As a small child, I was lucky to be at the launch of Apollo 17, the last manned mission to the Moon, and I've remained enamored with space ever since. And fortunate as a physician to have contributed to NASA life sciences research and to practice aerospace medicine, inspired by the cross-disciplinary teamwork required to tackle audacious challenges and how space is has often brought the world together through the lens of seeing our planet as one without borders. Now, just as the historic Apollo moon landings were transformational inflection points in history, so too is the global health crisis of COVID-19, which, despite its many challenges and tragedies, like the sinister Cold War setting, which launched the space race, can have silver linings. As Regina Dugan, former head of DARPA, wrote, “Sputnik set off the space age, COVID can spark the health age.”
在我小的时候,我很幸运能见证 阿波罗17号的发射 那是迄今为止最后一次 载人的月球任务 从那之后我一直十分迷恋太空 作为一位医生 我有幸致力于美国航空航天局 (NASA)生命科学的研究工作 从而得以在太空医药领域实践 并且一直从这种跨学科的 团队工作中获得灵感 这项工作需要勇于面对 很多大胆的挑战 而且与太空相关的课题 常常需要着眼于整个世界 让人们通过透镜看到 一个没有边界的星球 就像阿波罗号 在月球上的多次登陆 是历史上的转折点一样 新型冠状病毒给全世界 带来的健康危机也同样如此 尽管它带来了许多挑战与悲剧 但与凶险的冷战 引发了太空竞赛类似 这次健康危机也可以给人类带来后福 美国国防部高级研究计划局 的前局长雷吉娜·杜根写道, “斯普特尼克1号人造卫星 开启了太空时代, 新型冠状病毒 可以开启健康新时代。“
The silver linings include the unprecedented acceleration of innovation, collaboration and discovery, catalyzing a future of health and medicine that can help us reimagine and bring us a healthier, smarter, more equitable post-COVID world. Now, many solutions ride the rails of rapidly, exponentially developing technologies that are rapidly doubling in their speed-price performance, as exemplified by Moore's Law, which has enabled the billionfold improvements in memory and computation, resulting in the ubiquitous supercomputer smartphones most of us carry in our pockets. I still have my now ancient iPhone 2 here. Still works, which felt magical 12 years ago but now feels slow and kludgy. And I'm sure my iPhone 11 will soon seem antique, perhaps as its features dissolve into the rumored to soon arrive augmented reality smartglasses.
这些后福包括 前所未有的全面推进 创新、合作和新发现的进程 催化出可供人们重新构想的 健康科学和医药的未来 并带来一个更健康、更智能 和更公正的后新冠病毒世界 目前,许多解决方案 借着技术迅猛发展的东风 性能迅速翻倍,而价格快速下跌 以摩尔定律为例 芯片的内存和计算能力 得到了十亿倍的提升 结果是超级电脑和智能手机的普及 使得我们能随身携带这些设备 我还保留着古老的苹果手机2代 它今天仍然能正常工作, 12年前这就像魔法一样神奇 但如今却让人觉得笨拙缓慢 我很肯定我的苹果手机11代 也会很快变成老古董 可能是因为它的功能 会被传闻中即将到来的 增强现实智能眼镜全面替代
Now exponential technologies packed into our smart devices are becoming increasingly medicalized, with sensors able to detect an ear infection and more. So what used to fit on a desktop computer now fits on our wrist and these are now entering the domain of FDA-approved medical devices. But the future isn't about any one technology, but their convergence as they get faster, cheaper, better. In fact, creating entire new fields at their interfaces, from computational biology, robotic surgery, digiceuticals, telemedicine to AI-enabled radiology. And while many industries have been disrupted and breached the fourth industrial age, health and medicine often feel stuck in the second or third. Critical data is still stuck being shared on fax machines, paper forms. We're stuck in waiting rooms waiting for our visits. I recently had my own echocardiogram only made available to share with me on a CD-ROM. I don't even own a CD-ROM player anymore.
