攻克癌症 拜登的登月計劃 Biden's moonshot mission

A couple of weeks ago I wriggled my way into an overcrowded conference room at the World Economic Forum in Davos to listen to US vice-president Joe Biden talk about efforts to cure cancer with a “moonshot” (an American buzzword for high-risk, potentially high-return forms of research).

1月的某一天，我擠進達沃斯世界經濟論壇(WEF)一個擁擠的會議室，聽美國副總統喬•拜登(Joe Biden)談論發起一個“登月計劃”(moonshot)治癒癌症的努力（moonshot是個美國流行詞彙，代指高風險和潛在高回報的研究形式）。

It was very revealing for two reasons. For one thing, when I saw Biden performing at close quarters, I finally realised why Democratic party elders have been muttering for months that he would be their preferred presidential candidate if Hillary Clinton fails to galvanise the voters.

這極其發人深省，原因有兩個。首先，當我近距離觀察拜登的表現時，我終於意識到爲何民主黨的元老們數月以來一直在說，如果希拉里•克林頓(Hillary Clinton)無法激勵選民，拜登將是他們青睞的總統候選人。

Biden can connect with an audience with an ease that, sadly, Clinton often lacks: though he arrived woefully late for the moonshot meeting, he oozed such charm that the audience (almost) forgave him. And when he explained why he was involved in the moonshot initiative — namely because his own son died of brain cancer — he was compelling. “I have experienced the dreaded C word, which is the most frightening word that anyone wants to hear walking out of the office,” he said. “Had I run [for president] I would have liked to be the president who changes the face of cancer — we need an absolute moonshot.”

拜登可以輕而易舉地與觀衆交流，遺憾的是，希拉里經常欠缺這點：儘管他遲到了很久才露面，但他在“登月計劃”會議展露出來的魅力讓觀衆幾乎原諒了他。當他解釋他爲何參與這項“登月計劃”時（因爲他自己的兒子死於腦癌），他的話令人信服。“我經歷過癌症這個可怕的詞，這是人們在走出辦公室的時候希望聽到的最可怕的詞，”他表示，“如果我競選（總統），我希望成爲一位改變癌症面貌的總統，我們絕對需要登月計劃。”

But the more important reason why the session was so revealing was the nature of the people Biden had gathered together. Some — including Toby Cosgrove, president of Cleveland Clinic, and José Baselga, chief physician from Memorial Sloan Kettering Cancer Center — were doctors in the classic sense. But many were not. There were professors from other disciplines, and IT experts such as Bill McDermott, head of SAP software group, who was keen to explain how researchers can use big-data techniques to search for patterns in the mutations of cancers.

但此次會議如此發人深省的更重要原因是，拜登將各種類型的人召集在了一起。一些人是經典意義上的醫生，包括克利夫蘭診所(Cleveland Clinic)所長託比•科斯格羅夫(Toby Cosgrove)和紀念斯隆凱特琳癌症中心(Memorial Sloan Kettering Cancer Center)首席醫師何塞•巴塞爾加(José Baselga)。但很多人不是。其中有來自其他行業的教授和軟件集團SAP首席執行官比爾•麥克德莫特(Bill McDermott)等IT專家；麥克德莫特熱衷於解釋研究人員如何能夠利用大數據技術尋找癌症變異的規律。

There were biologists on the platform too, and a chemical engineer — Paula Hammond, head of chemical engineering at MIT. As Professor Hammond observed, scientists could borrow nanotechnology ideas from chemical engineering to breach biological barriers.

發表演講的還有生物學家和化學工程師、麻省理工(MIT)化學工程負責人保拉•哈蒙德(Paula Hammond)。正如哈蒙德教授認爲的那樣，科學家可以從化學工程領域借鑑納米技術創意，以突破生物屏障。

“If you asked a psychologist or philosopher what the role of a chemical engineer in fighting cancer [might be], there would not be a ready answer,” Biden explained. “But my son had cancer and one of the things he was talking about was the blood-brain barrier.”

