I'm going to tell you a story.
让我给你们讲一个故事。
I'm going to tell you a story about how the deadliest consumer product imaginable came to be.
这个故事讲的是你能想象的最致命的消费品是如何出现的。
It's the cigarette. The cigarette is the only consumer product that,
我指的是香烟。香烟是独一无二的消费品，
when used as intended, will kill half of all long-term users prematurely, later in life.
当按照预期使用时，它会让半数长期使用者在日后的生活中过早死亡。
But this is also a story about the work that we're doing at the Food and Drug Administration,
但这个故事也是关于我们在美国食品和药物管理局（FDA）的工作，
and specifically, the work that we're doing to create the cigarette of the future,
具体来说，就是我们正进行的制造未来香烟的工作，
that is no longer capable of creating or sustaining addiction.
使其无法再造成或维持上瘾。
A lot of people think that the tobacco problem or the smoking problem has been solved in the United States
很多人认为烟草问题或者吸烟问题在美国已经解决了，
because of the great progress that's been made over the last 40, 50 years, when it comes to both consumption and prevalence.
因为过去四五十年间我们在（烟草的）消费和使用率方面都取得了巨大进步。
And it's true; smoking rates are at historic lows. It's true for both adults and for kids.
确实如此；吸烟率处于历史低位。对于成年人和儿童都是如此。
And it's true that those who continue to smoke are smoking far fewer cigarettes per day than at any time in history.
另外那些继续吸烟的人每天吸的香烟数量确实比历史任何时候都少。
But what if I told you that tobacco use,
但如果我告诉你们烟草使用，
primarily because of firsthand and secondhand exposure to the smoke in cigarettes,
主要是暴露在香烟烟雾中吸入的一手烟和二手烟，
remains the leading cause of completely preventable disease and death in this country? Well, that's true.
仍然是这个国家完全可预防的疾病和死亡的主要原因时，你会怎么想？是的，这是真的。
And what if I told you that it's actually killing more people than we thought to be the case ever before? That's true, too.
如果再我告诉你，其实它杀害的人比我们想象的要多呢？这也是真的。
Smoking kills more people each year than alcohol, AIDS, car accidents, illegal drugs, murders and suicides combined.
每年死于吸烟的人数比酒精、艾滋、车祸、非法毒品、谋杀和自杀加在一起还多。
Year in and year out.
年复一年。
In 2014, Dr. Adams's predecessor released the 50th anniversary Surgeon General's report on smoking and health.
2014年，亚当斯博士的前任发表了美国卫生总署关于吸烟与健康的五十周年报告。
And that report upped the annual death toll from smoking, because the list of smoking-related illnesses got bigger.
这份报告还增加了每年因吸烟而死亡的人数，因为与吸烟有关的疾病越来越多。
And so it is now conservatively estimated that smoking kills 480,000 Americans every year.
依据目前的保守估计，美国每年因吸烟致死的人数为48万。
These are completely preventable deaths.
这些全是可预防的死亡。
How do we wrap our heads around a statistic like this?
我们该如何理解这样的数据呢？
So much of what we've heard at this conference is about individual experiences and personal experiences.
我们在这次会议上听到很多个体经历和个人经验。
How do we deal with this at a population level,
我们如何在人口水平上处理这个问题，
when there are 480,000 moms, dads, sisters, brothers, aunts and uncles dying unnecessary deaths every year from tobacco?
当每年有48万母亲、父亲、姐妹、兄弟、阿姨和叔叔不必要地死于烟草？
And then what happens when you think about this trajectory for the future?
当你思考未来的趋势时会发生什么？
And just do the simple math: from the time of the 50th anniversary Surgeon General's report five years ago,
只要做简单的计算：从五年前卫生总署的五十周年报道开始，
when this horrible statistic was raised, just through mid-century
那是这个可怕的统计数据发表的时间，只用了半个世纪，
that's more than 17 million avoidable deaths in the United States from tobacco use, primarily because of cigarettes.
美国就有超过1700万例可避免的因烟草引起的死亡，主要是由于香烟。
The Surgeon General concluded that 5.6 million children alive in the United States in 2014
卫生总署总结道，2014年美国有560万儿童
will die prematurely later in life because of cigarettes. Five point six million children.
日后将会因香烟过早死亡。560万儿童。
So this is an enormous public health problem for all of us
所以这对我们所有人都是巨大的公共健康问题，
but especially for us as regulators at the Food and Drug Administration and the Center for Tobacco Products.
尤其对我们这些在FDA和烟草制品中心的监管者而言。
What can we do about it? What can we do to reverse this trajectory of disease and death?
