喬布斯生前醫生倡導全新抗癌之道大綱
At a meeting of the nation's top oncologists in Denver a couple of years back, Dr. David Agus, a prominent cancer researcher, was giving a keynote address. Agus talked about the need to take a new approach to treating cancer. He argued that focusing on killing or slowing the spread of cancerous cells was not enough. After all, despite a half-century of research by some of the best medical minds in the world, the death rate from cancer hasn't changed much since the 1950s. Instead, doctors should try to keep a patient's entire system healthy so the disease is less likely to take root in the first place. He said we should be able to control cancer without fully understanding it. At that, hisses arose from the audience.
幾年前，在丹佛舉辦的一次全美頂尖腫瘤學家的會議上，知名癌症專家大衛·阿古斯博士做了一次專題演講，指出有必要採取一種新的方法來治療癌症。他認爲，只關注如何殺死癌細胞或減緩癌細胞的擴散是不夠的。半個世紀以來，儘管世界各地的醫學精英爲攻克這一難題進行了不懈的研究工作，但今天的癌症死亡率並沒有比上世紀50年代降低多少。因此，醫療人員應該想辦法保持病人整個機體的健康，從根本上降低腫瘤在人體內紮根的可能性。他表示，雖然我們目前還不完全瞭解癌症的病理機制，不過我們依然應該有辦法控制癌症。說到這裏，聽衆中響起了一陣噓聲。
A few Bronx cheers aren't enough to discourage a scientist as determined as Agus. He believes he has found a new way to greatly reduce the odds of getting sick and has set out his philosophy in a potentially game-changing new book, The End of Illness, which just became a New York Times bestseller. In it, he offers his prescription for preventive medicine, and backs it with studies and lively anecdotes.
不過這點噓聲並不能使像阿古斯這樣堅定的科學家感到氣餒。他相信他已經找到了一種辦法，可以大大降低人體生病的機率。阿古斯把他的理論寫成了一本有可能具有顛覆意義的新書——《疾病的終結》（The end of illness），這本書剛剛登上了《紐約時報》（New York Times）的暢銷排行榜。阿古斯在書中闡述了他的防病理論，並用相關研究和生動的病例進行了佐證。
When I caught up with this slim, casually dressed man, he rattled off ideas as if he couldn't let the world know fast enough about his thinking: "I want doctors to treat toward health and not treat toward disease," he said. Agus had his eureka moment after reading a 2004 Fortune article called "Why We're Losing the War on Cancer," by Cliff Leaf. Himself a cancer survivor, Leaf, a Fortune editor at the time, wrote that researchers have come to treat the individual features of cancer rather than putting their efforts into directly controlling cancer. "We have forgotten that curing cancer," says Agus, who was on the team of doctors who treated Steve Jobs in the last years of his life, "starts with preventing cancer in the first place."
我採訪這位身材瘦削、衣着隨意的醫學家時，他飛快地介紹着他的想法，彷彿唯恐全世界不能儘快瞭解自己的思想。他說：“我希望醫生們從病人健康時就着手治療，而不是到生病時纔去治。”阿古斯的靈感來自他2004年在《財富》雜誌（Fortune）上讀到的一篇文章：《爲什麼我們輸掉了與癌症的戰爭》（Why We're Losing the War on Cancer）。文章作者克里夫·利夫當時擔任過《財富》雜誌編輯，他本人就是一名癌症倖存者。他寫道，癌症研究人員們習慣於治療癌症的各種症狀，而不是設法直接控制癌症。史蒂夫·喬布斯去世前的最後幾年，阿古斯也是喬布斯治療團隊的一員。阿古斯說：“我們忘了治癌要從防癌開始。”
Today, if we get cancer, we attack the cells. If we get a heart attack, we perform a bypass. That's fine, but why not avoid the disease in the first place? Agus believes that diseases like cancer and heart disease should be thought of as verbs and not nouns. In his lexicon, "cancering" suggests a systemic problem. He points to a study of women who, after treatment for breast cancer, were given either an osteoporosis drug or a placebo. The ones who took the drug had a 40% lower rate of recurrence of the cancer, as their system was changed and the cancer didn't grow back. "Keep the soil healthy," says Agus, "and the bad seed won't grow."