“如果你問心理學家或哲學家，化學工程師在抗擊癌症中的作用（可能）是什麼，或許沒有現成的答案，”拜登解釋稱，“但我的兒子患了癌症，他曾經談到的一件事是血腦屏障。”

This disparate collection of people illustrates a bigger point: that many scientists realise that if they want to have any chance of curing cancer, they must break out of their medical silos. One of the key paradoxes in medicine today is that while technologies are increasingly straddling medical silos, practitioners are stuck in their narrow fields more rigidly than before. What Biden — and others — emphasise is that knocking down these silos is almost as important as throwing money at any cancer moonshot (the total price tag for Biden’s project is estimated at $1bn). “When you go home and talk to your friends about a cure for cancer, I bet that none of them say ‘data’ and ‘standardisation’,” he explained. “But we have to find a way to break down those silos. This is crucial.”

不同類型的人聚集在一起說明了一個更重要的問題：很多科學家意識到，若要有任何機會治癒癌症，他們就必須突破醫學“豎井”。當今醫學的一個重要悖論是，儘管科技日趨跨越醫學“豎井”，但醫學研究人員比以往更僵化地固守自己所在的狹窄領域。拜登和其他人強調，突破這些“豎井”幾乎與在癌症“登月計劃”方面投入資金一樣重要（據估計，拜登癌症項目的總投入爲10億美元）。“當你回家與朋友們討論治癒癌症時，我打賭沒有人會說‘數據’和‘標準化’，”他解釋稱，“但我們必須找到突破這些‘豎井’的辦法。這一點至關重要。”

Does Biden stand any chance in this respect? If you talk to individuals who are working within the gigantic American health system, it is painfully hard to feel optimistic. Last week, I took part in a medical debate in Baltimore and heard officials describe with horror the silos that beset Washington’s mighty National Institutes of Health (apparently there are 27 different departments in the NIH, which are often reluctant to collaborate). And last year I listened as the actor Michael J Fox, who suffers from Parkinson’s, talked about the silos undermining the search for a cure for that disease too; indeed, one of the reasons Fox created his own research foundation was precisely because he was so horrified by the fragmented pattern he saw.

從這方面來說，拜登是否有成功的機會？如果你與在龐大的美國醫療體制內工作的個人探討，你很難樂觀。最近，我參加了在巴爾的摩舉行的一場醫學辯論，聽到官員們恐懼地介紹困擾着強大的美國國家衛生研究院(NIH)的那些“豎井”（該協會貌似有27個不同的部門，彼此間往往不願合作）。去年，我還聽到罹患帕金森症的演員邁克爾·J·福克斯(Michael J Fox)講述了影響帕金森症治療研究的“豎井”；的確，福克斯創建自己的研究基金會的原因之一恰恰是他對自己目睹的這種各自爲戰的格局感到害怕。

Nevertheless, even if I am somewhat cynical about Biden’s chances of success, he deserves credit for at least putting the issue on the map; and if anyone has enough political muscle to force change, it just might be him. “I am very rude when dealing with bureaucratic delays,” he said. And it seems that whatever he does — or does not — achieve with his “moonshot” will probably feel more meaningful to him than anything he might have done in Iowa, New Hampshire or elsewhere in the grubby presidential race.

然而，即便我對拜登的成功機率有些懷疑，但他至少會因爲提出這個問題而受到讚譽；如果說有誰擁有足夠強大的政治實力推動變革，這個人或許就是他。他表示：“我在對付官僚拖延方面非常粗暴。”不管他的“登月計劃”會實現什麼（或者不會實現什麼），對於他而言，這或許比他在污穢的總統競選中在愛荷華州、新罕布什爾州或其他角落可能實現的任何成就都更有意義。

I wish him the best of luck; history sometimes twists in strange ways.

我祝他好運；歷史有時會造就奇怪的轉折。