现在,迅猛发展的科技 可应用于智能设备 也越来越支持医疗应用 比如可以检测耳内感染的传感器等等 所以,以前只能安装 在台式电脑中的元件 现在可以缩小到适合手腕的尺寸 并且还可以安装到美国食品 和药物管理局批准的医疗设备中。 但随着科技变得更快、 更便宜、更强大 未来不只是关于一种科技, 而是各种技术的融合 实际上,要在各项技术 结合点创造全新领域 从计算生物学、机器人手术、 数字药剂学、远程医疗到 支持人工智能的放射学 虽然许多产业已经被影响 并且突破了第四工业时代 卫生和医学时常还感到 在第二或第三工业时代动弹不得 重要的数据任然仅限于 在传真机和纸质媒介上被分享 我们被困于等待我们来访的等候室里 我最近有了我自己的超声波心动图 但它只能在一个只读光盘 存储器(CD-ROM)上分享给我 可我甚至连一个CD-ROM都没有
Tools for managing pandemics in 2020 rely on the same core technologies used in the pandemic of 1918: face masks, social distancing, handwashing. So part of the challenge in advancing global, local health are our models, our mindsets. We don't really practice health care. We practice sick care. Sick care is based on intermittent episodic data, usually only obtained within the four walls of the clinic or hospital bed, and leads to our reactive sick care model, where we wait for the patient to show up in the emergency room with a heart attack, stroke or late-stage cancer or for the pandemic to arrive on our shores.
在2020年用于管理新冠疫情的手段 和在1918年西班牙大流感中 所依赖的核心技术是一样的: 口罩、扩大社交距离、 和洗手 所以提升全球和 地方卫生的一部分挑战 是我们的模式,我们的心态 我们不是真的在练习医疗保健 我们在练习伤病护理 疾病护理基于间歇性的、不定期的数据 能够获取的通常只有诊所之内 或是病床之上 这导致了我们的 反应性疾病护理模式, 我们等待病人在急救室出现, 突发心脏病的、 中风的或是癌症晚期的病人 或者是因为大流行病而至的病人
I believe the convergence of many of the accelerating technologies and approaches being catalyzed by COVID will bring us from intermittent sick care to an age of continuous, proactive, personalized, crowdsourced health care that can increasingly bring care anytime, anywhere more effectively and lower costs around the planet.
我相信许多正在飞速发展 的技术的收敛性 和新冠疫情下发展的解决问题方式 会带我们脱离间歇性的疾病护理 来到一个拥有持续的, 先发制人的、个性化的 众包医疗保健的时代 这可以逐渐在任何时候、 任何地方更有效的带来护理 并且降低全球各地的医疗成本
For example, the convergence of ever smaller interconnected devices now riding 5G is creating not just an Internet of Things but an Internet of Medical Things. Much of this convergence is in the field of digital health, the ability to connect the dots between data sources from personal genomics and medical records with apps and services that match the needs of an individual, patient or caregiver. And as incentives and reimbursements align, COVID has pushed us to an increasingly virtualized care, from the hospital to home to our phone to on and even inside our bodies. The age of hospital to home-spital is upon us.
比方说,更小的互连接设备的融合 现在依靠5G 创造的不仅仅是一个物联网 更是一个医疗物联网 这种融合大部分是在数字健康领域 在数据源之间连接数据点的能力 则来自私人的基因组学和医学记录 通过应用和服务来匹配个人、病人 或医生的需求 作为激励和补偿 新冠肺炎已经推动了 美国日益虚拟化的护理模式 从医院到家里,再到我们的手机 甚至是我们的身体内外 从医院到家庭的时代已经降临
Now, the challenge of this hyperconnected age is that we're creating exponential amounts of big data that's too often siloed in formats that can't even talk to each other. So we need to narrow that gap between data, turning that into actual information for the patient, physician, public health worker, and speed its safe and effective use in the community clinic and bedside. The pandemic has instigated an immense amount of international sharing and collaboration amongst clinicians and researchers to narrow that gap. What was learned in managing patients in Wuhan and then in the intensive care units of Italy has helped New York City hospitals and their learnings in turn have spread to centers around the world.
现在,这个超联通时代的挑战在于 我们正在制造指数级的大数据 但它常常被条块分割以至于不能相互沟通 所以我们要缩小数据之间的差距 把它变为真正的信息提供给病人、医生 公共卫生工作者 并且在社区诊所和病床旁 加速它安全且高效的使用 这次新冠肺炎引发了 大量的国际共享以及 临床医生和研究人员之间 的合作来缩小这一差距 我们在武汉管理病人方面所学到的 然后是在意大利的 重症监护室里所学到的 对纽约的医院都有所帮助 而他们所学反过来也 传递到了世界的每一个角落
Let's take a quick dive into some examples of what's happening across the health care paradigm in the age of COVID and the implications for the future. From new forms of data to help prediction of prevention to faster diagnostics, more tailored therapy and increasingly crowdsourced discovery.
