PAUL SULLIVAN2026年5月26日 Dadu ShinHumans have — presumably — always aspired to living longer, healthier lives. Now that might be more possible than ever before — especially if you have enough money.人类一直渴望活得更长久、更健康——大概是这样。如今，这个愿望或许比以往任何时候都更有可能实现——尤其是如果你有足够的钱。Think about the Fountain of Youth. Versions of the promise of a life-giving spring date to Ancient Greek philosophers, with variations through the centuries. But the basic concept was: Find the spring, drink its waters, and you’re young and spry again.想想“不老泉”吧。关于赋予生命的泉水的种种传说可以追溯到古希腊哲学家，在几个世纪中演变出不同的版本。但基本概念始终如一：找到这口泉水，喝下它，你便能重获青春活力。Today, people seem more inclined than ever to believe there is a path to better health, increased longevity and an improved healthspan — a term from the 1980s meaning that the quality and quantity of life can more closely align.如今，人们似乎比以往任何时候都更倾向于相信，存在一条道路，可以通往更健康、更长寿，以及更长的“健康寿命”（healthspan）——这个术语源自上世纪80年代，意指生命的质量与长度更加紧密的结合。To meet this desire is a growing longevity and wellness industry.为了满足这种渴望，长寿与健康产业正日益壮大。Typically on the science side, in addition to doctors in traditional practices are the growing number of concierge medical practices across the country that offer a wide range of services to those who can afford them. Begun in the 1990s and expanding ever since, they eschew insurance in favor of annual retainers that can range from $4,000 to $45,000 or more.在科学领域，除了传统诊所的医生外，全美各地还出现了越来越多提供礼宾医疗服务的诊所，为负担得起的人提供各种服务。这种模式始于上世纪90年代并不断扩张，它们避开医疗保险，使用年费制，收取每年4000美元到4.5万美元乃至更高的预付会员费。The internal medicine or family medicine doctors who have started these practices are not necessarily better trained than the doctors who have stayed in the traditional insurance-model practices. But they have chosen to see fewer patients, spend more time with them, and offer in-house services — like scans, for example — that otherwise would have to be outsourced.创办这些诊所的内科或全科医生并不一定比留在传统保险模式诊所的医生受过更好的训练。但他们选择接待更少的患者，花更多时间在患者身上，并提供原本需要外包的院内服务，例如影像扫描检查。According to the Private Physicians Alliance, a membership group of concierge doctors, somewhere from 7,000 to 22,000 concierge medical practices operate in the United States today. That’s compared with nearly 400,000 insurance-based medical practices, according to the Bureau of Health Workforce.据礼宾医生会员组织“私人医生联盟”称，目前美国大约有7000到2.2万家礼宾医疗诊所。相比之下，根据美国卫生人力局的数据，基于保险的医疗诊所将近40万家。Typically, a concierge doctor sees about 20 percent (or less) of the patients that an insurance-based doctor sees. That patient has the doctor’s cellphone and greater access to the doctor’s time.通常情况下，礼宾医生接待的患者数量大约是保险内医生的20%（或更少）。患者拥有医生的手机号码，并且能更多地占用医生的时间。The growing and expanding wellness industry doesn’t have criteria for entry. So aside from trained doctors, it also leaves room for those in the lucrative vitamin and supplement business, which has grown rapidly on the promise of enhancing health and longer life. In 2024, it was valued at $192 billion. Supplements can include tablets, capsules, powders and gummies.不断发展壮大的健康产业并没有准入门槛。因此，除了受过训练的医生之外，它也为利润丰厚的维生素和补充剂业务留下了空间。这些业务凭借增强健康和延长寿命的承诺而迅速发展。2024年，该行业的估值达1920亿美元。补充剂包括片剂、胶囊、粉剂和软糖等形式。