今天，一旦病人得了癌症，我們就會試圖去殺死癌細胞。如果病人心臟病發作，我們就做心臟搭橋。這無可厚非。但我們爲什麼不能“防病於未然” 呢？阿古斯認爲，我們應該把癌症和心臟病這類疾病看成一個動詞，而不是名詞。在阿古斯的字典裏，“患有癌症”意味着一個系統性的問題。他指出，在一項研究中，一組女性在接受了乳腺癌治療後，醫生向她們發放了一些治療骨質疏鬆的藥物或安慰劑。但服用了這些藥物的患者的複發率卻比平均水平低了40%。隨着她們的身體系統發生良性改變，癌症沒有再復發。阿古斯說道：“只要保持土壤健康，壞的種子就無法萌芽。
One way to keep your body's soil healthy is to treat inflammation. When something is wrong with your body, it goes into panic mode and triggers inflammation, a process that rallies the vascular, immune, and cellular systems to heal injured tissue. Numerous studies show that patients who take statins — which not only lower cholesterol but reduce inflammation — lowered cancer rates by 40%, although no one knows exactly why. That's not all. A growing body of evidence suggests that inflammation may be linked to a host of other diseases, from heart attacks to Alzheimer's to diabetes. This doctor's orders? Ask your physician if you should be on Lipitor or other statins and a regimen of baby aspirin, which help curb your body's inflammation.
保持身體土壤健康的方法之一是治療炎症。身體出毛病的時候，人體機能就會進入一種恐慌模式，引起炎症。發炎這個過程就是身體在調動血管、細胞和免疫系統來修復受損的組織。大量研究表明，服用他汀類藥物的病人，患癌機率會降低40%，只是具體原因尚不明確。他汀類藥物不僅能降低膽固醇，還可以消炎。此外還有越來越多的證據顯示，炎症可能與大量其它疾病有着聯繫，如心臟病、老年癡呆、糖尿病等。阿古斯對此有何建議呢？可以詢問醫生，看看是否可以服用立普妥（Lipitor）或其它的他汀類藥物，或經常服用小劑量阿斯匹林來養生，這有助於人們控制身體的炎症。
There are other simple ways to fight inflammation. Agus explains that it's better to walk a lot than to do an intense burst of exercise and then sit behind a desk all day. (The rhythmic part of walking helps your lymphatics function, part of the system that controls your immune system.) Wear comfortable shoes, which lowers stress on joints. (Walking barefoot or in high heels can cause damage to the joints and thus inflame your feet.)
此外還有一些預防炎症的簡單方法。阿古斯解釋道，與其一次性進行大量高強度的激烈運動然後在桌子後面坐一整天，遠遠不如多走點路更好。（走路的節奏對人體的淋巴系統有益，而淋巴系統在一定程度上控制着免疫系統。）儘量穿舒服的鞋子，它可以減輕關節的壓力。（光腳或穿高跟鞋走路可能導致關節受損，從而引發足部炎症。）
His approach has its detractors. Dr. Rita Redberg, a professor of medicine at UCSF, argues that the evidence doesn't support the widespread use of statins. "I prescribe medicine to make people feel better or live longer, and statins do neither," she says. Not only that, statins can have side effects ranging from muscle aches to diabetes.
不過也有人反對阿古斯的理論。比如加州大學舊金山分校（UCSF）的醫學教授麗塔·萊德伯格認爲，現有證據並不支持他汀類藥物的廣泛使用。她說：“我給病人開藥的目的是要讓病人感覺更好或活得更久，而他汀類藥物並不能起到以上任何一種效果。”不僅如此，他汀類藥物還可能導致包括肌肉疼痛和糖尿病在內的副作用。
Of course, Agus thinks statins in many cases do more good than harm and, anyway, are just one tool in his arsenal. The nice thing about his approach is that nothing requires a superhuman effort — a lot of it is just commonsense, healthy living.
