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Professor Kim Lyerly Interview

Professorfor Research in Cancer and Professor of Surgery, Duke University; Director of the Duke Comprehensive Cancer Center.

Professor H. Kim Lyerly, M.D., FACS. He serves the editorial board of 12 scientific journals.  Dr. Lyerly has been appointed a member of the National Cancer Advisory Board by President George W. Bush. He is also a member of the scientific advisory committee on the Susan G. Komen for the Cure Foundation and the Burroughs Welcome Fund, and he has served as chair of the executive committee of the integration panel of the Congressionally Directed Medical Research Programs in Breast Cancer. Dr. Lyerly is a member of advisory boards for the M.D. Anderson Cancer Center and the Universities of Michigan, Chicago, and Wisconsin. He co-directs the NCI sponsored workshop of cancer clinical trials and is the scientific chair of the Southwest Oncology Group Molecular Therapeutics Committee.

《医师报》记者

  • 您觉得,作为一名医生,应该如何看待诺贝尔奖和自己的关系?毕生的目标?潜心钻研后的水到渠成?还是其他什么?

So I guess you’re asking if the physician to a practicing medicine are impacted by the Noble Prize, or the science behind the prize that is worth it? So I think the Nobel Prize is very important, they highlight major scientific changes that often have an impact on medicine either because they have a direct relationship to a human condition, or they develop tools for scientists to study human health and diseases. So it’s often a balance of a direct observation, or tools, or inside of fundamental process.

我猜你要问的应该是医生行医是否会受诺贝尔奖的影响,或者诺奖背后的科研工作是否值得?我认为诺贝尔奖非常重要,它突出的是对医学发展有决定性影响的科学变化,这些变化的重要性不但体现在他们直接关系着人类的生存,更为科学家们研究人类健康和疾病的关系提供了多种方法和途径。因此,诺贝尔奖应该在直接的临床观察、研究方法和基础研究过程中取得平衡。

 

2、中国有一位院士曾经说过:“做科研是医生的天职天命”。您是否认可这样的说法?医生与科研之间应该是一种怎样的关系?医生应该如何做好科研?

That’s a very good question. I think in medicine,there are something , in which  the medical solution is very good , I think that’s very helpful. And a doctor should practice that, are very effective. There aresomething in medicine that the success is very poor, sometimes for example the management of patients with advanced cancers, the outcome to the patients remains poor. So there’re many things to do research on. But those physicians, who would like to improve what we do today, have to be involved in research.  So I don’t think anyone wants to have a poor outcome, and spend their whole life repeating of poor outcome for the next patient and the next patient. So research allows them to have a hope for the future, not only for their own interest, but a hope to improve the outcomes for patients, that hope could be an understanding of new treatment, or new diagnoses, but sometimes it comes into new understanding of the disease. So the Nobel Prize was awarded a few years ago for understanding of the virus infection causes cancer of the cervix, so now the development of a vaccine to prevent that infection.   So rather than a new surgical   tool, or new medicine to treat cervical cancer,    the hope would be that we always prevent cervical cancer by preventing the viral infection that causes that. So I think that’s an example where research, you know, really does have both impact on understanding the disease, and then hopefully the future would be improved outcomes, or maybe elimination of the disease itself.

这是个很好地问题。我认为,涉及医学有很多有效地解决办法,作为医生应该尽量应用,很有帮助。但是,医学领域也有一些成果极其有限的部分,比如针对晚期癌症患者,救助手段和科研成果还极为欠缺,所以需要研究的东西还有很多。而对于想要致力于改善目前诊疗水平的医生而言,科研工作是必不可少的。我相信,没有人愿意终其一生,把缺陷明显、亟待完善的诊疗技术反复应用于一个又一个病人身上。科研可以带来希望,不仅仅是出于医生的个人兴趣和利益,最主要可以提升病患的诊疗效果。这里所说的希望可以是新疗法,新的诊断方法,有时候也可以是对疾病的全新认识。所以几年前,诺贝尔奖颁发给了发现病毒感染导致宫颈癌的科研成果,然后又颁给了研发疫苗来防治感染的科研成果。我们希望将来防治宫颈癌的方法可以变成预防引起宫颈癌的病毒感染,而不是用新的手术或者药物来治疗。因此,我认为,做科研不仅要疾病的理解,而且希望在未来,科研可以改良治疗效果甚至消除疾病本身!

 

组委会采访

  1. No Chinese-born medical scientist has won a Nobel Prize in the field of medicine. From your experience and knowledge regarding China’s medical industries, would you please communicate to our perspective audience one existing advantage or disadvantage in any of Chinas present medical atmospheres?

