I.H.116.Right Business.Warren Buffett.Pharma
救治已经掉在地上的苹果，让它重新长回树上，这是对抗不可抗力的行为，这个行业有大量道德沦丧的行为，以前有脑白金、龟鳖丸，现在这样的神药只多不少。
1、《1999-05-03 Berkshire Hathaway Annual Meeting》
29. “We blew it” on pharmaceutical stocks
“在制药股上我们失误了”
WARREN BUFFETT: Zone 7.
沃伦·巴菲特： 7号区域。
AUDIENCE MEMBER: Hi, my name is McCall Bang (PH). I’m from central Florida. It’s nice and sunny there.
提问者： 嗨，我叫麦考尔·邦（音），来自佛罗里达州中部。那里的天气阳光明媚。
WARREN BUFFETT: Not so bad here either, now. (Laughs)
沃伦·巴菲特： 这里现在也还不错。（笑声）
AUDIENCE MEMBER: My question was, last year somebody asked about the pharmaceutical companies and the aging baby boomers, et cetera. And you said it was difficult to single out individual companies. And I believe Mr. Munger succinctly said that we blew it on that one.
提问者： 我的问题是，去年有人问到制药公司和老龄化的婴儿潮一代等话题。您说很难挑出个别公司。我记得芒格先生简洁地说，我们在这方面搞砸了。
I was wondering, however, if the idea of regulation and, you know, the specter of what happened in ’92, ’93 with an unelected politician kind of dampered the whole industry for a period, there — if that plays a part in giving you a little ambivalence about investing in that area for the future.
然而，我想知道，是否因为监管的观念，以及92、93年期间一位非选举产生的政治人物对整个行业造成了一段时间的打击，这是否让您对未来投资该领域感到有些犹豫？
Is that simply an unknowable? Or with all the, you know, a lot of the political — the things we see here today — if that causes you some concern about, you know, the future of that area?
这只是一个无法知晓的问题吗？还是因为我们今天看到的许多政治因素，这让您对该领域的未来感到担忧？
I know that you’re concerned about the growth of — in companies having to spend money, in Washington with regulation, et cetera. So, I’d like to know your thoughts, specifically if you have some ambivalence because of future regulation with pharmaceutical companies?
我知道您对公司在华盛顿为了应对监管等问题需要花费增长成本感到担忧。所以，我想知道您的具体看法，是否因为未来对制药公司的监管而感到有些犹豫？
WARREN BUFFETT: Well, if we could buy a group of leading pharmaceutical companies at a below-market multiple, I think we’d do it in a second. And we had the opportunity to do that in that 1993 period, as you mentioned. And we didn’t do it. So, we did blow it.
沃伦·巴菲特： 如果我们能以低于市场倍数的价格买入一组领先的制药公司，我想我们会立刻去做。正如您提到的那样，在1993年期间我们有这个机会。但我们没有这么做。所以，我们确实搞砸了。
Because clearly, the pharmaceutical industry, as a whole, has done very well. And it has some of the threats that you enumerated, in terms of regulation and so on.
因为显然，整个制药行业表现得非常好。虽然它确实有您提到的监管等威胁。
But, you know, every industry has some problems. And the pharmaceutical industry has enough going for it that the threats you named should not cause, in my view, should not cause the securities to sell at a depressed multiple, which they did.
但是，每个行业都有一些问题。我认为，制药行业有足够的优势，您提到的那些威胁不应该导致其证券以低倍数出售，但它们确实发生了这种情况。
Now, that’s no longer the circumstance. We don’t like — you know, we’re not going to buy them at present prices. But, we — at least I think they’re, you know, as a group, they’re good businesses.
现在，这种情况已经不复存在。我们不喜欢，也不会以目前的价格购买它们。但至少我认为，它们作为一个整体来说，是不错的企业。
I do think it’s very hard to pick out the winner. You know, so if I did buy them, I would buy them — I would buy a group of the leading companies. But I wouldn’t be buying them at these prices.
我确实认为很难挑出赢家。所以，如果我要买的话，我会买一组领先的公司。但我不会以当前的价格买入。
Charlie?
查理？
30. Munger defends “almost obscene amounts of money” for drug companies
芒格为制药公司“近乎骇人听闻的利润”辩护
CHARLIE MUNGER: Yeah. I would argue that the pharmaceutical industry has done more good for the customers than almost any other industry in America. It’s just fabulous what’s been invented in my lifetime, starting with all the antibiotics that have prevented so much death and so much family tragedy.
查理·芒格： 是的，我认为制药行业为客户带来的好处超过了美国几乎所有其他行业。在我的一生中，它所发明的东西是惊人的，从各种抗生素开始，这些药物避免了大量的死亡和无数家庭悲剧。
And I think the country has been very wise to have a system where the pharmaceutical companies can make almost obscene amounts of money. I think we’ve all been well-served by the large profits in the pharmaceutical industry.
我认为，美国有这样一个系统，让制药公司可以赚取近乎骇人听闻的利润，这是非常明智的。我认为，制药行业的巨额利润很好地服务了我们所有人。
2、《2002-05-04 Berkshire Hathaway Annual Meeting》
33. Hard to pick pharmaceutical winners
很难挑选出制药行业的赢家
WARREN BUFFETT: Let’s hear from area 8, please.
沃伦·巴菲特：让我们听听第8区的声音。
AUDIENCE MEMBER: Hi, my name is Jennifer Pearlman from Toronto, Canada.
听众：你好，我叫詹妮弗·珀尔曼，来自加拿大多伦多。
Mr. Buffett, in 1998, you were asked to comment on the pharmaceutical industry, and at that time your answer was that you considered it a mistake not to have taken a basket approach to the industry.
巴菲特先生，1998年，您被问及关于制药行业的问题，您当时的回答是，您认为没有采取行业整体策略是一个错误。
I was wondering if you could revisit the issue, now that valuations have contracted so dramatically.
我想知道，既然估值已经大幅收缩，您是否能重新审视这个问题。
And also, considering that health care spending is outpacing inflation, and that there are significant moats in the industry, I was wondering if you could share with us your thoughts on the health care industry at large.
此外，考虑到医疗保健支出超过了通货膨胀，并且该行业有显著的护城河，我想知道您是否能与我们分享您对整个医疗保健行业的看法。
WARREN BUFFETT: Charlie may be better equipped on that than I am, but it certainly — it’s been, as an industry, a very, very good business over time. And if you take the aggregate capital in it and what it’s earned over time, it’s been a very good business.
沃伦·巴菲特：查理可能比我更擅长这个问题，但从整体来看，这个行业长期以来一直是一个非常非常好的生意。如果你考虑到这个行业的总资本以及它随时间赚取的利润，它一直是一个非常好的生意。
And we did make a mistake, your memory’s 100 percent accurate, in we’d — in what we said in earlier meetings, because we should have taken a package approach. We actually did buy a tiny, tiny bit, but that’s worse than buying none almost. I mean, it’s just aggravating — back there in ’93.
我们确实犯了一个错误，你的记忆完全正确，正如我们在之前的会议中所说的，因为我们本应采取整体策略。实际上我们确实买了一点点，但几乎不如什么都不买。我是说，这真让人恼火——回到1993年。
It’s certainly the — they’re certainly the kind of businesses that, as an industry, we can understand. We would not have great insights on specific companies. So, if we did something, we would be more inclined to do it on an industry-wide basis.
这些无疑是——它们无疑是我们能够理解的那种行业。如果我们做什么，我们更倾向于采取行业整体策略，而不是集中在具体公司上。
It’s hard to evaluate the individual companies. As you know, Bristol-Myers has recently had a big stumble, and even Merck has fallen back. And so, it’s hard to pick the winners.
很难评估个别公司。正如你所知道的，布里斯托尔-迈尔斯最近出现了大的失误，甚至默克也回落了。所以，很难挑选出赢家。
But that’s no reason not to have a basket approach to the industry. And at some valuation level, it would be something we would think very hard about. And it’s something where we could put quite a bit of money if it happened, which is another plus to us.
但这不是不采用行业整体策略的理由。在某个估值水平下，它会是我们非常认真考虑的事情。而且，如果发生，我们可以投入相当大的一笔资金，这对我们来说是另一个好处。
Charlie?
查理？
CHARLIE MUNGER: Well, I mean, failed to get it right the last time. We’ll probably fail to get it right the next time. (Laughter)
查理·芒格：嗯，我的意思是，上次没弄对。下次我们可能还是弄不对。（笑声）
芒格的立场更偏向于价值观，巴菲特的立场是不可知论者。
WARREN BUFFETT: I don’t know what he had for lunch. (Laughter)
沃伦·巴菲特：我不知道他午餐吃了什么。（笑声）
3、《2005-04-30 Berkshire Hathaway Annual Meeting》
55. Future of pharmaceuticals is “too hard”
制药业的未来“太难”
WARREN BUFFETT: Number 3, please?
沃伦·巴菲特：请给我三号？
AUDIENCE MEMBER: Good afternoon. Scott Jeffords (PH) from Davidson, North Carolina.
观众成员：下午好。我是来自北卡罗来纳州戴维森的斯科特·杰福兹（音）。
The major pharmaceutical companies have faced a myriad of fundamental and legal challenges in recent years.
近年来，大型制药公司面临着无数的基本和法律挑战。
With that in mind, and given the apparent ongoing nature of those obstacles, how should investors be thinking about the long-term prospects for this very important industry?
鉴于此，并考虑到这些障碍的明显持续性，投资者应如何看待这个非常重要行业的长期前景？
WARREN BUFFETT: Well, my answer is, I don’t know. But maybe Charlie will. And it’s — you know, it’s a terrific question.
沃伦·巴菲特：嗯，我的回答是，我不知道。但也许查理会知道。而且，你知道，这是个很好的问题。
It’s just that — that industry is in a state of flux now. It does very important things for mankind. It’s historically earned good returns — very good returns — on invested capital.
只是那个行业现在正处于变动状态。它为人类做了非常重要的事情。历史上，它在投资资本上获得了良好的回报——非常好的回报。
But it’s going — it could well be that the world will unfold differently for those companies in the future than the past. It may — that may not be the case.
但事情正在发展——未来这些公司的发展可能与过去不同。也许——情况可能并非如此。
And I’m — I don’t think I’m really qualified to give you a good answer on that because much of it is in the political realm. And my judgment about the — what politicians will do is probably not better than yours.
我——我认为我没有资格给你一个好的答案，因为这很大程度上属于政治领域。而我对政治家会做什么的判断可能并不比你更好。
Charlie? 查理？
CHARLIE MUNGER: I share Warren’s agnosticism on the subject. We just throw some decisions into the “too hard” pile and go on to others. (Laughter)
查理·芒格：在这个问题上，我和沃伦一样持不可知论态度。我们只是把一些决策放到“太难”堆里，然后继续处理其他事情。（笑声）
4、《2008-05-03 Berkshire Hathaway Annual Meeting》
65. It’s OK to buy pharmaceuticals as a group
可以买入一组制药企业
WARREN BUFFETT: Number 11.
沃伦·巴菲特：第 11 号。
AUDIENCE MEMBER: Hello. I’m Clemmon Low (PH) from Toronto, Canada. I want to thank you for the wonderful meeting, and I think I’ve learned a lot more here in a few hours than many, many more hours during university days.
观众成员：你好。我是来自加拿大多伦多的克莱蒙·洛（音）。感谢你们举办这次精彩的会议，我觉得在这里的几个小时里学到的东西比大学时期的许多小时还要多。
My question is, you have invested in drug companies such as Johnson & Johnson and Sanofi. How do you evaluate the pipeline of these companies and know if their competitive advantage is, indeed, enduring?