當然，阿古斯還是認爲他汀類藥物在許多情況下利大於弊。除此之外，他還有許多別的養生辦法，這些辦法好在並不需要我們做出什麼超人的努力。阿古斯的許多養生之道都是常識性的，也就是培養健康的生活方式。
Agus also believes we need new tools to really understand our bodies. He suggests that each of us get genetically profiled. This won't tell us whether we'll contract a certain disease but will tell us the probability of getting it, allowing us to make the proper adjustments. A few years ago he co-founded Navigenics, a company that does genetic screening at $400 a pop and is backed by venture capitalist John Doerr of Kleiner Perkins, an early investor in Google (GOOG). When Agus had his own DNA profiled — the results are in the book for all to see — he found he was at risk of having a heart attack. This was strange because his cholesterol had always been low. Nonetheless, it was enough to persuade him to go on a healthier diet and start taking statins.
阿古斯也相信，我們還需要一些新的工具才能真正瞭解我們的身體。他建議我們每個人都應進行基因成像。基因圖像並不會告訴我們是否會染上某種疾病，但會告訴我們染上這種病的機率有多大，從而幫助我們做出正確的判斷。幾年前，他與別人合作創辦了一家名叫Navigenics（意爲“基因導航”——譯註）的公司，專門提供基因檢測服務，每次收費400美元。這家公司得到了凱鵬華盈投資公司（Kleiner Perkins）風投家約翰·杜爾的資助，他是谷歌的早期投資人之一。阿古斯也給自己的DNA畫了像，還把結果展示在書裏公之於衆——他發現自己存在罹患心臟病的風險。這有點奇怪，因爲他的膽固醇水平一直很低。儘管如此，他還是開始攝入更健康的飲食，並開始服用他汀類藥物。
New tools may also make it possible to detect diseases at a much earlier stage. The key is understanding how proteins — which are the building blocks of life — operate. Faulty proteins can be early indicators of a disease. The trouble is, tracing proteins is incredibly hard to do — they are the size of a single neutron. About eight years ago Agus started another company called Applied Proteomics. He joined up with supercomputer guru Danny Hillis to create a system with the horsepower to catalogue hundreds of thousands of protein levels. The company is still a work in progress, but if it succeeds, it will provide an important diagnostic tool.
我們在一些新工具的幫助下或許能在更早的階段檢測到隱藏的疾病。問題的關鍵在於我們需要理解構建生命的基石——蛋白質的活動機理。缺損的蛋白質可能是某種疾病的早期標誌，然而追蹤蛋白質是一項極其因難的工作——蛋白質的大小隻有一箇中子那麼大。大約8年前，阿古斯創辦了另一家公司，名叫 Applied Proteomics。他與超級計算機專家丹尼·希利斯合作開發了一個系統，有能力對幾十萬個蛋白質水平進行編目。目前這家公司仍處於科研階段，一旦它取得成功，就能爲醫學界提供一個重要的診斷工具。
When Agus's book was reviewed by the Daily Mirror in England last month, he says he got 7,000 angry blog and e-mail responses. Some accused him of trying to cash in on his DNA-profiling firm. Agus's response? That he has only a small stake in the DNA firm.
阿古斯說，上個月英國的《每日鏡報》（Daily Mirror）刊發了一篇書評，介紹了他的新書，結果一下子有7,000多人憤怒地發博文或寫電子郵件對他進行譴責。有些人指責他想乘機宣傳自己的基因成像公司以此謀利。阿古斯對這個問題的回答是，他在那家DNA公司只有很少的股份。
Agus, however, has a bigger challenge ahead. He needs to get his ideas widely accepted by the medical community. Maybe then he can turn those hisses into cheers.
實際上，阿古斯未來面臨着更大的挑戰——他需要讓自己的理念被醫學界廣泛接受。也許到那時，他才能把聽衆席上的噓聲變成歡呼聲。
