Henry R. Black :ASH主席

International circulation: Dr. Black， what is your opinion is the must see topic， or topics， at ASH 2009?

Henry Black: I think for the Chinese population， the talk about sodium is going to be very key. We need a worldwide initiative and the Chinese eat a lot of salt， that is well known， and they have a lot of strokes， and those are directly related. XX working on that before obesity catches up with some of the other things that they work on. I think that there will be a good discussion of a J curve that would be important， although coronary disease isn’t as much of a problem， although the stroke is， it is likely to become one as the Chinese adopt our bad diets， so I would be very concerned about that. And， also， there are some very important public health things that we are doing with respect to how you deal with young people. As far as the basic science findings are concerned， I have not go much， in fact， to recommend， but we have some excellent things， many coming from Asia.

《国际循环》: Dr. Black，您认为ASH2009上必看的热点话题或话题有哪些？

Henry Black: 我认为对中国人而言，有关钠的对话将非常关键。我们需要一个全球性的计划，并且很明显中国人食盐过多，而且中风的发生率很高，两者间存在直接联系。我想盐的作用在肥胖之前，并且超过了其他许多危险因素。我认为对J曲线也有很好的讨论，这点非常重要，虽然冠心病不是一个大问题，但中风却是。随着中国人采取我们的坏饮食习惯，这有可能成为另一个问题，所以我非常关注这一方面。此外，还有许多非常重要的公众健康问题，涉及如何管理年轻人。对于基础科学的进展，我了解不是很多，但我们有许多优秀的东西，许多来自于亚洲。

International circulation: What are the difficulties for implementing research into effective hypertension prevention and treatment strategies?

Henry Black: Well， I think the problem is effectives. So， to be really be sure of what you were seeing you would need to have a control group， it would have to be large and would have to be long， so it would be what we call ‘drop ins’ and ‘drop outs’， where people are assigned to just come back in a year and tell us how they are doing， who start to need treatment， so they get treated， and that will make it harder to interpret the data. So， they are hard to do. I do not think we need， necessarily， to develop a better understanding of the value of doing this. It is a question of how you get people to stay with， say， a lifestyle modification regimen.

《国际循环》: 将研究结果转换成有效的高血压预防和治疗策略存在哪些困难？

Henry Black: 对，我认为问题在于“有效”。为了确保所见的是真实的，你需要有一个对照组，这不得不将扩大试验的规模，延长研究时间，还会发生我们所说的“加入”和“脱落”病例，这里提到的人们仅需要在1年内回访，告知我们他们的情况，谁开始需要治疗，为此而得到治疗，使得解释数据时更加困难。因此，他们很难去做。我不认为对所做事情的价值一定要有更好的理解。如何使人们坚持，仍是个问题，即，一种调整生活方式的治疗。

International circulation: Do you have any specific suggestions for lifestyle modifications for the Chinese population?
HB: It would be the salt， because obesity is not a major problem in China at the moment – it might get there soon – but how do we get people to start liking less salty foods， to tax salty foods? We always like to use tax as a club (stick). How to use more potassium， which is helpful? But it is very hard to do and took us 25 years in the US just to bring about a real change in smoking habits. We knew from 1964 that cigarette smoking was not good for you， there was a lot of pushback on that， and we did not see rates turn around until the mid to late 1980s.
《国际循环》: 您对中国人调整生活方式有何特定的建议？

Henry Black: 应该关注于盐，因为目前肥胖并非中国人的主要问题，而其可能很快就会！如何使人们喜欢更清淡的食物，难道为咸味食品加税？过去我们一直喜欢将征税作为一种手段。如何补充更多有益的钾？但做起来很难，美国用了25年时间仅仅改变了吸烟习惯。从1964年起，我们就知道吸烟有害，并采取很多措施干预，但直到20世纪80年代中期才看到吸烟率的下降。

International circulation: And do you think the smoking model could apply to sodium?

Henry Black: Sure， we could label foods as being high in salt， we could put different colors if they were high， low or medium salt foods. I mean， everybody here knows that if it is a light blue container it is skimmed milk， so we could do the same thing with high salt foods. But I think there would be a lot of concerns about that and we should have a very wise， long term goal， not short term， that would be very important. And， operate with children: children get into the habit of eating a lot of salt， and it is hard to turn that around.

《国际循环》: 您是否认为吸烟模式也适用于钠？

Henry Black: 对，我们可以标出含盐量过高，我们可采用不同颜色标示高、中、低盐食品。我的意思是，这里每个人都知道浅蓝容器代表脱脂牛奶，因此对高盐食品我们可采用相同方法。但我想必须考虑到很多问题，需要有很高的智慧，需要有长期而非短期的目标，这点非常重要。并且应从儿童开始：因为儿童一旦养成食盐过多的习惯，将很难改掉。

International circulation: So， you have mentioned continuing medical education. What do you think is the best strategy for providing quality education for healthcare professionals?
HB: Oh， giving them enough time to go to something. We do pre- and post- tests， that is sometimes useful， but it does not translate into outcomes. Again， to look at what RVA and the English have done， they keep track of what happens， they set goals， and we are seeing people reach them. But， unless you actually see fewer strokes in a practice， that would correlate with how much goals are being met， we are still guessing.
《国际循环》： 您提到了继续医学教育。您认为为医务人员提供高质量教育的最佳策略是什么？

Henry Black: 为其提供足够多的时间去做某事。我们进行课前测试或课后测试，有时很有效，但其不能转化成结果。另外，看看RVA和英国人所做的，他们记录所发生的，他们设立目标；并且我们看到人们的达到目标。然而，除非实践中真的见到卒中减少，这与设立多大的目标有关，否则我们仍需继续揣测。

International circulation:  And， finally， do you have any advice for your Chinese colleagues about those education techniques?

Henry Black:It is a little hard to know， I do not practice them. I think anything short of outcomes really does not matter， and the only real way to know about outcomes is to order charts， and very few people will sit still for that.
International circulation: Very good， thank you Sir.

Henry Black:You are welcome.

《国际循环》：最后，您对中国的同仁在教育技术上有哪些建议？
Henry Black:很难知道，我不能教育他们。我想短期的结果实际上并不重要，对于结果我知道的真正方法是做图表，对此极少有人视而不见。
《国际循环》：非常好，谢谢。
Henry Black:不客气。