在医学领域至今尚未有中国籍科学家获得诺贝尔奖。基于您的经验和知识,参照中国医疗产业现状,您能列举出一个中国医疗大环境下的优势或劣势吗?

Well, I think there is one very large advantage in China. And that is a very large number of people, and the health care system that is evolving to provide care for all those people. Because our ability to understand medical outcomes depends on the number of events that occur in a population. And so let’s say something that occurs commonly, that you would like to see a number of events occur. And you would like to compare that to another situation. You also want to look for a number of events that can occur, if you have very large numbers of patients, the time for those events to occur could be much more rapid than a situation where you have few people. So, for example, the study for a new therapy could actually occur in china in a way that would allow people to understand very quickly, that something is working or not working.  The key thing about how new therapies are developed is that it is a process; some trial, we don’t like to say this, but sometimes there are some errors, and then you learn and you advance quickly. So the idea that the testing could occur in a population where you would know more quickly the outcome, and then you learn from that, and then move to the 2nd step or 3rd step or the 4th step. You can see that there might be enormous advantage in China in which the uniform application of rules and regulations and the health care system would allow someone to learn very quickly what’s the right form of therapy or right strategy or new medicine for that condition. So, that could be extremely powerful and enormous opportunity for china in the medical establishment.

中国有一个非常明显的优势:人口基数大,就需要匹配相应的健康医疗系统。因为我们了解诊疗效果的能力取决与人群疾病治愈数量。有一个大的人口数量做基数,对治愈率的判断要远远迅速于比人口基数小的情况。所以,举个例子来说,在中国研究一种新疗法我们可以更快地知道其是否可行。新疗法的研发需要经历一个过程,一些试验——虽然不愿已承认,有时候确实会有错误发生。然后从错误中学习可以取得更快的进步。所以,在一个人口基数大的环境下,你的科研试验可以更快地测试出结果然后从中学习,而后进入到第二、第三、第四个步骤,所以在中国因为人口基数的原因,你可以更快的了解一种理论、一种策略、或者一种新药的实际效果。可以看到,中国在实施统一的规则和条例方面有巨大的优势,中国的医疗体系能够让人更快地知道某种情况下某个疗法的正确的形式、策略和药物的使用。对于中国医疗建设这是个极为重大的机遇。

 

  1. On May 8th in Beijing, the NPLS organizing committee will officially announce the Nobel Prize Star (NPS) award winners. The NPLS organizing committee awards the NPS award to encourage innovative medical thought for the creation of new medical ideas.Considering your position today in the medical science field and your scientific forefather’s experiences in the past, the public could assume that medical leaders and/or medical professionals have used your experiences, discoveries, work, or knowledge to assist in fighting human disease. If you could share one interesting instance or experience related to your professional and/or personal growth, while in seek of your own scientific endeavors, what would it be?

5月8日组委会会宣布今年诺奖之星的评选结果,诺奖之星的评选是为了鼓励中国年轻医学科学家的创新和创造。从您自身的角度和成长科研经历出发,大家可以认为很多医学领袖或医学工作者曾经利用您的科研成果或理论知识来帮助他们对抗人类疾病的研究。是否可以请您分享一个您亲身经历、与您的科研道路或者个人成长方面相关有趣的事情?

 

Professor Lyerly:  Well, I think that the important thing that would be useful to share is the fact that, you know, an environment that allows people to question what exists, and to challenge what we think we know is really important.I think a good example from my own personal experience was that I was working in a cancer research laboratory, as young scientist, and there were many medicines that had been developed for cancer that were found to be ineffective, and so they were put on shelves in storage. And during that time there was a new disease that was emerging in the United States and around the world, which was the infection of humans with a virus, a new form of human infection called Human Immunodeficiency virus, or HIV. Now the HIV virus used a form of replication that was different than what most people expected life forms to take. Most life forms went from a DNA, which is the back bone of the genetic information for us. DNA is made into RNA and RNA is the blueprint to make the building blocks of life, proteins, and so forth. Retroviruses went backwards, they went from RNA to DNA, and then went and completed their lifecycle. When HIV first emerged it was a devastating disease. People thought there would be an elimination of a significant percentage of mankind.  People began to look at stopping HIV infection and they began to explore the use of old chemotherapy agents that were not very effective. So, people developed screening strategies where the process of reverse transcription, this backwards form of life was tested in test tubes, and identified a drug called AZT that seemed to block that process and in fact that was subsequently tested in the laboratory, and found that it could inhibit the HIV virus and subsequently these new medicines which were actually old failed medicines were tested in people that had HIV infection and were shown to be effective. And this foundational piece failed chemo-therapy and the reverse of the lifecycle led to the development of the anti-retroviral medications that have proven so effective in the abatement and treatment of the HIV infection in the United States, around the world and so forth.So that would be my sense, that if we had believed that a failed drug wasn’t going to work anymore or if we believed that there was only one way of life, that could occur, we’d never would have put together the opportunity to develop new therapies, you know that directly impacted people all over the world.

