【外交政策 201411】破碎的世界：2014百大思考者 － 疗伤者

满仓

【中文标题】破碎的世界：2014百大思考者 － 疗伤者
【原文标题】A World Disrupted: The Leading Global Thinkers of 2014
【登载媒体】外交政策
【原文链接】http://globalthinkers.foreignpolicy.com/




截止到11月，埃博拉疫情已经造成了将近5000人的死亡，它让我们看到人类的生命是多么脆弱，全球和地方的医疗体制是多么的不堪一击。这些医生、护士、研究人员和发明家在面对埃博拉和其它危机时，想尽一切办法保护生命和医疗机构。他们努力研究有效、廉价的丙型肝炎治疗方案，发起运动根除印度的小儿麻痹，开发诊断疟疾的新方法，挑战临床医学和传统文化对精神分裂的定义。他们帮助整个世界为人类注入急需和力量和希望。


乔瑟芬•芬达•赛璐
护士，塞拉利昂

“在疫区拒绝死亡。”

西非的医疗工作者遭到埃博拉的重创。由于在面对突如其来的危机时缺少足够的防护工具和必要的资源，根据世界卫生组织提供的信息，截止到8月35日，已经有240人被感染，120多人死亡。这些数字还在不断上升，很多医疗工作者已经心怀恐惧地逃离工作岗位。

但是还有很多人在坚守。对于副护士长乔瑟芬•芬达•赛璐来说，在塞拉利昂凯内马政府医院大楼中看护埃博拉病人，无异于被判处死刑。8月底，已经有15名护士死亡，这个数字大约是当时塞拉利昂埃博拉医护人员总数的一半。但是被她的同事称为“妈妈”的赛璐拒绝离开岗位，尽管她的家人多次请求，尽管很多战斗在抗击埃博拉疫情前线的医护人员将遭到社会不公正的对待。

她在接受《纽约时报》采访时说：“这里需要我。我岁数不小了，年轻人都在看着我。”


凯文•华利、拉里•蔡特林
科学家，圣迭戈

“发明针对肆虐疫情的治疗方案。”

今年年初，埃博拉在西非肆虐，没有任何药物可以阻挡它的蔓延。8月，一份从未在人体上测试过的血清抗体被辗转送到了两位美国传教士手中，他们都感染了埃博拉——结果他们幸存了下来。几乎在一夜之间，由凯文•华利和拉里•蔡特林在圣迭戈的Mapp生物医药公司研制的ZMapp，变成了家喻户晓的名字。

美国卫生与服务部迅速给Mapp拨款2490万美元，要求他们在18个月之内研发并测试这个药物。蔡特林在接受《纽约时报》采访时说，面对这样一笔巨款，他们的小公司“彻底找不着北了”。

人们对药物的安全性和效果还没有透彻的了解，而且把药给谁、如何进行人体实验也都会面临严肃的道德问题。但是在8月底，实验室的测试显示ZMapp成功治愈了感染埃博拉病毒的猴子，似乎证明这个血清是让人类战胜疾病的真正武器。华利在接受《圣迭戈联合论坛报》的采访时说：“有药物在手，一切都迎刃而解，无论是对个人还是对社会。”


凯瑟琳•亨特
古病理学家，英国

“揭露癌症古老的秘密。”

22岁时被诊断出癌症，恐怕有这样遭遇的人都不会跑到沙漠里去挖骨头吧，但凯瑟琳•亨特就是这样。化疗结束两个月之后，这位崭露头角的考古学家把大学最后一个学年的课程安排到埃及进行挖掘。然后她在达拉谟大学获得了古病理学家的学位。2012年，她与别人联合创办了古肿瘤研究组织。目前，她已经记录下239个古代癌症病例。

4月，她和她的同事找来10位研究人士，共同发布了一个互动、开源的数据库，亨特因为这项工作获得了TED荣誉会员的奖励。她说她希望考古学领域的扩大可以帮助我们了解当代的癌症疾病，因为导致癌症的因素不仅仅是农药污染。2010年的一篇论文说在埃及的木乃伊身上只发现了几例癌症病例，但是亨特说这篇论文缺少数据。这些数据正是她在寻找的东西。


谭雅•鲁尔曼
人类学家，加利福尼亚斯坦福

“文化与精神分裂的关系。”

