Bill Gates:
In every part of the world, people are living longer than they used to. Thanks to scientific advancements, fewer people die young from heart disease, cancer, and infectious diseases. It’s no longer unusual for a person to live well into their 80s and beyond. My dad will celebrate his 92nd birthday in a couple weeks, a milestone that was practically unimaginable when he was born. This fact—that people are living longer than ever before—should always be a wonderful thing. But what happens when it’s not?
比尔盖茨:
在世界上的每一个地方，人们都比以前要活得久。得益于科学进展，越来越少的年轻人会死于心脏病、癌症、以及传染病。能活到80岁以上的人越来越常见。我的父亲再过几周就要庆祝他的92岁生日了。在他出生的年代，活那么久是不可想象的。人们越活越久的事实理应总是一件美妙的事，但长寿什么时候会变成坏事呢？
The longer you live, the more likely you are to develop a chronic condition. Your risk of getting arthritis, Parkinson’s, or another non-infectious disease that diminishes your quality of life increases with each year. But of all the disorders that plague us late in life, one stands out as a particularly big threat to society: Alzheimer’s disease.
你活得越久，就越有可能出现慢性疾病。你得关节炎、帕金森病、或是其他非传染性疾病的风险每年都在增加，而这些疾病会影响你的生活质量。在所有影响老年人生活的恶疾中，一种疾病对社会有着尤其大的威胁，它就是阿兹海默病。
You have a nearly 50 percent chance of developing the disease if you live into your mid-80s. In the United States, it is the only cause of death in the top 10 without any meaningful treatments that becomes more prevalent each year. That trend will likely continue as baby boomers age, which means that more families will watch their loved ones suffer from cognitive decline and slowly disappear. Despite this growing burden, scientists have yet to figure out what exactly causes Alzheimer’s or how to stop the disease from destroying the brain.
如果你能活到80多岁，患上阿兹海默病的机会要接近50%。在美国前十大致死原因里，这是唯一缺乏有效治疗方式的疾病。而且，它正变得越来越流行。随着“婴儿潮一代”的老去，这一趋势还会持续，这意味着更多家庭会看到他们深爱的家人出现认知能力的衰退和逐渐丧失。尽管这一负担越来越重，科学家们还不知道究竟是什么导致了阿兹海默病，也不知道如何防止这种疾病摧毁大脑。
I first became interested in Alzheimer’s because of its costs—both emotional and economic—to families and healthcare systems. The financial burden of the disease is much easier to quantify. A person with Alzheimer’s or another form of dementia spends five times more every year out-of-pocket on healthcare than a senior without a neurodegenerative condition. Unlike those with many chronic diseases, people with Alzheimer’s incur long-term care costs as well as direct medical expenses. If you get the disease in your 60s or 70s, you might require expensive care for decades.
我起初对阿兹海默病感兴趣，是因为无论是从情感上，还是从经济上，它都让家庭和医疗系统付出了高昂的代价。这种疾病带来的经济负担很容易量化。患有阿兹海默病或其他痴呆症的患者每年在医疗上花的钱，比那些没有神经退行性疾病的老人，要多出5倍！和许多慢性疾病不一样，患有阿兹海默病的人需要长期的照料支出，也需要直接的医疗花费。如果你不幸在60或70多岁得了阿兹海默病，你可能需要好几十年的昂贵照料。
These costs represent one of the fastest growing burdens on healthcare systems in developed countries. According to the Alzheimer’s Association, Americans will spend $259 billion caring for those with Alzheimer’s and other dementias in 2017. Absent a major breakthrough, expenditures will continue to squeeze healthcare budgets in the years and decades to come. This is something that governments all over the world need to be thinking about, including in low- and middle-income countries where life expectancies are catching up to the global average and the number of people with dementia is on the rise.
这些开支是发达国家医疗系统里快速增长的一项负担。根据阿兹海默病协会的数据，2017年，美国人要在阿兹海默病患者和其他痴呆症患者上花2590亿美元。在治疗没有突破的前提下，这些支出在接下来的几年、几十年里只会越来越多，挤压医疗经费。这是全世界的政府都应该考虑的问题：低收入和中等收入国家的预期寿命正在赶上全球的平均水平，罹患痴呆症的患者数量也在上升。
The human cost of Alzheimer’s is much more difficult to put into numbers. It’s a terrible disease that devastates both those who have it and their loved ones. This is something I know a lot about, because men in my family have suffered from Alzheimer’s. I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you’re experiencing a gradual death of the person that you knew.
