.

确实，它闪闪发光。

It is, it's shiny.

它闪闪发光，在显微镜下更是如此。其实有件事我一直想写，那就是疾病的审美性。人们认为疾病是可怕的，确实如此，且常伴随悲剧。作为医护工作者，我们理应关怀患者及其家属。但另一方面，疾病也有其诡异的美感，尤其从微观视角来看时。

It's shiny, and under the microscope as well, you know. I think, in fact, I'll tell you one thing I do want to write about, and that's the aesthetics of disease. Because people think disease is awful, and it is awful and often tragic. And we should, as a caring profession, definitely minister to those with disease and families who have to have that lived experience of disease around them. But at another level, disease has its strange beauty to it, especially when you think about it from a a micro point of view.

因此，我想以一种不同的方式探讨疾病问题，重塑我们对疾病的认知。疾病具有多重维度，并非全是负面影响。

So I'd like to shine a light on disease in a slightly different way and rehabilitate our feelings about disease. There are many different dimensions to it and they're not all negative.

听起来像是一个委员会的任务

Sounds like a commission to

对我而言是的。或者说是一本书。

me. Yes. Or a book.

上个月我们在上海启动的这个肝癌防治委员会，是由中国同事——特别是复旦大学——牵头，但关注的是全球肝癌负担。这是我们首次由中国主导针对全球性议题的委员会。这有其原因：肝癌发病明显偏向亚太地区。正如我们讨论阿尔茨海默病时提到的，预计到2050年新增肝癌病例将翻倍。但我们在肝癌防治方面大有可为。

Now, this commission that we launched in Shanghai last month, a commission looking at liver cancer and what to do about it, We've had several commissions from China, but they've usually been commissions about issues This was a commission led by colleagues from China, particularly from Fudan University, but it's a commission that looks at the global burden of liver cancer. So it's the first time we've had a commission led from China about a global issue. There's a reason for that, and that is that the pattern of liver cancer definitely is biased towards Asia, the Asia Pacific region. Again, just as we've been talking about with Alzheimer's, the projections are that we're going to see the number of new liver cancer cases almost double between now and two thousand and fifty. But there is a lot that we can do about liver cancer.

而且潜力巨大，尤其是乙肝疫苗接种。到2050年，乙肝将成为肝癌的首要诱因。

And, again, in enormous potential, not least vaccination against hepatitis b. By 2050, hepatitis b is gonna be the leading cause of liver cancer.

这就是该病在亚洲高发的主要原因吗？

And is that the main reason that this skews towards Asia?

正是如此。酒精使用和其他代谢因素会越来越常见，但委员会估算的数据——我第一次看到时还以为是笔误——确实令人震惊。这就是这类委员会的价值所在：它们总能发现让你驻足深思的惊人事实。

Exactly. Exactly. Exactly. Alcohol use and other metabolic causes are going to become more common, but we what what this commission estimates, which is actually when I first saw the figure, I thought it was a typo because I couldn't quite believe that this was the case. You know, sometime this is why these commissions become so interesting because they discover something, and it stops you in your tracks when you see the figure.

据他们估计，60%的肝癌是可预防的。60%。试想2050年将新增150万肝癌病例，150万这个数字非常庞大。但如果我们能及时干预，其中60%本可避免。我们的干预措施主要包括推广乙肝疫苗接种、控制酒精摄入以及解决肝癌的代谢性诱因。

What they've estimated is that sixty percent of liver cancers are preventable. Sixty percent. So if you think that there's gonna be one point five million new cases of liver cancer by 2050, one point five million, that's a that's a lot. But sixty percent of those are preventable if we could intervene. And we're basically intervening around hepatitis b vaccination, about addressing alcohol, and addressing these metabolic causes, of liver cancer.

因此，这份委员会报告既是敲响警钟，也应被视为开展高价值行动的绝佳机遇。需要说明的是，我们启动该委员会时，正值美国社会对疫苗安全性提出质疑、同时呈现乙肝疫苗接种证据的时期。这是个极其迫切的议题——我们必须全力支持乙肝疫苗接种。关键点在于：乙肝疫苗应在新生儿出生首日接种。

So, you know, this is a again, it's a commission that that rings an alarm bell, but should be seen as an amazing opportunity to to do something of immense value. I would just say that we launched this commission all around the time when these question marks were being raised around vaccine safety and when evidence was being given around hepatitis B vaccination in The United States. And and this is a very a very live issue. We should be absolutely supporting hepatitis B vaccination. And the the point about when you give hepatitis B vaccine, you're supposed to give it on the first day of birth.