根据当代医药学的理论，精神分裂病人会听到一些声音，这种疾病症状可以通过药物和其它疗法来治愈。但是斯坦福大学的人类学家谭雅•鲁尔曼关注的是另一个层面，她想要知道这些声音在说什么，以及为什么会出现这些声音。

6月，鲁尔曼与他人在《英国精神病杂志》上联合发表了一篇文章，内容是基于他们与美国、印度和加纳精神分裂病人的面谈。她发现美国病人都认为这些声音充满了暴力，是可怕的疾病症状。而印度和加纳的病人都认为这些声音充满了正面的含义，掺杂了个人感情，甚至还听到家人和上帝的声音。

这项研究显示，文化背景影响了精神病的体验，或许可以凭借这个发现来量身定制治疗方案。例如在美国，可以鼓励病人与他们的声音互动，而不是惧怕。鲁尔曼在接受《赫芬顿邮报》的采访时说，这是对声音的“颠覆性思考”，对临床医学有重要的意义。


戈尔达娜•乌尼亚克•诺瓦科维奇
生物医学工程师，纽约

“破解软骨组织难题。”

二十多年来，医药工程的一项重大挑战是如何复制机能性人类软骨组织。关键软骨组织无法自行修复，用动物细胞制作的替代品强度不够。这时出现了戈尔达娜•乌尼亚克•诺瓦科维奇和她在哥伦比亚大学干细胞和组织工程实验室的团队。经过多年实验软骨组织的替代品，他们在4月份宣布，成功用3D打印机制作出人体组织。打印机的“墨水”就是人类干细胞。

别指望你的膝盖和手肘可以很快用上这种新型的软组织，临床应用还依然很遥远。乌尼亚克•诺瓦科维奇在哥伦比亚大学工程学院的演讲中说：“我们暂时还不会临床应用”，但这是我们的最终目标。“我们的寿命延长，高质量的生活也要延长。如果这真的会实现，那么我们的确要为自己的身体准备一些备用零件了。”


迪派克•卡普尔
扶轮社印度国家小儿麻痹症主席，印度

“战胜印度的小儿麻痹。”

迪派克•卡普尔精确地记得国际卫生组织宣布印度不再受小儿麻痹症困扰的时间：2014年3月27日下午2:31。他在接受《华尔街日报》的采访时说，他看了看表，因为这是“历史性的一刻”。

印度是一个脊髓灰质炎病毒肆虐的绝佳场所，它有密集的人口、糟糕的卫生条件、不清洁的饮用水和营养不良的现象。2009年，这个国家的小儿麻痹发病数量占全球的一半（2014年全球受该疾病困扰的人数为250，大部分在巴基斯坦）。更糟糕的是，给儿童注射疫苗的政策遭到了很多印度穆斯林的抵制。

卡普尔的委员会在说服穆斯林领导人接受疫苗的过程中扮演了重要的角色，他认为这个转变是根除小儿麻痹症的关键所在，而且这种疫苗还可以一次性防范两种疾病。

他的成功值得那些小儿麻痹依然肆虐，而且人们对疫苗持怀疑态度的国家借鉴。


约翰•容泽、迈克尔•索菲亚
国民保健联盟主席CEO、OnCore生物制药联合创始人，华盛顿特区、宾夕法尼亚州多伊尔斯顿

“与大公司对抗，生产救命药物。”

怎么才能让一个药物无法进入的器官可以接受并保持药物的效果？这就是生物技术专家迈克尔•索菲亚在设法击退丙肝病毒时所面临的最大问题。这种肝脏疾病在全世界有1.3到1.5亿长期患病者。

这位巴尔的摩人采取了一种巧妙的方法，用《纽约客》所谓的“看不见的外衣”包裹这种药物，伪装进入肝脏。器官中的酶会深入这种外衣，让药物与疾病对抗，同时又不会损坏身体的其它细胞。Gilead医药公司给这种药物起名为Sovaldi，并推向市场。与其它治疗方案结合使用，可以在短短12周的疗程里治愈80％的病患。

但是这个疗程需要花费8.4万美元。7月，一位长期致力于谋求地价药物的活动人士约翰•容泽向Gilead公司发出一封公开信，敦促他们降低价格。Sovaldi仅在2014年第二季度就为这家公司带来了34.8亿美元的收入。容泽在7月份的一次研讨会上说：“这是病人必需的药物，但是高昂的价格让人们无法得到。”尽管Gilead到目前为止并未降低售价，但是这家公司在9月份授权7家印度公司可以向90个发展中国家销售廉价的简配版药物。