让我们快速深入了解一些 在新冠肺炎时期的医疗保健范式中 发生的例子 这些例子也影响到了未来 从新形式的数据有助于预防预测 到更加快速的诊断、 更定制化的治疗方案 以及越来越多的众包式的发现
Let's start with prevention. Now, while our genomes impact our health outcomes and our health spans, our social determinants of health, our social, and our day-to-day behaviors drive most of our risk for disease and associated costs. And we now have an explosion of new tools to help measure and improve our healthy behaviors. The first Fitbit only launched in 2009. Wearables are now ubiquitous and can measure almost every element of our physiology, behavior and even mental health. And they're evolving all the way from disposable tattoos that can stream vital signs 24/7 to an integration of big data that can -- Even small data from a simple wearable, tracking the patient discharged home after a hip replacement or a coronavirus infection can determine if the patient is recovering as expected, walking more, doing great or not so great and trigger early intervention.
让我们从预防开始 现在,虽然我们的基因组 影响我们的健康结果 和我们的健康寿命 我们健康的社会性决定因素 我们的社交活动和日常行为 驱动了我们大部分的疾病风险 以及相关花费 现在我们有了大量新的工具 来帮助测量和改善我们的健康行为 第一个Fitbit(科技公司) 的产品于2009年推出 可穿戴设备现在已经普遍存在 并且几乎可以测量 我们所有的生理因素、 行为甚至是心理健康 它们从可以24小时显示生命体征 的一次性纹身开始 到无所不能的的大数据一体化 即使是来自简单可穿戴设备的小数据 也可以在一次髋关节置换手术 或是新冠病毒感染后 进行跟踪观察 它可以判断病人是否按预期康复 走得更多,做得很好 或者不是那么好并且 需要触发早期干预
We're evolving from a world of quantified self where our digital data remains silent on our devices to one of quantified health where the data can be shared securely with clinical teams and researchers to help optimize prevention, diagnose disease early and with feedback loops, personalize and optimize therapy. From wristband vitals, including blood pressure, now obtainable without a cuff, and soon sensors that will measure our blood oxygenation levels to continuous blood sugar monitoring, to shock'ables, hearables, ring'ables that can replace an entire sleep lab fitting on our finger to inside’ables, chips beneath our skin, to track our physiology and lab values, to even underwear'ables, Internet of Medical Things sensors so cheap today you can get a pack of ten of them, have one on each pair of your underwear, now being used to do what's called remote patient monitoring to help detect signs of respiratory decompensation of patients with bronchitis or COVID. Breath'ables are showing promise. Nanonoses that can detect molecules in our breath correlating to cancer, metabolic disease and even diagnosing infectious disease. In fact, we now don't need to wear anything. Invisibles, ambient sensing from AI-enabled cameras can track her vital signs. To voice as a biomarker to manage and detect mental health challenges, signs of heart disease, now being able to differentiate between a cough from a common cold to that one caused by coronavirus.
我们正在从一个量化 自我的世界进化 在那里我们的数字数据 在我们的设备上保持沉默 到一个可量化的健康世界 在这里数据可以和 临床团队、研究人员安全共享 来帮助优化预防措施 从而乘早诊断疾病 获得相应反馈 以此来个性化和优化治疗方案 从无需戴在手上 就可以测量的腕部 关键信息,包括血压 到不久的将来,从测量血氧饱和度 以实现持续的血糖监测 到可以完全取代手指上的 睡眠测量器的可震动、可响铃的 传感器 再到可内置于我们皮肤之下来追踪 我们生理机能和实验室的评价值 甚至还有可置于内衣下的芯片 互联网的医用传感器 在当今是如此便宜 你可以轻松的获得一大包, 并在每一件内衣下都安装这些传感器 用来远程控制 帮助测试气管炎病人的呼吸代谢失调 或是新冠肺炎 有关呼吸的设备也展示出了好的前景 可以探测分子的纳米鼻 在我们有关癌症、代谢疾病 的呼吸中可以诊断传染病 实际上,我们不需要穿任何东西 通过人工智能的隐形、 环境感应的摄像机 可以跟踪她的生命体征 作为生物标志化合物来管理 和探测心理健康问题 心脏病的标志 现在可以区分由普通感冒引起的咳嗽 和由新冠引起的咳嗽之间的区别
And we'll soon be exuding our digital exhaust 24/7, our digitome. How do we make sense and truly leverage it? One path is through crowdsourcing. The million-participant All of Us trial from the National Institutes of Health is doing just that where data donors, and I'm one, can contribute our medical records, genomes and wearable data to build a much better and diverse data set, crossing racial and socioeconomic groups to help foster better precision medicine for all of us.