Medications undergo stringent Food and Drug Administration review and are prescribed by doctors. Vitamins like D, B-12 and iron can be prescribed as well to address specific deficiencies that are identified in blood tests. Supplements, however — like collagen, creatine and fish oils — undergo less rigorous testing and are usually taken voluntarily, rather than prescribed by a doctor.药物需要经过美国食品药品监督管理局(FDA)的严格审查，并由医生开具处方。维生素D、维生素B-12和铁剂等也可以作为处方药开具，以解决在血液检查中发现的特定营养缺乏问题。然而，胶原蛋白、肌酸和鱼油等膳食补充剂的检测不那么严格，且通常是人们自愿服用，而非由医生开具处方。The F.D.A. puts more of the responsibility for their efficacy on the manufacturers. The American Medical Association has cautioned people from putting too much stock in supplements, which the F.D.A. treats as food and not medicine. Supplements often are sold in monthly subscriptions and frequently promoted by prominent podcasters and influencers, who often generate income through the sale of them.FDA将确保产品效用的责任更多交给制造商。美国医学会曾警告人们不要过分相信补充剂，因为FDA是将这些产品视为食品而非药物来管理的。补充剂经常以按月订阅的方式销售，并频繁由知名播客和网红进行推广，这些人往往通过销售补充剂来获取收入。Steve Mister, president and chief executive of the Council for Responsible Nutrition, a trade group for supplements, said the average person spent $50 a month on supplements and is more likely focused on longstanding ones that had proven benefits, like vitamin D, Omega 3 and calcium.补充剂行业协会“负责任营养理事会”的总裁兼首席执行官史蒂夫·米斯特表示，普通人每月在补充剂上的花费约为50美元，并且更倾向于关注那些历史悠久且已被证明有益的补充剂，比如维生素D、欧米伽-3和钙。While he is concerned with influencers who make promises that aren’t backed up by science, he also pushed back against doctors who dismiss less-well-known supplements without understanding them. “They’re suspicious of these products because they’re not taught about them in medical school,” Mr. Mister said.虽然他对网红做出的那些没有科学依据的承诺感到担忧，但他也反驳了那些不了解情况就盲目否定小众补充剂的医生。“他们对这些产品持怀疑态度，是因为他们在医学院没有学过这些内容，”米斯特说。Combining standard drugs and supplements can be tricky — both for patients and for doctors.将标准药物和补充剂结合使用可能会很复杂——对患者和医生来说都是如此。“I had a patient who was on a statin but decided to add red yeast rice as a supplement to lower her LDL cholesterol,” said Dr. Cari Dawson, who runs the Colorado Center for Medical Excellence, a concierge practice in Denver. “The problem was she decided to take her statin every other day, and she took a supplement that you don’t know what’s in it all the time. She picked red yeast rice over a statin that we’ve studied for 30 years.”“我有一位原本在服用他汀类药物的患者，但她决定添加红曲米作为补充剂来降低低密度脂蛋白胆固醇，”在丹佛经营礼宾诊所科罗拉多卓越医疗中心的卡里·道森医生说。“问题是，她决定隔天服用一次他汀类药物，而且她服用了一种成分不明的补充剂。她选择了红曲米，而不是我们已经研究了30年的他汀类药物。”卡里·道森医生在丹佛经营着科罗拉多卓越医疗中心，这是一家提供礼宾医疗的诊所。“只要有人对医疗体系存在不信任，他们就总会去寻找替代疗法，”她说。 Theo Stroomer for The New York TimesDr. Dawson said she often debunked what people had seen online about statins and supplements, contending that the information had no scientific support.道森医生说，她经常驳斥人们在网上看到的关于他汀类药物和膳食补充剂的说法，指出这些信息并没有科学依据。“There’s a lot of noise about statins online,” she said. “Yes, about 5 percent of people will get achy muscles with them. We know that’s real. But 95 percent of people do fine on this drug. And there’s an argument that everyone over the age of 50 should be on a statin to lower their cholesterol.” (She ultimately persuaded the patient to stick with the statin, she said.)“网上有很多关于他汀类药物的杂音，”她说。“没错，大约有5%的人服用后会感到肌肉酸痛。我们知道这是真实存在的。但是95%的人服用这种药都没问题。而且有一种观点认为，所有50岁以上的人都应该服用他汀类药物来降低胆固醇。”（她说，她最终说服了该患者继续服用他汀类药物。）