我的问题是，您投资了像强生和赛诺菲这样的制药公司。您如何评估这些公司的产品线，并判断它们的竞争优势是否确实持久？
WARREN BUFFETT: Well, that’s a good question. And unlike many businesses, when we invest in something like pharma, we don’t know the answer on the pipeline. It will be a different pipeline anyway five years from now.
沃伦·巴菲特：嗯，这是个好问题。与许多企业不同，当我们投资于制药行业时，我们并不知道研发管线的答案。无论如何，五年后它将是一个不同的管线。
So we don’t know whether Pfizer or Merck, you know, or you name it — Johnson & Johnson — we don’t know which of those will come up with a blockbuster commercial drug three or four years from now, and we don’t try to assess it.
所以我们不知道辉瑞、默克，或者你说的任何公司——强生——我们不知道其中哪一家会在三四年后推出一款重磅商业药物，我们也不试图评估它。
医药公司在专业领域的话语权极不对称。
What we do feel is, if we have a group of those companies bought at reasonable prices, that, overall, pharma will do well. Maybe not quite as well as they have in the past, but they’re doing something enormously important. They’re doing something that should offer chances for decent profits over time.
我们确实感到，如果我们以合理的价格购买这些公司的股票，总体而言，制药行业会表现良好。也许不会像过去那样好，但他们正在做一些极其重要的事情。他们正在做一些应该在长期内提供可观利润机会的事情。
And we do not pick one by one. I could not tell you what’s the number one potential in the pipeline of a J&J or Sanofi — whatever which one you want to name.
而且我们不是一个一个挑选。我无法告诉你在强生或赛诺菲的产品线中哪个是最有潜力的——无论你想提哪个。
So I think in that area, actually, a group approach makes sense, which is not the way we would go at the banks or something of that sort.
所以我认为在那个领域，实际上，采用组合方法是有意义的，这不是我们在银行或类似地方会采取的方式。
I do think if you buy pharma stocks at a reasonable multiple, a group of them, you know, you’ll probably do OK five or 10 years from now. I would not know how to pick the specific winner.
我确实认为，如果你以合理的倍数购买一组制药股票，你知道，五到十年后你可能会表现不错。我不知道如何挑选出具体的赢家。
Charlie? 查理？
CHARLIE MUNGER: Well, you speak from a position where you have a monopoly of our joint knowledge about pharmacology. (Laughter)
查理·芒格：好吧，你说话的立场是，你垄断了我们共同的药理学知识。（笑声）
5、《2024-11-17 A $12,000 Surgery to Change Eye Color Is Surging in Popularity》
At 18, James started permanently changing her appearance. She got breast implants and veneers. She underwent two Brazilian butt lifts, in which fat is transferred into the buttocks. In May, she changed her brown eyes to green via keratopigmentation.
18 岁时，詹姆斯开始永久性地改变她的外貌。她做了隆胸手术和贴面。她进行了两次巴西提臀手术，将脂肪转移到臀部。五月，她通过角膜染色术将棕色眼睛变成了绿色。
“It is the best decision I’ve made with my money ever,” said James. She said she hasn’t experienced lasting side effects.“
这是我用钱做出的最好的决定，”詹姆斯说。她说她没有经历过持久的副作用。
James said that cosmetic surgery helps her deal with her insecurities, and that she is willing to accept its risks.
詹姆斯说整容手术帮助她应对不安全感，并且她愿意接受其风险。
“People say I want attention. Everybody wants attention. I do things that make me feel seen,” she said. “I never felt good till now.”
“人们说我想要关注。每个人都想要关注。我做让我觉得被看到的事情，”她说。“直到现在我才感觉好。”
Harvard geneticist David Sinclair’s seductive notion that aging is a treatable disease has helped companies he founded to raise more than $1 billion. The investors have almost nothing to show for it.
哈佛遗传学家大卫·辛克莱尔关于衰老是一种可治疗疾病的诱人观点帮助他创办的公司筹集了超过 10 亿美元。投资者几乎没有任何收获。
Four companies trying to develop longevity drugs have gone bankrupt or largely halted operations. Another four either haven’t yet tested their drugs or gene therapies in humans or have run only small-scale trials that make it difficult to know whether a drug will work.
四家试图开发长寿药物的公司已经破产或大幅停止运营。另有四家公司尚未在人类身上测试其药物或基因疗法，或者仅进行了小规模试验，难以判断药物是否有效。
Yet none of that has dented Sinclair’s status as the longevity business’s brightest star and chief salesman. Not only has he turned ideas from his own Harvard lab into commercial ventures, other entrepreneurs, attracted by his clout with both consumers and other scientists, have brought him in as a co-founder of their companies.
然而，这些都没有削弱辛克莱作为长寿行业最耀眼明星和首席推销员的地位。他不仅将自己在哈佛实验室的想法转化为商业项目，其他企业家也因他在消费者和其他科学家中的影响力而邀请他成为他们公司的联合创始人。
Sinclair also has co-founded companies that sell directly to consumers products such as antiaging dog chews, supplements and tests that purport to show one’s “biological age.”
辛克莱还共同创办了几家公司，直接向消费者销售产品，如抗衰老狗咀嚼片、补充剂和声称能显示一个人“生物年龄”的测试。
Over the years, Sinclair’s business pitch has remained largely the same: Aging can be slowed or reversed, and we are about to figure out how.
多年来，辛克莱的商业宣传基本保持不变：衰老可以减缓或逆转，我们即将找到方法。
“A lot of my colleagues dislike that phrase, the reversibility of aging,” he told a roomful of longevity investors in September at a conference in Gstaad, Switzerland. “But I truly believe that, based on my lab’s research and now others, that aging can be reversed. If I can make one medicine that would change people’s lives, I’d be very happy.”
“我的许多同事不喜欢‘衰老可逆’这个说法，”他在九月份瑞士格施塔德的一次长寿投资者会议上对满屋子的人说。“但我真的相信，基于我实验室的研究以及现在其他人的研究，衰老是可以逆转的。如果我能制造出一种能改变人们生活的药物，我会非常高兴。”
Talk like that has drawn criticism from fellow scientists, who say Sinclair tends to exaggerate the findings and implications of age-related research, tarnishing a nascent field vying for credibility. The board of the Academy for Health and Lifespan Research, a group Sinclair co-founded and led, asked him to resign as president earlier this year after he was quoted as saying a dog chew sold by a company he co-founded, Animal Biosciences, reversed aging in dogs.
这样的言论引来了同行科学家的批评，他们表示辛克莱尔倾向于夸大与年龄相关研究的发现和影响，损害了一个争取信誉的新兴领域。今年早些时候，辛克莱尔共同创立并领导的健康与寿命研究学会的董事会要求他辞去会长职务，因为他曾表示他共同创立的公司 Animal Biosciences 出售的一种狗咬胶可以逆转狗的衰老。
It isn’t unusual for startups based on unproven science to go bust. Promising drugs regularly fail when moved from the lab into the real world. Compounds safe for mice prove toxic to people. Moreover, getting Food and Drug Administration approval for longevity drugs is complicated by the fact that the agency doesn’t consider aging a disease.
对于基于未经证实的科学的初创公司来说，破产并不罕见。当从实验室转移到现实世界时，有前景的药物经常失败。对小鼠安全的化合物对人类却有毒。此外，获得食品和药物管理局对长寿药物的批准因该机构不认为衰老是一种疾病而变得复杂。
Some institutional investors are steering clear. “I am not a huge fan of longevity,” said Dr. Christiana Bardon, co-managing partner of biotech-investment company MPM BioImpact, noting that trials to assess lifespan extension are difficult to run. “I don’t have any proof any of these magic bullets have an effect.”
一些机构投资者正在避开。“我不是长寿的忠实粉丝，”生物技术投资公司 MPM BioImpact 的共同管理合伙人克里斯蒂安娜·巴登博士说，并指出评估寿命延长的试验很难进行。“我没有任何证据表明这些灵丹妙药有任何效果。”
The notion that science can keep people young, though, has captivated many in Silicon Valley. In 2013, Google launched Calico Life Sciences, a company focused on the biology of aging that has $2.5 billion in funding. Cell-reprogramming company NewLimit was founded in 2021 with $150 million from investors including Coinbase founder Brian Armstrong. Altos Labs opened in 2022 to pursue cell rejuvenation, raising $3 billion from investors including Yuri Milner, an early Facebook backer.
然而，科学可以让人保持年轻的观念吸引了硅谷的许多人。2013 年，谷歌成立了 Calico Life Sciences，这是一家专注于衰老生物学的公司，拥有 25 亿美元的资金。细胞重编程公司 NewLimit 于 2021 年成立，获得了包括 Coinbase 创始人 Brian Armstrong 在内的投资者的 1.5 亿美元投资。Altos Labs 于 2022 年成立，致力于细胞复兴，从包括早期 Facebook 支持者 Yuri Milner 在内的投资者那里筹集了 30 亿美元。
Sinclair, who is 55 years old, said in an email that companies he co-founded that went public “paved the way” for many of today’s longevity companies. “In the mid-2000s, it was not widely recognized that aging research could be a legitimate path for developing drugs to treat both rare and common disease,” he said. “Science has its successes and failures, but the most important thing is you keep learning, discovering, and trying to move the discipline forward.”
55 岁的辛克莱在一封电子邮件中表示，他共同创立的上市公司“为今天的许多长寿公司铺平了道路。”他说：“在 2000 年代中期，衰老研究尚未被广泛认为是开发治疗罕见和常见疾病药物的合法途径。科学有其成功和失败，但最重要的是你要不断学习、发现，并努力推动学科向前发展。”
Sinclair’s business career began in 2004 when he co-founded Sirtris Pharmaceuticals. His lab found that resveratrol, a compound found in red wine, appeared to prolong lifespan in worms, yeast and other organisms. Sirtris wanted to make a reformulated version. He was among the first to get a big pharmaceutical company to buy into the notion that a longevity drug could get to market, selling Sirtris in 2008 to GSK—then GlaxoSmithKline—for $720 million. His shares at the time were worth $9.3 million.
辛克莱的商业生涯始于 2004 年，当时他共同创立了 Sirtris 制药公司。他的实验室发现红酒中的一种化合物白藜芦醇似乎可以延长蠕虫、酵母和其他生物的寿命。Sirtris 希望制作一种重新配方的版本。他是最早让大型制药公司相信长寿药物可以上市的人之一，并于 2008 年以 7.2 亿美元将 Sirtris 出售给 GSK（当时为葛兰素史克）。他当时的股份价值 930 万美元。
He clinked a glass of red wine with Barbara Walters that year on a special called “Live to be 150…Can You Do It?” Walters asked how much wine she would have to drink to benefit from resveratrol. Sinclair said 1,000 bottles a day, but added that he could make a version of resveratrol that would be more potent.
那一年，他与芭芭拉·沃尔特斯在一个名为“活到 150 岁……你能做到吗？”的特别节目中碰了一杯红酒。沃尔特斯问她需要喝多少酒才能从白藜芦醇中受益。辛克莱说每天 1000 瓶，但补充说他可以制作一种更有效的白藜芦醇版本。
The segment included a video of a mouse on a high dose of resveratrol running twice as far on a treadmill as an untreated mouse. Sinclair said the mice on resveratrol didn’t get heart disease, cancer, or osteoporosis and lived 30% longer. “We think resveratrol can have similar benefits in people,” he said.
该片段包括一段视频，显示一只高剂量服用白藜芦醇的老鼠在跑步机上跑的距离是未处理老鼠的两倍。辛克莱说，服用白藜芦醇的老鼠没有患上心脏病、癌症或骨质疏松症，寿命延长了 30%。他说：“我们认为白藜芦醇在人类身上也能有类似的好处。”
When Walters pointed out some people might be skeptical, he responded: “I agree. But it’s true. What else can we say?”