我们很快就可以发出 我们24小时的数字排气 我们的数字化 我们如何使其合理化并真正利用它? 一种方式是通过众包 来自美国国立卫生研究院的 万人参与的“我们所有人” 试验正是在这样做 数据捐赠者,我也是其中之一, 可以贡献我们的医疗记录、 基因组和可穿戴数据 以建立一个更好的 系统以及不同的数据集 跨种族和社会经济群体, 来帮助我们所有人发展更好的精确医学
Integrating this information for the individual and public health will lead to predictalitics, our own personal check engine lights that can give us early proactive warning. And recent work is demonstrating that wearables can detect presymptomatically the onset of the flu, or, as recently published by Stanford, in 83 percent of COVID patients smartwatches can detect COVID infections early, often days before onset of symptoms. Self-reporting websites like Covid Near You enable us to locally generate infections maps, and combined with our social graphs and contact tracing apps, may provide us detailed suggestions about who we might want to consider being near or socially distanced from.
为个人和公共健康整合这些信息 将引领预测 我们自己的个人检查引擎灯 可以给我们提供早期预警 最近的工作阐明了 可穿戴设备可以在症状前 检测流感的爆发 或者,正如最近斯坦福所发布的那样 在83%的新冠肺炎病人中 智能手表可以提前 检测出新冠肺炎的感染 通常是在产生症状的几天之前 自我报告的网站例如 “你身边的新冠病毒” 使我们能够在本土生成感染地图 并结合我们的社交图表 和联系人跟踪应用程序, 会提供关于我们可能要考虑靠近 或在社交上远离的人的详细建议
What about advancements in diagnostics and monitoring? What used to require a full clinic or laboratory can now fit into a digital doctor's bag or the pocket of a patient. From COVID quarantine kits enabling tracking of oxygen saturation, temperature and lung sounds, we're starting to integrate these into virtual visits, providing real-time enhancements of a virtual physical exam. And the diagnostic tools are becoming increasingly infused with AI machine learning, including consumer ultrasounds, which can bring diagnostics anywhere at very low cost, including the ability to evaluate the lungs in suspected COVID patients. The laboratory has shrunk to microfluidic platforms that can be attached to our smartphones and enable anyone to take measurements from blood or saliva.
那么诊断和监测方面的进步如何呢? 过去需要一个完整诊所 或实验室的东西 现在可以被装进一个数字医生的包里 或者是一个病人的口袋里 从能够跟踪血氧饱和度、 温度和肺部声音的新冠病毒检疫包, 我们开始将这些整合进虚拟访问 提供虚拟体检的实时增强功能 随着诊断工具也越来越普及 通过人工智能机器学习 包括消费超声 它可以以极低的成本 将诊断带到任何地方 包括在新冠肺炎疑似感染者中 评估肺部的能力 实验室已经缩小为微流控平台 它可以连接到我们的手机上 使任何人都能对血液和唾液进行测量
Many of these diagnostics are leveraging the smartphone and its camera for a medical selfie. For example, instead of taking your urine to the lab to diagnose a potential urinary tract infection, in the privacy of your home simply dip the urine dipstick, take a picture with your smartphone camera and have the results made available immediately to your doctor and pharmacy. Similar phone-based apps and approaches are being used and developed for fast, frequent, cheap and easy COVID testing. Novel approaches to community level diagnostics are also being explored, including next gen sequencing of sewage for early detection of COVID-19, identifying hotspots and predicted outbreaks a week or more early.
许多诊断都是利用 智能手机及其摄像头 进行医学自拍 例如,与其带你的尿液去实验室 从而诊断潜在的尿路感染 你不如在你自己的家里蘸一下尿尺 并用你的手机摄像头拍一张照片 然后将结果立即提供给您 的医生和药房。 类似的基于手机的应用程序 和方法正在被使用和开发 用于快速、频繁、便宜 和便捷的新冠病毒检测 社区层面的新诊断方法也正在被探索 包括对污物进行下一代测序 来对新冠病毒进行早期发现 提前一周或更早的识别热点并预测疫情
The explosion of data sources, however, is really beyond the capacity of the human mind to effectively integrate. We're now getting help from AI, or as I call it, IA, intelligence augmentation. IA is being leveraged in reading CT scans to diagnose COVID, to enhancing the vision of a gastroenterologist performing a colonoscopy to identify lesions they might have missed. And AI is playing an active role in helping identify and develop new antivirals. And while AI is often perceived as a threat by some clinicians, it can't replace the human touch or empathy. And I don't think doctors or nurses will be replaced by AI, but doctors and health care systems who’re collaborating with AI in the future will be replacing those who don’t.
