摘要：Every day seems to bring more exciting news. First the drugs tackled diabetes. Then, with just an injection a week, they took on o
正文翻译
Every day seems to bring more exciting news. First the drugs tackled diabetes. Then, with just an injection a week, they took on obesity. Now they are being found to treat cardiovascular and kidney disease, and are being tested for Alzheimer’s and addiction. It is early days yet, but glp-1 receptor agonists have all the makings of one of the most successful classes of drugs in history. As they become cheaper and easier to use, they promise to dramatically improve the lives of more than a billion people—with profound consequences for industry, the economy and society.
似乎每天都有更多振奋人心的消息。这些药物最初用于治疗糖尿病，后来发现每周只需注射一次可以减肥，现在发现可以治疗心血管和肾脏疾病，并且正在进行旨在治疗阿尔茨海默病和成瘾的试验。虽然只是初期阶段，但GLP-1受体激动剂堪称有史以来最成功的一类药物。随着价格越来越便宜和更易使用，它们有望显著改善数十亿人的生活，对工业、经济、社会产生深远的影响。
In the three years since semaglutide was approved for treating obesity, it has taken America by storm. After decades of disappointing “miracle cures”, these drugs work. Image-conscious influencers and well-heeled financiers are not their only users. Already one in eight American adults has been on glp-1 drugs. Novo Nordisk, maker of semaglutide, branded Ozempic for diabetes and Wegovy for weight loss, and Eli Lilly, which makes tirzepatide, a more effective alternative, have together added around $1trn in market value since 2021.
自从三年前司美格鲁肽获准用于治疗肥胖症以来，这种药物迅速风靡美国。在“神奇疗法”令人失望数十年后，这些药物见效了。注重形象的网红和阔绰的金融家并不是唯一的用户，目前已有八分之一的美国成年人在使用GLP-1药物。司美格鲁肽由诺和诺德公司生产，用于治疗糖尿病和减肥的品牌名分别为诺和泰（Ozempic）、诺和盈（Wegovy）。替尔泊肽由礼来公司生产，具有更显著的功效。自2021年以来，两家公司的市值总共增加了约1万亿美元。
The action is now moving beyond America. With over two-fifths of the world overweight or obese, demand for glp-1 drugs is voracious. Pharma companies are racing to make them work as pills, which would be cheaper to produce than jabs, and to reduce their side-effects. Generic versions for older glp-1 agonists are entering the market. Semaglutide is to come off patent in Brazil, China and India in 2026; eight such drugs are in the works in China. That is just as well. As incomes in the developing world have risen and life has become more sedentary, people’s waistlines are catching up with those in the West.
这一趋势正在向美国以外的地区蔓延。全球有超过五分之二的人超重或肥胖，GLP-1药物的市场需求是巨大的。制药企业正在争相将其制成片剂，使生产成本低于注射液，并减少副作用。非专利的旧版GLP-1受体激动剂正在进入市场。司美格鲁肽在巴西、中国、印度的专利将于2026年到期；中国正在研发八种此类药物。这样也好，随着发展中国家收入的提高，生活方式日益趋向久坐不动，人们的腰围正在接近西方人的水平。
Curbing obesity would be consequential. Yet glp-1 drugs promise to do much more. Overweight patients on semaglutide have been found to suffer fewer heart attacks and strokes; the benefits, astonishingly, seem to be largely independent of how much weight is lost. Tirzepatide improves sleep apnoea. Trials show that glp-1 agonists reduce chronic kidney disease in diabetics; and there are signs they may lessen brain shrinkage and cognitive decline in Alzheimer’s. Studies of health records suggest that they may help with addictions, too; people already on glp-1 drugs in America were less likely to overdose on opioids or abuse cannabis or alcohol. Researchers are even talking, in hushed tones, of their anti-ageing effects.
减肥具有重要意义，但GLP-1药物可能还有其他功效。研究表明，使用司美格鲁肽的超重患者在心脏病发作和中风方面的风险显著降低。令人惊讶的是，这些益处似乎与减肥没什么关系。替尔泊肽可以改善睡眠呼吸暂停。试验证明，GLP-1受体激动剂能够降低糖尿病患者的慢性肾病发生率；有迹象表明，这种药物可能减轻阿尔茨海默氏症患者的大脑萎缩和认知能力下降。医疗记录研究显示，它们还可能有助于戒除成瘾。在美国，使用GLP-1药物的患者不容易过量服用阿片类药物、滥用大麻、酗酒。研究人员甚至私下议论抗衰老功效。
How can one class of drug do so much? As our briefing explains this week, not only do the drugs act in the gut, but they also bind to receptors all over the body and in the brain. The drugs appear to reduce inflammation and interact with mechanisms lixed to cravings and feelings of reward. With every new finding, researchers are learning more about the workings of disease and the lixs between the body and the brain.
一种药物为何有这么多功效？正如我们本周的简报栏目所阐述的，这些药物不仅在肠道中发挥作用，而且与全身和大脑中的受体相结合。这种药物似乎能减少炎症，并与欲望和奖赏效应相关的机制相互作用。每有一项新发现，研究人员就能进一步了解疾病机制以及人体与大脑之间的关联。
Naturally, more work is needed. Although glp-1 agonists have been used in diabetes for 20 years, some of the newer findings are based on observational studies, and will need to be supplemented by randomised trials. Patients may need to remain on these medicines for their whole lives, and their long-term benefits have yet to be quantified.