“The F.D.A. does not allow supplement companies to market their products as a substitution for prescription drugs,” Mr. Mister said. “I worry about misinformation all the time.”“FDA不允许补充剂公司将其产品作为处方药的替代品进行销售，”米斯特说。“我一直都在担心错误信息的问题。”Dr. Dawson said she understood, though, where this searching came from. “If you have anyone who has any distrust of the medical system, they’re always seeking out alternative treatments,” she said.道森医生表示，她能够理解人们为什么会不断寻找各种替代疗法。“只要有人对医疗体系存在不信任，他们就总会去寻找替代疗法，”她说。Dr. Anton Titov, founder of Diagnostic Detectives Network, is a supplement opponent, contending that their advocates are driven by financial gains — and playing on the distrust people have in institutions far beyond medicine.诊断侦探网络公司的创始人安东·季托夫医生反对使用补充剂，他认为补充剂的倡导者是受经济利益驱动的——而且是在利用人们对体制——不仅仅是医疗体制——的不信任。“You can sell gazillions of supplements and vitamins. You have to see the patient to prescribe the statin. You can’t make money telling people to get on the maximum dose of statins to improve their cardiovascular health,” he said, about the supplement business. His practice finds experts in specialty areas to help clients solve their often complex medical issues. He said he charged a flat fee of around $6,000, which escalates if more experts were needed or he had to do more to connect patients and doctors.“补充剂和维生素能卖出天文数字般的销量。可你想开他汀类药物，就必须亲自给病人看诊。你不能靠告诉人们服用最大剂量的他汀来改善心血管健康来赚钱，”他在谈到补充剂行业时说道。他的公司会帮客户寻找各专业领域的专家，帮助客户解决他们往往复杂的医疗问题。他表示，自己的服务收费大约是6000美元起步；如果需要更多专家参与，或协调病患与医生的工作量更大的话，费用还会相应增加。To sort through the various approaches to longevity, a key question might be: What’s the best way to invest money in my health so I live well for decades to come?要在五花八门的长寿方案中理清头绪，也许有一个核心问题值得先问：怎样把钱花在健康上，才能让自己在未来数十年活得好？Dr. Jordan Shlain, the founder of Private Medical who is considered one of the earliest concierge doctors, said the focus for everyone, regardless of wealth, was similar. Putting aside fatal accidents, there are four major causes of death: cardiovascular, neurological, cancerous and metabolic, he said.乔丹·施莱因医生是Private Medical的创始人，被视为礼宾医生的先驱之一。他说，无论贫富，每个人关注的重点其实大同小异。他表示，撇开意外死亡不谈，人类有四大主要死因：心血管疾病、神经系统疾病、癌症和代谢疾病。“Your genetics are critical, and they account for 50 to 70 percent of your longevity,” Dr. Shlain said. “Then you get to these foundation things: sleep, exercise, diet and social nutrition. Sleep and social interactions are the most important things to focus on.”“你的基因至关重要，它们决定了你寿命的50%到70%，”施莱因医生说。“然后才轮到这些基础要素：睡眠、锻炼、饮食和社交营养。睡眠和社交互动是最需要关注的事情。”To manage care through nontraditional medical practices, patients should expect different things at different price points. While the concierge practices generally have smaller patient loads, the offerings can become even more personalized.通过非传统医疗方式管理健康时，不同价位意味着不同层级的服务。礼宾医疗通常患者量较小，因此服务也可以变得更加个性化。Dr. Ramon Jacobs-Shaw, a Harvard-trained doctor who is board-certified in internal medicine and pediatrics, is a private doctor, generally defined as one who operates in a self-owned practice outside a larger medical system. He makes old-fashioned house calls from his base in Fairfield County, Conn., and does not see patients in an office. The cost for him to focus on you is $25,000 a year.拉蒙·雅各布斯-肖医生毕业于哈佛，持有内科与儿科双执照，他是一名私人医生——通常指那些在大型医疗体系之外自立门户执业的医生。他以康涅狄格州费尔菲尔德县为基地，提供老派的上门出诊服务，不在诊所接待病人。他专注为你服务的费用是每年2.5万美元。