The fragmentary bones, but only one full skull, of several individuals led the discoverers to conclude that these were remains of a previously unknown extinct species of humans.

考古學家10年前在印尼佛羅列斯島的一個洞穴裡發現了一些東西，一位科學家盛讚它為「有關人類演化百年來最重要的發現」。其中只有一個完整的頭骨，其餘則為分屬幾個人的零散骸骨。考古學家據此認為，它們是學術界此前未知的一種已滅絕人種的遺骸。

The Australian and Indonesian scientists named the species Homo floresiensis. Some call ed these unusually small people, who had apparently lived on the island as recently as 15,000 years ago, the hobbits.

It was mystifying that people with brains apparently no larger than a chimpanzee’s, one-third that of modern Homo sapiens, would have been capable of making the stone tools found in the cave around them.

Further, was a single skull sufficient evidence of a distinct human species? How could the Flores skull be proved normal and not that of a modern human with a growth disorder ?

澳洲與印尼的考古學家將這個人種稱為佛羅列斯人。部分人士將這些顯然1.5萬年前存活於佛羅列斯島的異常矮小人種稱為哈比人。令人不解的是，大腦容量顯然不比黑猩猩大，而且僅及現代人1/3的該人種竟然有能力以石頭製作同時在該洞穴發現的各種工具。此外，僅是一個頭骨是否就足以證明他們是個別的人種？如何證明佛羅列斯頭骨是正常人的骨頭，而不屬於成長失調的現代人？

Now the skeptics have revived the debate with papers published this month in The Proceedings of the National Academy of Sciences. One article points out what are said to be flaws in the original reports ; the other describes evidence suggesting the individual was born with Down syndrome.

懷疑哈比人存在者最近再度炒熱這個話題，這個月並透過美國國家科學院彙報發表文章。其中一篇點出被指為原始報告中的幾項缺失。另一篇敘述的證據則指出這個頭骨的主人患有唐氏症。

Among the flaws, the critics say, were underestimates of the stature and the brain size of the most complete skeleton, designated as LB1, from Liang Bua Cave. In their view, LB1’s stature was a little more than 1.2 meters tall, not one meter, as in the original estimate. New measurements of the brain size were also larger.

批評者指出，原始報告的一項缺失是，低估梁布亞洞穴中代號LBI的最完整骨架主人的身高與大腦容量。他們認為，LBI身高大約略多於1.2公尺，不是最初估計的1公尺。腦容量的最新估算數字也比較大。

The authors of the first journal paper — Robert B. Eckhardt and Alex S. Weller of Penn State University, Maciej Henneberg of the University of Adelaide, in Australia, and Kenneth J. Hsu of the National Institute of Earth Sciences in Beijing — concluded that the defining features of the specimen as originally described “do not establish the uniqueness or normality necessary to meet the formal criteria for a type specimen of a new species.”

賓州州立大學的艾克哈特與魏勒、澳洲阿德雷得大學的漢尼柏格，以及北京大學地球與空間科學學院的許靖華是前述第一篇報告的共同作者。他們指出，科學家最初形容的該人種特徵「並不構成符合新人種正式標準所不可或缺的獨特性或常態性」。

Dr. Henneberg and Dr. Eckhardt were the lead author and co-author of the Down syndrome hypothesis . Based on a re-examination of the evidence, the y said the revised dimensions of the LB1 cranium and femur fell in the range predicted for an individual with Down syndrome from that region .

The larger size estimate also matches that of some people today on Pacific islands.

漢尼柏格與艾克哈特分別是提出唐氏症假設那篇報告的主要執筆人與共同執筆人。他們重新檢視相關證據後指出，LBI頭蓋骨與股骨大小的修正後結果符合該區域唐氏症患者的推估數字。比較大的估計數字也與目前存活於部分太平洋島嶼的人種相符。

The scientists also pointed to a left-right mismatch of facial features as being characteristic of people with Down syndrome, one of the most common developmental disorders in humans. They noted that it occurred in more than one human birth per 1,000.

Other scientists who tended to accept the new-species interpretation have rejected what they call the “sick hobbit hypothesis.”

唐氏症是最普遍的人體發育障礙之一。科學家指出，臉部左右不對稱是唐氏症患者的主要特徵之一，發生機率大約1/1000。

傾向於接受新人種理論的其他科學家駁斥他們所說「哈比人生病的假設」。

Searches have failed to yield more skulls, needed to determine if LB1 is one of a kind or one of an extinct human species . Until then, Dr. Eckhardt said, the new analysis yielded a “less strained explanation” than adding a branch to the human family tree.

要確定LBI是個特例還是已絕種人種的一員，必須有更多頭骨才行，然而後續搜尋並未找到更多頭骨。艾克哈特說，在發現更多頭骨之前，新的分析結果提供了不像為人類大家族譜系增加一個支系那麼牽強的解釋。

我們通常認為醫療照護具有在地性，多數人求助於家附近的醫師與醫院。中國大陸不輸出醫療保健。人們的健康與壽命隨國家甚至區域而異。

But when it comes to health care spending, the picture is starting to look more global.

至於醫療保健的開支，全球化樣貌已經浮現。

After decades when health spending in the United States grew much faster than it did in other Western countries, a new pattern has emerged in the last two decades. And it has become particularly pronounced since the economic crisis. The rate of health cost growth has slowed substantially since 2000 in every high-income country, including the United States, Canada, Britain, France, Germany and Switzerland, according to data from the Organization for Economic Cooperation and Development.