当然，有必要进行更多的研究。虽然GLP-1受体激动剂用于治疗糖尿病已有20年，但有些新发现是基于观察性研究，需要随机试验作为补充。患者可能需要终生服用这些药物，长期功效有待于量化。
That makes the costs uncertain, too. For now the drugs are expensive: tirzepatide is priced at over $500 a month in America. Their immediate side-effects, which can include nausea, pancreatitis, diarrhoea and muscle loss, may be off-putting; the effects from decades of taking them are uncertain. Some worry about the medicalisation of everyday life, and whether people will binge, knowing they can fall back on a cure.
这也使得治疗费变得不确定。目前这种药物价格昂贵：在美国服用替尔泊肽的每月费用超过500美元。即刻发生的副作用可能令人反感，包括恶心、胰腺炎、腹泻、肌肉流失。服药数十年的影响尚不明确。有人担心日常生活变得医疗化，人们是否会因为知道可以依靠药物而暴饮暴食。
Yet with time, experimentation and innovation, the benefits will become clearer, and the costs will come down. Healthy habits and good public-health advice will still matter. But practitioners have long despaired that nothing works for many obese people. If the drugs live up to their early promise, it would be perverse and cruel to deprive patients of medicines that could dramatically improve their lives. The drugs could hold the same promise for addiction.
但随着时间的推移和更多的试验和创新，益处将变得明朗，费用也会下降。健康的生活习惯和良好的公共卫生建议仍然很重要。但医生一直对无法医治许多肥胖者而感到绝望。如果这些药物能达到预期疗效，那么拒绝患者使用可以极大提高生活质量的药物是残忍和没有道理的。这些药物对成瘾可能也有疗效。
Stand back and the possibilities are thrilling. In 2019 heart disease, stroke, diabetes, Alzheimer’s and kidney disease ranked among the top ten global causes of death. By 2050, as the world ages and developing countries’ health care improves, these diseases will take a bigger toll. Last year more than 100,000 Americans were killed by opioid overdoses and 180,000 died from drink.
重新审视一下，这些药物的潜力振奋人心。2019年，心脏病、中风、糖尿病、阿尔茨海默病、肾病位列全球十大死因。到2050年，随着世界老龄化和发展中国家医疗条件的改善，这些疾病将导致更多人死亡。去年，超过10万名美国人因过量服用阿片类药物而死亡，18万人因酗酒而死亡。
For patients, the new uses of glp-1 drugs would mean not just longer, healthier and more productive lives, but happier ones, too. In a world of abundance people succumb to their impulses even if they know their behaviour is harmful in the long term. Although glp-1 agonists may limit the pleasure of instant gratification, they promise to end intrusive cravings and improve long-term health.
对于患者来说，GLP-1药物的新用途不仅意味着更长寿、更健康、更充实的生活，也意味着更幸福的生活。在一个物质充裕的时代，即使人们知道自己的行为从长远角度有害健康，他们还是会屈从内心的冲动。虽然GLP-1受体激动剂可能限制人们及时行乐，但它们有望消除令人烦恼的欲望，改善长期健康。
The total bill for prescribing these drugs could be vast. Yet for governments they would lower some other costs: the direct medical bill for obesity alone amounts to $260bn a year in America; substance abuse is a huge burden for the criminal-justice system. The state would raise less revenue from taxes on alcohol, but income-tax revenues would go up, as the workforce became healthier.
开这些药物的总费用可能很大，但能为政府减少其他开支：在美国，光是肥胖症的直接医疗费用每年就高达2600亿美元；药物滥用给刑事司法系统造成了沉重负担。政府的酒税收入将会减少，但随着劳动力变得更加健康，所得税收入将会增加。
Less is moreish
越少越好
Rather as the contraceptive pill encouraged women to stay in education and work, so glp-1 drugs could lead to profound economic and social change by enhancing productivity and freedom. Some business models could be upended. If craving can be controlled, junk-food companies, advertisers and even drug-dealers may shift their focus from quantity to quality.
正如避孕药激励女性继续接受教育和工作，GLP-1药物可能通过提升生产力和自由而引发深刻的经济和社会变革。一些商业模式可能被颠覆，如果欲望可以被控制，那么垃圾食品企业、广告商、甚至毒贩可能注重质量，而不是数量。
Social mores could evolve. In the West thinness is prized as the ideal of beauty, because for so many it is hard-won, whereas obese people suffer discrimination and lower wages. If being thin is easier, that may change. Obesity and addiction may less often be seen as moral failings, but as illnesses that can be treated. The glp-1 revolution is just beginning. Its promise is tantalising.
社会习俗可能逐渐发生变化。西方国家以瘦为美，因为许多人不易实现这个目标，而肥胖者则遭受歧视，工资也较低。如果轻松就能变瘦，情况就可能发生改变。肥胖和成瘾可能不再被经常视为道德沦丧，而是可以治疗的疾病。GLP-1革命才刚刚开始，前景诱人。
来源：龙腾网看世界