“The hallmark of patient care is that doctor-patient relationship,” he said. “Right now, it feels transactional. Health care should not be that way. It requires a relationship, and that requires time.”“医疗护理最核心的东西是医患关系，”他说。“现在的医疗感觉越来越像一种交易。医疗本不该如此。它需要的是一种关系，而关系需要时间来培养。”Some concierge doctors are part of practice groups. MD2, which first opened in Seattle in 1996 and now has offices around the country, limits its doctors to 50 patients and charges $30,000 a year. Private Medical, which Dr. Shlain founded, charges $45,000 a year for each patient and sees just 1,500 families in six locations in California, Florida and New York. The Atria Health and Research Institute costs $60,000. Its two locations, New York and Palm Beach, have in-house specialists, including cardiology, neurology and women’s health.一些礼宾医生隶属于诊所集团。MD2于1996年在西雅图创立，如今已在全美多地设有分支，每位医生的患者数量上限为50人，收费是每年3万美元。施莱因医生创立的Private Medical每位患者年费为4.5万美元，在加利福尼亚州、佛罗里达州和纽约州共有六处诊所，仅为1500个家庭提供服务。阿特里亚健康与研究机构的收费则达到每年6万美元。它在纽约和棕榈滩设有两处中心，设心脏科、神经科、女性健康等驻诊专科医生。“What’s different about our approach is we focus holistically on the prevention of disease,” said Alan Tisch, Atria Health’s co-founder and chief executive. “We’re primary care plus 15 other specialties. We’re also lifestyle and psychology. We integrate all the most cutting-edge technology in-house so we don’t have to send you out for it. And we’re here to keep you healthy, but we’re also responsible for giving the best care for you and your family when you get sick.”“我们的与众不同之处在于，我们是从整体上专注于疾病的预防，”阿特里亚健康与研究机构的联合创始人兼首席执行官艾伦·蒂什说。“我们是初级保健加上其他15个专科，同时涵盖生活方式指导和心理健康。我们将所有最前沿的技术整合在院内，无需将你转介他处。我们的职责是让你保持健康，同时也负有为你和你的家人在患病时提供最好的治疗。”Meantime, regardless of the medical practices one chooses, Dr. Titov said the two things anyone could do to promote their longevity was to focus on their cardiac health and weight. “G.L.P.s [not inexpensive injectable drugs for weight management] are showing that all these other ailments go away when people lose weight. So, get to your ideal weight, and then do exercise.”与此同时，不管选择哪种医疗体系，安东·季托夫医生认为，每个人都可以做两件真正有助于延寿的事：关注心脏健康，以及控制体重。“GLP类药物（一种价格不菲的注射类减肥药）已经表明，当人们减重之后，很多其他疾病也会随之消失。所以，先把体重降到理想范围，再去运动。”Dr. Aaron Wenzel, a former emergency room physician and weight-loss doctor, runs a concierge practice in Nashville that is focused on overall wellness. He charges $10,900 a year. “When I was doing E.R. medicine, I had this epiphany that the only people I ever saw improve their health removed excess fat from their body,” he said.亚伦·温泽尔医生曾是一名急诊科医生和减肥专科医生，目前在纳什维尔经营一家专注于整体健康的礼宾诊所，年费为1.09万美元。“在做急诊的那些年，我明白了一件事：我所见过的健康状况真正改善的人，无一例外都减掉了身上多余的脂肪，”他说。While G.L.P.s make it easier today, he said his practice focuses on helping people optimize their metabolism. It’s hard work, which is why he has sympathy for people who seek supplements as an easier route.他表示，尽管GLP类药物让这件事变得容易了，但他的诊所更注重帮助患者优化新陈代谢。不过这并不容易，这也是为什么他对那些转而依赖保健品寻求捷径的人抱有一份同情与理解。“I’m seeing a lot of people, regardless of economic firepower, be drawn to the noise of the new thing. But their diet, their fitness, their relationships are fragile.”“我看到很多人，不论经济实力如何，都被各种新鲜事物的喧嚣所吸引。然而他们的饮食、健身习惯和人际关系，其实都非常脆弱。”Those, he said, are what people need to spend their time and money on the most.他说，那些才是人们最应该投入时间和金钱的地方。翻译：杜然点击查看本文英文版。获取更多RSS：https://feedx.net https://feedx.site