对我来说,如果一个环境能够允许人们质疑和挑战那些我们认为正确的事物十分重要。举个我自己的例子,年轻的时候,我在一家肿瘤研究实验室工作,很多为治疗肿瘤儿研发的药物因为无效而被弃之高阁。那个时候,在美国和全世界爆发了一种新的疾病,实际上是病毒感染,那是一种被称之为人类免疫缺陷病毒或者HIV的新型感染。HIV病毒跟大多数人设想的生命形态不同,它用复制的方式不断繁殖。绝大多数生命形式来自于DNA,对我们而言,DNA是承载遗传信息的载体,DNA转录为RNA,RNA则是构造生命、蛋白质等的蓝图。逆转录酶病毒正好相反,他们从RNA逆转录为DNA,然后完成生命周期循环。HIV病毒刚出现的时候几乎是一种毁灭性的病毒,人们甚至它会毁灭相当比例的人口。科学家们开始重视阻断HIV病毒的传播,并着手开发原有的化疗药物治疗,但效果并不好。后来,科学家们用逆转录筛选的方式在试管中检测HIV病毒,发现有一种叫做AZT的药物似乎可以阻断这个过程,随后经过实验室的测试,这种药物确实可以阻断HIV病毒感染,随后的人体试验也表明,这些之前对其他疾病无效的药物对于HIV病毒感染者而言,却是十分有效。这些失败的基础化疗药物和逆转的生命周期造就了抗逆转录酶病毒治疗药物的产生,这些药物对美国乃至世界在减轻和治疗HIV病毒感染中起了很大的作用。所以,我想说的是,如果我们以为之前测试无效的药物将来也不可能再派上用场,或者生命的形式只有一种,那么我们就无法把握机会发现可能改变整个人类命运的新疗法。

 

Justin:  Was that in the 80’s or 90’s?

这件事发生在80年代还是90年代

Professor LyerlyIn the 80’s

80年代

Justin:  I was born in 1980’s.

我就是80后

Professor Lyerly: Yes, I was a medical student and people were just discovering HIV, I was a medical student at UCLA, so the young people would come in and they would die in front of us, so we spent a lot of time on antiretroviral sciences at that time.

对,我当时还是加州大学医学院的学生,人类也刚刚发现HIV病毒,病人可能刚刚走进医院,然后就死在你的面前,所以人们花了很多时间进行抗逆转录酶的研究。

 

  1. In your own opinion, what major advantages would you make use of that is existing in China’s medical industries that could potentially attract Chinese-born medical scientists and/or mandarin-speaking practitioners living abroad, to return to China for the fight against human disease?

您认为,中国医疗产业的哪一个主要优势足以吸引海外的华人科学家返回中国,在中国为人类对抗疾病的斗争努力?

Lyerly:  Well, I think there are many things that motivate people. But I do think people who have an interest and passion in improving outcomes, look for opportunities, and those opportunities could be in the development of programs that are specific to fight diseases of interest to them, whether that’s cancer or autism or all kinds of disease. The ability to have organizational structure and pathways of success, for that, that’s clearly one.Then also I think an investment in the scientific resources and infrastructure that’s necessary to be, an active and productive scientist. So currently the investment by the central Chinese government in biomedical research is growing every year, which is fantastic. But still, it is a very, very small fraction of the investment that the U.S. makes every year. The U.S. investment has been stable in accounting for inflation that has actually been dropping off for the last few years which always makes it a very difficult. If we born young people, there is no room for them because the biomedical infrastructure is not growing.  So, the best opportunity for China is, to try to, I think, to promote the opportunities for young scientists to develop and blossom, and the mature in a Chinese biomedical establishment.

我认为很多方面都可以鼓舞人才回国,但同时我也认为,那些对科研成果的改进有兴趣和热情和在寻找发展机会的人,可以投入到发展对抗癌症、自闭症或其他任何疾病的专项项目去,很明显,拥有良好的组织机构和通往成功的途径是其中之一。其次,我认为,科研资源和基础设施的投入,对于吸引积极高产的科学家也很必要。所以,近年来中国中央政府对生物医学领域的投入逐年增长是一个非常好的现象。但跟美国比较,这个比例还是过小,并且由于通货膨胀的影响,美国政府的稳定投入相较而言已算逐年递减,这实际上给美国医学研究产业制造了一些困难,因为如果生物医疗基础设施没有增加,新出生的人就没有条件从事相关科研工作。因此,我认为,对中国来说最好的办法就是为年轻科学家的发展和成功创造更多的机会,并提供一个成熟的医疗大环境。

Justin: O.k., so you would say it would branch off of many outside investments and internal investments too, right?