我们对此能做些什么呢？我们应如何扭转这种疾病和死亡的趋势？
Well, we have an interesting guide to help unravel issues like:
我们有个有趣的指南来帮助解决问题，比如：
How did the cigarette as we know it come to be?
我们所知道的香烟是怎么来的？
What is the true nature of the tobacco and cigarette business?
烟草和卷烟业的真正性质是什么？
How did the industry behave in the historically unregulated marketplace?
该行业在历史上不受监管的市场中是如何运作的？
And our guide is previously secret internal documents from the tobacco industry.
我们的指南来自烟草行业曾经保持机密的内部文件。
Come with me in a tobacco industry document time machine.
那么请和我一起进入烟草业文件的时间机器。
Nineteen sixty-three was 25 years before the Surgeon General was finally able to conclude that the nicotine and cigarettes was addictive.
1963年，那是在卫生总署最终得出尼古丁和香烟会使人上瘾的结论前25年。
That did not happen until the Surgeon General's report in 1998.
直到1998年卫生总署的报告才出现。
Nineteen sixty-three was one year before the first-ever Surgeon General's report in 1964.
1963年，是1964年史上卫生总署第一次发布报告的前一年。
I remember 1964. I don't remember the Surgeon General's report, but I remember 1964.
我记得1964年。我不记得卫生总署的报告了，但我记得1964年。
I was a kid growing up in Brooklyn, New York.
我是个在纽约布鲁克林长大的孩子。
This was at a time when almost one in two adults in the United States smoked.
那个时候几乎一半的美国成年人吸烟。
Both of my parents were heavy smokers at the time.
那时我父母都是重度烟民。
Tobacco use was so incredibly normalized that -- and this wasn't North Carolina, Virginia or Kentucky, this was Brooklyn
烟草使用极为正常--这里不是北卡罗莱纳，不是弗吉尼亚，也不是肯塔基，这是布鲁克林，
we made ashtrays for our parents in arts and crafts class.
我们甚至在工艺美术课上为父母做烟灰缸。
The ashtrays I made were pretty awful, but they were ashtrays.
我做的烟灰缸很难看，但倒是能用。
So normalized that I remember seeing a bowl of loose cigarettes in the foyer of our house and other houses
平常到我记得在我们家和其他房子的门厅里有一碗散装香烟，
as a welcoming gesture when friends came over for a visit.
作为朋友来访时的招待品。
OK, we're back in 1963. The top lawyer for Brown and Williamson,
好了，我们回到1963年。布朗和威廉姆森的首席律师，
which was then the third-largest cigarette company in the United States, wrote the following:
布朗和威廉姆森是当时美国第三大烟草公司，写下了如下句子：
"Nicotine is addictive. We are, then, in the business of selling nicotine -- an addictive drug."
“尼古丁会上瘾。我们的业务是出售尼古丁，一种会让人上瘾的毒品。”
It's a remarkable statement, as much for what it doesn't say as for what it does say.
这个声明很不可思议，不仅在于它说出的话，还在于它没说的内容。
He didn't say they were in the cigarette business. He didn't say they were in the tobacco business.
他没说他们是做香烟生意。他没说他们在烟草行业。
He said they were in the business of selling nicotine.
他说他们是销售尼古丁的行业。
Philip Morris in 1972: "The cigarette isn't a product, it's a package. The product is nicotine.
1972年，菲利普·莫里斯公司说：“香烟不是一种产品，它是个包装。产品是尼古丁。
The pack is a storage container for a day's supply of nicotine. The cigarette, a dispenser for a dose unit of nicotine."
烟盒是储存一天所需尼古丁的容器。香烟是一剂量单位尼古丁的分配器。”
We'll come back to this dose unit notion later.
我们稍后会回到剂量单位的概念。
And R.J. Reynolds in 1972: "In a sense, the tobacco industry may be thought of as being a specialized,
还有1972年的雷诺兹烟草公司：“在某种意义上，烟草行业可以说是制药行业中一个专业化、
highly ritualized and stylized segment of the pharmaceutical industry.
高度仪式化和风格化的部门。
Tobacco products uniquely contain and deliver nicotine, a potent drug with a variety of physiological effects."
香烟制品独一无二地包含并投送尼古丁，一种具有多种生理效应的强效药物。”
At the time, and for many decades, publicly, the industry completely denied addiction and completely denied causality.
当时，并且几十年来，这个行业公开地完全否认上瘾，完全否认背后的因果关系。
But they knew the true nature of their business.
但他们知道他们生意的真正本质。
And from time to time, there have been health scares made public about cigarettes, going back many decades.
