2025-11-26 07:30:00
2017年10月24日，拉尔夫·阿布拉罕博士出现在美国国会大厦。| 摄影：比尔·克拉克/CQ Roll Call 通过盖蒂图片社提供
本文出自《Logoff》，这是一份每日新闻简报，帮助您了解特朗普政府的动态，同时不让政治新闻占据您的生活。点击此处订阅。
欢迎来到《Logoff》：美国疾病控制与预防中心（CDC）迎来了新任副主任，这位新官员有着长期且令人担忧的反疫苗言论和行为记录。他是谁？拉尔夫·阿布拉罕博士，他此前曾是国会议员，并担任过路易斯安那州卫生部长。他似乎在周末就已开始新工作，但尚未有官方宣布其被任命为高级公共卫生职位；我们目前所知的信息来自媒体报道（Substack平台《Inside Medicine》率先报道）。
我们对阿布拉罕的观点了解多少？他多次传播公共卫生错误信息，包括支持无效的新冠治疗方法如伊维菌素，并且似乎与卫生部长罗伯特·F·肯尼迪 Jr. 在疫苗问题上持相似立场。在担任路易斯安那州卫生部长期间，阿布拉罕终止了推广儿童疫苗的活动，并未能及时向路易斯安那州居民通报百日咳死亡病例。
背景如何？像CDC这样的联邦公共卫生机构正处于一场关于疫苗的持续权力斗争中心，肯尼迪作为一位著名的反疫苗倡导者，似乎与更为谨慎的官员如FDA局长马丁·马卡里发生冲突。阿布拉罕的过往记录，包括传播已被证伪的疫苗与自闭症之间的联系，以及白宫支持的泰诺与自闭症之间的无根据关联，表明他很可能会成为肯尼迪的盟友。
这有什么意义？阿布拉罕加入CDC是肯尼迪一系列令人担忧举措的最新一例。此前，肯尼迪曾将CDC疫苗咨询小组的所有成员撤换，并通过撤掉刚刚确认的CDC主任职位，引发了一波辞职潮。这导致公众对美国公共卫生机构的信任逐渐流失，并加剧了关于疫苗的混淆和错误信息。
好了，现在是时候结束今天的阅读了。在这里，我们带来一些好消息来平衡今天简报的上半部分：一种挽救生命的疟疾疫苗即将变得更便宜。价格从每剂约4美元降至2.99美元。虽然只是小幅调整，但大规模应用将带来重大影响。全球疫苗联盟Gavi表示，这一降价将使其在未来五年内能够资助3000万剂疫苗，可能帮助约700万名儿童。如果您想要一些远离新闻周期的内容，这里有一篇精彩的长文供您在假期周末阅读：《Defector》撰文讲述了真实版“马丁·至尊”，即乒乓球运动员马丁·莱斯曼，他是即将上映同名电影（讲述虚构的马丁·莱斯曼）的灵感来源。
This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.
Welcome to The Logoff: The CDC has a new second in command — with a long, concerning record of anti-vaccine rhetoric and actions.
Who’s the new guy? Dr. Ralph Abraham, who was previously a member of Congress and the surgeon general of Louisiana, is the CDC’s new principal deputy director. He seemingly started the job over the weekend, but there has been no official announcement of his appointment to a senior public health role; we only know about it thanks to reporting (the Substack Inside Medicine had it first).
What do we know about Abraham’s beliefs? Abraham has repeatedly shared public health misinformation, including backing ineffective Covid-19 treatments like ivermectin, and he appears to align closely with Health Secretary Robert F. Kennedy Jr. on vaccines.
As Louisiana surgeon general, Abraham ended a campaign to promote childhood vaccinations and failed to alert Louisianans about whooping cough deaths in a timely manner.
What’s the context? Federal public health agencies like the CDC are at the center of an ongoing power struggle over vaccines, with Kennedy, a prominent anti-vaccine advocate, seemingly clashing with more restrained officials like FDA Commissioner Marty Makary. Abraham’s record — including promoting debunked claims about vaccines and autism and the unsubstantiated Tylenol-autism linkage promoted by the White House — suggests he will be a Kennedy ally.
Why does this matter? Abraham’s arrival at the CDC is the latest in a series of concerning moves by Kennedy, who previously removed every member of a CDC advisory panel on vaccines and crippled the agency’s senior leadership by removing its newly confirmed director and sparking a wave of resignations. The result has been a steady erosion of confidence in America’s public health agencies and more confusion and misinformation about vaccines.
Here’s some good news from the world of global public health to balance the top half of today’s newsletter: A livesaving malaria vaccine is about to get cheaper. It’s a small change — from about $4 to $2.99 per dose — but at scale, it’s set to make a big difference. Gavi, a global vaccine partnership, says the cut will let it fund 30 million more doses of vaccine over the next five years, potentially helping some 7 million children.
And if you want something a little more removed from the news cycle, here’s a great long read to file away for the holiday weekend: Defector wrote about the real Marty Supreme, table tennis star Marty Reisman, who served as inspiration for the upcoming film of the same name (about the fictional Marty Reisman).
2025-11-26 05:10:00
2025年10月16日，参议员马克·凯利（D-AZ）带领一个旅游团参观美国国会大厦。| 摄影：Tom Williams/CQ-Roll Call, Inc 通过盖蒂图片社
要点总结：
表面上看，特朗普政府对参议员马克·凯利的迫害令人担忧。但深入分析后，情况却有所不同：这既是特朗普独裁野心的证据，也反映出其政府在实施这些野心方面的无力和低效。
凯利的情况始于一周前，他与五位有国家安全背景的民主党议员共同出现在一段视频中，直接面向军人。凯利和其他人警告称，特朗普政府正在“将我们的现役军人和情报界专业人士与美国公民对立起来”。因此，他们希望提醒军人，他们有权甚至有义务拒绝任何非法命令。白宫对此非常愤怒。上周，特朗普在Truth Social上称该视频是“叛国行为”，并表示叛国是“可判处死刑的罪行”。尽管特朗普没有执行死刑的权力，但这种言论本身就令人不安。
随后，周一，国防部长彼得·海格塞思试图将特朗普的愤怒转化为实际政策。他宣布对凯利展开调查，声称凯利作为退休海军军官，受五角大楼管辖，威胁要将其召回现役并以“干扰军队秩序和纪律”为由进行军事法庭审判。理论上，这非常令人担忧：总统公开呼吁处决反对党议员，而军方首脑试图将一名议员送上军事法庭。这听起来像是典型的独裁行为。然而，如果这个威胁真的严重，那它就是真的。但正如一位军事法专家所言，这次调查是“荒谬的”：没有理由相信凯利的行为构成违法，从他言论的性质到他的议员身份都说明这一点。
事实上，特朗普政府试图进行法律上站不住脚的政治起诉已成为一种习惯。就在本周一，一名联邦法官驳回了对前FBI局长詹姆斯·科米和纽约州检察长丽蒂西亚·詹姆斯的高调联邦起诉，裁定起诉人林赛·霍利甘的任命本身非法。这在某种程度上是为霍利甘挽回面子，因为她在技术细节上犯了严重错误，导致案件从一开始就注定失败。
此外，今年早些时候，前司法部官员查尔斯·邓恩（“三明治先生”）因向美国海关与边境保护局官员投掷三明治而被起诉，但最终被无罪释放。而邓恩的无罪释放，又是在特朗普政府在华盛顿和洛杉矶多次未能成功起诉反移民抗议者之后发生的。这显示出特朗普政府在司法系统中的无力。
特朗普政府似乎确实想要将政治对手送进监狱。但要做到这一点并不容易，即使你的盟友掌控了最高法院。它需要克服一个拥有多重内部检查机制的法律体系，以确保其独立性。而到目前为止，特朗普政府尚未证明自己具备这样的能力。
为什么凯利案（可能）无法推进？
“军事法庭”这个词常常让人联想到虚假的审判。但在美国体系中，军事法庭相对专业，有专门的法官和律师，努力在法律原则和先例的框架内工作。虽然这个系统并不完美，比如长期以来对被告存在偏见，但这种状况可能正在改变。2022年，一位军事律师尼诺·莫内亚在法律评论文章中指出，近年来的改革使得军事系统“比任何民事法庭都更有利于被告”。