所以您是说也应该把范围拓展到外部投资和国际投资,对吗?

Lyerly: Yup.

是的

  1. For Chinese Continuing Medical Education graduates, who are currently overseas, and having at least 4 years of organized medical research and being unable to acquire a medical residency, for whichever reason, would you encourage those medical investigators to pursue their professional medical careers in China? Why or why not?

对于在海外的中国医学留学生而言,还需要至少4年的有组织的医学科研时间,也未必能取得住院医生实习资质,不管处于何种原因,你能鼓励这些留学生归国继续他们的医学事业吗?

Well, the reality of being a biomedical researcher is that you have a life where your foot is in two worlds, one as a physician and a practitioner, and the other is a scientist. So I think the opportunities is for any tradition scientist, if they can find that right balance, I think it would be a very interesting opportunity to pursue. If any one of those opportunities is limiting. For example, if you’re a high-quality physician but you don’t have any opportunity to do research, that imbalance is not very useful.    Or, if you’re a great researcher and have research activities but the practice of medicine is not appropriate, then that becomes a challenge. I think one example of that, is the Oncology field in which the translational part or the application of your science into human care is an important part of that.  So, if you think that you have insight into treating cancer, then you develop a therapy that you think will either improve the treatment or reduce toxicities, then it’s a very important thing to try to move that idea and to test it into people, what we call translational research.  If there are structural limitations, for example, new medications are not available, or there is regulatory pearls, the testing new medicines, then I think some of the best scientists, in my opinion, that would like to see their basic research translated to improvements in human health, they may seek opportunities that really allow that to happen. And that may be something for leaders and policy makers to consider as they’re thinking about building the biomedical research capacity in parts of the world.

实际上,作为一个医学科研工作者应该同时生活在两个世界,就是说一方面作为临床医生,另外一方面还要作为科研人员。他们应该把平衡这两方面的关系,如果任何一方面受限,比如你是一个很优秀的医生,但没有什么机会参与科研,那么这种不平衡就会造成不利的影响。同样,如果你是一名非常优秀的科研人员,从事科研工作,但临床工作不匹配的话,也会遭到质疑。比如,在肿瘤研究领域,研究成果的转化或应用就是一个重要的部分。所以,如果你想研究肿瘤诊疗,那你就应该发展或者可以改善治疗或者减少毒副作用的疗法,然后在临床试验中测试有效性,这就是我们所说的转化医学。如果存在结构性限制,例如,新型药物不能上市,或者存在行政管理条款限制,或者新药测试程序,我想那些乐于见到他们的基础研究成果转化为能改善人类健康状况的医疗手段的优秀的科学家们自然会去寻找其他实现的途径。如果领导层或政策制定者正在考虑生物医学科研能力的建设,这是他们应该要关注的一个问题。

 

  1. Would you please offer a few words of advice that could help inspire our young audience of medical scientists working to make a difference in China’s general public health status?

您能给想为中国健康产业做出贡献的年轻科学家们说一些鼓励的话或给点建议吗?

I think the important thing about medicine is that it continues to change. When I was in medical school, there was many things that I was taught, that are now proven to be, wrong. And these things have important implications for care of many common diseases.  So, I think for those people that are young, that are caring for people, the idea that they can improve the care of the population, they can take opportunities to learn fundamental science that can improve the care of people, but they can also think about improving the application of care, or improving systems that deliver care, all of those things are important and I think balancing individual’s interests, and the opportunities, that will lead to, I think a meaning of their passion and their life and the outcomes of that meaning, you know contributions to society that will have lasting effects. So, again, I think people who have the opportunities in China to make a difference. I think the emerging recognition that difference can be made from policy, to clinical research, to basic research is encouraging and I think the ongoing investments that are being made are really creating enthusiasm for people, that they really do see the potential to have the opportunity, to have all of that, in a career in china.

医学在不断进步,之前我在医学院学到的很多东西现在都已经被证明是错误的,但这些东西对很多常见疾病的治疗有重要的启示。所以,对于年轻人来说,他们可以学习基础科学,提高人类的医疗水平,他们也可以考虑医学的转化,提供医疗服务,所有这些都很重要。我认为在个人兴趣和机遇两者之间找到一个恰当的平衡点,可以使得激情和现实生活都更有意义,更具成就感,让任感觉到自己对于社会的贡献是持续有效的。我想,中国是有机会有所变更创新的,当务之急是对于临床研究、基础研究进行政策上的改革,还有正在进行中的科研投入,都可以进一步激发大家的进取心,让大家看到在中国的潜在机会。