地平线系列：药物依赖（2010）

你会遇到口干
You would have dry mouth,
视线模糊 排尿困难的问题
blurred vision, problems passing urine.
全科医师 马丁·洛力博士
你会觉得神志不清 反应迟钝
You’d feel knocked out and dopey.
这种状况比你
It would be barely better
服药前的情况好不了多少
than the situation you were actually in to start with.
一种新药物的到来 改变了这一切
It all changed when a new wave of drugs came along.
科学家意识到 一种大脑中的化学物质
Scientists had realised that a brain chemical,
血清素 影响着我们的情绪
serotonin, affects our mood.
如果他们能够找到一种
If they could find a way to boost
提高大脑中血清素含量的方法
the amount of serotonin in the brain,
就能够提高我们的幸福感
it could improve our sense of wellbeing.
他们检验了数百种化合物
They tested hundreds of compounds
最终成功研制出了一种药物
and managed to create a new class of drugs
它消除了
that had a fraction of the
传统抑郁症治疗药物的副作用
side effects of the older anti-depressants.
这组化合物被命名为
This group was termed
选择性血清素再吸收抑制剂
selective serotonin re-uptake inhibitors,
简称SSRIs
SSRIs.
很快人们便熟知了其商品名
Soon they were known simply by the
这也是市场上首次出现此类药物 百忧解
brand name of the first one on the market, Prozac.
突然之间忧郁也可以通过治疗缓解了
Suddenly depression had become a treatable condition,
这也让抑郁症更为社会所理解
and that made it more socially acceptable.
如果你有治疗某种疾病的良药
If you have an effective treatment for a condition,
那些患有这种病的人
people who suffer from
便会从各地纷至沓来
that condition will come out of the woodwork
如果有效 他们还会来
and you’ll find more often that, build it and they will come.
到19世纪末
By the 1990s, the number of
寻求治疗的人数变成原来的三倍
people coming forward seeking treatment tripled.
很快抗抑郁药SSRIs成为万用药方
Soon SSRIs were a solution to everything.
那个时候 如果你去普通诊所看看
Back in those days, if you came into a GP’s surgery looking
因自行车被偷或是狗死去而致的忧伤情绪
a little bit glum cos someone stole your bike or your dog died,
都会被诊断为抑郁
you’d be assessed as being
开出抗抑郁药的药方
depressed and be given anti-depressants.
使用太过度了 这已是如今人们的共识
Way overkill. Everyone now admits that was true.
不久 反对SSRIs的浪潮掀起
In time, the tide began to turn against SSRIs.
随着越来越多的人服用这一药剂
As more and more people took them,
一些严重的 令人不安的副作用出现了
some disturbing serious side effects began to emerge.
大约有五分之一的人
The risks are that approximately one in five people
服药后可能会感到焦躁
will become much more anxious on these drugs,
而一百人中会有一个人有自杀倾向
that one in 100 or so will go on to a suicidal act,
每五百到六百人中会有一个人
that one in the area of something like 500 to 600 people
真的会自杀
may go onto complete suicide,
而这些人如果不服用此药就不会这样
who wouldn’t have done so if they hadn’t been on the pills.
其中一种药接受了审查
One drug in particular came under scrutiny.
颇具争议的抗抑郁药物塞乐特的制♥造♥者
The makers of the controversial anti-depressant drug Seroxat
因其对服药后可能产生自杀倾向
have been criticised by the health care regulatory body
这一信息的隐瞒
for withholding information about the
而被医疗监管机构批评
risk of suicidal behaviour associated with the drug.
2006年 塞乐特的制♥造♥商
In 2006, GSK, the makers of Seroxat,
葛兰素史克承认
one of these SSRIs,
塞乐特使自杀倾向提高了8倍
admitted that Seroxat raised the risk of suicide eight times.
遗憾的是 药物副作用并不是新鲜事
Sadly, side effects from drugs are nothing new.
反应停事件是战后的一次药物灾难
Thalidomide was the great drugs disaster of the post-war era.
在19世纪50年代
Given to expectant mothers
反应停用于缓解准妈妈们的晨吐问题
with morning sickness in the late 1950s,
但不久后其毁灭性的副作用便显现出来
it was not long before its devastating side effect became clear.
它于1961年撤出市场
It was withdrawn in 1961
而且由此诞生了新的审判程序
and brought with it new trials procedures
以期防止这样的悲剧再次发生
that were supposed to prevent anything like it happening again.
然而 事情并未如人愿
But they haven’t.
有迹象显示
There are warnings that
一种被全球几百万人使用的
a drug used worldwide by millions of people
治疗关节炎的药物有可能
with arthritis could
增加心脏病和中风的发病几率
increase the risk of heart attacks and strokes.