当沃尔特斯指出有些人可能会持怀疑态度时，他回答说：“我同意。但这是真的。我们还能说什么呢？”
In 2010, GSK stopped testing the drug in cancer patients over safety concerns. Three years later, GSK announced it was closing Sirtris.
2010 年，GSK 因安全问题停止了在癌症患者中测试该药物。三年后，GSK 宣布关闭 Sirtris。
“I think if it was still under my care and passion, [Sirtris] would have had a champion,” Sinclair told an audience at the Aspen Institute this July. He got a laugh when he said that elderly people simply need a reboot. “The good news is we can do it in mice. I don’t think it will be that long in people,” he said. “Technology is going so fast even I, as an optimist, underestimate the pace of change.”
“我认为如果它仍在我的关心和热情之下，[Sirtris] 会有一个冠军，”辛克莱尔在今年七月的阿斯彭研究所对观众说。他说老年人只需要重启一下时，引起了笑声。“好消息是我们可以在小鼠身上做到。我认为在人类身上不会太久，”他说。“技术发展得如此之快，即使是我，作为一个乐观主义者，也低估了变化的速度。”
Although Sirtris ultimately failed, its lucrative sale to GSK energized a field once considered a research backwater, and gave Sinclair cachet and connections.
尽管 Sirtris 最终失败了，但其以高价出售给 GSK 激励了一个曾被视为研究荒地的领域，并为 Sinclair 带来了声望和人脉。
In 2011, Sinclair and colleagues from Sirtris founded OvaScience to commercialize research they believed would help older women become pregnant. It went public in 2012.
2011 年，辛克莱尔和来自 Sirtris 的同事创立了 OvaScience，以商业化他们认为可以帮助年长女性怀孕的研究。该公司于 2012 年上市。
In a presentation in December 2014, Sinclair told OvaScience investors that traditional in vitro fertilization treatments often fail because the amount of “chemical energy” inside an older woman’s eggs is too low. OvaScience’s treatment, he said, could effectively reverse an egg’s age with stem cells harvested from a woman’s own ovaries, boosting its energy levels enough to promote fertilization.
在 2014 年 12 月的一次演讲中，辛克莱告诉 OvaScience 的投资者，传统的体外受精治疗往往失败，因为年长女性卵子内的“化学能量”太低。他说，OvaScience 的治疗可以通过从女性自身卵巢中提取的干细胞有效逆转卵子的年龄，提高其能量水平以促进受精。
Sinclair told them he saw the technique as a test case of antiaging technology, and that his role was to connect the scientist who had pioneered the treatment with financial backers. In a half-century, he said, people would look back at OvaScience’s work as “the beginning of a new chapter in the way that humans can control their bodies…It may not be 50 years actually. It may be only 10, the way things are going.”
辛克莱告诉他们，他将这项技术视为抗衰老技术的试验案例，他的角色是将开创该治疗方法的科学家与财务支持者联系起来。他说，半个世纪后，人们会回顾 OvaScience 的工作，认为这是“人类控制自己身体方式的新篇章的开始……实际上可能不需要 50 年。按照目前的发展速度，可能只需要 10 年。”
The next day, OvaScience shares jumped 24%, to $43. The stock peaked in March 2015, at $53, which valued the company at more than $1.3 billion. Sinclair’s stake of more than 700,000 shares was worth some $37 million at the time, according to the Journal’s analysis of regulatory filings.
第二天，OvaScience 的股价上涨了 24%，达到 43 美元。该股在 2015 年 3 月达到顶峰，达到 53 美元，当时公司市值超过 13 亿美元。根据《华尔街日报》对监管文件的分析，辛克莱持有的超过 70 万股股份当时价值约 3700 万美元。
Later that month, OvaScience said its treatment hadn’t improved IVF success rates in patients. Its shares tumbled 35%, to $34.73. By March of 2018, the stock was trading for less than $1.
当月晚些时候，OvaScience 表示其治疗并未提高患者的试管婴儿成功率。其股价暴跌 35%，至 34.73 美元。到 2018 年 3 月，该股票的交易价格已低于 1 美元。
By then, OvaScience had abandoned the fertility treatment, according to SEC filings. The company had limited revenue when it was effectively acquired by Millendo Therapeutics in a reverse merger in 2018.
到那时，根据美国证券交易委员会的文件，OvaScience 已经放弃了生育治疗。该公司在 2018 年通过反向合并被 Millendo Therapeutics 有效收购时，收入有限。
Around the time OvaScience’s stock was peaking in 2015, another company Sinclair co-founded, CohBar, was going public to develop treatments for obesity and fatty liver disease. The founders raised nearly $75 million overall. In a shareholder presentation that year, the company featured Sinclair’s selection in 2014 as one of Time’s 100 Most Influential People.
大约在 2015 年 OvaScience 的股票达到顶峰时，Sinclair 共同创立的另一家公司 CohBar 正在上市，开发肥胖症和脂肪肝疾病的治疗方法。创始人总共筹集了近 7500 万美元。在那年的股东演示中，公司展示了 Sinclair 在 2014 年被评为《时代》杂志 100 位最具影响力人物之一。
“He was sort of the ultimate scientist-entrepreneur,” said Dr. Pinchas Cohen, a CohBar co-founder and the dean of the University of Southern California Leonard Davis School of Gerontology, in an interview.
“他算是终极科学家兼企业家，”CohBar 联合创始人、南加州大学伦纳德·戴维斯老年学学院院长 Pinchas Cohen 博士在一次采访中说道。
CohBar’s great hope, a synthetic version of a natural hormone, had been used to treat obesity and fatty liver disease in mice. After going public, CohBar conducted small studies in humans testing the safety of the drug.
CohBar 的巨大希望，一种天然激素的合成版本，已被用于治疗小鼠的肥胖和脂肪肝。在上市后，CohBar 进行了小规模的人体研究以测试该药物的安全性。
In May 2018, CohBar said stockholders planned to sell more than 27 million shares. Sinclair listed more than 800,000 shares for sale but wasn’t required to report transactions.
2018 年 5 月，CohBar 表示股东计划出售超过 2700 万股。Sinclair 列出了超过 80 万股待售，但不需要报告交易。
In financial disclosures, CohBar repeatedly called into question its ability to continue as a going concern, citing losses and dwindling cash reserves. In 2022 it suspended development on its leading drug candidates, citing safety concerns and disappointing study results.
在财务披露中，CohBar 反复质疑其作为持续经营企业的能力，理由是亏损和现金储备减少。2022 年，由于安全问题和令人失望的研究结果，它暂停了其主要药物候选产品的开发。
Shareholders sued CohBar in 2023, saying they had been misled about a merger CohBar planned with oncology company Morphogenesis. The merger fell apart that year and CohBar said it would dissolve.
股东在 2023 年起诉 CohBar，称他们在 CohBar 计划与肿瘤公司 Morphogenesis 合并一事上受到了误导。合并在那一年破裂，CohBar 表示将解散。
Back when CohBar was conducting its research, Dr. Nir Barzilai, another co-founder, introduced Sinclair to Adam Neumann, founder of then highflying co-working space giant WeWork.
早在 CohBar 进行研究时，另一位联合创始人 Nir Barzilai 博士将 Sinclair 介绍给了当时炙手可热的共享办公空间巨头 WeWork 的创始人 Adam Neumann。
In 2017, Sinclair co-founded Life Biosciences, a longevity incubator set up to turn promising findings from scientists’ labs into startups. Neumann provided the initial $25 million, two years before WeWork board members sought to oust Neumann as CEO.
2017 年，辛克莱共同创立了生命生物科学公司，这是一家长寿孵化器，旨在将科学家实验室中的有前途的发现转化为初创公司。纽曼提供了最初的 2500 万美元，两年后 WeWork 董事会成员试图罢免纽曼的首席执行官职务。
Life Biosciences expanded rapidly, forming subsidiaries and growing to 90 employees. Over the years, it raised about $158 million. It licensed a gene therapy from Sinclair’s Harvard lab to develop as a possible treatment for a rare eye condition that causes sudden vision loss.
生命生物科学公司迅速扩张，成立了子公司并发展到 90 名员工。多年来，它筹集了约 1.58 亿美元。它从辛克莱的哈佛实验室获得了一种基因疗法的许可，用于开发一种可能治疗导致突然视力丧失的罕见眼疾的疗法。
Sinclair’s lab and department would receive a share of any royalties Harvard earns from the treatment, a common practice at universities that try to license out their professors’ work.
辛克莱的实验室和部门将从哈佛从该治疗中获得的任何版税中分得一杯羹，这在试图将教授的工作授权出去的大学中是一种常见做法。
Sinclair appeared that year in an NBC News segment titled, “Researchers say they are close to reversing aging,” promoting his lab’s work on genetic reprogramming for vision loss in mice and brain cells.
辛克莱尔那年出现在 NBC 新闻的一期节目中，标题为“研究人员称他们接近逆转衰老”，宣传他实验室在小鼠视力丧失和脑细胞基因重编程方面的工作。
“So maybe once a year you go get a prescription from your doctor, you take it for a week, and it reverses your aging, is that your vision here?” asked the journalist, Dr. Akshay Syal.
“所以也许每年你去找医生开个处方，服用一个星期，它就能逆转你的衰老，这就是你的愿景吗？”记者阿克谢·赛亚尔博士问道。
“It’s not just a vision,” Sinclair responded. “It’s going to happen. It’s like asking the Wright brothers, ‘Are we going to fly?’ Of course we are. It’s just a matter of when.”“这不仅仅是一个愿景，”辛克莱回应道。“这将会发生。这就像问莱特兄弟，‘我们会飞吗？’当然会。这只是时间问题。”
Life Biosciences closed subsidiaries, cut its workforce to 13, shut its lab and contracted most work on the therapy to outside researchers, Chief Executive Jerry McLaughlin said in an interview.生命生物科学公司关闭了子公司，将员工人数减少到 13 人，关闭了实验室，并将大部分治疗工作外包给外部研究人员，首席执行官杰里·麦克劳克林在一次采访中表示。
Life Biosciences has since shared data at conferences that it said showed the therapy restored some visual function in monkeys. Executives met with the FDA last December to discuss what evidence they would need to start a trial in people. McLaughlin said Life Biosciences hopes to start a trial by 2026.
自那以来，Life Biosciences 在会议上分享了数据显示该疗法恢复了猴子的一些视觉功能。高管们去年 12 月与 FDA 会面，讨论他们需要什么证据才能开始人体试验。McLaughlin 表示，Life Biosciences 希望在 2026 年前开始试验。
Life Biosciences has changed from an incubator to a biotech focused on reprogramming cells, McLaughlin said. Sinclair remains on the company’s board but doesn’t direct its science. “We appreciate his genius and discoveries and enthusiasm for what we do here,” he said.
生命生物科学公司已从孵化器转变为专注于细胞重编程的生物技术公司，麦克劳克林说。辛克莱仍在公司的董事会中，但不直接指导其科学工作。“我们欣赏他的才华、发现以及对我们在这里所做工作的热情，”他说。
At the Aspen Institute in July, a woman in the audience asked Sinclair when a Life Biosciences drug might be available for glaucoma.
在七月份的阿斯彭研究所，一位观众中的女士问辛克莱，生命生物科学公司的药物何时可能用于治疗青光眼。
FDA approval could take four to five years, Sinclair responded. “By the end of next year,” he said, “I will likely be able to tell you if it works.”
FDA 批准可能需要四到五年，辛克莱回应道。“到明年年底，”他说，“我可能会告诉你它是否有效。”
Metro International Biotech, which Sinclair helped found in 2016, is trying to develop a formulation of nicotinamide mononucleotide, or NMN, as an FDA-approved drug to treat age-related conditions such as Alzheimer’s disease. NMN has already been marketed to consumers as a longevity-promoting supplement, and Sinclair frequently speaks about how his elderly father takes it daily as part of his longevity regimen.