这个时间点至关重要。美国当时有人主张'乙肝是性传播疾病，应等到儿童10-12岁再接种'，这种观点完全违背科学证据，是彻头彻尾的错误建议。参议院听证会上甚至出现过这种论调，连特朗普总统本人也这样说过。

It's it's that's key for all all kinds of reasons. And what was being argued in The US was hepatitis b is a sexually transmissible disease, and you shouldn't have to give it to children until they're 10 or 12 years old. And this is completely against all the scientific evidence. It's completely the wrong advice. That this is what was being said at these senate hearings, and even president Trump said it himself.

这是错误信息，甚至可称为虚假信息。本委员会的使命正是彰显乙肝疫苗接种对防控肝癌的核心重要性，并倡导在最早可能时机进行接种。

This is misinformation. Some might even say it's disinformation. And what this commission does is to show absolute central importance of hepatitis B vaccination for the eliminate or the control of liver cancer and giving it at the earliest possible opportunity.

完全正确。我们还有个结直肠癌委员会，由中国合著者领导，近期我们另一位编辑也参与其中。您过去二十年多次访华——今早我听新闻提到中国推出K签证，您听说了吗？旨在吸引海外科学家赴华。

Absolutely. And we've got another commission, the Colorectal Cancer Commission, which is being led by a Chinese co author, and one of our other editors was there recently. And you've visited China many times over the past twenty years. I was listening to the news this morning, they're bringing out this China K visa, have you heard of this? To try and attract scientists from abroad to China.

关键是不需要事先获得工作offer。该政策主要面向科学家和AI研究人员，不仅希望吸引美籍华裔学者，更欢迎全球各国人才，包括英国等地的研究者，以此打造更具国际化的科研社区。

So you don't, crucially, you don't have to have a job offer. And it essentially is aimed at scientists and AI researchers to try and draw people into China, not just Chinese who have emigrated and working in The US, but anybody, English, from wherever you are, to try and make it a much more international community.

这非常有意思。过去二十年我见证了中国——我想他们也会认同我的观察——从科研相对欠发达国家跃升为科学超级大国的历程。其科研机构与医疗中心向学术型机构转型的发展速度，确实令人叹为观止。

Well, that is very interesting. I didn't know that. I have watched over the last twenty years China go from a and and I think they would agree, I'm not being unkind, a sort of relatively underdeveloped scientific nation to now being a scientific superpower. I mean, there's no question. The velocity of development of scientific institutions and hospitals which become academic centers, medical centers, has just been phenomenal.

我确实对高等教育和研究领域的投资感到惊叹。最近出版的一本书试图分析中国为何能成为科学强国，这非常有趣。书中提出的观点是：谁在管理西方国家？答案是律师主导着西方。

I marvel actually at the investment that's been put into higher education and research. I think it's quite interesting that there's a book that's been published recently that tries to analyze why has China become this scientific superpower. And the argument is who runs Western countries? The answer is lawyers run Western

国家。这不公平。

countries. That's unfair.

那么，律师是做什么的？他们制定法规，编写法律。而法律的作用是什么？法律阻止我们做某些事。

And and and, of course, what do lawyers do? They write regulations. They write laws. And what do laws do? Laws stop us from doing things.

当然我们需要这种约束。不能任由所有人随心所欲地伤害他人。律师有其存在价值，但这本质上就是我们的社会——由制定法规的律师主导的西方社会。中国则完全相反。

Well, that's we need that. We can't all go around doing everything we want to harms other people. So there's a place for lawyers, but that's basically our society. Western societies run by lawyers who write regulations. China, completely the opposite.

他们由工程师和科学家管理。工程师做什么？他们建设，他们创造。那么中国擅长什么？

They're run by engineers and scientists. What do engineers do? They build things. They make things. So what what is China good at?

建设和制造。或许我们需要减少律师对社会的主导，增加工程师和科学家的参与。中国或许也需要一些律师参与社会治理。但他们的优势在于深刻理解科学对发展和经济增长的核心作用。而我们关于制造业的所有争论，甚至对制药业投资不足的讨论，都证明我们仍未真正明白。

Building things and making things. So so so maybe what we need to learn the lesser of, we need fewer lawyers running our society and more engineers and scientists. And maybe maybe China needs a few lawyers as well running its society. But but what the advantage they've got is that they are just supremely brilliant at understanding the centrality of science for development and for their economic growth. And we've kind of all the debates we have about manufacturing industry, even investment in the pharmaceutical industry or lack of, in this country anyway, attest to the fact that we still don't really get.