因此，海格塞思不能随意将凯利送进监狱。他需要构建一个实际的案件，证明凯利在视频中的言论违反了《统一军事司法法》。然而，几乎没有理由相信他能做到这一点。首先，凯利的言论本身显然没有问题。视频内容主要是重申一个基本的法律原则：军人有权拒绝非法命令。凯利并未暗示特朗普或海格塞思的任何具体命令是不道德或非法的，他只是指出特朗普的政策方向可能带来法律风险，并提醒士兵们了解他们拒绝非法命令的权利。没有理由认为仅仅提醒士兵法律是试图非法制造混乱。否则，军事律师在训练士兵时就该经常这样做。
即使如此，凯利的行为仍存在两个具体问题，专家认为这为海格塞思的调查设置了重大障碍。首先，凯利已经退役，从未有类似案件针对退休军官在退役后发表的言论。其次，美国宪法明确保护国会议员在履行职责时的言论自由，即“言论与辩论”条款，规定议员在国会会议期间发表的言论不受起诉。法院多次将这种保护扩展到国会会议之外的言论，只要这些言论是议员在履行职责时对公共政策进行讨论的一部分。
因此，若要将这次“调查”变成真正的威胁，海格塞思需要找到一位愿意主张退休军官在退役期间准确陈述法律的行为违反了仅适用于现役军人的法律的军事检察官，并且认为这种违反足够严重，足以忽视国会成员的宪法权利。这是一项非常艰巨的任务，专家普遍认为这种可能性极低。
一位退休的海军陆战队律师米克·沃根纳在接受NPR采访时表示：“很难看出这个案件能继续下去。”另一位退休军事律师查理·斯威夫特告诉《纽约时报》，凯利的“法律真实陈述”很可能受到“言论与辩论”条款的保护。而专注于民兵关系研究的学者史蒂夫·赛德曼则认为，特朗普政府的这些努力最终将无果而终。他在社交媒体上写道：“特朗普政府说了很多狠话，但很少真正落实。我认为一旦他们意识到自己正在启动一个难以控制的程序，他们就会让这件事慢慢淡去。”
当然，专家的共识可能有误。也许特朗普政府能找到一位愿意推动这种荒谬指控的军事律师，或者一位愿意支持他们的军事法官。我们不能排除任何可能性。但考虑到特朗普政府在最近的法院案件中屡屡失败，从科米到“三明治先生”，人们不应对其成功抱有太大希望。
特朗普政府试图对政治对手进行起诉，其成功率极低。这不仅是因为其缺乏能力，更因为其试图进行一场“司法系统接管”或“政权更迭”的尝试。特朗普并不想遵守美国法律体系中的正常规则，这些规则对政治异议有较强的保护。他希望拥有足够的权力，让他的威胁显得更加真实。
然而，特朗普无法仅通过解雇司法部官员并替换他们来实现这种转变。他需要说服成千上万的人，包括普通陪审团和受终身保护的联邦法官，相信他们长期以来遵循的规则不再适用，他们必须抛弃这些规则，将总统的意愿置于书面法律之上。这并非不可能，例如土耳其总统埃尔多安就成功地制造了针对伊斯坦布尔市长和其他401人的荒谬腐败指控。但埃尔多安自2003年以来一直执政，并投入大量时间和精力来控制土耳其的司法系统。
而特朗普至今尚未执政满一年，也没有显示出任何系统性地腐败普通刑事法院（无论是民事还是军事）的能力或计划。虽然一个由共和党控制的最高法院可以保护许多特朗普的政策，但它无法裁定每一个或大多数刑事案件。甚至在特朗普的关税权力听证会上，最高法院也显示出其能力的极限。
这种无能是特朗普野心在系统性障碍面前受挫的一个反映。当试图进行一场政权更迭时，人们往往倾向于在人事安排上优先考虑对领导人的忠诚。然而，研究独裁政权的学者们早已指出，忠诚与能力之间存在权衡。有时，最能干的人并不一定是最政治上可靠的人。当你的野心要求你极度重视忠诚而忽视能力时，最吸引人的候选人往往是那些能力最弱的人。
这并不是说特朗普的总体独裁计划注定失败。而是说，特朗普政府目前正损害自己的机会。他们试图以一种粗暴的方式推行独裁，这是一次对法律体系中中立原则的明显攻击，即使是最优秀的人才也难以成功执行。而彼得·海格塞思显然不是其中的佼佼者。
On the face of it, the Trump administration’s persecution of Sen. Mark Kelly (D-AZ) seems really scary. But if you look a little deeper, the story starts to look a little different: proof of Trump’s authoritarian ambitions, to be sure, but also evidence of the weakness and incompetence of his administration’s efforts to actually act on them.
The Kelly situation began a week ago, when the senator appeared in a video with five other elected Democrats — all of whom have national security backgrounds. In the video, addressed directly to members of the military, former NASA astronaut Kelly and his colleagues warn that the Trump administration is “pitting our uniformed military and intelligence community professionals against American citizens.” For this reason, they wished to remind military professionals that they have a right — and maybe even an obligation — to disobey any unlawful orders they might receive.
The White House was furious. In Truth Social posts last week, Trump called the video “seditious behavior by traitors,” adding that sedition is a crime “punishable by death.” While this rhetoric appeared empty — Trump lacks the power to execute senators — that doesn’t make it any less alarming coming from the president.
Then, on Monday, Secretary of Defense Pete Hegseth tried to translate Trump’s fury into actual policy. He announced an investigation into Kelly, who he claims is uniquely subject to Pentagon jurisdiction due to his status as a retired Navy officer — threatening to order him back to active duty and prosecute him under military law for allegedly interfering with the “good order and discipline of the armed forces.”
In theory, this is all very scary: a president openly calling for the execution of opposition party legislators, and the head of his armed forces attempting to haul one of those legislators in front of a military tribunal. That sounds like textbook authoritarianism.
And if the threat against Kelly were serious, it would be. Yet as one leading scholar of military law put it, the investigation is “preposterous”: there are a number of reasons to believe that there’s no actual case against the senator, ranging from the unobjectionable content of Kelly’s message to his status as a lawmaker.
Indeed, attempting legally laughable political prosecutions has become something of a habit for the Trump administration. Just this Monday, a federal judge dismissed high-profile federal indictments of former FBI Director James Comey and New York state Attorney General Letitia James — ruling that the prosecuting attorney, Lindsey Halligan, was herself appointed illegally. In a way, this is a face-saving ruling for Halligan; she had so badly screwed up the Comey case as a technical matter that it was doomed from the outset.
These dismissals come on the heels of the early November acquittal of “Sandwich Guy” Charles Dunn, the former Justice Department official who famously chucked a Subway grinder at a Customs and Border Protection officer in Washington, DC. And Dunn’s acquittal itself comes after a summer where the Trump administration repeatedly failed to secure grand jury indictments against anti-ICE protesters in DC and LA, an astonishing record given that grand juries have a reputation for indicting nearly anyone prosecutors want.