辛克莱于 2016 年协助创立的 Metro International Biotech 正在尝试开发烟酰胺单核苷酸（NMN）配方，作为 FDA 批准的药物，用于治疗与年龄相关的疾病，如阿尔茨海默病。NMN 已经作为促进长寿的补充剂向消费者销售，辛克莱经常谈到他年迈的父亲如何每天服用它作为其长寿计划的一部分。
In 2022, he and celebrity chef Serena Poon, who he describes as both his personal partner and business partner, started Fully Aligned, which calls itself a consumer wellness company.
2022 年，他与名厨 Serena Poon（他称其为个人伴侣和商业伙伴）创立了 Fully Aligned，这是一家自称为消费者健康公司的企业。
He co-founded Tally Health in 2022 with Whitney Casey, a partner at a private-equity firm. Casey got interested in the Sinclair lab’s efforts to develop a cheek-swab test to tell people their biological age, a measure of how fast their body is aging physically rather than chronologically. Tally started selling $229 test kits and touting celebrity investors including John Legend, Chrissy Teigen, Pedro Pascal, Shonda Rhimes and Zac Efron.
他于 2022 年与私募股权公司合伙人惠特尼·凯西共同创立了 Tally Health。凯西对辛克莱实验室开发一种通过脸颊拭子测试来告知人们其生物年龄的努力产生了兴趣，这是一种衡量身体老化速度而非按时间计算的指标。Tally 开始销售 229 美元的测试套件，并宣传包括约翰·传奇、克里斯西·泰根、佩德罗·帕斯卡、珊达·莱梅斯和扎克·埃夫隆在内的名人投资者。
Sinclair talked up his test on Joe Rogan’s podcast in 2021 when there was an online wait list but before it became widely available. “You want to do this test, we should do a mouth swab,” he told Rogan. “I bet you’re younger than you are and we could tell everybody.”
辛克莱在 2021 年乔·罗根的播客中谈到了他的测试，当时有一个在线等待名单，但尚未广泛提供。他对罗根说：“你想做这个测试，我们应该做一个口腔拭子。我打赌你比实际年龄更年轻，我们可以告诉大家。”
Biological-age tests haven’t been proven to effectively measure and monitor health, many scientists say. Casey said Sinclair left Tally’s board due to a conflict of interest when the company began selling its products. Sinclair said he remains “enthusiastic” about biological age tests, “with continued improvements in their accuracy.”
许多科学家表示，生物年龄测试尚未被证明能够有效测量和监测健康。Casey 说，当公司开始销售其产品时，Sinclair 因利益冲突而离开了 Tally 的董事会。Sinclair 表示，他对生物年龄测试仍然“充满热情”，“随着其准确性的不断提高。”
Sinclair said he believes that his companies will someday produce life-changing medicines. “Developing medicines that safely and effectively target aging,” he said, “is a difficult endeavor that has turned out to take longer than I expected.”
辛克莱说，他相信他的公司有一天会生产出改变生活的药物。他说：“开发能够安全有效地针对衰老的药物是一项艰难的工作，结果比我预期的要花更长的时间。”
He didn't crack the code of aging, but he did crack the code of swindling without jailing.
他没有破解衰老的密码，但他确实破解了不入狱诈骗的密码。
Yeah if you claim you have found the "fountain of youth" and can put phd after that claim you will legally swindle and make a pile.
是的，如果你声称找到了“青春之泉”，并且可以在这个声明后加上博士学位，你将合法地骗取并赚取一大笔钱。
I met David when he was a faculty job candidate in the department where I was an Assistant Professor - we did not hire him. I see that his enthusiasm for his work remains undiminished.
我遇到大卫时，他是我所在系的一个教职候选人，当时我是一名助理教授——我们没有聘用他。我看到他对工作的热情依然不减。
Some of us in the Boston-Cambridge biotech community knew he was a snake oil salesman. The article left out that GSK was unable to replicate the findings of the Sirtris Resveretrol scam. Sinclair's science would be well received in The Journal of Irreproducible Results.
我们波士顿-剑桥生物技术社区中的一些人知道他是个江湖骗子。文章没有提到葛兰素史克无法复制 Sirtris 白藜芦醇骗局的发现。辛克莱的科学将在《不可重复结果杂志》上受到欢迎。
Health insurers are on edge, even after a suspect was arrested in the killing of UnitedHealthcare’s chief executive.
即使在一名嫌疑人因杀害 UnitedHealthcare 首席执行官被捕后，健康保险公司仍然紧张不安。
The companies continue to face a wave of anger from many of their own customers, along with praise for the killer of one of the business’s most prominent leaders. It is a new level of criticism of the industry that stretches back to before the passage of 2010’s Affordable Care Act, which made major changes in the rules around health coverage.
这些公司继续面临来自许多自身客户的愤怒浪潮，同时也有人称赞杀害该企业最杰出领导者之一的凶手。这是对该行业的新一轮批评，追溯到 2010 年《平价医疗法案》通过之前，该法案对健康保险的规则进行了重大改变。
“Most people who work in health plans believe they are supporting action for patients, but it’s clearer than ever that the American public doesn’t necessarily see it that way,” said Sachin H. Jain, the CEO of SCAN Group, a nonprofit insurer. “There’s a broader reckoning.”
“大多数在健康计划中工作的人认为他们正在支持患者的行动，但现在比以往任何时候都更清楚的是，美国公众不一定这样看待它，”非营利保险公司 SCAN Group 的首席执行官 Sachin H. Jain 说。“这是一场更广泛的清算。”
A wash of online memes suggested the killing was justified and threatened similar treatment for other health insurance CEOs. One social-media screenshot making the rounds among health-insurance executives showed a poster that read, “Wanted, Dead or Alive,” with the last word crossed out, and a list of names and pictures of top industry executives.
一波网络迷因暗示这次杀戮是正当的，并威胁对其他健康保险公司的首席执行官采取类似的对待。在健康保险高管中流传的一张社交媒体截图显示了一张海报，上面写着“通缉，生死不论”，最后一个词被划掉，并附有行业顶级高管的名字和照片列表。
Leaders of smaller insurers who never worried about their safety before now have 24-7 security details. Executives at many insurers refused to allow their names to be used in this article, saying they didn’t want to draw more attention in a volatile time.
以前从不担心安全的小型保险公司领导现在有 24 小时的安全保障。许多保险公司的高管拒绝在这篇文章中使用他们的名字，称他们不想在动荡时期引起更多关注。
Vicky Gregg, the former CEO of BlueCross BlueShield of Tennessee, said she got repeated death threats when she was in the job years ago, and the company had to seek restraining orders on some people.
Vicky Gregg，田纳西州蓝十字蓝盾的前首席执行官，说她在几年前担任该职位时多次收到死亡威胁，公司不得不对一些人申请限制令。
“Something like this has the potential to break through that sort of insulation that a lot of people have,” Gregg said. “They can’t imagine that anybody would want to be hostile or do something like what happened to [Thompson]. They can’t see themselves there and they can’t see that their companies are in that level of disgruntlement with their members.” But, she said, “I don’t think shooting someone in the street is a way to approach any of those kinds of problems.”
“这样的事情有可能突破许多人所拥有的那种隔绝，”格雷格说。“他们无法想象有人会想要敌对或做出类似于[汤普森]所遭遇的事情。他们无法想象自己会处于那种境地，也无法看到他们的公司与其成员之间存在那种程度的不满。”但她说，“我不认为在街上射击某人是解决任何此类问题的方法。”
The industry has long been the focus of harsh scrutiny. Fourteen years ago, then-President Barack Obama amplified allegations that an insurer was dropping coverage of women with breast cancer, which the company disputed. The following year, a group of protesters temporarily halted the shareholder meeting of insurer Aetna, shouting and carrying signs and bullhorns.
长期以来，该行业一直是严厉审查的焦点。十四年前，时任总统巴拉克·奥巴马加大了对一家保险公司取消乳腺癌女性保险的指控，该公司对此表示异议。次年，一群抗议者暂时中止了保险公司 Aetna 的股东大会，他们高喊口号，举着标语和扩音器。
The 2010 Affordable Care Act, Obama’s signature health law, attempted to ease many of the pain points that were prominent at the time. In addition to expanding coverage to more people, the law banned insurers from refusing to cover people with pre-existing health conditions. It blocked insurers from setting maximum payouts for care and required many plans to cover a list of significant minimum health benefits.
2010 年《平价医疗法案》，即奥巴马的标志性健康法，试图缓解当时突出的许多痛点。除了扩大覆盖范围以惠及更多人之外，该法案还禁止保险公司拒绝为已有健康状况的人提供保险。它阻止保险公司设定护理的最高赔付限额，并要求许多计划涵盖一系列重要的最低健康福利。
But the ACA “did not do a lot to address the underlying reasons why healthcare costs are high,” said Cynthia Cox, a vice president at health-research nonprofit KFF.
但 ACA“并没有做很多事情来解决医疗成本高的根本原因，”健康研究非营利组织 KFF 的副总裁辛西娅·考克斯说。
The law didn’t impose broad restrictions on processes such as prior authorization, in which insurers require patients and doctors to get permission before getting medical procedures. Many online critics now argue that insurers block access to needed care to save money.
法律并未对事先授权等流程施加广泛限制，在这些流程中，保险公司要求患者和医生在进行医疗程序之前获得许可。许多在线评论者现在认为，保险公司为了省钱而阻碍了所需护理的获取。
In a video that leaked online last week, Andrew Witty, the CEO of UnitedHealth Group, UnitedHealthcare’s parent company, told employees after the killing of UnitedHealthcare CEO Brian Thompson that the moment was shattering. “In my working career, maybe in my life, this is one of the lowest weeks I’ve experienced,” he said.
在上周泄露到网上的一段视频中，UnitedHealth Group（UnitedHealthcare 的母公司）的首席执行官安德鲁·威蒂在 UnitedHealthcare 首席执行官布莱恩·汤普森被杀后告诉员工，这一时刻令人震惊。他说：“在我的职业生涯中，也许在我的一生中，这是我经历过的最低谷的一个星期之一。”
He defended the company’s role and procedures, and said the vitriolic social-media messages don’t reflect reality. “We make sure that care is safe, appropriate and it’s delivered when people need it,” he said. “The health system needs a company like UnitedHealth Group.”
他为公司的角色和程序进行了辩护，并表示充满敌意的社交媒体信息并不反映现实。他说：“我们确保护理是安全的、适当的，并在需要时提供。” “卫生系统需要像联合健康集团这样的公司。”
On Monday, a UnitedHealth spokesman said the company hoped the arrest “brings some relief to Brian’s family, friends, colleagues and the many others affected by this unspeakable tragedy.”
周一，联合健康集团的一位发言人表示，公司希望逮捕行动“能给布莱恩的家人、朋友、同事以及许多受到这一不可言喻的悲剧影响的人带来一些安慰。”
Insurers’ role in the healthcare economy positions them to bear the brunt of many consumer complaints. They are mostly paid by employers and government agencies, which set many of the rules around the coverage they offer. The insurers are supposed to rein in costs on services that, for individual patients, can mean the difference between life and death.
在医疗经济中，保险公司的角色使其成为许多消费者投诉的主要对象。它们的费用主要由雇主和政府机构支付，这些机构制定了许多关于其提供的保险范围的规则。保险公司应该控制服务成本，而这些服务对于个人患者来说，可能意味着生死攸关的差异。
At the same time, health spending in the U.S. has continued to rise, and individual consumers are often stuck with large out-of-pocket charges such as deductibles when they need to actually use their coverage. Insurers are typically taking the calls when customers run into complicated billing tangles and confusing rules.