科学不仅仅是经济中为自身利益游说的一个组成部分。它具有根本性的重要意义——关乎发现，进而发展这些发现并将其应用于我们的生活。而我们却已遗忘这些真谛。

Science is not just another part of the economy which is lobbying for its own self interest. There's something very fundamentally important about science. It's about discovery, and then it's about developing those discoveries and implementing those discoveries in our lives. And we've just forgotten those lessons. And

它极大地推动了经济的其他部分。你知道吗？在中国就能看到这种现象。

it drives so much of other parts of the economy. You know? You see that in China.

影响深远是因为你看——虽然我记不清具体数字——但中国大学每年培养出数以万计的工程师。相比之下我们培养的只是涓涓细流，这要归功于他们的教育体系。从学生时代起，工程学就被视为崇高职业。我上大学时，那些土木工程或机械工程专业的学生，都是留着油腻长发、在学生会里被大家忽视的角色，因为他们不怎么洗澡。而在中国，这些人被奉为精英中的精英。

So much because then it drives you know, if you look at the I can't remember the actual number, but it's literally tens of thousands of engineers come out of China's universities every year. I mean, we have a trickle by comparison, but that all goes back through their school system. So right from being at school, you know, it's seen as something rather admirable to do engineering. When I went to university, all the people who were who did civil engineering or or or mechanical engineering, they they were the ones with long greasy hair, who you kind of generally ignored in the student union, because they didn't wash very much. In China, those people are elevated to be the elite of the elite.

是啊。而我们根本没做到这点。所以我们需要给予工程师和科学家更多应有的尊重。

Yeah. And we we just don't do that. So, you know, we we need to we need to give more credit to our engineers and our scientists than we do.

但我觉得很有趣的是，他们正试图在国际上与美国的科学家和工程师资源不对等的情况下吸引人才。

But I thought it was very interesting that they're trying to draw scientists and engineers internationally in the asymmetry with The US.

这完全合理对吧？现阶段吸引美国科学家显然是最明智的策略。

Which makes perfect sense. Right? At this point, to try and attract US scientists is just the obvious play.

但我不确定。你觉得英国科学家会如何看待这种局面？

But I don't know. I mean, would you would you what you think it would be like as a a UK scientist meeting?

是的。文化方面...怎么说呢

Yes. The cultural Well, what

我认为这取决于你去哪里。要知道，他们在吸引美国华人人才回国方面做得非常好。我是否愿意短期借调到北京工作？当然愿意。我的意思是，和任何国家一样，如果你不会说当地语言，也没有融入社交网络，那显然会很有挑战性。

I think it depends where where where you go. So it is you know, they have done very well at bringing back Chinese talent from The United States. Would I want to go and work in Beijing for for secondment for a short term? Yes, absolutely. I mean, as with any country, if you don't speak the language and you're not embedded in friendship networks, then that's obviously gonna be challenging.

但去那里待一两年的话，现在英语已是学校系统里最常教授的语言，所以现在有一代年轻人英语流利得惊人。我们的学校很少教中文，在这方面确实处于劣势。不过，如果我想去像清华这样的大学工作，那里有绝佳的校园环境，研究设施的投资令人惊叹。正如我所说，英语是常用的教学语言。

But going there for a period of time, one or two years, English is now the language that's most commonly taught in the school system, so there's a generation of young people now where they are just incredibly fluent in English. We don't teach Mandarin in our schools very much, so it's definitely at a disadvantage there. But certainly, if I wanted to go and work at a university like Xinghua, it's a fantastic campus. The investment in the research facilities is amazing. As I say, English is commonly used as a language for teaching.

如果我能年轻二三十岁，我会毫不犹豫地在中国工作几年。要知道，三十年前我曾为《柳叶刀》杂志在纽约生活过两年。现在如果有人问我，或者时光倒流他们问，是否愿意去北京或上海为《柳叶刀》工作两年，我绝对会立刻答应。

I wouldn't think twice about spending a couple of years if I was twenty, thirty years younger than I working in China. You know, thirty years ago I went to live in New York for two years for The Lancet. Now if somebody said to me, or if I rewind time back and they said, would you go and live in Beijing or Shanghai for two years and work for The Lancet, I'd absolutely snap it up.