The Trump administration, it seems, really does want to send its political enemies to jail. But doing that is hard — even when your friends control the Supreme Court. It requires overcoming a legal system with multiple internal checks designed to safeguard its independence. And, at least so far, the Trump administration simply hasn’t proven itself capable of doing that.
The phrase “military tribunal” conjures up images of sham trials. But in the American system, military courts are fairly professional — with dedicated judges and attorneys attempting to work within the confines of legal principles and precedent. The system is hardly perfect; it has, for example, a longstanding reputation for bias against defendants. But this may be changing: in a 2022 law review article, military attorney Nino Monea argued that recent changes have created a military system that is “more pro-defense than any civilian court.”
Hegseth therefore cannot simply snap his fingers and send Kelly to the brig. He needs to put together an actual case that the senator’s appearance in the video violated the Uniform Code of Military Justice, the federal law that governs the military court system. And there is very little reason to think he can do that.
To begin with, the content of Kelly’s speech is self-evidently unproblematic. For the most part, the video is a restatement of a basic legal principle: the black-letter law that members of the military can refuse unlawful orders. Kelly does not, at any point, suggest that a specific order from Trump or Hegseth is immoral or illegal. He just says that their policy direction creates a risk of illegality, and that soldiers should be aware of their right to refuse any unlawful orders that come up.
There is no reason to think that simply reminding soldiers of the law is an attempt to unlawfully sow indiscipline. Otherwise, the military lawyers who train soldiers would be doing so on a regular basis.
But even if this weren’t true, Kelly’s actions present two other specific problems that experts say create major hurdles for Hegseth’s investigation.
First, the senator is no longer in the military. No case like this has ever been brought against a retired officer for comments that were made after their retirement, and it’s questionable whether the statute in question even applies to someone in that position.
Second, the Constitution explicitly protects speech by members of Congress made as part of their official duties. This is Article I’s “speech and debate” clause, which says that members of Congress are immune from prosecution for comments made “during their attendance at the Session of their Respective Houses.” Court rulings have repeatedly extended this protection to comments made outside of legislative chambers, so long as they are part of their official role in debating public policy.
To turn his “investigation” into anything seriously threatening, then, Hegseth would need to find a professional military prosecutor willing to argue that a retired officer accurately stating the law during their retirement somehow violated laws traditionally applied only to active-duty service members — and that this violation was egregious enough to justify ignoring the well-established constitutional rights afforded to members of Congress.
That’s a very tall task, and experts are extremely skeptical that such a thing could work.
Speaking to NPR, retired Marine Corps attorney Mick Wagoner argued that “it is hard to see [the case] going forwards.” Charlie Swift, another retired military attorney, told the New York Times that Kelly’s “true statement of the law” was most likely protected by the speech and debate clause to boot. And Steve Saideman, a scholar of civil-military relations who is deeply worried about the effects of the administration’s politicization of the military, believes that the Trump administration’s efforts here will ultimately come to little.
“This admin talks a lot of shit, doesn’t always follow up,” he writes on social media. “I think once they realize they would be starting a process they would quickly lose control of, they will let this one fade.”
Of course, it’s possible that the expert consensus here is wrong. Perhaps the Trump administration will find a military lawyer willing to push such a flimsy case, and perhaps they’ll find a military judge willing to rule in their favor. We can’t rule anything out.
But their series of recent failures in court, from Comey to the Sandwich Guy, suggest that one shouldn’t be especially optimistic about their chances. Time after time, the Trump administration has tried to prosecute political opponents — both prominent and not — and their batting average has proven to be abysmal. There is little reason to believe that the military justice system would be especially different, especially when the target is a sitting US senator.
Why?
To answer that question, it’s helpful to think of the Trump administration as attempting a kind of hostile takeover of the legal system — or, more provocatively, a regime change.
Trump doesn’t want to play by the normal rules of the US legal system, which contain fairly robust protections for political dissent. He wants to be able to punish people who contravene or defy him, to have enough power that his Truth Social threats feel more far more real than they currently do.
Trump cannot enact such a transformation simply by firing Justice Department officials and replacing them. He needs to convince thousands of people, ranging from ordinary jurors to lifetime protected federal judges, that the rules they’ve long played by no longer apply — that they can and must discard the procedures they’ve been socialized and trained to follow, and give the whims of the president near-absolute priority over the written law.
This isn’t an impossible task: look at the way that Turkish President Recep Tayyip Erdogan has been able to gin up a preposterous corruption charges against the mayor of Istanbul and 401 others. But Erdogan has been in power since 2003, and has spent an enormous amount of time and energy working to impose political controls over the Turkish justice system.
But Trump hasn’t yet cracked a single year in power, and has not shown any ability or even coherent plan to systematically corrupt the workings of ordinary criminal courts (either civilian or military). A GOP-controlled Supreme Court can protect many of his policies, but can’t rule on every or even most criminal cases. And even the Court showed signs of reaching its limits during the oral arguments on Trump’s tariff powers.
The incompetence issue is, in part, a reflection of this broader systemic barrier to Trump’s ambitions.
When you’re trying to do a kind of regime change, you tend to prioritize personal loyalty to the big man in your staffing choices. Yet there is a well-known trade-off, established in studies of authoritarian militaries, between loyalty and competence. Sometimes, the most competent people aren’t the most politically reliable. And when your ambitions require you to heavily prioritize loyalty over competence — because what you’re demanding is so often so obviously absurd in traditional legal terms — the most appealing hires end up being some of the least competent.
None of this is to say that Trump’s overall authoritarian project is doomed to failure. Rather, it is to say that the Trump administration is currently undermining its own chances. They are trying to do authoritarianism in a ham-fisted way — a blatant assault on the neutral norms of the legal system that would be hard to execute even if the best people were in charge of it.
And Pete Hegseth is very much not one of the best people.
2025-11-26 01:00:00
Vox的Future Perfect栏目以提供关于当今时代最大议题之一——工厂化养殖中数以十亿计的动物用于食品的持续、严谨且道德清晰的报道而自豪。但还有一个可能更为重要且被忽视的故事隐藏其中。虽然人类每年养殖并屠宰约800亿只陆地动物，但我们实际使用的鱼类和其他水生动物数量却更多，估计每年在数百亿甚至数万亿级别。而且，这些水生动物如何到达我们的餐桌正在迅速变化：截至2022年，人类所食用的大多数鱼类并非来自海洋捕捞，而是来自水产养殖。这些水产养殖场的条件极其残酷，因此被动物福利倡导者称为“水下工厂”。但这不仅仅是数字的问题。我们捕捞和养殖鱼类的方式对覆盖地球大部分面积的海洋产生了巨大影响，因此也影响着地球生命的未来。这种影响还将持续扩大，因为水产养殖（也称为水产养殖业）是全球增长最快的农业部门之一。因此，今年我们决定专门推出一个项目，深入探讨这个神秘、低调且报道不足的鱼类世界以及人类如何利用它们。我们将探讨塑造哪些动物被视为可食用、有价值或值得同情的社会叙事，例如人类试图快速驯化鲑鱼（这种动物在野外会进行数百英里的迁徙），将其关在狭小的养殖场中；关于鱼类是否能感知痛苦的哲学和伦理讨论；以及为何我们应该认真对待虾作为道德主体（是的，真的）。这一系列内容包括文字报道、播客和视频，代表了我们对鱼类及水产养殖最深入的报道之一，可能会让你重新思考你对这些被误解的水生生物的认知。敬请关注未来几个月的更多故事。本系列内容得到了Animal Charity Evaluators的支持，该组织获得了EarthShare的资助。Vox Media对本报道内容拥有完全的自主权。——Future Perfect副编辑 Marina Bolotnikova
Vox’s Future Perfect takes pride in being one of the top destinations in media for consistent, rigorous, ethically clear-eyed coverage of one of the biggest stories of our time — the mass production of billions of animals for food on factory farms.