与此同时，美国的医疗支出持续上升，个人消费者在实际使用保险时往往面临高额的自付费用，如免赔额。当客户遇到复杂的账单纠纷和混乱的规则时，保险公司通常会接到电话。
A 2023 survey of 3,605 insured consumers by KFF found that 81% rated their insurance positively, but 58% had experienced a problem with it in the past year. Less-healthy people had more complaints.
KFF 对 3,605 名投保消费者进行的 2023 年调查发现，81%的人对他们的保险评价积极，但 58%的人在过去一年中遇到过问题。健康状况较差的人有更多抱怨。
The current online backlash has surfaced a more bitter tone. “I’m shocked that people aren’t saying the obvious, like ‘I’m mad and this doesn’t work, but this was a 50-year-old guy with a wife and kids and this was unacceptable,’” said Alan Muney, a former health-insurance executive who worked at insurers including Cigna.
目前的网络反对声浪显现出更为激烈的语气。“我很震惊人们没有说出显而易见的话，比如‘我很生气，这行不通，但这是一个有妻子和孩子的 50 岁男人，这是不可接受的，’”曾在包括信诺在内的保险公司工作的前健康保险高管艾伦·穆尼说道。
Insurers have responded by battening down—removing names and photos of executives from public websites and bolstering security at work locations. After Thompson’s death, Centene, a Medicaid-focused insurer that was scheduled to hold its investor day in New York this week, instead made it a virtual event.
保险公司已经做出反应，采取了防范措施——从公共网站上删除高管的姓名和照片，并加强工作地点的安全。在汤普森去世后，专注于医疗补助的保险公司 Centene 原定于本周在纽约举行投资者日活动，但改为线上活动。
8、《2024-12-10 Insurance CEOs Aren’t the Problem》
Thanks to email, which came before social media, press commentators like myself already knew America contained its share of stupid, malignant people, like those applauding the murder of a healthcare CEO.
多亏了电子邮件，它比社交媒体出现得更早，像我这样的新闻评论员已经知道美国有一些愚蠢、恶毒的人，比如那些为一家医疗保健公司首席执行官被谋杀而欢呼的人。
They and their media encouragers point in the wrong direction. In fact, most insurance CEOs would like to get back to rational risk pooling against large, unpredictable costs rather than serving as gatekeeper to a grossly regressive tax loophole for the insured class’s lavish health spending.
他们和他们的媒体支持者指向了错误的方向。事实上，大多数保险公司的首席执行官希望回归理性的风险分摊，以应对大额、不可预测的成本，而不是充当被保险阶层奢侈健康支出的严重累退税收漏洞的守门人。
Even Medicare denies care—if it didn’t Medicare would be going broke faster than it already is. A for-profit insurer at least has an incentive to balance the two wants of its customers, an affordable premium vs. access to the care they desire.
即使是医疗保险也会拒绝提供护理——如果不这样做，医疗保险的破产速度会比现在更快。至少营利性保险公司有动力平衡客户的两种需求，即可负担的保费与获得他们想要的护理之间的平衡。
But understand the system we have today: It takes the 165 million most economically competent Americans, those in prime working years and their families, and gives them a giant, regressive tax incentive to overconsume and to be insensitive to trade-offs between cost and benefit.
但要了解我们今天的系统：它让 1.65 亿最具经济能力的美国人，即处于黄金工作年龄的人及其家庭，获得一个巨大的、累退的税收激励，促使他们过度消费，并对成本和收益之间的权衡不敏感。
As a gold-standard RAND Corp. experiment from 1974 to 1982 showed, these are the consumers best situated to control costs and assure quality. Instead we produce abominations of cost shifting like the following: In 2022, employers and private insurers paid hospitals 254% of what Medicare would have paid for the same services.
正如 1974 年至 1982 年的金标准 RAND 公司实验所显示的那样，这些消费者最有能力控制成本并保证质量。相反，我们产生了如下成本转移的恶果：在 2022 年，雇主和私人保险公司支付给医院的费用是 Medicare 为相同服务支付的 254%。
Unfortunately, President Obama was insincere. In principle, an individual mandate to stop free riders plus subsidies restricted to the needy could be the only system we need, no Medicare, no Medicaid, no giant tax subsidy to employer-provided insurance.
不幸的是，奥巴马总统不真诚。原则上，个人强制措施以阻止搭便车者，加上仅限于有需要者的补贴，可能是我们唯一需要的系统，没有医疗保险，没有医疗补助，没有对雇主提供保险的巨额税收补贴。
But instead we have the system we have and I find myself in the middle of my own experiment. The other motorist was at fault. Her insurer offered promptly to settle. I notified my insurer (Aetna) and my healthcare provider (Danbury Hospital) in writing that I would be assuming my insurer’s share of my medical costs.
但相反，我们有我们现有的系统，我发现自己处于自己的实验中。另一位司机有过错。她的保险公司迅速提出和解。我书面通知了我的保险公司（Aetna）和我的医疗服务提供者（Danbury Hospital），我将承担我的保险公司在我医疗费用中的份额。
In writing, Aetna advised me to make “sufficient allowance in any settlement you receive to satisfy the health plan’s claim.” I did. After letting the bills accumulate, I spoke to my so-called Aetna One Advocate who assured me that, once booked, the charges don’t change. I provided Aetna the requested paperwork to make sure I would be billed at the negotiated insurance company rate. The hospital responded in writing and said it would send a bill but “we need to allow more time for the claim to finalize.”
在书面中，Aetna 建议我在任何收到的和解中“充分考虑满足健康计划索赔的费用。”我照做了。在让账单累积后，我与所谓的 Aetna One Advocate 交谈，他向我保证，一旦入账，费用不会改变。我向 Aetna 提供了所需的文件，以确保我会按商定的保险公司费率收费。医院书面回应说会寄送账单，但“我们需要更多时间来完成索赔。”
You can guess what happened next. Six months later, I still haven’t received a bill but, in just the past few weeks, the charges posted to Aetna miraculously doubled to $81,840.22 from $36,667.11.
你可以猜到接下来发生了什么。六个月后，我仍然没有收到账单，但就在过去的几周里，Aetna 的费用奇迹般地从$36,667.11 翻倍到$81,840.22。
Of course, I won’t be paying this amount. The average cost for a two-day hospital stay is $22,000, and that includes treatment. I received no treatment. The hospital said I might have a lacerated liver. Its representatives kept asking if my pain and bloating were improving. I kept repeating I had no such symptoms. After 24 hours, the hospital acknowledged reality but still dragged its feet for a day before discharging me. On day two, my swollen ankle was finally X-rayed—a calcaneal avulsion fracture, also untreatable. It heals on its own.
当然，我不会支付这个金额。两天住院的平均费用是 22,000 美元，包括治疗费用。我没有接受任何治疗。医院说我可能有肝脏裂伤。医院的代表不断询问我的疼痛和腹胀是否有所改善。我一直重复我没有这些症状。24 小时后，医院承认了现实，但仍然拖延了一天才让我出院。第二天，我肿胀的脚踝终于拍了 X 光——跟骨撕脱性骨折，也无法治疗。它会自行愈合。
OK, Danbury Hospital does not have the most glowing online reputation. Did the hospital have an incentive, given my generous employer-provided, taxpayer-provided insurance, to keep me in the hospital as long as possible? Yes.
好的，丹伯里医院的在线声誉并不是最好的。鉴于我慷慨的雇主提供的、纳税人提供的保险，医院是否有动机让我尽可能长时间地留在医院？是的。
Understand: I’m no healthcare curmudgeon, having received excellent and even life-saving care from George Washington University, Georgetown University and New York’s Westchester Medical Center over 40 years. In common, they listened—notably, when I overruled a strong treatment recommendation that struck me as crossing the line into overtreatment. Not surprisingly, because I’m a source of valuable information about my own condition, I was right and saved the system many thousands of dollars in unnecessary care and myself unnecessary risk.
理解：我不是一个对医疗保健持批评态度的人，在过去的 40 年里，我从乔治华盛顿大学、乔治城大学和纽约的威彻斯特医疗中心获得了出色甚至是救命的护理。共同点是，他们倾听——尤其是当我否决了一项让我觉得过度治疗的强烈治疗建议时。不出所料，因为我是自己病情的宝贵信息来源，我是对的，并为系统节省了数千美元的不必要护理，也为自己避免了不必要的风险。
Your results may vary. Medicine is a business of mixed and uncertain outcomes. But the government could do no harm. At its worst, our system endangers patients with overtreatment. It also punishes the conscientious. On good advice, after all, I should have hired a lawyer and driven up costs for all concerned out of any relation to my actual suffering or loss.
您的结果可能会有所不同。医学是一项结果混杂且不确定的业务。但政府可能无害。在最糟糕的情况下，我们的系统因过度治疗而危及患者。它也惩罚了有良知的人。毕竟，根据良好的建议，我本应该聘请律师，并使所有相关人员的费用增加，而与我实际的痛苦或损失无关。
The murder of UnitedHealthCare’s Brian Thompson and two attempts on the life of Donald Trump recall the late 1960s and 1970s. It’s no coincidence, I believe, that next came a period of energetic Carter-Reagan reform that restored dynamism to the economy and Americans’ belief that their government can act competently.
联合健康集团的布莱恩·汤普森被谋杀以及两次对唐纳德·特朗普的暗杀企图让人想起了 20 世纪 60 年代末和 70 年代。我相信，这并非巧合，接下来是一个充满活力的卡特-里根改革时期，这一时期恢复了经济的活力以及美国人对政府能够胜任的信念。
In those days, white papers flooded journalists’ inboxes. Constant were invitations to learned reform seminars in Washington hotel ballrooms. You’ll know the tide has turned for the better when government again becomes ambitious really to fix things that can be fixed, like our healthcare payment system.
在那些日子里，白皮书充斥着记者的收件箱。不断有邀请参加在华盛顿酒店宴会厅举行的学术改革研讨会。当政府再次真正有雄心去解决可以解决的问题，比如我们的医疗支付系统时，你会知道情况已经好转。
9、《2024-12-12 Doctors Say Dealing With Health Insurers Is Only Getting Worse》
The killing of a top health insurance executive outside a Midtown Manhattan hotel last week triggered an outpouring of public anger at an industry many Americans blame for the ills of the nation’s healthcare system.
上周，曼哈顿中城一家酒店外一名顶级健康保险高管被杀，引发了公众对该行业的愤怒，许多美国人将国家医疗系统的问题归咎于该行业。
Count doctors among the aggrieved.
将医生列入受害者之中。
They deal day in and day out with insurers including UnitedHealthcare, whose chief executive, Brian Thompson, was shot to death last week by an assassin who targeted him outside the company’s annual investor conference. Doctors say their frustration is born of intimate experience and has been building for years.
他们日复一日地与包括 UnitedHealthcare 在内的保险公司打交道，该公司的首席执行官布莱恩·汤普森上周在公司年度投资者会议外被一名刺客枪杀。医生们表示，他们的挫败感源于亲身经历，并且已经积累了多年。
Their chief complaint is the aggravation and expense of convincing insurance companies to pay them for their patients’ treatment. Even when they are ultimately approved, MRI scans and other vital but costly procedures often require days of campaigning and paperwork, say doctors.
他们的主要抱怨是说服保险公司为患者的治疗付款的麻烦和费用。医生表示，即使最终获得批准，MRI 扫描和其他重要但昂贵的程序通常需要数天的游说和文书工作。
“It’s getting worse,” said Dr. Zulfiqar Ahmed, an internist in Augusta, Ga., who has practiced in the U.S. for 35 years. “This is not only UnitedHealthcare—this is universal in this country.”