时不时地，有关于香烟的健康恐慌被公诸于众，早在几十年前就是如此。
How did the industry respond? And how did they respond in this historically unregulated marketplace?
这个行业是如何回应的？它们在这个历史上不受监管的市场中是如何反应的？
Going back to the 1930s,
回到20世纪30年代，
it was with advertising that heavily featured imagery of doctors and other health care professionals sending messages of reassurance.
他们在广告中让医生和其他医护人员传达安抚信息的画面占据了显著位置。
This is an ad for Lucky Strikes, the popular cigarette of the time in the '30s:
这是美国好彩公司的一则广告，它是30年代流行的香烟产品：
We laugh, but this was the kind of advertising that was there to send a health message of reassurance.
我们笑了，但这就是那类广告用来传递让人放心的健康信息。
Fast-forward to 1950s, '60s and '70s.
快进到20世纪50年代，60年代和70年代。
And here, again, in the absence of regulation,
同样缺乏监管，
what we're going to see is modifications to the product and product design to respond to the health concerns of the day.
我们看到了商家通过修改产品和产品设计来响应当时的健康顾虑。
This is the Kent Micronite filter. And here, the innovation, if you will, was the filtered cigarette.
这是肯特微型过滤器。这里所谓的创新是过滤香烟。
What the smoker of this product didn't know, what their doctor didn't know, what the government didn't know,
这个产品的烟民不知道，他们的医生不知道，他们的政府不知道，
is that this was a filter that was lined with asbestos... so that when smokers were smoking this filtered cigarette
这个过滤器的内衬是石棉，所以当吸烟者吸食过滤香烟时，
and still inhaling the chemicals and smoke that we know are associated with cancer and lung disease and heart disease,
他们仍然吸入化学物质和烟雾，这些我们知道跟癌症、肺病和心脏病相关的东西，
they were also sucking down asbestos fibers.
他们还在吮吸石棉纤维。
In the 1960s and the 1970s, the so-called innovation was the light cigarette.
在20世纪60和70年代，所谓的创新是淡味香烟。

This is a typical brand of the day called True.
这是当时一个典型品牌，叫做True。
And this is after the Surgeon General's reports have started coming out.
这是在卫生总署报告开始发行后出现的。
And you see the look of concern on her face.
你可以看到她脸上的担忧。
And then it says, "Think about it." And then even below that in the small print are tar numbers and nicotine numbers.
然后它说，“考虑一下。”然后在更下面的地方，用小字写着焦油和尼古丁数据。
What was a light cigarette? How did it work?
什么是淡味香烟？它的原理是什么？
This is an illustration of the product modification known as "filter ventilation." That's not a real filter blown up.
这个图例展示了被称为“过滤通风”的产品修改设计。这并不是真正过滤器的放大图。
That's just a picture so that you could see the rows of laser-perforated ventilation holes that were put on the filter.
这只是张图示，能让你看到在过滤器上的一排排激光穿孔的通风孔。
When you look at a real cigarette, it's harder to see.
现实中你观察香烟时，它很难看到。
Every patent for this product shows that the ventilation holes should be 12 millimeters from the lip end of the filter.
这种产品的每一项专利都说明通风孔应和过滤器的唇端相距12毫米。
How did it work? The cigarette got stuck into a machine.
它的原理是怎样的？把香烟塞进机器里。
The machine started puffing away on the cigarette and recording tar and nicotine levels.
机器开始吞云吐雾地吸烟，并记录下焦油和尼古丁的含量。
As the machine smoked, outside air came through those ventilation holes
当机器抽烟时，外部空气进入这些通风孔，
and diluted the amount of smoke that was coming through the cigarette.
稀释了香烟产生的烟雾。
So as the machine smoked, there really was less tar and nicotine being delivered compared to a regular cigarette.
所以当机器抽烟时，确实比常规香烟输送的焦油和尼古丁要少。
What the tobacco industry knew was that human beings don't smoke like machines.
烟草工业知道人类不像机器那样抽烟。
How do human beings smoke this? Where do the fingers go? Where do the lips go?
人类是如何抽烟的？手指放在哪里呢？嘴唇应该放在哪里？
I told you that the patent said that the holes are 12 millimeters from the lip end.
我说过，专利说通风孔距唇端12毫米。
The smoker didn't even know they were there, but between fingers and lips, the holes get blocked.
吸烟者甚至不知道它们在那里，但在手指和嘴唇之间，通风孔被挡住了。
And when the holes get blocked, it's no longer a light cigarette.
当这些小孔被堵住时，它就不再是淡味香烟了。
Turns out that there's actually basically as much nicotine inside a light cigarette as a regular cigarette.