But there’s arguably an even bigger, even more neglected story hidden within that one. Although humans raise and slaughter about 80 billion land animals every year, we use even more — orders of magnitude more — fish and other aquatic animals for food, with most estimates somewhere in the hundreds of billions or even trillions annually. And the way those animals make it to our plates is changing rapidly: As of 2022, most of the fish that humans eat are not caught wild from the ocean but raised on fish farms, which are so cruel they have been widely dubbed by animal welfare advocates as “underwater factory farms.”
But this is about more than just numbers. Consider that the way we catch and farm fish has enormous implications for the oceans that cover the vast majority of the Earth, and therefore for the future of life on Earth. And its influence will only continue to expand: Fish farming, also known as aquaculture, remains the fastest-growing agricultural sector globally.
So, this year, we decided to devote a project to the mysterious, secretive, under-covered world of fish and the humans who use them. We consider the evolving societal narratives that shape which animals are viewed as edible, valuable, or worthy of compassion — from humanity’s attempt to rapidly domesticate salmon (an animal that, in the wild, migrates along epic journeys of hundreds of miles) and confine them to cramped farms, to the captivating philosophical and ethical foundations of the debate over whether fish feel pain, to the case for taking shrimp seriously as moral subjects (yes, really).
Spanning text stories, podcasts, and video, Eating the Ocean represents some of our deepest coverage of fish and fish farming yet — and it might just challenge you to rethink everything you know about the misunderstood aquatic creatures that populate most of our planet. Check back for more stories in the coming months.
The stories in this series are supported by Animal Charity Evaluators, which received a grant from EarthShare. Vox Media had full discretion over the content of this reporting.
—Marina Bolotnikova, deputy editor, Future Perfect
2025-11-26 00:10:00
避免尴尬的关键在于消除情境中的权力感。感恩节是尴尬的“超级碗”。你可能喜欢这些人在某种程度上，但对话的脚本却模糊不清。我们是否该拥抱？是否该谈论政治？当有人在半小时内第三次问“工作怎么样？”时，我该说什么？我们通常将这种不适感归咎于自己，认为自己社交能力差或者出了问题。但哲学家亚历山德拉·普拉基亚斯认为，这种看法是错误的。她是汉密尔顿学院的哲学教授，也是《尴尬：一种理论》一书的作者，她主张尴尬并非源于个人，而是源于情境。在她看来，尴尬发生在我们无法依靠既定的社会规则来应对互动时，我们突然陷入无脚本的即兴状态。我邀请普拉基亚斯参加《灰色地带》节目，探讨为何尴尬值得哲学关注，以及如何改变我们对这些令人不适时刻的态度。这场对话是在2024年录制的，但随着我们即将进入与亲友的节日交谈，它显得尤为相关。完整播客每周一发布，欢迎在Apple Podcasts、Spotify、Pandora等平台收听。本次采访已进行删减和编辑。
你如何定义尴尬？让我先说说它不是什么。尴尬不是一种性格特征。我认为不存在“尴尬的人”，而只有“尴尬的情境”。当我们在互动中缺乏必要的社交资源时，尴尬就会发生。我们不知道该遵循哪些规范，自己扮演什么角色，对方又扮演什么角色，或者当前处于哪种脚本中。因此，尴尬不是“你”的问题，而是“我们”的问题。但有些人显然比其他人更容易感到尴尬，这是为什么？
人们在尴尬体验上确实存在差异。这与我们使用语言的方式有关。如果我说“塞恩在派对上很尴尬”，可能意味着塞恩自己感到尴尬，也可能意味着塞恩让我感到尴尬。这两种说法常常被混淆。有些人确实难以解读社交信号，而另一些人发出的信号与多数人的预期不符。比如眼神接触不同、谈话节奏稍有偏差，这些都可能让互动显得生硬。但这并不意味着我们应该将整个问题归结为性格标签。很多时候，真正的问题在于我们的脚本不一致。将尴尬归咎于某个人，可能会掩盖这一点。此外，有些人总是感到尴尬，因为他们过度自我意识，内心不断评论自己的行为，评估每一个举动。这会创造出比情境本身更严重的尴尬。
尴尬是否源于对他人害怕？还是另有原因？我认为尴尬与不确定性密切相关。你不知道自己处于什么情境，也不清楚他人如何看待你。这与社交焦虑有关。有些人会用“我尴尬”作为免责声明，以降低他人的期待。他们可能在说：“请不要在这个领域对我过于苛刻。”但尴尬本身并不总是源于恐惧。有时候，其他人觉得尴尬的人其实并不觉得尴尬，他们没有痛苦。真正感到不适的是我们其他人。恐惧真正出现的时候，是我们害怕制造尴尬。我们非常希望避免这种情况。例如，在“Me Too”运动之后，一些男性表示他们没有在工作中指出骚扰行为，因为他们担心这会制造尴尬。这种尴尬的不适感超过了他们挑战不当行为的责任感。因此，尴尬与归属感密切相关。我们渴望被接受，希望留在群体中。害怕被视为“制造尴尬的人”可能会让我们感到非常不安。
尴尬和“尴尬感”（cringe）有什么区别？我认为尴尬感是事后产生的。尴尬发生在当下，你正试图决定下一步该做什么。而尴尬感则是在事后回想时，突然想起自己说了什么，身体瞬间紧绷。这是一种回顾性的感受。我们常常将两者联系在一起，因为我们会将尴尬视为一种羞耻。我们可能会想：“那个尴尬的时刻暴露了我真实的样子。”然后反复回想，产生尴尬感。如果我们把故事转向“那个尴尬的时刻揭示了情境或脚本的问题”，尴尬感可能会减轻一些。虽然回忆仍然令人不适，但它不再是对你个人的深刻批判。
日常生活中最常见的尴尬时刻有哪些？当人们被问及时，常常提到诸如在别人家做客时不小心堵住了厕所，或者在群聊中发送了一条本应针对群内某人的消息。还有经典的肢体失误，比如一个人伸手要拥抱，另一个人却伸出手要握手，两人在半空中僵住，最终形成一种奇怪的半拥抱。告别也是常见的尴尬时刻。在派对上，是向所有人告别，还是只向主人告别，或者根本不告别？如果要告别，是拥抱、挥手、握手还是点头示意？这种对脚本的不确定感正是尴尬的来源。此外，还有一些更个人化的尴尬时刻。你提到在别人面前听自己主持的播客时感到讨厌，这其实是很多人共同的经历。在熟人面前扮演“公众自我”可能会让人感到极度痛苦。
为什么闲聊如此令人尴尬？闲聊其实是一种社交工具，而不是寻找意义的方式。它是一种信号，表明“我们关系良好，彼此看见，这是友好的。”因此，天气、体育或“工作怎么样？”等话题一直很流行，因为它们提供了低风险的话题来支撑互动。当非语言信号与语言内容不匹配时，闲聊就会变得尴尬。比如对方明显心不在焉，或四处张望，或站在奇怪的距离上。虽然话题仍是“最近怎么样？”，但整个交流却显得不协调。
当我们过于害怕尴尬，或刻意避免它时，会失去什么？我们会失去真正的联系，也会回避重要的话题。悲伤就是一个很好的例子。许多正在哀悼的人表示，朋友和同事似乎都消失了，这并非因为他们不关心，而是因为他们不知道该说什么。他们不想说错话，所以干脆什么也不说。这是一次巨大的损失。某人正经历人生中最艰难的时刻，而周围的人却因害怕制造尴尬而无法提供支持。
有没有减少生活中尴尬的建议？我认为目标不应是消除尴尬。适度的犹豫和不确定性是有益的，它能给我们时间反思，避免陷入那些习以为常但有害的社交脚本。我们可以改变对尴尬的态度。首先，要学会承认不确定性。可以说：“我不确定我们通常怎么做，你更喜欢哪种方式？”这样可以将问题公开，而不是在内心猜测和纠结。其次，明确你的优先事项。如果你知道感恩节谈论政治会很尴尬，提前决定你的目标是什么。你是想为某人发声？还是想维持关系？或者只是想避免争吵？这种清晰的目标可以帮助你在对话变得不适时做出更合适的回应。最后，简单地接受尴尬。当你不再把它当作灾难，尴尬对你的控制力就会减弱。你会开始思考：“虽然那很不舒服，但我挺过来了，它并没有定义我。”请收听完整对话，并关注《灰色地带》播客，可在Apple Podcasts、Spotify、Pandora等平台收听。
Thanksgiving is the Super Bowl of awkwardness.