阿兹海默病给人带来的损失更难用数字去衡量。对于患者以及他们所爱的人来说，阿兹海默病都是一种糟糕的疾病。我对此非常了解。我的家族里，许多男性都有阿兹海默病。当疾病夺走你所爱的人的心智，而你对此无能为力，这种感觉坏透了。你就像是在经历熟人的慢性死亡。
My family history isn’t the sole reason behind my interest in Alzheimer’s. But my personal experience has exposed me to how hopeless it feels when you or a loved one gets the disease. We’ve seen scientific innovation turn once-guaranteed killers like HIV into chronic illnesses that can be held in check with medication. I believe we can do the same (or better) with Alzheimer’s.
我的家族史并不是我关心阿兹海默病的唯一原因，但我的个人经历却让我感受到，当你或你所爱的人不幸得了这个疾病，你会是多么绝望。我们已经见证科学创新把HIV这样一度致死的杀手变得慢性可控，能用药物暂停病情发展。我相信我们也能在阿兹海默病上做到同样的事，甚至做得更好。
I’ve spent considerable time over the last year learning about the disease and the progress made to date. There’s a lot of amazing work being done in this field to delay Alzheimer’s and reduce its cognitive impact. What I’ve heard from researchers, academics, funders, and industry experts makes me hopeful that we can substantially alter the course of Alzheimer’s if we make progress in five areas:
去年，我花了很多的时间来了解这种疾病，以及目前我们所取得的进展。这个领域里有许多令人赞叹的工作，能延缓阿兹海默病进展，或是减轻它对认知的影响。我从研究者、学术圈、投资人、以及产业专家里了解到的信息让我充满信心。如果我们能在下面五大领域取得进展，我们将极大地改变阿兹海默病的病程。
1. We need to better understand how Alzheimer’s unfolds. The brain is a complicated organ. Because it’s so difficult to study while patients are alive, we know very little about how it ages normally and how Alzheimer’s disrupts that process. Our understanding of what happens in the brain is based largely on autopsies, which show only the late stages of the disease and don’t explain many of its lingering mysteries. For example, we don’t fully understand why you are more likely to get Alzheimer’s if you’re African American or Latino than if you’re white. If we’re going to make progress, we need a better grasp on its underlying causes and biology.
我们需要更好地了解阿兹海默病是如何进展的。大脑是一个复杂的器官。在患者还活着的时候，我们很难研究大脑。所以我们对大脑的正常衰老，以及阿兹海默病对它的影响还知之甚少。我们对于“大脑中发生了什么”的理解很大程度上依赖于尸检，它只能显示这种疾病的晚期症状，而无法解释它的复杂秘密。比如说，我们还没有充分理解，为什么非裔美国人或者是拉美人比白种人罹患阿兹海默病的风险更高。如果我们想要取得进展，我们需要更好地了解疾病背后的原因和生物学。
2.We need to detect and diagnose Alzheimer’s earlier. Since the only way to diagnose Alzheimer’s definitively is through an autopsy after death, it’s difficult to identify the disease definitively early in its progression. Cognitive tests exist but often have a high variance. If you didn’t sleep well the night before, that might skew your results. A more reliable, affordable, and accessible diagnostic—such as a blood test—would make it easier to see how Alzheimer’s progresses and track how effective new drugs are.
我们需要更提早地检测和诊断阿兹海默病。目前唯一确诊阿兹海默病的方法就是死后的尸检，因此我们很难在疾病进展早期确确实实地找到疾病。认知测试是一种选择，但它的变数很大。如果你前一天没睡好，就会影响到你的结果。像血检那样更可靠、用得起、而且能用得上的诊断方法会让我们更容易地看到阿兹海默病如何进展，并追踪新药的治疗效果。
3. We need more approaches to stopping the disease. There are many ways an Alzheimer’s drug might help prevent or slow down the disease. Most drug trials to date have targeted amyloid and tau, two proteins that cause plaques and tangles in the brain. I hope those approaches succeed, but we need to back scientists with different, less mainstream ideas in case they don’t. A more diverse drug pipeline increases our odds of discovering a breakthrough.