彭文昆、约翰•莱文多斯基、布莱恩•格利姆博格
科学家、生物学家、博士生，新加坡、克里夫兰、波士顿

“用磁场诊断疟疾。”

尽管埃博拉占据了今年新闻的头条，但是非洲人民的第一大杀手依然是疟疾——可治愈型疟疾。据世界卫生组织的信息，2012年，全世界大约有2.07亿人感染疟疾，62.7万人死亡，其中90％的死亡病例都发生在非洲。

医疗界长期在寻找这种疾病的诊断方法，不需要借助劳动密集型的实验室、廉价、简单、可携带，而且最重要的是可靠的诊断方法。答案是什么？或许是磁铁。

研究人员知道，疟疾寄生虫以富含铁元素的血红素为食。所以在过去几年中，很多人都在竞相研制一种磁力设备，用《克里夫兰老实人》的一位记者的话来说，可以检测“疟疾寄生虫排出的含有铁元素的粪便”。彭文昆和约翰•莱文多斯基都已经制作出设备的原型，他们的原理脱胎于布莱恩•格利姆博格的设计，而且已经准备投产。

只需要一滴血液，这两种技术完全不同的设备可以在几分钟里给出检测报告。不仅能在症状出现之前检测出疾病，而且检测结果比目前使用的方法更加可靠。这项技术目前还在研制阶段，但是有可能从恐怖的疟疾病毒手中拯救无数的生命。


桑吉塔•博蒂亚
物理学工程师，马萨诸塞州剑桥

“为结肠镜手术找到温和的替代方案。”

结肠癌通常不会致命，如果在早期发现，5年以上的存活率超过90％。但只有40％病患可以在早期确诊，部分原因在于筛查结肠癌的价格昂贵，而且需要使用结肠镜检查等大手术。但是，有了桑吉塔•博蒂亚的发明，一切都改变了。

今年，博蒂亚和她在麻省理工学院的团队已经成功开发出一项新的技术，用一种简单、廉价的方式来筛查结肠癌，就像孕检一样方便。患者摄入一种特殊的纳米颗粒，体内的瘤所释放出的酶会破坏这种颗粒，所需要的仅仅是小便样本。现在，博蒂亚和她的团队正在尝试把纳米颗粒放在一勺酸奶中，检测就更简单了。

这项技术目前还在测试阶段，但是实验中的纳米颗粒被注入老鼠体内之后，展示出明显的效果。如果成功，这项技术在发展中国家将变得尤为重要，因为它可以在条件简陋的农村地区使用，只需要特殊的设备。




原文：

The Ebola epidemic, which had caused nearly 5,000 deaths by early November, has cruelly underscored the fragility of human life—and the tenuousness of global, national, and local health systems. Whether dealing with Ebola or other crises, these doctors, nurses, researchers, and inventors are working to protect both lives and systems from breaking. From advocating for effective, affordable hepatitis C treatment, to spearheading the campaign that eradicated polio from India, to developing a new method of detecting malaria, to challenging the way clinicians and cultures describe schizophrenia, they are helping provide the world with tools that can inject much-needed strength and hope into global health.

Josephine Finda Sellu
Nurse
|Sierra Leone
For defying death in the hot zone.      

Health workers in West Africa have been hit hard by Ebola. Lacking sufficient protective gear and other resources in the face of an unprecedented crisis, some 240 had become infected and more than 120 had died by Aug. 25, according to the World Health Organization. Those numbers have only risen since, and many health workers have fearfully fled their jobs.

But many have stood their ground. For deputy nurse matron Josephine Finda Sellu, working in the Ebola wing of a government hospital in the Sierra Leonean city of Kenema was all but a death sentence. By late August, 15 nurses had died, reportedly comprising around half the health workers killed in Sierra Leone at the time. But Sellu, called “Mummy” by her staff, refused to abandon her post despite pleas from her family and the biting social stigma heaped on many health workers who have remained on Ebola’s front lines.

“There is a need for me to be around,” she told the New York Times. “I am a senior. All the junior nurses look up to me.”