我们是在向中国提供什么修道院吗？虽然我觉得自己年龄正合适，不过把狗带过去可能会很困难。但我很乐意去中国待上一两年，听起来太棒了，我完全同意。

Are we offering some convents to China? Because I think I'm of roughly the right age, although I reckon getting my dog over there would be difficult. But I mean, would happily go and spend a year or two in China, I think that sounds fantastic, I agree.

我认为这真是个令人兴奋的发展。对国家而言，这是让科学界国际化的绝佳机会。

I think it's such an exciting development, really. What an amazing opportunity it is for the country to try and internationalize their scientific community.

当然，中国面临着人口结构问题，这可能是某些政策的动机。要知道，预测显示到本世纪末中国人口将从14亿减少到7亿。也就是说75年内人口减少50%。现在是2025年，现在出生的人75年后应该还活着。但到他们75岁时，国家规模将只有现在的一半。

Of course, there is a demographic problem that China faces, which is which might be motivating some You of know, again, the projection is that China's gonna go from 1,400,000,000 people to 700,000,000 people by the end of this century. So that's, you know, 50% reduction in the population of China within 75. So it's 2025 now. So somebody born now will be alive, hopefully, in seventy five years' time. But by the time they're 75, their country will be half the size that it is.

虽然人工智能在经济上会很出色并能提高生产力，但推动经济还是需要人。更重要的是，需要有人推动经济来赚钱，以支付庞大的老年人口的养老费用。

Now that okay. I'm I'm sure AI is gonna be wonderful economically and drive productivity, but you need people to drive the economy. And even more, you need people to drive the economy to earn the money to pay for the care of the older population, of which there will be an enormous number

太多了。

So many.

在中国，他们的劳动力将大幅缩减。需要照护的老年人口将急剧增加。这是个问题，只有两种解决方式。

In China. So and their so their their workforce is going to contract massively. The number of older people requiring care will increase massively. There's a problem. And there's only two ways to solve that.

一是多生孩子，二是引进移民。但他们还没解决多生孩子这部分，那么能通过吸引移民来解决吗？

One, have more children or two, import people. So, you know, they haven't solved the the have more children part of that equation. So can they solve it by getting people to move there?

我记得中学时就被教导全球人口定时炸弹即将引爆。老师总说，当劳动年龄人口达到峰值时，真正的问题才会开始。三十年前我还在想，到时候总会有人解决吧。结果根本没人提这事。

I feel like when I was at secondary school, we were taught about the worldwide demographic time bomb that's gonna go off. And I was always taught, when you get to peak working age, that's when the real problems are gonna start. And I was like, you know, thirty years back thinking to myself, well, someone would have done something about it by then. And no one's said anything about it. No.

现在我们都看到了。

And here we are.

不，这个人口结构挑战确实是我们面临的最有趣也最棘手的问题之一。未来有很多难以预测的事情，比如人工智能究竟会带来什么影响？

No. Well, it's it's it's I I think this demographic challenge, it's one of the most interesting but intractable ones that we face because there are many things that are gonna happen in the future which are very difficult to predict. You know? It's it's hard to know what AI is really, really going to do. You know?

我无法确定二十年后是否会有原子弹爆炸，也无法预知下一场新冠级别的疫情何时发生。只能给出大致概率，但可以确定生育率不会突然回升——不存在什么灵丹妙药。到本世纪末，西班牙、意大利、葡萄牙这些国家的人口将缩减50%。

I can't predict for sure whether an atomic bomb is going to go off in twenty years' time or not. I can't be sure when the when the next COVID, like, pandemic is gonna happen. I can give a rough probability, but I can't be sure. But I can be sure that fertility rates are gonna be sticking pretty much to there's not gonna be some magic bullet that's gonna solve this. So we're going to see countries like Spain, Italy, Portugal, have their populations also contract by 50% by the end of the century.

波兰和德国等国家将面临人口大幅减少。许多前东欧集团国家也将出现类似的人口减少，如果无法支撑老龄人口，其经济和社会结构将变得极其脆弱。讽刺的是，当前反移民言论盛行之际，恰恰是那些对流动人口高度开放的国家将在未来取得成功。这就是人口政治学的现实。

Countries like Poland and Germany are gonna see significant reductions in their populations. A lot of the Eastern Bloc former Eastern Bloc countries are going to see similar reductions in population, making their economies extremely fragile and indeed their societies extremely fragile if they're not able to support their older populations. So it's gonna be the countries that are very, very open, which is also bizarre given that we've got the sort of rhetoric against migration at the moment. It's gonna be the countries that are very open to mobile populations that are going to succeed in the future. So, you know, this is where the politics of the demography

西方世界当前的布局并不利于成功。

The the West is not currently setting itself up to succeed.

