地平线系列：药物依赖（2010）

在你的一生中
Over the course of your lifetime,
医生可能给你开了超过一万四千颗药丸
you’re likely to be prescribed more than 14,000 pills.
这种小小的粉末压片
Tiny little spheres of
有着魔法般的功效
crushed powder with almost magical effects,
药物可以拯救生命
pills that will possibly save
并将寿命延长数十年
and extend your life by decades.
实际上 任何药物都是一种奇迹
Any medicine actually is a miracle.
只要你想想药物的工作原理
If you really think about what a medicine does,
人居然能研制出一种化学药品
that you can design a small chemical
调控生物进程 进而治疗疾病…
to interfere with a biological process to alter disease…
我们能做到这一点真的令人嗔目结舌
I mean, it is just astonishing that you ever get there.
这些神奇药物得以出现
These miraculous pills
所需的运气与研究并重
often owe as much to serendipity as science.
我们研制这种药的初衷 是为了治疗心绞痛
We started with a drug that we hoped would be effective in angina
最后却发现这种药物
and we ended up with a medicine
对治疗阳痿非常有效
that was highly effective in erectile dysfunction.
这种药物发现的偶然性表明
This accidental nature of drug discovery means little is known
在服用药物前我们对它知之甚少
about what they can do until we all take them.
即便投放市场之后
In many ways you learn as much about
你对药物许多方面的了解也并无增加
your medicine after it’s launched as you knew before.
导致的结果让人不安
The results of this process can be unsettling.
一旦你服下一片药 就开始了一场交易
When you take a tablet, you’re entering into a bargain.
作为服药方的我们
Our side of the deal is that we honestly
诚挚地相信 药物利大于弊
believe the tablet will do you more good than harm,
但你必须接受这样一种可能性
but you have to accept the possibility that it may,
从长远来看 它会不会弊大于利
in the long term, do you more harm than good.
只是我们现在还不清楚而已
We just don’t know that yet.
药物依赖 [BBC 地平线系列]
我们和药物的联♥系♥
Our relationship with pills
从生命的最初开始
starts from the very beginning of our lives,
从父母递给我们药片时就开始了
from the medicines handed to us by our parents.
以前必须吃这些止痛药
I used to get so upset having to
总让我很烦恼 因为我不想吃
take these pain killers because I didn’t want to,
我当时大概五岁 所以我妈妈
so my mum, I was probably about five,
把它们掰成两半
and my mum used to snap them in half
把药倒到橙汁里给我喝
and tip the actual medication into orange squash for me.
我妈妈每天都给我吃药
My mum gives me my tablets every day.
随着我们长大 我们开始凡事依赖药物
As we grow up, we begin to pop pills for everything.
我们服用抗生素 去抗击疾病
There are the antibiotics we take to fight off disease,
每两年还要吃不止一个疗程
more than one course every two years of our lives.
有28000种止痛药供人挑选
The 28,000 pain killers we each take
用于减少痛苦
to make us feel better.
还有帮人避孕的药片
Pills to stop us having babies.
我其实是靠吃药帮助才怀孕的
I actually got pregnant on the pill.
所以
So…
帮人度过中年综合症的药物
Medicines to carry us through middle age.
抑制素[他汀类药物 用以降低胆固醇]
Statins.
-辛伐他汀 -还是辛伐他汀
– Simvastatin. – Simvastatin.
甚至还有帮我们延缓衰老
Even tablets to extend our youth
提升床上战斗力的药物
and improve our performance in bed.
没错 我用过
Yes, yes, I have used it.
第一个月很有效
The first month it came out.
当你到了70岁时
By the time you’re in your 70s,
你可能每天最少要吃5片药
you’ll probably be taking at least five tablets a day.
我们服用的药 代表了我们
The pills we take define who we are.
药品是我日常生活的一部分
Pills are just part of my everyday life.
也代表了我们的身体状况
And what we are.
我吃很多药
I take a lot of pills.
事实上 我每天得吃15颗药才能活着
Matter of fact, I take 15 a day to keep alive.
但它们并不总是有益的
But they’re not always beneficial.
我们仔细看了盒子背面
We read through the back
发现所列的症状我都有
and I had every symptom on that packet.
我们到底对自己吃的药了解多少
How much do we really know about the pills we take?
那些药物 真能达到预期效果吗
And can we trust them to do what they’re supposed to?
这是现代科学的一座神殿
This is a temple to modern science –
葛兰素史克公♥司♥ 全球最大药剂集团
葛兰素史克公♥司♥的制药实验室
the pharmaceutical labs at GSK.