结果实际上，淡味香烟里面的尼古丁含量其实跟常规香烟一样。
The difference was what's on the outside. But once you block what's on the outside, it's a regular cigarette.
差异在于外面的东西。但一旦你挡住外面的东西，它就是一支常规的香烟。
Congress put FDA in the business of regulating tobacco products 10 years ago this June.
10年前的六月，国会让FDA介入烟草监管。
So you heard the statistics at the beginning about the extraordinary contribution to disease and death that cigarettes make.
于是你在开头听到了那些香烟导致疾病和死亡的惊人统计。
We've also been paying a lot of attention to how the cigarette works as a drug-delivery device
我们也把很多注意力放到香烟作为药物传输设备的工作原理
and the remarkable efficiency with which it delivers nicotine. So let's take a look.
以及它传递尼古丁的非凡效率。那么让我们看看。
When the smoker puffs on the cigarette, the nicotine from that puff gets up into the brain in less than 10 seconds.
当吸烟者吸一口烟时，这口烟里的尼古丁会在不到10秒内进入大脑。
Less than 10 seconds. Up in the brain, there are these things called "nicotinic receptors." They're there ... waiting.
不到10秒。在大脑里，有叫“尼古丁受体”的东西。它们在那里...等待着。
They're waiting for, in the words of that Philip Morris document, the next "dose unit of nicotine."
它们在等待，用菲利普·莫里斯公司那份文件的话来说，下一个“剂量单位”的尼古丁。
The smoker that you see outside, huddled with other smokers, in the cold, in the wind, in the rain,
你看到在外面的吸烟者，跟其他吸烟者挤在一起，在寒冷中，在风中，在雨中，
is experiencing craving and may be experiencing the symptoms of withdrawal.
正在经历渴望，并可能正在经历戒断症状。
Those symptoms of withdrawal are a chemical message that these receptors are sending to the body, saying, "Feed me!"
戒断症状是这些受体传递给身体的化学信息，说，“喂我！”
And a product that can deliver the drug in less than 10 seconds
一个可以在10秒内传递药物的产品
turns out to be an incredibly efficient and incredibly addictive product.
结果成为一种难以置信的高效和上瘾的产品。
We've spoken to so many addiction treatment experts over the years.
多年来，我们跟很多成瘾治疗专家交谈过。
And the story I hear is the same over and over again:
我听到同样的故事不断重复：
"Long after I was able to get somebody off of heroin or cocaine or crack cocaine, I can't get them to quit cigarettes."
“我早就能让某人戒掉海洛因、可卡因或强效纯可卡因，但我无法让他们戒烟。”
A large part of the explanation is the 10-second thing.
很大一部分解释是那个10秒钟。
FDA has it within its regulatory reach to use the tools of product regulation
FDA已经在监管范围内使用产品监管工具，
to render cigarettes as we know them minimally or nonaddictive. We're working on this.
让我们所知的香烟成瘾性最低或不成瘾。我们正在为此努力。
And this could have a profound impact at a population level from this one policy.
这一个政策可能在人口层面上产生深远的影响。
We did dynamic population-level modeling a year ago, and we published the results in "The New England Journal."
一年前我们做了人口层面的动态建模，我们在《新英格兰杂志》上发表了研究结果。
And because of the generational effect of this policy,
因为这项政策的世代效应，
which I'll explain in a minute, here's what we project out through the end of the century:
我马上会解释，这是我们预测到的本世纪末的情况：
more than 33 million people who would otherwise have gone on to become regular smokers won't,
超过3300万本来会成为常规吸烟者的人不会成为吸烟者，
because the cigarette that they'll be experimenting with can't create or sustain addiction.
因为他们将要试验的香烟不会产生或维持成瘾。
This would drive the adult smoking rate down to less than one and a half percent.
这将使成人吸烟率下降到1.5%以下。
And these two things combined would result in the saving of more than eight million cigarette-related deaths
这两件事情相结合，可以拯救800多万例吸烟有关的死亡，
that would otherwise have occurred from the generational impact of this.
他们的死亡本会因世代影响而导致的。
Now, why am I saying "generational"? It's about kids.
为什么我提到“世代”？这跟儿童有关。
Ninety percent of adult smokers started smoking when they were kids.
90%的成人吸烟者从孩童时期就开始吸烟。
Half of them became regular smokers before they were legally old enough to buy a pack of cigarettes.
其中一半人在合法购烟年龄前就成为了老烟民。
Half of them became regular smokers before they were 18 years old.
其中一半人在18岁之前就成为了老烟民。
Experimentation. Regular smoking. Addiction. Decades of smoking.