确实如此。我们正在为重大失败埋下伏笔。我们必须接纳未来人口增长的主要来源——撒哈拉以南非洲地区。我们需要以开放态度迎接这一趋势并做好准备。

It's not. It's absolutely not. We're setting ourselves up for a massive fail. And we also need to embrace where population is going to grow from, which is going to be Sub Saharan Africa. And we need to be welcoming that and preparing for it.

到本世纪末，撒哈拉以南非洲人口将从约10亿增长到30亿。这意味着全球90亿人口中，每三人就有一人来自该地区。我们当下为此做了哪些准备？我们如何与非洲国家建立良好外交关系？

Again, you're going to see the population in Sub Saharan Africa grow from around 1,000,000,000 to 3,000,000,000 by the end of the century. Well, that's 3,000,000,000 out of 9,000,000,000. No, one in three people on the planet will be coming from Sub Saharan Africa. So what are we doing today to prepare for that? How are we building good diplomatic relations with African countries?

我们是否在非洲投资教育、投资医疗？没有。我们实际上正在撤退，缩减发展援助——

Are we investing in Africa, investing in education, investing in health services? No. We're not. We're actually retreating. We're pulling back our development, which is

寿命更长也更健康。

the age Longer and healthier.

更长寿。我认为更健康才是关键。杰西米，你想谈谈《自然》杂志那篇关于一位117岁长寿女性的研究报道？

For longer. Healthier, I think, is the key there. And so, Jessamy, you wanted to talk about a piece in Nature that looked at a woman that lived to 117, and some studies that were done on her.

是的。这是一项针对已确认的最长寿老人进行的高通量多组学研究。论文里好像称她为M1197。不知道为什么这么命名。不过挺有意思的，对吧？

Yeah. It's this high throughput multiomics study that was done on the oldest living person confirmed. I think they call her something like M1197 in the paper. I don't know why. But it's interesting, isn't it?

因为他们研究了大量基因变异，发现她在心血管风险和阿尔茨海默症相关基因方面简直中了基因彩票。但研究还涉及很多关于饮食和肠道菌群的内容——我觉得这部分研究明显严重不足，我们所有人都...

Because they look at lots of different genetic variants and find that she sort of won the genetic lottery in terms of cardiovascular risks and indeed for genes for Alzheimer's. But then there's also a lot there about diet and her microbiome, which is obviously a hugely, I think under researched and under understood. I think we all-

看完这篇文章后，我真的觉得自己该多吃点酸奶了。

I really feel like I'm upping my intake of yogurt after reading this article.

哦对，我是说从现在开始要一天喝三次酸奶。

Oh, right. I mean, it's yogurt three times a day from now on.

没错。这样能调理菌群。117岁的长寿秘诀。记得选低糖酸奶。

Yeah. And that fixes the biome. Yeah. 117. Low sugar yogurt.

当心点。你得...

Be careful. You gotta you

继续看

look on

像是樱桃酸奶。

the like cherry yogurt.

看，我每天早上都喝酸奶，但后来在报纸上看到，我喝的那个品牌酸奶含糖量太高，这正是我喜欢它的原因。所以现在我打算改喝低糖的。

Look on the I have yogurt every morning, but then I read in the newspaper that the yogurt, the brand of yogurt I have has too much sugar in it, which is why I enjoy it so much. So now I'm gonna have to go for the low sugar.

但它含有很多细菌吗？如果有的话，也许能起到平衡作用。

But does it have a lot of bacteria? Because if it does, maybe maybe that balances

这太离谱了。真的。这是我们这期播客里最中产阶级的言论了。不过你可以试试用快煲锅做，效果非常好。

That's out. True. It's the most middle class thing we're gonna say on this podcast. But but you could try making it an instant pot. It's very good.

杰斯敏，我刚才在纠结这个词的发音。

I was struggling, Jesmyn, with the pronunciation of this word here.

哦，端粒。端粒。端粒。这是DNA中非常有趣的部分，人们正在研究它。端粒长度与你的年龄之间存在某种关联。

Oh, telomeres. Telomeres. Telomeres. There are these very interesting parts of the DNA that people are researching. And there's some sort of association between the length of your telomeres and how old you are.

所以在旧金山和硅谷，有很多初创公司在研究如何延长端粒。

And so people who are in San Francisco and Silicon Valley, there's lots of sort of these startups looking at how can we try and lengthen Telemis.