You love these people (mostly), but the scripts are fuzzy. Do we hug? Do we talk politics? What do I say when someone hits me with the third “so, how’s work?” in an hour?
We tend to treat that discomfort as a “me” problem, like we’re bad at socializing or broken in some way.
Alexandra Plakias thinks that’s the wrong story. She’s a philosopher at Hamilton College and the author of Awkwardness: A Theory, and she argues that there are no awkward people, only awkward situations. Awkwardness, for her, is what happens when the unwritten scripts that guide our social life break down and we are suddenly improvising without a map.
I invited Plakias onto The Gray Area to talk about why awkwardness deserves philosophical attention and what it might look like to change our relationship to those cringey moments. The conversation was taped in 2024, but it seemed relevant as we all prepare to plunge into those delightful holiday conversations with friends and family.
As always, there’s much more in the full podcast, which drops every Monday, so listen and follow us on Apple Podcasts, Spotify, Pandora, or wherever you find podcasts.
This interview has been edited for length and clarity.
How do you define awkwardness?
Let me start with what I think it isn’t. Awkwardness is not a personality trait. I don’t think there are “awkward people” in some deep way. When I was writing the book, people constantly said, “I am so awkward,” or “I cannot wait to read this; I am a very awkward person.” It’s a label people reach for very quickly.
In my view, awkwardness is a property of situations, not individuals. It happens when we don’t have the social resources we need to navigate an interaction. We don’t know which norms apply, which role we are playing, which role the other person is playing, or what kind of script we are in.
In that sense, awkwardness isn’t a “you” problem. It’s an “us” problem.
But some people clearly feel awkward more often than others. How do you explain that?
People definitely differ in their experience. Part of this is how we use language. If I say, “Sean is awkward at parties,” I might mean Sean feels awkward, or I might mean Sean makes me feel awkward. Those are two very different claims that often get blurred together.
Some people really struggle to read social cues. Others give cues that do not match what most people expect. Their eye contact is different. Their timing in conversation is slightly off. That can make the interaction feel jagged. But, that doesn’t mean we should reduce the whole thing to a personality label. Often, what’s really going on is that our scripts are misaligned. Blaming one person as “awkward” can obscure that.
And then, there are people who feel awkward all the time, because they’re hyper self-conscious. They’re running a little commentary in their heads, evaluating every move. That creates more awkwardness than the situation actually calls for.
Is awkwardness about being afraid of other people? Or is it something else?
I see awkwardness as closely linked to uncertainty. You don’t know what kind of situation you are in or how other people are reading you.
There’s a connection to social anxiety. Some people use “I am awkward” almost as a disclaimer. It lowers expectations. It’s a way of saying, “Please do not judge me too harshly in this domain.”
But, awkwardness itself is not always about fear. Sometimes the person everyone else experiences as awkward is totally fine. They’re not suffering. It’s the rest of us who feel off balance.
Where fear really comes in is in our fear of creating awkwardness. We are very motivated to avoid that. There are lots of cases where we know we should speak up or intervene, and we don’t, because we worry about making things weird.
After Me Too, for example, some men said they didn’t call out harassment at work, because it would have made things awkward. That’s a really striking admission. The discomfort of an awkward conversation outweighed the obligation to challenge serious wrongdoing.
So, awkwardness is tightly bound up with belonging. We want to be accepted. We want to stay inside the group. The risk of being seen as the person who “made it weird” can feel incredibly high.
Where does cringe fit into all of this? Are cringe and awkward the same thing?
I think of cringe as what happens after the fact. Awkwardness is in the moment. You’re standing there, trying to figure out what to do next.
Cringe is when you’re driving three days later and suddenly remember what you said, and your whole body tightens. It’s a very retrospective thing. It often attaches to awkward moments, but it’s not the same phenomenon.
We associate the two, because we tend to interpret awkwardness as shameful. We think, “That awkward moment showed everyone who I really am.” Then, we relive it and cringe.
If you shift the story to “that awkward moment showed something about the situation or the script,” the cringe can soften a bit. The memory is still uncomfortable, but it’s not such a deep indictment of you as a person.
What are some of the most common awkward moments in everyday life?
When you ask people, they often mention things like clogging someone’s toilet when you’re a guest in their home or sending a message to the group chat that was supposed to be about someone in that group chat.
There are also the classic physical misfires. One person goes in for a hug; the other offers a handshake. You both half switch midstream and end up in a strange, fumbling half-embrace.
Goodbyes at parties are a big one. Do you say goodbye to everyone, just the host, no one at all? If you do say goodbye, is it a hug, a wave, a handshake, a nod from across the room? That uncertainty about the script is what produces the awkwardness.
And then, there are more personal ones. You mentioned hating listening to your own podcast when other people are around. Many of us have some version of that. Being a “public self” in front of people you know can feel excruciating.
Why is small talk so painfully awkward?
Small talk is really a social tool, not a search for meaning. It’s a way of signaling, “We are on civil terms. I see you. You see me. This is friendly.”
That’s why topics like the weather, sports, or “how’s work?” are so persistent. They give you something low stakes to hang that interaction on.
Small talk becomes awkward when the nonverbal side doesn’t match. The other person is clearly checked out, or looking over your shoulder, or standing a strange distance away. The topic is still “so, how are things?” but the exchange feels off.
What do we lose when we’re too afraid of awkwardness, or when we go out of our way to avoid it?
We lose real connection, and we avoid important topics. Grief is a powerful example. Many people who are mourning say that friends and colleagues simply disappear — not because they don’t care, but because they don’t know what to say. And they don’t want to say the wrong thing, so they say nothing.
That’s a huge loss. Someone is going through one of the hardest experiences of their life, and the people around them are paralyzed by the fear of making it awkward.
Any tips for people looking to reduce the awkwardness in their life?
I don’t think the goal should be getting rid of awkwardness. Some hesitation and uncertainty is good; it gives us time to reflect before we slip into well worn but harmful scripts.
What we can do is change how we relate to it.
