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用機率管理健康

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（英文文章在中文文章之后）

2008年，谷歌的聯合創始人謝爾蓋?布爾發現，他身體的每一個細胞都有LRRK2的基因突變。LRRK2是一種基因突變，這個基因可能引起帕金森病發的病機率較高。也就是每個帕金森氏癥患者都有LRRK2突變，也不是每個有LRRK2突變的人都會得帕金森氏癥。但是，如果一個人的細胞中有LRRK2的基因突變，他一生中得到帕金森氏癥的機率會增加30%到75%。相較之下，一個普通美國人患帕金森氏癥的風險大約是1%。

布爾使用一組大數據做了他自己的研究，并得出結論，如果他不采取任何行動來減少帕金森氏癥，他有50%的機會患上帕金森氏癥。得出這個結論后，布爾開了一個部落客，這個部落客就命名為「LRRK2」。布爾還向媒體透露了這個消息。他的作法是希望藉此引起這方面的專家注意，甚至為他提供解決辦法。

此外，他還自己研究了LRRK2突變在人體的影像，他要自己找到方法，以降低自己得到帕金森氏癥的機會。

在他的研究中，他發現運動，尤其是潛水的年輕人，可以降低60%患帕金森氏癥的幾率。此后，一周中總有幾個晚上，布爾在一天的工作后，就開車上路到當地的游泳池。在那里，他換上泳褲，走到一個3米長的跳板上，看著下面的水，然后潛水，然后開始跳水。

布爾還嘗試涉足瑜伽、體操和搏擊。他嘗試了很多事來鍛煉自己的身體和精神。他說；「潛水本身很短暫，但很激烈」，他補充說：「你用力推開水，然后必須馬上扭轉過來。它確實讓你的心率加快了。」

其他研究表明，攝取咖啡因與降低帕金森氏癥風險也有幫助。所以，有一段時間，布爾每天喝一兩杯咖啡。但他不習慣咖啡的味道。于是他改喝綠茶。每次泳池鍛煉身體時，他就喝一杯綠茶，他希望透過生活方式來降低遺傳對他的影響。

「這一切都是現成的，」他說；「但假設根據飲食、鍛煉等因素，我可以將風險降低一半，降至 25% 左右。」

布爾說，通過飲食、運動等綜合考慮，他希望將風險降低一半，從50%左右降低到25%。然后，隨著神經科學的穩步發展，布爾希望將他的風險再降低一半，使他患帕金森氏癥的總體機會降到13%左右。

大約在那個時候，布爾還捐贈了超過5000萬美元，來開發或研究可能的藥物治療，甚至帕金森氏癥的治療方法。他希望這筆錢足以「發揮作用」。（當時，布爾的凈資產為150億美元。

但布爾并沒有就此止步。他想把他的風險降低到「10%以下」。雖然百分之十仍然比平均風險高十倍，但他最初的機會減少了五倍（即從50%下降到10%）。這離降低得病的機會還有很長的路要走。

我的一位醫生朋友曾經說過；病人不需要把他們的命運交給醫生。他的意思是；照顧身體是病人自己的責任屬，而不是他的醫生。醫生的作用是提供專業意見供病人參考。

布爾寫道：「我很幸運提早發現我很容易得到帕金森病」。「我現在有機會調整我的生活以減少得病的機率（例如，有證據表明運動可能對帕金森病有保護作用）。我也有機會在這種疾病可能影響我之前，就開始進行和支持對它的研究。而且，不管我自己的健康如何，它都能幫助我的家人和其他人。」

當然，即使布爾什么都不做，他可能也不會得帕金森氏癥。但我們不應該這樣想。最好假設；如果我們什么都不做，沒有設法嘗試降低風險或讓它延遲發病，最壞的情況就是會發生。這樣，即使我們確實生病了，我們也不會有任何遺憾。

布爾在面對他的潛在疾病時表現出積極主動的態度。當我們面臨潛在的問題和實際問題時，我們可以從他的例子中學習。我們應該嘗試估計風險，并盡我們所能降低風險。同樣，如果我們能做任何事情來增加成功的可能性，我們就應該這樣做，以改善我們的生活。最后，我們的協同努力可以大大有助于避免問題或增加我們成功的可能性。

Using a Positive Attitude to Face Problems

In 2008, Sergey Brin, Google’s co-founder, found that there were LRRK2 mutations in every cell of his body. LRRK2 is a genetic mutation which is linked to a higher rate of Parkinson’s disease. Not everyone with Parkinson's has the LRRK2 mutation, and not everyone with the LRRK2 mutation will get Parkinson’s. However, if one has the LRRK2 mutation, it means that one’s chance of getting Parkinson's is between 30 to 75 percent in one’s lifetime. For reference, the risk of an average American getting Parkinson’s is about one percent.