Kevin Whaley, Larry Zeitlin
Scientists
|San Diego
For inventing a possible cure for a raging epidemic.      
As Ebola began tearing through West Africa early this year, no drug existed to stop it. Then, in August, an experimental serum of antibodies that had never even been tested on humans was given to two American missionaries infected with the disease—and they survived. Almost overnight, ZMapp, made by Kevin Whaley and Larry Zeitlin’s San Diego-based Mapp Biopharmaceutical, became a household name.

The U.S. Department of Health and Human Services quickly allotted $24.9 million to Mapp to fast-track development and testing over 18 months. The sudden interest in the small company, Zeitlin told the New York Times, has been “absolutely overwhelming.”

The drug’s safety and effectiveness are not yet fully understood, and there are serious ethical questions about who should get the drug and how to do human trials. But in late August, lab tests showed that ZMapp cured monkeys infected with Ebola, suggesting the serum might be a real game-changer. “Once you have a drug it could have a huge impact,” Whaley told the San Diego Union Tribune, “for individuals or for large populations.”

Kathryn Hunt
Paleopathologist
|United Kingdom
For unearthing cancer’s ancient secrets.      

Being diagnosed with cancer at age 22 might stop a lot of people from digging in the desert for ancient bones. Not Kathryn Hunt: Just two months after her chemotherapy ended, the budding archeologist spent part of her senior year of university on a dig in Egypt. She then went on to get a degree in paleopathology—the study of ancient diseases—at Durham University, and in 2012, she co-founded the Paleo-oncology Research Organization. So far she has documented 230 cases of ancient cancer.

In April, she and her colleagues brought together 10 researchers to work on an interactive, open-source database, and Hunt was rewarded for her work with a TED fellowship. She says she hopes this expanding field of archeological inquiry will add to contemporary understandings of cancer, proving that it isn’t only caused by modern pesticides or pollution. A 2010 paper claimed that only a handful of cancer cases had been found in Egyptian mummies, but Hunt says the paper lacked data. And data are exactly what she’s looking for.

Tanya Luhrmann
Anthropologist
|Stanford, Calif.
For linking culture and schizophrenia.      

According to modern medicine, the voices that people with schizophrenia hear are symptoms of a disease that can be tackled with medication and other therapies. But Stanford University anthropologist Tanya Luhrmann takes a different approach: She wants to know what voices are saying—and why.

In June, Luhrmann co-authored a study in the British Journal of Psychiatry that was based on interviews with people with schizophrenia in the United States, India, and Ghana. She found that while American patients perceived their voices as violent, intrusive signs of disease, people in India and Ghana tended to have more positive, personal relationships with them: They even heard the voices of family members or God.

The study suggests that culture affects how people experience psychosis, a finding that could lead to a new tailoring of treatment. In the United States, for instance, patients could be encouraged to interact with their voices, instead of fearing them. As Luhrmann told the Huffington Post, this would be a “radical way of thinking” about voices—one that could reap enormous clinical benefits.

Gordana Vunjak-Novakovic
Biomedical engineer
|New York City
For cracking the cartilage conundrum.      

For over two decades, a major challenge for medical engineers has been reproducing functional human cartilage. The crucial tissue doesn’t regenerate on its own, and replacements made from animal cells aren’t strong enough. Then came Gordana Vunjak-Novakovic and her team of researchers at Columbia University’s Laboratory for Stem Cells and Tissue Engineering. After years of working to create replacement cartilage, they announced in April that they successfully used a 3-D printer to produce the tissue. How? By using “ink” made from human stem cells.

Don’t expect to find this new cartilage in your knees or elbows anytime soon. Clinical use is still a ways off. “We are not ready to go into patients,” Vunjak-Novakovic has said. But human application is the goal. “We live longer and we would like to live better,” she said in a talk at Columbia University’s engineering school. “And if this is going to happen, then we really need spare parts to maintain our bodies.”

Deepak Kapur
Chairman, India National PolioPlus Committee
|India
For crushing fear to defeat polio in India.      

Deepak Kapur knows precisely when the World Health Organization officially declared India polio-free: 2:31 p.m. on March 27, 2014. He checked his watch to know “exactly when history was made,” he told the Wall Street Journal.

India was a perfect home for the poliovirus: It has a huge population, poor sanitation, impure drinking water, and malnutrition. As recently as 2009, the country was home to around half of the world’s cases of polio. (Worldwide, the disease has infected more than 250 people in 2014 to date, mostly in Pakistan.) Complicating matters, the campaign to vaccinate millions of children faced resistance among India’s Muslims.