One thing is to practice admitting uncertainty. It’s okay to say, “I’m not sure what we usually do here, what do you prefer?” Rather than guessing and spiraling internally, you bring the question out into the open.
Another is to clarify your priorities. If you know that talking about politics at Thanksgiving will be awkward, decide in advance what your goal is. Do you want to stand up for someone? Do you want to preserve a relationship? Do you just want to avoid a screaming match? That clarity can guide how you respond, even when the conversation gets uncomfortable.
And then, there is simple exposure. The more you let yourself feel a bit awkward without treating it as a catastrophe, the less power it has over you. You start to think, “Okay, that was uncomfortable, but I survived. It did not define me.”
Listen to the rest of the conversation and be sure to follow The Gray Area on Apple Podcasts, Spotify, Pandora, or wherever you listen to podcasts.
2025-11-25 20:15:00
美国现任总统唐纳德·特朗普与英伟达联合创始人兼首席执行官黄仁勋。目前全球最大的公司是英伟达，自1993年以来，它一直在生产一种专门的计算机芯片，称为GPU（图形处理单元）。这些芯片负责执行显示图像、视频和3D图形所需的复杂计算。在早期，如果你想玩像《虚幻》、《雷神之锤》或《半条命》这样的“尖端”PC游戏，你很可能购买英伟达的GPU（当时更常被称为显卡）。
“如果你在1998年是个非常认真的游戏玩家，你就会在家里组装一台高性能电脑，你会满手电路板和焊锡工具，”《华尔街日报》科技与商业记者罗比·惠兰告诉《今日解释》节目主持人诺埃尔·金。
“你还会购买英伟达的显卡，装进你那台酷炫的高性能游戏电脑里，然后通过互联网玩游戏。”
如今，英伟达的产品已不再局限于游戏领域。其芯片技术更加先进，现在成为推动人工智能热潮的硬件基础。“想想像ChatGPT、Gemini、NotebookLM或Claude这样的产品，”惠兰说。由于英伟达现在对科技行业至关重要，因此该公司对整个美国经济的健康状况有着重要影响；股市的波动往往取决于英伟达是否发布了一份好的财报或差的财报。
此外，英伟达及其创始人黄仁勋也已成为美国政治、外交关系和国际外交中的重要人物。惠兰在《今日解释》节目中详细讲述了英伟达公司的发展历程、其商业活动以及黄仁勋与特朗普总统的友谊。以下是他们对话的节选，内容经过删减和润色。完整播客内容更丰富，因此请在Apple Podcasts、Pandora和Spotify等平台收听《今日解释》。
请介绍一下黄仁勋，这位英伟达的幕后人物。黄仁勋是英伟达的联合创始人兼首席执行官。他出生于台湾，而台湾如今已成为人工智能热潮的智力中心。他幼年时移居美国。如今，他不仅是地球上最大的公司的CEO，也是在外交和国际事务中极具影响力和权力的人物。他与特朗普总统是很好的朋友。我认为，鉴于他所掌控的权力和经济实力，他可以说是目前地球上最重要的人物之一。
如果你回顾特朗普就职典礼那天的情景，你会发现当时有很多科技公司的CEO出席，但黄仁勋却不在其中。为什么他当时没有参加？我的理解是，特朗普在1月份可能甚至不知道黄仁勋是谁。他知道黄仁勋是一位成功的科技公司CEO，但当涉及到特朗普的管理风格、交易方式，以及黄仁勋能为特朗普在国际协议谈判中提供什么帮助时，他才逐渐成为特朗普在国际场合中展示的“明星”。特朗普经常夸耀黄仁勋的成功，称这是美国创新和智慧的典范。但我想，这种说法在特朗普上任之初并不存在。
那么，这段关系是如何发展并演变的呢？我必须回到2022年，当时是拜登政府时期。他们采取了一些措施，禁止某些产品（尤其是高性能微芯片）出口到特定国家。当时，人工智能竞赛正日益激烈，而英伟达被禁止向中国出口其芯片，因为存在严重的国家安全担忧和对中国技术追赶的担忧。这对英伟达来说是个大问题，因为它限制了其在全球范围内的扩张速度。
今年，特朗普再次当选美国总统，黄仁勋显然需要重新审视这一问题。当时，特朗普国家安全委员会中有许多有影响力的人士，他们成功地向特朗普论证了将最先进的技术出口到中国是不好的主意。因此，黄仁勋开始与特朗普建立友谊，因为与一位总统保持良好关系对于他来说非常重要，尤其是在这场思想战中。
今年8月，黄仁勋去找特朗普，问：“我需要做些什么才能再次在中国销售这些芯片？”经过英伟达与特朗普政府之间的大量谈判，最终达成的协议是，白宫要求黄仁勋让联邦政府参与英伟达的成功，并给予政府公司股份。这显然是黄仁勋的一大胜利。但问题在于，中国政府对所有国内客户说：“不要购买这些产品，它们不安全，存在安全问题。”因此，英伟达开始为中国开发新的芯片，名为B30A。
然而，这引起了华盛顿方面对国家安全和与中国竞争的担忧。他们实际上在黄仁勋不知情的情况下决定，不会批准高端芯片出口到中国。因此，英伟达至今仍无法进入中国市场。
你看到黄仁勋经常陪同特朗普参加国际活动，就高层面的问题与总统进行咨询。那么，这两个人在幕后到底发生了什么？有很多猜测认为这可能类似于埃隆·马斯克的情况。特朗普总是喜欢有科技亿万富翁作为顾问，与他讨论各种想法。
有一点需要知道的是，特朗普非常欣赏成功人士。我之所以知道这一点，是因为我曾直接与他交谈过。他喜欢那些成功的人在他身边。当特朗普意识到黄仁勋不仅是一位非常成功的、聪明的高管，还在英伟达打造了非常特别、强大的东西时，他立刻抓住了这一点。这引起了特朗普的注意，他决定自己非常欣赏黄仁勋。他们现在经常通电话，特朗普会在深夜打电话给黄仁勋，向他请教各种问题。黄仁勋也经常访问白宫，这在之前是很少见的。
但就在最近一个月，他似乎放弃了之前坚定的立场，不再坚持让英伟达在中国销售其产品。我认为这并不是由于两人之间有个人矛盾。我认为黄仁勋非常擅长管理这段关系，他承诺支持地球上最有权势的总统，使用这位总统最爱听的语言。
黄仁勋是否想像马斯克那样进入政府工作？还是他只是想在中国销售芯片，为公司谋取最大利益？我没有理由相信他有那样的野心。我认为黄仁勋被推上了国际外交和游说等新角色，这些对他来说都是全新的挑战。他的首要任务是为公司谋取最大利益，尽可能多地在全球销售产品。甚至更进一步，他希望让全世界都依赖他的技术，使英伟达在科技和人工智能发展的长期图景中占据更加核心的位置。
The biggest company in the world is Nvidia, and it’s been making the same product since 1993: a specialized computer chip called a GPU, or a graphics processing unit. Those chips do all the fancy, complicated math needed to display images, videos, and 3D graphics onto our screens.
Back in the day, if you wanted to play “state-of-the-art” PC games like Unreal, Quake, or Half-Life, you likely bought one of Nvidia’s GPUs (more commonly called graphics cards at the time).
“If you were a really serious gamer back in like 1998, you would be building your own high powered PC at home. You’d be up to your ears in circuit boards and soldering equipment,” Robbie Wheland, a tech and business reporter for The Wall Street Journal told Today, Explained co-host Noel King. “And you’d be buying one of Nvidia’s graphics cards, and putting that into your awesome high powered gaming computer that you would play on the internet.”