我们需要更多终止疾病的方法。一款阿兹海默病新药能从多个角度来预防或缓解疾病。至今，大部分的新药临床试验是靶向淀粉样蛋白和tau蛋白，这两种蛋白能导致大脑中的沉积和缠结。我希望这些方法能取得成功，但我们也需要支持那些采用不同、非主流方法的科学家，以防常规的手段遭遇失利。更多样的药物管线能增加我们找到突破的概率。
4. We need to make it easier to get people enrolled in clinical trials. The pace of innovation is partly determined by how quickly we can do clinical trials. Since we don’t yet have a good understanding of the disease or a reliable diagnostic, it’s difficult to find qualified people early enough in the disease’s progression willing to participate. It can sometimes take years to enroll enough patients. If we could develop a process to pre-qualify participants and create efficient registries, we could start new trials more quickly
我们需要让人们更便捷地参加临床试验。创新的速度取决于我们能多快做好临床试验。既然我们对疾病还没有很好的了解，也没有可靠的诊断方法，现在很难找到符合条件的早期患者来自愿参与临床试验。目前，单单是招募足够的患者就要花去很多年。如果我们能为符合条件的参与者开发出一种流程，让注册更高效，我们能就更快地开展新的临床试验。
5. We need to use data better. Every time a pharmaceutical company or a research lab does a study, they gather lots of information. We should compile this data in a common form, so that we get a better sense of how the disease progresses, how that progression is determined by gender and age, and how genetics determines your likelihood of getting Alzheimer’s. This would make it easier for researchers to look for patterns and identify new pathways for treatment.
我们需要更好地利用数据。每一次医药公司或研究实验室开展研究时，都会获得大量数据。我们应该将这些数据整理为更常用的格式，这样我们就能更好地理解疾病的进展、性别与年龄如何影响进展、以及遗传学如何决定罹患阿兹海默病的可能性。这些会让研究人员更方便地寻找疾病模式，并找到新的治疗方法。
By improving in each of these areas, I think we can develop an intervention that drastically reduces the impact of Alzheimer’s. There are plenty of reasons to be optimistic about our chances: our understanding of the brain and the disease is advancing a great deal. We’re already making progress—but we need to do more.
通过在这些领域取得进步，我认为我们能开发出一种干预手段，极大地减少阿兹海默病带来的影响。我们有很多理由可以保持乐观：我们对大脑和疾病的了解已经取得了很大进步，我们已经取得了进展。但我们需要做更多。
I want to support the brilliant minds doing this work. As a first step, I’ve invested $50 million in the Dementia Discovery Fund—a private fund working to diversify the clinical pipeline and identify new targets for treatment. Most of the major pharmaceutical companies continue to pursue the amyloid and tau pathways. DDF complements their work by supporting startups as they explore less mainstream approaches to treating dementia.
我想要支持做这些工作的聪明大脑。作为第一步，我已经为痴呆症发现基金捐赠了5000万美元。这是一家私募的基金，正在开拓临床管线，寻找新的治疗靶点。目前，大部分的主要医药公司在研究淀粉样蛋白和tau蛋白通路。痴呆症发现基金能支持那些探索非主流方法的初创新锐，与主要医药公司的工作形成互补。
I’m making this investment on my own, not through the foundation. The first Alzheimer’s treatments might not come to fruition for another decade or more, and they will be very expensive at first. Once that day comes, our foundation might look at how we can expand access in poor countries.
这笔资助是通过我自己，而不是基金会做出的。第一批阿兹海默病的疗法可能还需要十几年，甚至几十年才能成熟，它们最初也会非常昂贵。但当那一天到来时，我们的基金会可能会考虑如何让贫困国家的人也能用上这些疗法。
But before we can even begin to think about how we do that, we need lots of scientific breakthroughs. With all of the new tools and theories in development, I believe we are at a turning point in Alzheimer’s R&D. Now is the right time to accelerate that progress before the major costs hit countries that can’t afford high priced therapies and where exposure to the kind of budget implications of an Alzheimer’s epidemic could bankrupt health systems.
在我们能真正考虑这些事情前，我们还需要大量的科学突破。利用所有开发中的新工具和新理论，我相信我们正处于阿兹海默病研发的拐点。在国家受昂贵疗法的影响、阿兹海默病的流行让医疗体系破产前，现在正是加速研发进展的好时机。
This is a frontier where we can dramatically improve human life. It’s a miracle that people are living so much longer, but longer life expectancies alone are not enough. People should be able to enjoy their later years—and we need a breakthrough in Alzheimer’s to fulfill that. I’m excited to join the fight and can’t wait to see what happens next.
这是一个我们能显著改善人类生活的科学前沿。人们能活得比以前长很多，这是一个奇迹。但仅仅长寿是不够的。人们还需要能享受他们的晚年，而我们需要阿兹海默病的突破性疗法来实现这一目标。能够加入这场战斗，我感到很振奋。我已经迫不及待想看到下一步的进展了。
参考资料：
Why I’m Digging Deep Into Alzheimer’s
Alzheimer’s：阿兹海默病
arthritis: 关节炎
dementia：痴呆
pharmaceutical：药物的
amyloid：淀粉体
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