Kapur’s Rotary Foundation-run committee was instrumental in convincing Muslim leaders of the virtues of vaccination, and he sees their about-face as a key ingredient in polio’s eradication, alongside the use of a vaccine that targets two strains of the disease at once.

The success carries lessons for other countries where polio remains as endemic as suspicions about vaccination.

John Rother, Michael Sofia
President and CEO, National Coalition on Health Care; co-founder, OnCore Biopharma
|Washington, D.C.; Doylestown, Penn.
For delivering a lifesaving drug and taking on big pharma.      
How can you make an organ accept and retain a drug that normally won’t enter it? That’s one of the chief problems biotechnologist Michael Sofia faced while working on a way to defeat hepatitis C, the liver disease that affects between 130 million and 150 million chronic sufferers worldwide.

The Baltimore native developed a crafty solution: drape the drug in what the New Yorker called an “invisibility cloak” to disguise its entry into the liver. Enzymes in the organ would then break down the cloak, allowing the drug to fight the disease without harming the rest of the body’s cells. Marketed by the pharmaceutical company Gilead as Sovaldi, the drug, taken in combination with other therapies, can cure more than 80 percent of patients undergoing as little as 12 weeks of treatment.

But a full round of treatment can cost $84,000. So in July, John Rother, a longtime advocate of affordable pharmaceuticals, sent an open letter to Gilead, urging the company, which made $3.48 billion in Sovaldi sales in the second quarter of 2014, to lower prices. “This is a necessary drug for people who are sick, yet we’re allowing the price to impose an incredible barrier to access,” Rother said on a panel in July. Although Gilead has yet to drop the cost, in September the company did license the drug to seven Indian firms that will sell cheaper generic versions in some 90 developing countries.

Weng Kung Peng, John Lewandowski, Brian Grimberg
Scientist; biologist; Ph.D. student
|Singapore; Cleveland; Boston
For using magnets to beat malaria.      
   
Although Ebola has dominated headlines this year, it is still malaria—avoidable malaria—that remains one of Africa’s biggest killers. An estimated 207 million people worldwide were infected with the disease in 2012, according to the World Health Organization. Of those, 627,000 died—and 90 percent of the deaths occurred in Africa.

Public health advocates have long sought ways to diagnose the disease that don’t involve labor-intensive lab testing and are cheap, easy, portable—and, most importantly, reliable. The answer? It could be magnets.

Researchers have long known that the malaria parasite feeds on iron-rich hemoglobin. So for the past few years, the race has been on to design a magnetic device that, to put it simply, can detect the “iron-laden poop that malaria parasites leave behind,” as one reporter wrote in Cleveland’s Plain Dealer. Each with their own prototype device in hand, Weng Kung Peng and John Lewandowski, who refined his technology from an original concept developed by Brian Grimberg, are now eyeing the finish line.

Requiring only a drop of blood, both devices, which are technologically different, can generate diagnoses within a matter of minutes. Not only can both detect the disease before symptoms show, but their results could be far more reliable than today’s testing methods. The technologies are currently under development, but could save thousands from one of the world’s biggest killers.

Sangeeta Bhatia
Engineer and physician
|Cambridge, Mass.
For creating a kinder alternative to the colonoscopy.      
In the vast majority of cases, colon cancer doesn’t have to be fatal. If detected early enough, the five-year survival rate is 90 percent. But only 40 percent of those afflicted are diagnosed early, in part because screening requires expensive and invasive tests such as colonoscopies. But with Sangeeta Bhatia’s invention, that could all change.

This year, Bhatia and her team at the Massachusetts Institute of Technology have been working on a technique for a simple, cheap diagnostic that could make colon cancer screenings nearly as easy as a pregnancy test. Patients would be injected with special nanoparticles. In a positive test, enzymes produced by tumors would break down these particles, which would then be detected in a simple urine sample. Now, Bhatia and her team are working on a method to deliver the nanoparticles with a spoonful of yogurt, which could make testing even simpler.

The technique is still in the early testing phases, but preliminary experiments in which nanoparticles are injected into mice seem to have shown promise. If successful, the procedure could be particularly important in the developing world, where the test could be performed in rural settings, without specialized equipment.

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