Today, though, Nvidia’s product isn’t so niche. Their chips are more advanced, and they are now the hardware powering the artificial intelligence boom. “Think ChatGPT, Gemini, NotebookLM, or Claude,” Wheland said.
Because Nvidia is now essential to the tech sector, that has made the company very important to the well-being of the entire American economy; the stock market can swing on whether Nvidia releases a good earnings report or a bad one.
The company, and its founder Jensen Huang, have also become powerful players within American politics, foreign relations, and international diplomacy. Wheland broke down the story behind the company’s rise, its business dealings, and the founder’s friendship with President Donald Trump on Today, Explained.
Below is an excerpt of their conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
Tell me about Jensen Huang, the man behind Nvidia.
Jensen Huang is the co-founder and chief executive of Nvidia. He was born in Taiwan, which has really become the intellectual epicenter of the AI boom. And he moved to the US when he was a child.
Today, he’s not only just the CEO of the largest company on Planet Earth, he’s also an incredibly influential and powerful person in foreign relations, in international diplomacy. He’s a very good friend of President Donald Trump. And I think it’s not a stretch to say he’s one of the most important individual people on Earth right now, just given how much power and how much economic might he oversees.
If you go back to Trump’s inauguration, and you think about who was with him that day, many of them were tech CEOs, but Jensen Huang was not among them. Why wasn’t he there?
My understanding is that Donald Trump maybe didn’t even know who Jensen was in January.
He knew this was a guy who was a tech CEO, who had a very successful company. But when it came to his style of management; his style of deal making; and, more importantly, what Jensen could do for President Trump in terms of helping him negotiate international accords, he’s now become a show pony that Trump brings around to world leaders. He brags about how successful Huang is. He says this is really an example of American ingenuity and innovation.
But, I don’t think any of that existed when Trump took office in January.
Tell me about how this relationship develops, then, and evolves.
I have to go to 2022; we’re in the Biden administration. What they did was they took certain products, certain classes of products, which generally meant very powerful microchips and said, “You can’t sell these overseas to certain companies.” At the time, the AI race was just really heating up. But Nvidia was not allowed to sell its chips in China, in particular, because there were serious national security concerns and serious concerns about competition and not letting China catch up with us.
That was a big deal for Nvidia, because it really limited how quickly it could expand around the world. Fast forward to this year, and Donald Trump is back in the White House for a second term, and Jensen Huang obviously needed to revisit this issue.
There were a number of influential people in the Trump National Security Council who successfully made the argument that it’s a bad idea for us to be selling our most advanced technology to the Chinese. And, in that context, Jensen Huang starts building a friendship with Donald Trump because it was gonna be very important for him to be on friendly terms with a president, given how this war of ideas was shaking out.
In August of this year, he goes to Trump. He says, “What do I have to do to get you to let me sell this chip in China again?” And the deal they come to, after a lot of negotiations between Nvidia and the Trump administration, is that the White House asks Jensen to let the federal government in on their success by giving the government a stake in the company.
This is a huge win for Jensen Huang. But there’s a problem: The Chinese say to all the customers in their country, “Don’t buy this thing. It’s not safe. It has security concerns.” So, Nvidia starts developing a new chip for China. It’s called the B 30 A.
And, this is too much. This proves to be too much for people in Washington who are concerned about national security, concerned about competition with China. And they’ve actually decided, unbeknownst to Jensen Huang, that they’re not gonna approve high-quality chips to be sold in China.
And that’s where we are. Nvidia is still locked out of China.
You see Wong joining Trump on international trips, consulting with the president on high level issues. What has been going on with these two guys behind the scenes?
There’s a lot of speculation about whether this is another Elon Musk-type situation. President Trump always likes to have a tech billionaire who he can consult with and bounce ideas off of. One thing to know about Donald Trump, and I know this because I’ve spoken to him about it directly, is that he really likes people when they’re successful.
He likes that successful people are on his team. When it dawned on Trump that this guy, Jensen Huang, was just a really successful, brilliant executive, and he was building something really special and big and powerful in Nvidia, Trump really seized on that. It caught his attention, and he decided that he really liked Jensen Huang. They now speak often on the phone. Trump will call Jensen Huang late at night, pick his brain about things. Jensen’s a frequent visitor to the White House, which is something that he’d never done before this year, really.
But, in the last month, he has backed off of his seemingly unshakable commitment to let Nvidia sell its products in China. I don’t think it’s reflective of any kind of personality clash. I think that Jenssen’s been very good at managing the relationship, and he’s pledging his support to the most powerful president on Planet Earth using the language that that president loves to hear.
Does Jensen Huang want to work in government like Musk did, or does the guy just want to sell his chips in China and do what’s best for his business?
I don’t have any reason to believe that he does have those kinds of ambitions. I think that Jensen Huang has been thrust into this sort of role as an international diplomat, and as a lobbyist, and all these different roles that he’s had to play. They’re very new to him.
I think that his primary concern is doing what’s best for his company, selling as much product as he can around the world. Even more than that, he wants to get the whole world hooked on his technology and make Nvidia more central to the long-term picture of how tech develops and how AI develops.
2025-11-25 19:45:00
高盐饮食会导致高血压，而高血压是引发多种健康问题的“隐形杀手”。据《柳叶刀》最新研究显示，自2000年以来，全球19岁以下儿童中患有高血压的人数翻了一番。在美国，近一半的成年人患有高血压，这一比例是十年前的两倍。许多美国人，尤其是年轻人，对自身高血压状况并不知情。如果不加以控制，高血压可能导致心脏病、肺病、肾病，甚至痴呆症，并增加心脏病发作和中风的风险。
低钠、低脂、富含纤维和钾的食物有助于降低血压，规律的有氧运动也有类似效果。可穿戴设备（如Oura戒指或Apple Watch）和GLP-1药物为控制高血压提供了新的可能，但目前仍处于早期阶段。而感恩节则被认为是高血压的“最爱时刻”，因为节日饮食往往高盐，且缺乏运动。
高血压之所以危险，是因为它会损害血管和器官，导致肾脏功能衰竭、视力问题以及认知障碍，如阿尔茨海默病和痴呆症。2017年，医学界重新定义了高血压的标准，将血压临界值从140/90降至120/80，使得美国高血压患病率从约30%上升至近50%。然而，许多人仍不了解自己是否患有高血压，因为其症状不明显。
要管理高血压，建议采取DASH饮食法，即多吃水果、蔬菜、豆类、坚果和全谷物，减少钠和脂肪摄入。同时，每周进行150分钟的有氧运动，如步行、跑步、游泳、骑车和跳舞，并结合力量训练和瑜伽等伸展与呼吸练习，有助于控制血压。
目前，家庭血压监测仍需使用血压计，价格低廉（最低40美元），且可通过FSA或HSA报销。然而，这种方式不如可穿戴设备方便。Apple Watch等设备虽然具备血压监测功能，但不能用于诊断或长期监控高血压，也不能检测严重的心脏事件。GLP-1类减肥药物对高血压也有一定益处，但相关研究仍处于初步阶段，仍需配合健康饮食和运动。
好消息是，高血压是一种可以改善的健康问题。关键在于首先确认自己是否患有高血压。
Hypertension, also known as high blood pressure, is a silent killer that lurks among us, helping to claim millions of lives every year.
According to a new study published in The Lancet, the number of kids under age 19 who have high blood pressure has doubled worldwide since 2000. The rest of the population isn’t faring much better either: In the US, nearly half of Americans have hypertension — twice the rate from a generation ago.
