每天一篇经济学人 | Medicine and the brain 医学...

Disorders of the brain are a growing worry. Twelve mental-health conditions affect about 970m people around the world according to the Global Burden of Disease Project: more than one in ten of the population. Patchy data mean that this figure could well be an underestimate. On top of that, neurological problems, such as stroke, dementia, migraine, Parkinson’s, epilepsy and brain injury are collectively the leading global source of disability. Ageing populations with unhealthy ways of life are likely to make this problem much worse everywhere.

大脑紊乱越来越令人担忧。根据全球疾病负担项目的数据，12种精神健康疾病影响着全球约9.7亿人：超过十分之一的人口。分布不均匀的数据意味着这个数字很可能被低估了。除此之外，中风、痴呆、偏头痛、帕金森症、癫痫和脑损伤等神经系统问题是全球残疾的主要来源。人口老龄化和不健康的生活方式很可能使这一问题在各地更加严重。

In an ideal world science would be coming to the rescue. But the brain is a complex organ—sometimes described as the most complex structure in the known universe. Through good fortune and subsequent diligence, 20th-century science provided some pharmacological tools with which to treat some of the things that go wrong with it. But its fundamental mysteries have proved difficult to unravel. As a result, progress has been much slower than in treatments for the heart or cancer. 

在一个理想的世界里，科学会来拯救我们。但大脑是一个复杂的器官，有时大脑被描述为已知宇宙中最复杂的结构。通过好的运气和随后的勤奋，20世纪的科学提供了一些药理学工具，用来治疗与之相关的一些问题。但事实证明，它的基本奥秘很难解开。因此，它的进展比心脏或癌症的治疗要慢得多。

Indeed, it has sometimes been hard to discern much progress at all. The private sector spent an estimated $43bn on research into therapies for Alzheimer’s disease between 1998 and 2017 and came up empty-handed. That epic failure is perhaps the biggest reason why, in the 2010s, many drug firms abandoned or cut back on neuroscience research.

事实上，有时(甚至)很难看出有多少进展。1998年至2017年期间，私营部门在阿尔茨海默病疗法的研究上投入了约430亿美元，但最终空手而归。这种巨大的失败可能是2010年代许多制药公司放弃或减少神经科学研究的最大原因。

Happily, there are signs of a change afoot. In our Technology Quarterly this week we report on a renaissance in neuroscience, with many drug companies, some of them big ones, showing renewed interest in the field. This fresh energy is coming from a variety of techniques and ideas. Optogenetics, which uses genetic manipulation to get animal brains to reveal their workings—and open them up to change—through the use of light, is transforming brain science in the laboratory, as is the growth of tiny brain-like “organoids”. More precise diagnosis and well-validated biomarkers, which reveal the course of disease, are improving clinical trials. A growing openness to the investigation of previously recreational and stigmatised drugs is widening the range of possible medicines. New kinds of treatment, such as gene therapy, are expanding the range of diseases that can be tackled. Other advances are spurring progress in dealing with chronic pain. 

令人高兴的是，有迹象表明，改变正在发生。在本周的Technology Quarterly栏目中，我们报道了神经科学的复兴，许多制药公司，其中一些是大型制药公司，对这一领域表现出了新的兴趣。这种新能量的注入来自于各种各样的技术和想法。光遗传学通过基因操纵使动物的大脑显示出它们的活动方式，并通过光来激活它，从而改变动物的活动方式。光遗传学正在改变实验室中的脑科学，就像小的“类脑器官”的生长一样。更精确的诊断和有效的生物标志物能够揭示疾病的进程，改善临床试验。对以往娱乐性和污名化药物的研究越来越开放，这扩大了可能的药物范围。新的治疗方法，如基因疗法，正在扩大可治疗疾病的范围。其他方面的进步也在推动慢性疼痛治疗的进展。

At the same time a growing mound of “cohort” data is proving critical to understanding the biological roots of brain dysfunction. Projects like the uk Biobank track tens or even hundreds of thousands of individuals over a generation or more. They should help answer questions about the roots of brain disorders such as dementia that may take decades to emerge. 

与此同时，越来越多的“队列”数据被证明对理解大脑功能障碍的生物学根源至关重要。像UK Biobank这样的项目在一代人甚至更多代的人里跟踪了数万甚至数十万个人。它们应该有助于回答有关痴呆症等脑部疾病根源的问题，痴呆可能需要几十年才能出现。

As hopes rise for tackling this final frontier of biomedicine, it is worth remembering that the secrets to a healthy brain are not only going to come from a pill or psychotherapist’s couch. The health of the brain is influenced by what goes on outside it, such as nutrition, exercise, the abuse of alcohol, education, social connections and pollution. Of particular relevance these days is air pollution—which could have a negative influence on brain health at both the beginning and the end of life. None of this should be surprising: the health of the brain is tied to the health and the well-being of the body that it sits in. Efforts to ensure better brain health are an investment that will keep paying dividends for individuals, and for societies, for decades to come.

随着攻克生物医学这一最后前沿领域的希望增加，值得记住的是，保持大脑健康的秘密不仅来自于药物或心理治疗师的沙发。大脑的健康受到外界的影响，如营养、锻炼、酗酒、教育、社会关系和污染。如今，空气污染尤为重要，它可能会在生命开始和结束时对大脑健康产生负面影响。这些都不足为奇：大脑的健康与它所处的身体的健康和幸福息息相关。努力确保大脑更健康是一项投资，这将在未来几十年继续为个人和社会带来回报。