尝试。惯常吸烟。上瘾。数十年烟龄。
And then the illness, and that's why we're talking about a product that will kill half of all long-term users prematurely later in life.
然后是疾病，这就是为什么我们讨论的这个产品会让一半的长期使用者在以后过早死亡。
The generational impact of this nicotine-reduction policy is profound.
这个减少尼古丁的政策会带来深远的世代影响。
Those old industry documents had a word for young people.
那些旧的行业文件中用一个词形容年轻人。
They were described as "the replacement smokers."
他们被称为“替代吸烟者”。
The replacement smokers for addicted adult smokers who died or quit.
替代那些死亡或戒烟的成年烟民。
Future generations of kids, especially teens, are going to engage in risky behavior. We can't stop that.
未来世代的小孩，尤其是青少年，将会进行高风险行为。我们无法阻止他们。
But what if the only cigarette that they could get their hands on could no longer create or sustain addiction?
但如果他们唯一能入手的香烟无法产生或维持上瘾会怎样？
That's the public health return on investment at a population level over time.
这是长期在人口层面上投资的公共健康回报。
Haven't said anything about e-cigarettes. But I have to say something about e-cigarettes.
我还没有说到任何有关电子烟的事情。但我得谈一下电子烟。
We are dealing with an epidemic of kids' use of e-cigarettes.
我们正在应对电子烟在小孩中的流行使用。
And what troubles us the most, in combination with the rising numbers when it comes to prevalence, is frequency.
最让我们感到困扰的，是与不断上升的流行率相结合的使用频率。
Not only are more kids using e-cigarettes,
不仅有更多小孩在使用电子烟，
but more kids are using e-cigarettes 20 or more days in the past 30 days than at any time since e-cigarettes came onto the market.
而且自电子烟推出市场以来，在过去30天中使用电子烟20天以上的小孩数目达到了新高。
And at FDA, we're doing everything that we can using program and policy,
在FDA，我们正倾尽全力使用项目和政策，
first to get the word out to kids that this is not a harmless product
首先向小孩传递信息说，这不是一种无害的产品，
and to make sure that kids aren't initiating and experimenting on any tobacco product, whether combustion is present or not.
并确保孩子不会主动开始或尝试任何烟草制品，无论是否需要点燃。
But think about e-cigarettes in a properly regulated marketplace as something
但是想想电子烟在一个合理监管的市场上，
that could be of benefit to addicted adult cigarette smokers who are trying to transition away from cigarettes.
对于那些试图戒掉香烟的上瘾成年吸烟者来说可能是有益的。
So, I'll leave you with this vision:
所以，我将留给你们如下的愿景：
imagine a world where the only cigarette that future generations of kids could experiment with
想象这样一个世界，未来世代的儿童唯一能够尝试到的香烟，
could no longer create or sustain addiction because of a single policy.
因为一个政策，无法再产生或维持上瘾。
Imagine a world where health-concerned cigarette smokers,
想象这样一个世界，关注健康的吸烟者，
especially if a policy goes into effect that takes the nicotine levels down to minimally or nonaddictive levels,
尤其是在让尼古丁水平降低到最低或不上瘾程度的政策开始生效时，
could transition to alternative and less harmful forms of nicotine delivery,
可以过渡到危害更小的其它尼古丁传递形式。
starting with FDA-approved nicotine medications, like the gum, patch and lozenge.
他们可以从FDA批准的尼古丁药物开始，比如口香糖、贴片和嚼锭。
And finally, imagine a world and a properly regulated marketplace,
最后，想象这样一个世界和一个合理监管的市场，
whether it's e-cigarettes or whatever the technology of the day,
无论是电子烟还是任何当时的科技，
it's not the product developers and the marketers who decide which products come to market and what claims get made for them,
都不是由产品开发者和市场营销者决定什么产品进入市场以及对产品做出声明，
it's review scientists at FDA, who look at applications and decide, using the standard that Congress has entrusted us to implement and enforce,
而是由FDA的审批科学家审查申请，并使用国会委托我们实现和执行的标准，
whether a particular product should come to market,
来决定一个特定的产品是否能够进入市场，
because the marketing of that product and the words of our law would be appropriate for the protection of the public health.
因为那个产品的营销和我们遵循的法律应当有益于保护公众健康。
These are the kinds of powerful regulatory tools that are within our reach
这些都是我们可以使用的强有力的监管工具，
to deal with what remains the leading cause of completely preventable disease and death in the country.
可以用来处理这个国家的完全可预防的疾病和死亡的要因。
If we get this right, that trajectory, those 5.6 million kids, is breakable. Thank you.
如果我们正确处理，就能打破那个趋势，拯救那560万儿童。谢谢。