That might mean you, too. And I’m sorry, but the news gets worse: Thanksgiving is the disease’s favorite time of year. It seems our social calendar and our food supply are conspiring to give each of us this too-often-overlooked condition — with potentially deadly consequences.
Only about half of the people who have hypertension have it under control, a figure that has been declining over the past 10 years, even though this is among the most tractable public health problems that we have. With better monitoring, lifestyle modification, and medication, it is possible to reduce someone’s high blood pressure.
But the problem is, many of the people who have it, especially younger patients, are totally unaware.
What is high blood pressure, exactly?
Your blood pressure measures how hard the blood pumping through your veins is pushing against the walls of your arteries, and it serves as a proxy for how hard your heart and circulatory system have to work to move blood through your body. If you’ve ever had a physical exam or a routine check-up with your doctor, you’ve probably had your measurement taken using either a manual or automatic cuff. The standard healthy reading is 120/80 (the top figure measures the pressure during a heartbeat, and the bottom measures the pressure during those brief moments in between heartbeats).
If both numbers fall below that standard, it is considered to be a healthy reading. Anything above that starts to have negative consequences. First, arteries begin to harden, and organs can be damaged over time.
But high blood pressure and its effects on your body’s function can lead to other issues as well. It can damage your kidneys; hypertension is one of the leading causes of chronic kidney failure. It can damage your eyes, which are filled with tiny blood vessels, causing vision problems. And it can affect your cognition, driving up your risk of Alzheimer’s disease and dementia. Both your kidneys and your brain rely on being efficient filters in order to function; when the blood vessels inside of them get damaged, they become less efficient at filtering the bad stuff out of your body or your brain.
Over time, your blood pressure starts to rise — and a wide range of health problems can follow. The most obvious are heart attacks and strokes: Your blood vessels are damaged, and they start to accumulate plaque that further slows the flow of blood. When your blood flow becomes too obstructed, you can have a heart attack (if the blockage is near your heart) or a stroke (if it is in your brain) or a pulmonary embolism (if it is in your lungs).
When that happens gradually, it can lead to heart disease or chronic obstructive pulmonary disease (COPD) over the long term. Those conditions can kill you — either through a heart attack or pulmonary embolism. These are consistently among the leading killers in the US and worldwide, and even if you survive, you can face permanent paralysis or other lifelong limitations.
Its pernicious nature is why the medical community changed the definition of high blood pressure in 2017, significantly increasing hypertension rates in the US. Before then, the cutoff for high blood pressure was actually 140/90; anything between that and 120/80 was considered to be “pre” hypertension — a warning that you are on track for serious problems, but not in the final stage of the disease.
But as research continued to show that heart and blood vessel damage could occur even at lower readings, scientists reconsidered. The final straw came in 2015 when a large clinical trial of more than 9,000 people with elevated blood pressure found that lowering the patients’ blood pressure from 140/90 to 120/80 could cut their risk of serious cardiovascular events by 25 percent. When the definition was changed, US hypertension rates jumped from about 30 percent to nearly 50 percent.
Far more people were at risk than had previously believed.
And yet, despite being so obviously dangerous and so widespread, many people still don’t know if they have high blood pressure. By one estimate, nearly 40 percent of adults younger than 45 who have hypertension don’t know it. How can that be possible?
There is no obvious sign that you have it — unless you get checked regularly.
High blood pressure has a reputation among doctors as a “silent” killer: Patients sometimes experience no symptoms or very mild and vague symptoms. I once had a nurse remark to me that some people are walking around with blood pressures over 200 and have no idea.
It is only through the repeated and consistent measurement of your blood pressure over time that you can know with certainty whether you have a problem. A one-off reading — say, while you’re waiting at the pharmacy — can be misleading in either direction. Your blood pressure fluctuates throughout the day, and even if you have hypertension, you can get a normal reading sometimes. Conversely, if you have a spike of stress while being measured, you could have a high reading even without an underlying issue.
But here’s the problem: Many Americans, particularly young people, don’t see a health care provider regularly. Nearly half of the people in the US under 30 don’t have a primary care physician. And they may be paying the price: Data suggests heart attacks and other cardiovascular events are up among young adults.
Hypertension, like many diseases, does have a genetic or hereditary component — if you have a family history, you are at higher risk — but if you regularly eat too much sodium and do not get enough exercise, you’re putting yourself at risk, too. A traditional Thanksgiving dinner, for example, can easily have more sodium than any person is supposed to eat in an entire day. And lying on the couch for the entire afternoon after that meal isn’t helping either.
Luckily, Thanksgiving only comes once a year. But too many Americans eat salt-rich diets and stay sedentary the rest of the year, too.
You can change that. Doctors have come up with what they call the DASH (Dietary Approaches to Stop Hypertension) diet as the best strategy for managing your blood pressure. You should eat a lot of fruits and vegetables, beans and nuts, and whole grains. You should try to eat foods that are high in fiber and potassium (which helps your kidneys filter sodium); you, of course, want low-sodium and low-fat foods too. I typically buy the no salt added or reduced sodium options for, for example, chicken broth. Red meats and processed foods, both of which are linked to hypertension, are your enemies.
In the end, you want to eat between 1,500 and 2,000 milligrams of sodium in a day and no more. You could drink less alcohol and less caffeine, both of which raise your blood pressure temporarily, as well.
On the exercise front, working out is not always a foolproof weight-loss strategy — but it is proven to be effective in lowering your blood pressure. Walking, jogging, swimming, cycling, and even dancing are all good for you. But regardless of what you’re doing, your goal should be about 150 minutes per week. It is best to combine that classic “cardio” exercise with strength training (which both lowers blood pressure on its own and makes your aerobic workouts more effective) and even stretching and breathing routines like yoga, which can help regulate your heart and lead to better sleep. All of these things can help to keep your blood pressure down.
There is also a wide range of existing blood pressure medications, which can be very effective but do come with some risks, such as blood thinners that can cause excessive bleeding. We are entering a new age of medicine, however, in which wearable tech that allows patients to monitor their blood pressure minute by minute and GLP-1s are likely to become more commonplace.
Apple Watch rolled out a blood pressure monitoring capability this fall: You can turn on hypertension notifications, and your device will notify you if it detects consistently high blood pressure. The wearable tech company Oura Labs is working on something similar. Right now, the best way to monitor at home is to buy your own blood pressure cuff like the one at your doctor’s office; my own physician pointed me to the Omni units to monitor my blood pressure at home. They can cost as little as $40, and if you have an FSA or an HSA, it is an eligible expense.
But this can be a little inconvenient — you have to sit down, take a few minutes to get your blood pressure to “normal,” and then affix the cuff correctly to ensure you’ll get an accurate reading. Having the same capability walking around with you on your wrist at all times would be a boon, much like continuous glucose monitoring has helped people better manage their diabetes.
These are effectively brand new prototypes, however. As Apple itself warns, they should not be used to diagnose hypertension or to monitor and control it. Not everybody who has high blood pressure will have it detected by the Apple Watch. And it may not even be able to detect serious cardiac events, such as a heart attack.
Likewise, the new class of GLP-1 weight-loss drugs has shown modest benefits for hypertension, as well as reduced risk of heart attack and stroke. But that science is preliminary. We still have a lot to learn about those drugs and, even if they are effective, they would work best in tandem with a blood pressure-conscious diet and exercise routine.
The good news is that high blood pressure is a health problem you can do something about. You just have to figure out whether you have a problem in the first place.