但现代药品的发现
But modern drug discovery relies
更依赖于运气而不是精心的设计
more on an automated lottery than careful design.
这个化合物仓库
This store of chemical compounds
就是公♥司♥的核心所在
is the company’s crown jewels.
这就是新药物的来源地
This is where their new drugs come from.
这里是超过两百万的
In here is a library of
未命名化合物的仓库
over two million nameless chemical compounds.
科学家们对它们了解甚少
The scientists know very little about them.
它们可能有剧毒
They could be highly toxic,
也可能是治病救人的良药
or they could be harbouring a life-saving drug.
这实际上是海底捞针
It really is trying to find a needle in a haystack.
我们需要取出样品
It is about getting the samples out,
进行加工 筛选
processing them, screening them
史蒂夫·特布雷吉博士 葛兰素史克分子研发部
希望能发现一种化合物
and hoping we find that that chemical compound
能够对某种疾病有效
that is active against those disease areas.
这就需要开始碰运气了
This is where the lottery begins.
一种已知的疾病分子 我们称为靶分子
A known disease molecule, called the target,
逐一加入到这两百万化合物中
is introduced to each of the two million compounds, one by one,
去观察是否有反应
to see if anything happens.
在这两百万的化合物中
With the two million or so compounds,
我们可能会发现
we might get a few
一些化合物对靶分子有效
compounds that are active against that target.
然后我们得抓住这一个或两个的机会
We then have to take that one or two hits
化学家根据它们的母核结构
and the chemists will make hundreds, maybe thousands, of samples
合成出成千上万的类似物
related to that original
以期提高其活性
structure to try and improve the activity
最重要的是
and most importantly try
消除一切危险的和预期外的功效
to negate any safety or undesirable effects.
我们必须一遍一遍地筛选
We have to screen those over and over
确保我们的方向正确
again to make sure that we’re going in the right direction.
在数以万计的测试后
After hundreds of millions of tests,
只有少量的药品会进行人体测试
just a handful will make it through to trials on people.
总的来说 需要10亿的投入和15年的工作
In all, it takes about 1 billion and 15 years’ work
才能找到一种可以获批投产的化合物
to find the winning compound that can become a licensed drug.
寻找药物的旅程是宏大的
The journey to a medicine is an epic journey.
从想法的形成到药品审批通过的整个过程
That whole process from idea through to a drug approved
大卫·罗宾博士 辉瑞公♥司♥研发组长
失败一直如影随形
is one littered with failure.
尽管成功几率微乎其微
Despite the minute success rate,
但潜在的回报却是巨大的
the potential rewards are enormous.
我们希望这其中 有一种化学成分
We hope there would be chemicals in here
可以在未来治愈所有疾病
that would be the future cures for all sorts of disease areas.
想象一下就在这里
It would be nice to think that here
能找到种药物 治愈癌症 艾滋病 疟疾
we do have the cures for cancer, AIDS, Malaria,
及所有世卫组织高度关注的疾病 那该多好
any of the world Health Organisation top priorities.
倘若药物并非设计 而是偶然发现得来
If drugs are not designed but discovered,
那么 只有我们亲身尝试后
then it should come as no surprise that
才知道它真正的效用也并不奇怪
we only find out what they really do to us when we take them.
把手给我 把手给我 利亚姆
Give me your hand. Give me your hand. Liam!
这是利亚姆
This is Liam.
五岁 过度活跃 没办法集中
Aged five, he was disruptive, hyperactive and unable to focus.
利亚姆 有车来了 赶紧过来
Liam, there’s cars coming. Straight here now!
这位是埃德
And this is Ed.
我刚考完了今年的法律考试
I’ve just finished my law exams for this year.
我这两天还得参加铁人三项
I’ve got a triathlon coming up in two days’ time
而且我还有一堆工作
and I’ve got a couple of jobs
最近忙个不停 所以事情很忙乱
on the go at the minute so things can be quite hectic.
有时候我感觉
It does sometimes feel like
一天的时间并不够用
there aren’t quite enough hours in the day.
不要 利亚姆!
Don’t, Liam!
虽然原因不同
For very different reasons,
埃德和利亚姆都从同种药物中获益
both Ed and Liam have found benefits from the same drug.
五岁的时候 利亚姆被确诊为
Aged five, Liam was diagnosed
注意力不足过动症 简称ADHD
with attention deficit hyperactivity disorder, ADHD.