數十年來，美國的醫療開支成長幅度比其他西方國家大上許多，過去20年則已出現新的形態，經濟危機出現後尤其明顯。根據經濟合作暨發展組織（OECD）的統計，自2000年起，每一個高收入國家的醫療支出成長都大幅減緩，其中包括美國、加拿大、英國、法國、德國與瑞士。

“We used to be different,” said Louise Sheiner of the Brookings Institution in Washington, “Since about 1990, we’ve looked about the same.”

華府布魯金斯研究所的露易絲．謝納說：「我們曾經各不相同。大約1990年起，我們卻看起來大同小異。」

The synchronized slowdown offers reasons to be skeptical about neat explanations for the trends in any one country, be it local changes in medical practices or various attempts to slow cost growth. The slowdown has also reduced budget pressures around the world.

各國支出同步減緩，使我們有理由懷疑任一國家對最新趨勢的簡單解釋，無論是在地的醫療做法改變或是減緩成本增速的各種嘗試。增速減緩同時減輕了各國承受的預算壓力。

What’s behind the pattern? Economic growth around the industrialized world has been slow for much of the last decade, and the aging of the population in much of the world has created fiscal pressures to rein in health spending. But these economic and political forces – which in turn leave governments and households with less money to purchase medical care – do not appear to be the only causes.

背後的因素是什麼？過去10年的許多時候，工業化世界的經濟成長全面減緩，全球許多地區人口老化的趨勢則產生抑制醫療健保開支的壓力。這些經濟與政治力量雖使各國政府與家庭較無力購買健保，卻似乎不是僅有的因素。

The world’s health-care systems are also converging in important ways. New drugs and medical advances, which were once adopted locally and spread more slowly, are now experiencing international launches. Medical technology companies are increasingly global, and seeing regulatory approval in many markets at once. Strategies that can reduce the need for expensive hospital stays, such as performing surgeries in outpatient clinics, are expanding around the world.

全球各國醫療體系也已經開始以重要的方式匯流。新藥與醫學研究進展曾經只能在地採用，推廣也比較緩慢，如今已開始具有國際化性質。醫療技術公司越來越全球化，並在許多市場同時獲得有關當局核准。可減少昂貴住院需求的策略，如門診手術，開始在各地推展。

Two recent papers highlighted the trend. One in The Journal of the American Medical Association compared the United States with countries in the O.E.C.D. Its author, David Squires of the Commonwealth Fund, a New York health care research group, concluded that the similarities in spending growth suggested that “the factors that stimulated the slowdown in the United States also affected other industrialized countries.”

兩項新報告凸顯這種趨勢。發表在美國醫學學會期刊的報告比較美國與OECD國家。執筆人紐約研究機構「聯邦基金」的史奎爾斯指出，開支成長趨勢相似意味「在美國促成減緩的因素也影響其他工業化國家」。

The other paper, from the O.E.C.D., found that what really differentiates the United States from other countries is the high prices we have long paid for medical care, not differences in how doctors are treating their patients.

另一項由OECD發表的報告指出，美國不同於他國是長期以來美國醫療收費較高，而非醫師診治方式不同所致。

The economic crisis drove down demand for new medical services, as people lost their jobs and coverage, or simply decided to put off elective procedures like knee replacements. Tougher times also led to policy tightening by federal and state officials – and employers, who have increasingly moved from generous health insurance plans to those that expose their workers to more out-of-pocket costs.

經濟危機使人們失業並失去醫療保險，或者決定暫緩如膝關節更換手術之類自主選擇性醫療，對新式醫療服務的需求因而減少。時機歹歹也使聯邦、州政府官員與雇主收緊政策。給員工的慷慨醫療保險日漸轉為自付額更高的保險。

Expanded health insurance in the United States included new people, but it also cut back on spending, much of it from lower reimbursements to hospitals and insurers.

擴大後的美國聯邦醫療保險把更多人納入，卻同時減少開支，相當部分來自減少對醫院與保險公司的給付。

At the same time, the development of new expensive medical technologies has slowed for a decade or so. In the pharmaceutical market, many big blockbuster drugs lost their patent protection, and few expensive, mass-market medications have come to replace them.

同時，昂貴新醫療技術的開發已減緩約10年。在製藥市場，許多轟動一時的重要藥物已失去專利保護，卻只有極少數針對大眾市場的昂貴新藥取代它們。

Many of these same forces affect other countries. They also had fewer new drugs, devices and procedures to adopt. And their economies were slammed by the global recession.

這些因素中有不少同樣也影響其他國家。可供它們採用的新式藥物、儀器與醫療步驟同樣變少。它們的經濟同樣因全球衰退而受創。

Other countries also have political mechanisms to reduce spending. Most countries have aggressive regulatory systems that allow government officials to tamp down health spending directly when times get tough.

其他國家也備有減少開支的相關政治機制。多數國家的積極性法規體系使政府官員得以在大局吃緊時，直接裁減醫療健保開支。

Still, the similarities among countries are not the same thing as destiny. Peter Orszag of Citibank said, “Health care slowed down here and it slowed down there, and that doesn’t mean it’s all entirely cyclical.”

儘管如此，各國間的相似性不同於天命。花旗銀行的奧茲沙格說：「許多國家醫療健保開支同步減少。這並不意味它具有絕對的循環性。」