“情况越来越糟，”在美国行医 35 年的乔治亚州奥古斯塔市内科医生祖尔菲卡尔·艾哈迈德博士说。“这不仅仅是联合健康保险公司——这是这个国家的普遍现象。”
Like other clinicians, Ahmed made clear he was appalled by Thompson’s killing and those who have justified—or even celebrated—it on social media. “My heart is saddened for this Mr. Thompson,” he said. “He’s just part of the system, part of this big enormous system.”
和其他临床医生一样，艾哈迈德明确表示，他对汤普森被杀感到震惊，以及那些在社交媒体上为此辩护甚至庆祝的人。“我为这位汤普森先生感到心痛，”他说。“他只是这个系统的一部分，这个庞大系统的一部分。”
Still, doctors say that sympathy doesn’t change their feelings about having to haggle with doctors employed by UnitedHealthcare and other insurers to evaluate proposed procedures—and oftentimes, reject them. “They hire certain doctors, and they sit at a desk, and their whole purpose is to deny or delay,” Ahmed said, echoing a common complaint among doctors.
不过，医生们表示，同情并没有改变他们对与联合健康集团和其他保险公司雇佣的医生讨价还价以评估拟议程序的感受——而且往往会被拒绝。艾哈迈德说：“他们雇佣了一些医生，他们坐在办公桌前，他们的全部目的是拒绝或拖延。”这反映了医生们的普遍抱怨。
Health insurers say they play a valuable role financing the medical care that saves the lives of many patients. Denials keep a lid on unnecessary care and high costs, companies say, thereby keeping treatment affordable for everyone. Insurers also note that doctors, hospitals and drugmakers play a big role in soaring healthcare spending that they are trying to restrain, while ensuring patients get the medical care they need.
健康保险公司表示，他们在为挽救许多患者生命的医疗服务提供资金方面发挥了重要作用。公司称，拒绝不必要的护理和高昂的费用，从而使治疗对每个人都负担得起。保险公司还指出，医生、医院和制药商在不断攀升的医疗支出中扮演了重要角色，他们正试图加以控制，同时确保患者获得所需的医疗服务。
In a message to employees Wednesday, UnitedHealth Group CEO Andrew Witty memorialized Thompson’s “profoundly positive impact” on people’s lives.
在周三给员工的信息中，联合健康集团首席执行官安德鲁·维蒂缅怀了汤普森对人们生活的“深远积极影响”。
Doctors won a rare victory over an insurer last week. In November, Elevance Health’s Anthem unit had said it wouldn’t cover anesthesiology claims for surgeries in Connecticut, New York and Missouri that went beyond a certain time limit, prompting outrage from specialists and even New York Gov. Kathy Hochul. It reversed course last Thursday, a day after Thompson was killed.
上周，医生们在与一家保险公司的斗争中取得了一次罕见的胜利。11 月，Elevance Health 的 Anthem 部门曾表示，不会支付在康涅狄格州、纽约州和密苏里州进行的超过特定时间限制的手术麻醉索赔，这引发了专家们甚至纽约州州长 Kathy Hochul 的愤怒。上周四，在 Thompson 被杀的第二天，该公司改变了立场。
An Anthem Blue Cross Blue Shield spokesman said its policy change had been widely misinterpreted. “It never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services,” he added.
安森蓝十字蓝盾的一位发言人表示，其政策变更被广泛误解。他补充说：“安森蓝十字蓝盾从来没有，也永远不会有不支付医学上必要的麻醉服务的政策。”
America’s Health Insurance Plans, a national industry trade association, said state laws dictate how long an insurer has to pay a provider and ensure that they are paid in a timely manner. Delays can be caused when providers go out of network or are using manual processes to submit claims and receive payments, it said.
美国健康保险计划，一个全国性的行业贸易协会表示，州法律规定了保险公司支付给提供者的时间，并确保他们及时获得付款。它表示，当提供者不在网络内或使用手动流程提交索赔和接收付款时，可能会导致延迟。
The industry’s overall rate of prior authorization denials isn’t public. Medicare Advantage plans, a popular form of health insurance, denied 7.4% of 46.2 million requests submitted on behalf of enrollees in 2022, up from 5.7% in 2019, according to an analysis of federal data by KFF, a health-policy nonprofit. A recent Inspector General audit found that 13% of prior authorization denials from Medicare Advantage plans were for benefits that should otherwise have been covered under Medicare.
该行业的整体事先授权拒绝率并未公开。根据健康政策非营利组织 KFF 对联邦数据的分析，Medicare Advantage 计划是一种流行的健康保险形式，2022 年代表参保人提交的 4620 万份请求中有 7.4%被拒绝，高于 2019 年的 5.7%。最近的一次监察长审计发现，Medicare Advantage 计划中 13%的事先授权拒绝是针对本应由 Medicare 覆盖的福利。
Even when insurers pay, doctors may still find themselves on the hook. Consider the plight of Dr. Anthony Ekong, an ophthalmologist specializing in retinal care who has built a solo practice in Bangor, Maine.
即使保险公司支付费用，医生仍可能发现自己负担沉重。考虑一下安东尼·埃孔医生的困境，他是一位专注于视网膜护理的眼科医生，在缅因州班戈建立了一个个人诊所。
Last month, Ekong received a stack of letters from a company called Cotiviti, which is an auditor for the insurer WellCare, a unit of Centene. In an effort to provide excellent customer service, Cotiviti wrote, it had reviewed payments Ekong had received for treating elderly patients with macular degeneration and macular edema. It determined WellCare had overpaid. The bill: more than $300,000.
上个月，Ekong 收到了一家公司名为 Cotiviti 的一堆信件，该公司是保险公司 WellCare 的审计员，而 WellCare 是 Centene 的一个部门。Cotiviti 写道，为了提供卓越的客户服务，他们审查了 Ekong 因治疗患有黄斑变性和黄斑水肿的老年患者而收到的付款。他们确定 WellCare 多付了款。账单：超过 30 万美元。
“We would have to shut down or file for bankruptcy,” said Ekong.
“我们将不得不关闭或申请破产，”埃孔说。
WellCare, in turn, suggested he make up the difference by billing his patients. But many are elderly and struggling to get by. Among them are Eugene Strout, 71, and his wife, Donna-Marie Strout, 72, who subsist on Social Security and Eugene’s occasional shifts driving a school bus. At one point, Ekong offered to pay the couple to clean his office every week to help fund the $600 a month they’d have to pay if they switched to another insurer. The Strouts ended up reluctantly moving their care to their local hospital, which still accepts their insurance. The Strouts worry that the hospital could also end up dropping the insurance.
WellCare 则建议他通过向病人收费来弥补差额。但许多病人年纪大了，生活困难。其中包括 71 岁的尤金·斯特劳特和 72 岁的妻子唐娜-玛丽·斯特劳特，他们靠社会保障和尤金偶尔开校车的班次维持生计。有一次，埃孔提议每周付钱给这对夫妇打扫他的办公室，以帮助支付如果他们换到另一家保险公司每月需要支付的 600 美元。斯特劳特夫妇最终不情愿地将他们的护理转移到当地医院，该医院仍然接受他们的保险。斯特劳特夫妇担心医院也可能最终取消保险。
“It’s egregious, invalid and a breach of trust,” Ekong said.
“这是极其恶劣的、无效的，并且是对信任的破坏，”埃孔说。
A representative for Centene said the company is looking into the issue further and hopes to amicably resolve it.
Centene 的一位代表表示，公司正在进一步调查此事，并希望友好解决。
Andrew MacLean, chief executive of Maine Medical Association, said he receives phone calls every day from physicians struggling with health insurers demanding so-called clawbacks for bills that had already been paid.
缅因州医学协会首席执行官安德鲁·麦克莱恩表示，他每天都会接到医生的电话，他们正在与要求所谓的追回已支付账单的健康保险公司作斗争。
“It almost feels like they do it because they can,” MacLean said of the insurers. “By no means do we applaud this or would we condone violence, but it’s a scary indication of just how frustrated people are about the current system and the imbalance of power—and physicians certainly feel that.”
“这几乎让人觉得他们这样做是因为他们可以，”麦克莱恩谈到保险公司时说。“我们绝不赞成或纵容暴力，但这清楚地表明人们对当前系统和权力不平衡的极度不满——医生当然也有这种感觉。”
In a recent post on X, Dr. Alan Nguyen, a spine specialist in Fort Myers, Fla., noted that when insurance-company doctors reject an MRI request, he now asks for their name and health provider identification number. “I tell them if a cancer is missed, then the patient will know who to sue,” wrote Nguyen. In an interview, he said he believes the situation had worsened significantly over the last five years. When insurers denied treatment, Nguyen observed, doctors were still left to deal with the patients and their pain.
在最近的一篇 X 上的帖子中，佛罗里达州迈尔斯堡的脊柱专家艾伦·阮博士指出，当保险公司医生拒绝 MRI 请求时，他现在会要求他们的姓名和健康提供者识别号码。“我告诉他们，如果错过了癌症，那么患者将知道该起诉谁，”阮写道。在一次采访中，他表示，他认为这种情况在过去五年中显著恶化。当保险公司拒绝治疗时，阮观察到，医生仍然需要处理患者及其痛苦。
A familiar lament among doctors is how sweeping changes over the last 20 years—some instigated by insurers, others not—have degraded their profession. Once autonomous and highly esteemed, doctors are increasingly employees of large hospital chains and find themselves trapped between insurers and their own cost-conscious management.
医生中一个熟悉的抱怨是，过去 20 年间的一些重大变化——有些是由保险公司引发的，有些则不是——已经降低了他们的职业地位。曾经自主且备受尊敬的医生，如今越来越多地成为大型医院连锁机构的雇员，发现自己被夹在保险公司和自身注重成本的管理之间。
“Healthcare is run by the business types,” said Dr. Mark Davidian, a radiologist in Sacramento, Calif., who despaired at the loss of agency when caring for patients. He took particular umbrage when he discovered from news reports that UnitedHealthcare’s Thompson earned some $10 million last year and then imagined how that might be received by a cancer patient who had been denied treatment.
“医疗保健由商业类型的人管理，”加州萨克拉门托的放射科医生马克·大卫安博士说，他对在照顾病人时失去自主权感到绝望。当他从新闻报道中得知联合健康集团的汤普森去年赚了大约 1000 万美元时，他特别感到愤怒，并想象一位被拒绝治疗的癌症患者会如何看待这一点。
When Davidian finished his training 25 years ago, things were different. “Doctors had their own practices. They called the shots,” he said. If, for example, he was dissatisfied with the staff or the equipment at a particular hospital, he would send his patients elsewhere, he said.
大卫安在 25 年前完成培训时，情况有所不同。“医生有自己的诊所。他们说了算，”他说。例如，如果他对某家医院的员工或设备不满意，他会把病人送到别处，他说。
Nowadays, he works for a hospital chain in northern California, and feels bound by the prerogatives of managers determined to contain costs. “Nobody speaks for the patient anymore that has any sort of power,” he said. “The problem is, with healthcare we’re supposed to care.”
如今，他在加利福尼亚北部的一家医院连锁机构工作，感到受到决心控制成本的管理者特权的约束。他说：“现在没有人能为患者发声，拥有任何形式的权力。”“问题是，在医疗保健方面，我们应该关心。”
While larger chains may have the wherewithal to grapple with insurers, the costs weigh heavily on smaller practitioners.
虽然较大的连锁店可能有能力与保险公司周旋，但这些成本对较小的从业者来说是沉重的负担。
Dr. Richard Lechner, a family dentist in New Britain, Conn., for years paid for three administrative staff members whose days, he said, were mostly spent fighting with insurers. This for an office that consisted of one dentist and two hygienists.