一种广泛用于肥胖症治疗的药物
Doctors have been told to stop prescribing
其处方已经被叫停
a drug commonly used in the battle against obesity.
其潜在风险已超过药效
The benefits no longer outweigh the considerable risks.
过去的五年里 仅在英国
In the last five years, in the UK alone,
就有八种药物
eight drugs have been
被监管机构撤出市场
withdrawn from the market by the regulators.
抗肥胖药物 利莫那班
The anti-obesity drug, Rimonabant,
由于引起自杀倾向而被禁用
was banned because it could cause suicide.
万络曾用来治疗类风湿性关节炎和痛经
Vioxx, used to treat rheumatoid arthritis and menstrual pain,
在五年内引发14万人心脏病发作
was withdrawn after it caused 140,000
而后被撤出市场
heart attacks in five years.
然而 药物出现不理想的作用
The discovery of undesired effects is, however,
也是源于药物试验性的本质
intrinsic to the experimental nature of medicine.
临床试验在几千人身上进行
Clinical trials are done on thousands of people,
然而有些副作用
but some side effects are only found
只有上百万的人服用以后
when hundreds of thousands take them,
也就是药物进入市场之后才会被发现
when the drug comes to the market.
你可能会出现一些副作用
You might start picking up side effects
葛兰素史克新药研发组长 帕特里克·瓦伦斯博士
可能是一些意料之外的
that you couldn’t have anticipated,
你不了解的 很罕见的副作用
that you didn’t know, that are relatively rare
却有可能很重要
but nonetheless can sometimes be important.
药物发展就是在不断的进行临床试验
Drug development is an ongoing clinical trial
我们都是试验的一份子
in which we all play a part.
是药三分毒
There’s no such thing as a totally safe medicine.
根本没有一种药物
There’s no such thing as a
我们能了解它的一切
medicine that we know absolutely everything about
因此有一些不确定因素 且将持续存在
and therefore there is some uncertainty, and that persists.
因为这源于药物的本质
Because this goes to the heart of what medicines are.
你在制♥造♥药物的过程
When you make a medicine,
你要试图打乱基本的生物进程
you’re trying to disrupt a fundamental biological process.
这是个复杂的变化
That’s a pretty profound change.
你不可能不产生预期外效果
You can’t do that without producing some unwanted effects.
那么问题就是
So then the question is,
你愿意为药物的益处承担多大的风险
what risk are you prepared to take for what benefit.
副作用不仅仅限于
Side effects are not restricted
包装后面写的那些
to the dangers written on the back of the packets.
对于成千上万的人们来说
For hundreds of thousands of people,
一开始本是治病良药
the thing that set out to be the solution
后来却成为了问题所在
has become the problem itself.
我一开始想 “真好”
I’m thinking, “Oh, lovely”,
后来我想”我必须吃药”
then I think, “I’ve got to have my tablets”,
我只想让这不适的感觉消失 真的
I just want this uncomfortable feeling to start going, really.
这就是我想要的
That’s all I want it to do.
它们曾是我最好的朋友
These used to be my best friends.
现在不是了 我很讨厌它们
They’re not now. I hate them.
乔·帕姆对止痛药上瘾
Jo Palmer is addicted to pain killers.
它可以完全改变你的性格
It changes your personality totally.
我很讨厌自己用药后
You know ,I hated the person
变成的那个人 现在也这样
that was emerging from it and I still do.
乔 从18年前就开始上瘾
Jo’s addiction started 18 years ago
当时医生给她开了强效止痛药
when she was prescribed
来治疗她的慢性痛
strong pain killers to deal with chronic pain.
但当她被治愈时
But by the time she’d been cured,
她发现自己已经离不开这种药了
she found she couldn’t function without the drugs.
这些年来 药瘾已经毁了她的生活
Over the years, the addiction has taken over her life,
上瘾引起疼痛 身体活动受到限制
causing pain itself, limiting what she can physically do.
乔曾试图克服药瘾
Jo has struggled to
但是她却摆脱不了
overcome her addiction but she can’t escape it.
问题就在于止痛药随处可见
The problem is that she can score her drugs on the high street.
你放眼望去会发现有很多药店
There is quite a lot of chemists when you look round,
你可以对照药剂师排班表去买♥♥
and you go in and you do it on a rota system,
所以每个药剂师
so one chemist thinks
都以为你只是每周买♥♥一次
that you’re just getting them once per week.
但是后来你拉你朋友去买♥♥ 你不是有意
But then you drag people into it and you don’t mean to.
但是 当我让我丈夫给我买♥♥药的时候
But you, you know, when I asked my husband to get them for me,