硅谷的投资规模真是惊人，对吧？

It is amazing the amount of Silicon Valley investment, right?

天啊。

Oh my gosh.

延长寿命。

Extending the lifespan.

实际上，我并不太想大幅延长自己的寿命。

And I don't think I'd want to extend my lifespan that much, actually.

不，我指的是这篇《自然》文章中的主角玛丽亚·布拉纳斯·莫雷拉，用她的全名而非编号来称呼她，这样感觉更有人情味。

No, I mean, the person featured in this Nature article, Maria Branas Moreira, to give her her full name rather than her number, which feels more personable.

她出生于旧金山，但后来回到了加泰罗尼亚。值得注意的是，这篇发表在《细胞报告医学》期刊上的研究论文的主要作者们——这本期刊由我们的姊妹公司爱思唯尔细胞出版社出版——全都来自加泰罗尼亚。确实，任何在加泰罗尼亚生活过的人都知道，那里简直是世界上的微型天堂。完美的气候、美丽的海景、绝佳的美食，难怪她能活到一百多岁——换作是谁在那种地方不都能长寿吗？

She was born in San Francisco, but then went back And to I note that a lot of the leading authors of this research paper, was published in a journal called Cell Reports Medicine, so by our sister, bit of Elsevier Cell Press, they all come from Catalonia. Yes. Well, anybody who's spent any time in Catalonia, I mean, is a little micro paradise of the world, So it's not surprising that she's lived to a 100 and whatever she's lived to, because wouldn't we all in a place like that, which it has the most perfect weather, beautiful sea, amazing food.

是啊。

Yeah.

确实如此。我确实想知道波旁耳朵占去了我生命中的多少年。

It's true. I do wonder how many years of my life Bourbons Ear has

准确。精确。精确。精确。精确。

taken Exactly. Precisely. Precisely. Precisely. Precisely.

而且他们在实验室里完成了这项了不起的多组学蓝图，所有这些工作都很棒。抬头看看。环顾四周，想想她为什么能活得这么久，因为她生活在天堂般的加泰罗尼亚。你不觉得这有些——我是说，我不了解伯蒙西，我确信那里很棒，但这就是重点所在。

And and they've done this wonderful multi omics blueprint, all this stuff in the lab, which is great. Look up. Look around you and wonder why she's lived so long because she lives in the paradise, which is Catalonia. And don't you think that has some I mean, I don't know Bermondsey. I'm sure it's wonderful, but I exactly the point.

正是这个重点。

Exactly the point.

不是加泰罗尼亚，对吧？

It's not Catalonia, is it?

不，不是加泰罗尼亚。你在伯蒙西可享受不到地中海饮食。

No. It's not Catalonia. You're not having the Mediterranean diet in Bermondsey.

是啊。我只能看着泰晤士河冲刷上来的东西。

No. I'm watching stuff wash up on the Thames Right.

看起来情况不太乐观。确实如此。要知道，我认为这是一项杰出的科研成果，但他们或许也需要兼顾环境因素。考虑到这位女士并非生活在世界上的贫困地区。

It doesn't look great. Exactly. So, you know, I think this is, you know, a wonderful piece of science, but maybe they also need to balance it with The environment. With thinking about the fact that this woman is not living in a bad part of the world.

所以这就是你长寿的秘诀吗？

So is that your that's your key to to long life?

我的长寿秘诀，没错。我的长寿秘诀就是找到适合居住的地方，然后放手去生活。对，当你找到理想居所时，尽情享受。不过说实话，那里确实很美好。

My key to long yeah. My key to long life is find the right place to live and and then just go for it. Yeah. Enjoy enjoy it when when you found your your perfect place. But, no, I mean, this is it's lovely there.

好的。既然我们已经找到了理想居所，或许该就此打住了。理查德、杰萨米，非常感谢两位再次做客《柳叶刀之声》。再次感谢各位收听《柳叶刀之声》，如果想收听更多柳叶刀播客节目，请访问thelancet.com/podcast，我们所有节目都在那里。

Alright. That's probably a good place to stop as we found our our perfect place to live. Richard, Jessamy, thank you both so much for for joining me again on The Lancet Voice. Well, thanks once again for joining us here at The Lancet Voice. If you're interested in listening to more Lancet podcasts, you can go to thelancet.com/podcast where you'll find all of our offerings.

感谢收听，我们下次再见。

Thanks for joining us, and we'll see you again next time.