多年来，康涅狄格州新不列颠的家庭牙医理查德·莱克纳博士为三名行政人员支付工资，他说这些人的工作日大多用于与保险公司斗争。这是一个由一名牙医和两名卫生员组成的办公室。
“They’re always throwing up roadblocks for practitioners like me to get paid,” Lechner said. Requests for additional documentation, or claims of paperwork lapses, were, he said, “specifically designed to prolong, prolong, prolong and then hope the dentist gives up.”
“他们总是为像我这样的从业者设置障碍以获得报酬，”莱希纳说。要求提供额外的文件，或声称文书工作有疏漏，他说，这些“专门设计来拖延、拖延、再拖延，然后希望牙医放弃。”
Last year, Lechner did give up: He sold his private practice to Dental Associates of Connecticut, a company that operates a network of more than 40 dental offices across the state. Like Davidian, he is now an employee. Much of the work of chasing insurance claims is now handled by a specialist team at Dental Associates’ central office.
去年，莱希纳确实放弃了：他将自己的私人诊所卖给了康涅狄格州牙科协会，这是一家在全州经营 40 多个牙科诊所网络的公司。像大卫安一样，他现在是一名员工。追踪保险索赔的工作现在主要由牙科协会总部的专业团队处理。
“The primary reason I sold my dental practice is because I couldn’t keep up with the insurance companies’ shenanigans,” he said. “I thought I was going to have a stroke.”
“我出售牙科诊所的主要原因是我无法跟上保险公司的恶作剧，”他说。“我以为我会中风。”
CUMMING, Ga.—After three years of doctors’ visits and $40,000 in medical bills didn’t cure their daughter’s rare condition, April and Justin Beck found a specialist three states away who offered a promising treatment.
乔治亚州卡明——在经历了三年的就诊和 40,000 美元的医疗费用后，艾普丽尔和贾斯汀·贝克的女儿罕见病仍未治愈，他们找到了一位远在三个州之外的专家，提供了一种有希望的治疗方案。
They set out before dawn last spring for the nine-hour drive to Arkansas Children’s Hospital in Little Rock, where Dr. Aravindhan Veerapandiyan explained how infusions of antibodies could help Emily, now 9 years old, and her misfiring immune system.
去年春天，他们在黎明前出发，驱车九小时前往小石城的阿肯色儿童医院，阿拉温丹·维拉潘迪扬医生解释了抗体输注如何帮助现年 9 岁的艾米丽以及她紊乱的免疫系统。
They returned home with an appointment to start the infusions. But the Becks’ insurer, UnitedHealthcare, declined to pay for a treatment it said wasn’t medically necessary.
他们带着开始输注的预约回到了家。但贝克一家投保的 UnitedHealthcare 拒绝支付该治疗费用，称其并非医学必需。
They decided to fight back. “I really had no idea it was going to be this hard,” April Beck said.
他们决定反击。“我真的没想到会这么难，”April Beck 说。
Health insurers process more than five billion payment claims annually, federal figures show. About 850 million are denied, according to health-policy nonprofit KFF. Less than 1% of patients appeal.
联邦数据显示，健康保险公司每年处理超过 50 亿份付款索赔。据健康政策非营利组织 KFF 称，其中约 8.5 亿份被拒绝。不到 1%的患者提出上诉。
Few people realize how worthwhile those labors can be: Up to three-quarters of claim appeals are granted, studies show.
很少有人意识到这些努力是多么值得：研究表明，多达四分之三的索赔申诉都会获批。
Patients who fight denied claims must marshal evidence from medical studies, navigate dense paperwork and spend hours on the phone during what is often one of the most difficult times of their lives. They debate insurers over whether a patient might ever recover from a stroke, or whether an expensive new treatment holds real promise.
患者在争取被拒绝的理赔时，必须收集医学研究的证据，处理繁琐的文书工作，并在生命中最艰难的时刻花费数小时打电话。他们与保险公司争论患者是否可能从中风中恢复，或昂贵的新疗法是否真正具有希望。
“Because a lot of people won’t appeal, won’t call, don’t have the knowledge to sit on the phone—a lot of those go away,” said Dr. Ezekiel Emanuel, an oncologist and medical ethicist at the University of Pennsylvania.
“因为很多人不会申诉，不会打电话，也没有足够的知识在电话上交涉——很多这样的情况就不了了之了，”宾夕法尼亚大学的肿瘤学家兼医学伦理学家以西结·伊曼纽尔博士说道。
The sense of futility that keeps people from appealing denied claims is part of a current of anger against insurers that surged in December after the assassination of UnitedHealthcare Chief Executive Officer Brian Thompson.
阻止人们对被拒绝的索赔提出上诉的无力感，是去年十二月针对保险公司愤怒情绪的一部分，这种愤怒在 UnitedHealthcare 首席执行官布赖恩·汤普森遇刺后达到了高潮。
Insurers say that to remain solvent, they must determine which crises merit reimbursement and which don’t. Insurers across categories face similar issues over who and what they’ll agree to cover amid rising costs—including home insurance companies that have canceled policies under increasing risks from natural disasters.
保险公司表示，为了保持偿付能力，他们必须确定哪些危机值得报销，哪些不值得。各类保险公司在成本上升的情况下都面临类似的问题，即他们将同意承保谁和什么——包括在自然灾害风险增加的情况下取消保单的房屋保险公司。
‘This appeal saved my life’
“这次申诉救了我的命”
Edward Stratton underwent four years of surgeries, radiation and chemotherapy after he was diagnosed with colorectal cancer in 2019. Doctors declared he had no evidence of cancer in July 2023. But the treatments had destroyed his liver.
爱德华·斯特拉顿在 2019 年被诊断出结直肠癌后，经历了四年的手术、放疗和化疗。医生在 2023 年 7 月宣布他已无癌症迹象。但这些治疗摧毁了他的肝脏。
Doctors recommended a transplant. His insurer, Elevance Health, rejected the claim and three appeals in letters referencing research showing a new liver didn’t improve outcomes for people with colorectal cancer. Elevance didn’t respond to messages from Stratton’s doctors demonstrating he didn’t have cancer anymore.
医生建议进行移植。他的保险公司 Elevance Health 拒绝了索赔，并在信中引用研究结果驳回了三次上诉，研究显示新肝脏并不能改善结直肠癌患者的预后。Elevance 没有回应 Stratton 的医生发送的信息，这些信息表明他已经没有癌症了。
Stratton, with help from his daughter, appealed again in July 2024 and copied regulators, Elevance board members and journalists on his email. The appeal cited a similar case in which Elevance overturned its denial, and noted two other insurers used updated guidance with more nuanced views of transplantation. Stratton also said denying him a transplant would kill him.
斯特拉特顿在女儿的帮助下于 2024 年 7 月再次提出上诉，并抄送了监管机构、Elevance 董事会成员和记者。他的上诉引用了一个类似案例，Elevance 曾推翻其拒绝决定，并指出另外两家保险公司采用了更新的指南，对移植持更细化的观点。斯特拉特顿还表示，拒绝为他进行移植将会要了他的命。
Elevance overturned the denial. His transplant in September was successful. Stratton, who is 65 and lives in Ballwin, Mo., is off disability, back to work as a medical-equipment salesman and playing golf again.
Elevance 推翻了拒赔决定。他在九月份的移植手术成功了。65 岁的 Stratton 居住在密苏里州巴尔温，目前已脱离残疾状态，重返工作岗位，担任医疗设备销售员，并重新开始打高尔夫。
“This appeal saved my life,” he said.
“这次上诉救了我的命，”他说。
Elevance said in an email that it followed a robust process in reviewing Stratton’s case. Elevance
在一封电子邮件中表示，在审查 Stratton 的案件时遵循了严格的流程。
“This case, however, involved an exceptionally rare set of circumstances,” Elevance said.
“然而，此案涉及一组极其罕见的情况，”Elevance 表示。
In Georgia, April Beck said her daughter, Emily, was an organized kindergartner who loved reading and helping get her classmates in line in 2021. Then she contracted Covid-19 and viral pneumonia. She recovered, but she had changed.
在乔治亚州，April Beck 说她的女儿 Emily 曾是一个井井有条的幼儿园学生，喜欢阅读，并在 2021 年帮助同学排队。然后她感染了新冠病毒和病毒性肺炎。她康复了，但她变了。
“It was like setting my kid on fire,” April said.
“这就像是把我的孩子点燃一样，”艾普丽尔说。
Emily woke in the night, moaning and shaking. She couldn’t sit still. Her handwriting regressed.
艾米丽在夜里醒来，呻吟着，身体颤抖。她无法静坐，书写能力倒退。
A psychiatrist prescribed Zoloft for Emily’s panic attacks and obsessive-compulsive symptoms and guanfacine for ADHD. After a series of tests, a doctor tried antibiotics and an antifungal. Her symptoms subsided. At the start of the 2022 school year, she was thriving.
一位精神科医生为艾米丽的惊恐发作和强迫症状开了左洛复，并为多动症开了胍法辛。经过一系列测试后，一位医生尝试使用抗生素和抗真菌药。她的症状缓解了。在 2022 学年开始时，她状态良好。
By November, though, Emily was having frequent meltdowns and panic attacks. Her pediatrician suspected a rare neurological condition brought on by infections, called pediatric acute-onset neuropsychiatric syndrome (PANS) or pediatric acute-onset neuropsychiatric disorders associated with streptococcal infections (PANDAS). The conditions are misfires of the immune system that attack children’s brains after an infection.
到了十一月，Emily 经常情绪崩溃并出现惊恐发作。她的儿科医生怀疑是一种由感染引发的罕见神经系统疾病，称为儿童急性起病神经精神综合征（PANS）或与链球菌感染相关的儿童急性起病神经精神障碍（PANDAS）。这些疾病是免疫系统的错误攻击，在感染后攻击儿童的大脑。
Antibiotics and steroids helped quell symptoms. But any cold or cough ignited her more severe behavioral symptoms, too. She kicked and bit, and once tried to jump out of a moving car.
抗生素和类固醇有助于缓解症状。但任何感冒或咳嗽都会引发她更严重的行为症状。她踢打、咬人，甚至曾试图从行驶中的汽车上跳下。
“She’s been on antibiotics for two years,” April said.
“她已经服用抗生素两年了，”艾普丽尔说。
‘Mommy cried’
“妈妈哭了”
Emily’s pediatrician suggested she see a PANS specialist. The closest one was Veerapandiyan at Arkansas Children’s Hospital. April spent hours on the phone in the spring of 2024 convincing the hospital to put Emily on his schedule in August.
Emily 的儿科医生建议她去看 PANS 专家。最近的一位是阿肯色儿童医院的 Veerapandiyan。2024 年春天，April 花了数小时打电话，说服医院将 Emily 安排在他的 8 月日程中。
Then came the bad news. The hospital said in an email on June 12 that under a new policy it wouldn’t take out-of-state patients. The appointment was canceled.
然后坏消息来了。医院在 6 月 12 日的电子邮件中表示，根据新政策，它不再接收外州患者。预约被取消了。
“Mommy cried,” Emily said.
“妈妈哭了，”艾米丽说。
April pleaded and got Emily back on the schedule the following week. At that first appointment, Emily regaled Veerapandiyan with all the snake species she could name. Veerapandiyan—known as Dr. Panda to his patients—prescribed immunoglobulin therapy, a solution of antibodies derived from human plasma. In one study of 21 children with moderate to severe PANS published in March 2021 in the Journal of Child and Adolescent Psychopharmacology, immunoglobulin therapy improved symptoms by more than 50%.