Brin did his own research using a large data set and concluded that he had a 50 percent chance of developing Parkinson’s if he didn’t do anything to curtail it. After this conclusion, Brin started a blog that was simply called “LRRK2.” He also told the media about his blog in order to try to attract experts to provide solutions for his reference.

In addition, he also studied the LRRK2 mutation in humans to try to find ways to reduce the chances of developing Parkinson's.

In his research, he learned of one study that found that young men who do exercise, especially diving, can reduce their chances of getting Parkinson's by 60 percent. So, several evenings of a week, Brin drives up the road to the local pool after a day’s work. There, he changes into his swim trunks, steps out onto a 3-meter springboard, peers at the water below, and dives into it.

Brin also tried to dabble in yoga, gymnastics and acrobatics. He tried many things to exert himself physically and mentally. But about the diving, he said, “The dive itself is brief but intense,” adding “You push off really hard and then have to twist right away. It does get your heart rate going.”

Other studies have shown that caffeine consumption is linked to a reduced risk of Parkinson’s. So, for a time, Brin drank one or two cups of coffee a day. But he couldn’t stand or get used to the taste of the coffee. So he switched to green tea.

With every pool workout and every cup of tea, he hopes to diminish his risk of getting Parkinson’s, counteracting his genetic predisposition with lifestyle changes.

Brin said that with a combination of diet, exercise, and so on, he hopes to cut his lifetime risk of developing Parkinson’s by half, from about 50 percent to 25 percent. Then, with the steady progress of neuroscience, Brin hopes that his risk will be cut in half again—bringing his overall chance of developing Parkinson's to around 13 percent.

Around that time, Brin also donated over US$50.00M to develop or investigate possible drug treatments or even cures for Parkinson’s. He hoped that this money would be enough to “really move the needle” in terms of making progress on treating and preventing Parkinson’s. (For reference, at that time, Brin’s net worth was around $15 billion.)

But Brin didn’t stop there. He wanted to lower his risk to under 10 percent. Although ten percent is still ten times higher than the average risk, it is a five-fold reduction from his original risk (i.e., from 50% down to 10%), which is much better than having a coin toss’s chance of getting the disease.

One of my doctor friends once said that patients don’t need to hand over their destiny to doctors. He meant that the real responsibility for one’s body belongs to the patient, not his or her doctor. The role of doctors is to provide professional opinions for the patient’s reference.

“I lucky know early in my life something I am substantially predisposed to,” Brin wrote. “I now have the opportunity to adjust my life to reduce those odds. I also have the opportunity to perform and support research into this disease long before it may affect me. And, regardless of my own health, it can help my family members as well as others.”

Of course, it’s possible that Brin wouldn’t get Parkinson’s even if he didn’t do anything. But we probably shouldn’t think that way. It's likely better to assume that the worst will happen if we don’t do anything. Doing so will help to motivate us to try to reduce the risk or at least delay the onset. That way, we won’t have any regrets, even if we do get sick.

Brin is fortunate in the sense that he has money to donate and because he found out about his genetic predisposition so early. However, all of us have conditions in our lives that could be improved or better accommodated in some way with effort on our part. And with the Internet, almost anyone can do a certain level of research and find experts with opinions on the maladies or situations that may affect us.

Brin demonstrated an aggressive and proactive attitude in facing his potential disease. We can learn from his example when we are facing potential problems and also actual problems. We should try to estimate the risk and do everything that we can to lower the risk. Similarly, if we can do anything to increase the probability of success, we should do so in order to improve our lives. In conclusion, a concerted effort on our part can go a long way in terms of avoiding a problem or increasing our likelihood of success.