艾普丽恳求后，成功让艾米丽在接下来的一周重新安排了预约。在第一次就诊时，艾米丽向维拉潘迪扬滔滔不绝地讲述她能叫出名字的所有蛇类。维拉潘迪扬——在患者中被称为“熊猫医生”——为她开出了免疫球蛋白疗法，这是一种从人类血浆中提取的抗体溶液。根据 2021 年 3 月发表在《儿童与青少年精神药理学杂志》上的一项针对 21 名中度至重度 PANS 儿童的研究，免疫球蛋白疗法使症状改善了 50%以上。
April felt her prayers had been answered. The family drove back to Georgia with a plan to start the infusions.
艾普丽尔觉得她的祈祷得到了回应。全家驱车返回乔治亚州，准备开始输注治疗。
The hospital staff sent five prior authorization requests for Emily’s treatment through the UnitedHealthcare insurance Justin gets through the construction company where he works as an operations manager. The insurer questioned or rejected each of them.
医院工作人员通过贾斯汀在其担任运营经理的建筑公司获得的 UnitedHealthcare 保险，为艾米莉的治疗提交了五次事先授权请求。保险公司对每一项请求提出质疑或予以拒绝。
Veerapandiyan and his colleagues at the hospital traded notes about their efforts to persuade UnitedHealthcare to cover Emily’s infusions. Each denial sparked a confusing reconsideration of whether to appeal or submit a new prior authorization request with updated information.
Veerapandiyan 和他在医院的同事交流了他们说服 UnitedHealthcare 支付 Emily 输液费用的努力。每次拒绝都会引发一场令人困惑的重新考虑，是要提出上诉，还是提交一份包含更新信息的新预授权请求。
The Becks hoped Emily could get the infusions closer to their home, but the cheapest provider they could find was more than four hours away and told them the infusions would cost $36,000 out-of-pocket—far more than they could pay.
贝克一家希望艾米丽能在离家更近的地方接受输注，但他们能找到的最便宜的提供方距离超过四个小时，并告诉他们输注的自费费用为 36,000 美元——远远超出他们的承受能力。
In one letter, UnitedHealthcare denied the treatment because the medication wasn’t ordered from an in-network pharmacy. In another, on July 25, the insurer said the treatment wasn’t medically necessary and hadn’t been proven helpful for Emily’s condition.
在一封信中，UnitedHealthcare 拒绝了该治疗，因为药物并非从网络内药房订购。在另一封于 7 月 25 日的信中，保险公司表示该治疗在医学上没有必要，并且尚未被证明对 Emily 的病情有帮助。
“The services are not eligible for coverage because your plan doesn’t cover unproven procedures,” the insurer said.
“这些服务不符合报销条件，因为您的保险计划不涵盖未经证实的治疗方法，”保险公司表示。
Rare cases often put patients and insurers in protracted conflict. Some people want experimental treatments that insurers reject because they aren’t thoroughly proven to work. But for patients with rare conditions, the number of cases are so small it’s difficult to widely document a drug’s effects.
罕见病例经常使患者和保险公司陷入长期冲突。 一些人希望接受实验性治疗，但保险公司因其疗效尚未被充分证明而拒绝支付。 但对于罕见疾病患者来说，病例数量极少，难以广泛记录某种药物的效果。
Care within two weeks of diagnosis gives PANS patients the best shot at recovery, according to a consortium of doctors who treat the syndrome. Emily had been experiencing symptoms for more than three years.
根据治疗该综合症的医生联盟的说法，在确诊后两周内接受治疗可为 PANS 患者提供最佳康复机会。Emily 的症状已持续了三年多。
Emily’s family and care providers decided to appeal. It took a month for the hospital to get documents ready to prove that her treatment was necessary and urgent.
Emily 的家人和护理提供者决定提出上诉。医院花了一个月时间准备文件，以证明她的治疗是必要且紧急的。
April and Veerapandiyan prepared the appeal at the end of August and requested that the insurer get back to them within 72 hours. To qualify for expedited review, patients must prove delaying treatment could jeopardize their life or ability to regain maximum function, or cause severe pain.
四月和维拉潘迪扬在八月底准备了上诉，并要求保险公司在 72 小时内回复他们。要符合加急审查的资格，患者必须证明延迟治疗可能危及生命或恢复最大功能的能力，或导致严重疼痛。
UnitedHealthcare replied on Sept. 14 that its denial based on the out-of-network pharmacy request was processed correctly and that the appeal wasn’t urgent. The Becks and their doctor sent a new appeal to the insurer’s escalation unit.
UnitedHealthcare 于 9 月 14 日回复称，其基于网络外药房请求的拒绝处理正确，且上诉并不紧急。贝克一家和他们的医生向保险公司的升级部门提交了新的上诉。
“You have exhausted all levels of internal appeal with UnitedHealthcare,” the insurer said in a letter to the Becks on Oct. 30.
“您已经用尽了与 UnitedHealthcare 的所有内部申诉级别，”保险公司在 10 月 30 日给 Beck 一家的一封信中表示。
New flare-ups 新的复发
UnitedHealthcare told the Becks that further appeals should go to an independent review organization, a government-contracted group that reviews appeals. A UnitedHealthcare representative later told Veerapandiyan’s office that ordering the infusion from an approved pharmacy would require a new prior authorization request. They found a new pharmacy and started over.
UnitedHealthcare 告诉 Beck 一家，进一步的申诉应提交给一个独立审核机构，这是一个受政府委托的组织，负责审核申诉。UnitedHealthcare 的一名代表后来告诉 Veerapandiyan 的办公室，从批准的药房订购输注需要提交新的事先授权请求。他们找到了一家新的药房并重新开始。
The Becks received a new denial on Nov. 13, saying the treatment wouldn’t be covered because it was unproven.
贝克一家在 11 月 13 日收到了新的拒赔通知，称该治疗不予覆盖，因为其尚未被证实有效。
“He could not do anything,” Veerapandiyan wrote to the group after failing to persuade a UnitedHealthcare doctor to approve the treatment.
“他无能为力，”Veerapandiyan 在未能说服 UnitedHealthcare 的医生批准治疗后写信给小组。
Emily had another flare-up after switching antibiotics. She started wetting the bed. In November, Arkansas Children’s Hospital said it had exhausted its options and wouldn’t pursue further appeals with UnitedHealthcare.
艾米丽在更换抗生素后又一次病情复发。她开始尿床。11 月，Arkansas Children’s Hospital 表示已用尽所有选择，不会再向 UnitedHealthcare 提出进一步上诉。
Emily went from sleeping 12 hours a day to barely sleeping. She flew into fits of rage that she called “her brain telling her bad things.” She thought bad guys were coming for her and considered stabbing herself.
Emily 从每天睡 12 小时变成几乎无法入睡。她会突然暴怒，称之为“她的大脑在告诉她坏事”。她认为坏人要来抓她，甚至考虑过刺伤自己。
Steroids helped relieve the symptoms. “We get these glimpses of her—who she is and who she should be. That’s what keeps us fighting,” April said.
类固醇有助于缓解症状。“我们能看到她的片刻闪现——她是谁，以及她本应成为的样子。这就是支撑我们坚持下去的动力，”艾普丽尔说道。
The Becks paid $20,000 out-of-pocket in 2023 for Emily’s medical care, including occupational therapy, psychiatric appointments, tests, supplements and medications that insurance wouldn’t pay for after meeting a large deductible. They accumulated $6,000 in medical debt. They started a GoFundMe campaign in 2024 to pay for the infusions.
贝克一家在 2023 年自掏腰包支付了 20,000 美元用于艾米丽的医疗护理，包括职业治疗、精神科预约、检测、补充剂和药物，这些费用在达到高额免赔额后保险仍不予报销。他们累积了 6,000 美元的医疗债务。2024 年，他们发起了 GoFundMe 筹款活动来支付输液费用。
April learned from a Facebook support group for parents of children with PANS/PANDAS about Claimable, a company using artificial intelligence to help patients appeal denials. Claimable was offering to submit claims for PANS/PANDAS patients free of charge.
April 从一个 Facebook 支持小组（该小组面向患有 PANS/PANDAS 儿童的家长）了解到 Claimable，这是一家利用人工智能帮助患者申诉被拒赔案件的公司。Claimable 提供免费为 PANS/PANDAS 患者提交索赔的服务。
The Becks on Dec. 6 sent their appeal to the new denial based on medical necessity by email to UnitedHealthcare, copying Andrew Witty, CEO of its parent company, as well as Georgia’s governor and attorney general. Claimable encouraged them to copy Witty on every interaction.
贝克一家于 12 月 6 日通过电子邮件向 UnitedHealthcare 提交了针对基于医疗必要性的最新拒赔决定的上诉，并抄送了其母公司首席执行官安德鲁·威蒂，以及乔治亚州州长和司法部长。Claimable 鼓励他们在每次互动中都抄送威蒂。
The package included a letter from the PANS Research Consortium stating that immunoglobulin therapy is widely accepted as standard treatment for kids like Emily and that, as of Nov. 22, 2024, 13 states have made it illegal to impede access to the treatment for people with PANS/PANDAS. The letter cited 25 studies backing the treatment’s efficacy. It was cosigned by physicians from Stanford and the National Institutes of Health.
该包裹包含一封来自 PANS 研究联盟的信，信中指出免疫球蛋白疗法被广泛接受为像 Emily 这样的孩子的标准治疗方法，并且截至 2024 年 11 月 22 日，已有 13 个州立法禁止阻碍 PANS/PANDAS 患者获得该治疗。信中引用了 25 项研究支持该治疗的有效性，并由斯坦福大学和美国国立卫生研究院的医生共同签署。
The appeal reached UnitedHealthcare’s escalation unit and the external agency. April included the half-dozen psychiatric medications they had tried, pictures of Emily’s regressed handwriting and four similar cases in which denials were overturned by health insurers.
上诉提交到了 UnitedHealthcare 的升级部门和外部机构。四月份，他们提供了曾尝试的六种精神科药物、Emily 退化的笔迹照片，以及四个健康保险公司推翻拒赔决定的类似案例。
“It’s on the medical director’s desk,” a UnitedHealthcare representative told her.
“它在医疗总监的桌上，”一位 UnitedHealthcare 代表告诉她。
One day in December, Emily relayed the story of her big trip to Arkansas and showed off the bedroom her sister and grandma decorated for her in a Pokémon theme. She was on the downward slope from a round of steroids and getting over a cold—when symptoms usually start.
在十二月的一天，Emily 讲述了她前往阿肯色州的大旅行，并展示了她的姐姐和奶奶为她装饰的宝可梦主题卧室。她正处于一轮类固醇治疗的后期，并且刚刚康复于感冒——通常在这个时候症状会开始出现。
April worried about the inevitable flare-up after each new virus or infection. A week later, Emily’s symptoms surfaced again.
艾普莉担心每次新的病毒或感染后不可避免的复发。一周后，艾米丽的症状再次出现。
Two days before Christmas, a representative from UnitedHealthcare called to say Emily had won her appeal. UnitedHealthcare told the Journal that its medical director decided the infusions would be appropriate as a trial for Emily.
圣诞节前两天，来自 UnitedHealthcare 的代表打来电话，说 Emily 的上诉成功了。UnitedHealthcare 告诉《华尔街日报》，其医疗总监认为输注作为 Emily 的试验治疗是合适的。
Her parents toasted with prosecco as Emily watched, beaming.
她的父母举杯普罗赛克庆祝，艾米丽在一旁微笑着观看。
Emily received the first treatment in late January. Each round of two back-to-back infusions took seven hours. Emily’s family and neighbors did their best to distract her with Netflix, visits and toys.
Emily 在 1 月下旬接受了第一次治疗。每轮连续两次输注需要七个小时。Emily 的家人和邻居尽力用 Netflix、探访和玩具来分散她的注意力。
“This has been the battle thus far,” April said. “This could just be the beginning.”
“到目前为止，这一直是一场战斗，”艾普丽尔说。“这可能只是个开始。”
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