然而,数据的爆炸性增长 确实超过了人类思维 有效整合的能力 我们现在正在从人工智能寻求帮助 我又称之为IA,即智能增强 IA被用来读取CT 扫描结果以诊断新冠 提高肠胃科医生通过结肠镜检查 来确定 他们可能错过的病变的能力 并且AI技术在帮助识别 和研发新的抗病毒药中 扮演重要角色 虽然AI技术经常被一些 临床医生视为威胁 但它不会取代人类的触摸或者共情 我并不认为医生 或护士会被AI技术所取代 但和AI技术合作的医生和医疗系统 将来会取代那些没有 合作的医生和系统
Finally, therapy. The pandemic has dramatically accelerated the use of virtual visits. Telemedicine visits are up on the order of a thousand percent in many settings. And I don't think we'll ever revert to pre-COVID levels as patients and clinicians are discovering the compelling convenience and efficacy. Even before virtual zoom or facetime with the clinician, asynchronous screening and support has been provided by ever-smarter chat bots that can help discern symptoms and triage problems effectively at lower cost. This includes virtualization and virtual augmentation to meet our mental health crisis, exacerbated by the many economic and other stressors which accompany this pandemic. 3D-printing is finding a role in health care, with newfound applications from printing personal masks to critical parts of ventilators and being leveraged by the growing maker movement, which is playing a major role in pandemic response, from making face shields and masks to improvising do-it-yourself ventilators.
最后,治疗方法 新冠疫情极大地促进了 虚拟访问的使用 在许多情况下,远程医疗 就诊率上升了1000%。 我不认为我们会恢复到 新冠病毒感染前的水平 随着患者和临床医生发现 其令人信服的便利性和有效性 甚至在临床医生使用 虚拟缩放或视频聊天之前 越来越智能的聊天机器人 已经提供了异步筛选和支持, 帮助我们以更低的成本 有效地识别症状和解决伤者分流问题 这包括虚拟化 和虚拟增强,以应对我们 的心理健康危机, 而伴随新冠疫情的 许多经济和其他压力因素 加剧了这一危机 3-D打印在医疗保健中 也有了一席之地, 新发现的应用 从打印个人口罩到 呼吸机的关键部件 并被不断增多的 制造者运动所利用 这一运动在新冠疫情 应对中发挥着重要作用 从制作面罩和口罩 到即兴制作自己动手的呼吸机
All together, these efforts are enabling the potential for democratization of health and medicine across the planet and access to information and care that was previously inaccessible. Clinical trials are being reshaped, leveraging smart devices, cloud-based analytic platforms and collaborators around the world. That's at this convergence of many rapidly developing and exponential technologies that we have the real potential to reshape and scale health care at our pandemic age. One where we can dramatically expand access to basic health care, increasingly personalized and proactive, leveraging the scale of digital platforms and technologies, enhancing digital connection and empathy, and the ability to blend virtual and in-person care, and leveraging the power of the crowd to share and build better maps that guide our individual health and public health journeys, and to develop validated and scaled solutions.
所有这些努力合在一起, 有可能在全球范围内 实现卫生和医疗的民主化, 并有可能获得以前 无法获得的信息和护理。 利用智能设备、基于云的分析平台 和世界各地的合作伙伴, 正在重塑临床试验 正是由于许多快速发展的 指数技术的融合 我们才有真正的潜力在新冠疫情时代 重塑和扩大医疗保健 在这一平台上,我们可以极大 地扩大基本医疗服务的普及, 越来越个性化和主动 利用数字平台和技术的规模 增强数字连接和同理心 以及融合虚拟和面对面护理的能力 并利用人群的力量共享 和构建更好的地图 来引导我们的个人健康 和公共卫生之旅 并开发经验证和缩放的解决方案
So imagine a new generation of volunteers, a global health corps similar to the volunteer paramedics and firemen of today that can be upskilled, use the powerful new tools to respond early and collectively to enhance contact tracing, isolation and quarantine, and to help identify and address social and other disparities.
所以想象一下新一代的志愿者, 一个全球健康军团 与现代的支援护理和消防员相类似 他们具备高技能 利用有效的新工具来乘早做出反应 共同加强接触者追踪、隔离和检疫, 并帮助识别和解决社交和其他障碍
So coming full circle. Twenty four years after I was at the launch of Apollo 17, I found myself as a medical student on a research clerkship at Johnson Space Center. And much to my surprise, one day in the clinic, I ran right into Gene Cernan, the Apollo 17 commander and the last man to walk on the Moon. After enthusiastically sharing my childhood memories of his launch, he shared one of his famous lines: "I walked on the Moon. What can't you do?" Indeed, what can't we do if we work together as one in the face of this pandemic? And just as the near tragedy of Apollo 13 rallied NASA to work creatively and collectively, so too can this in our pandemic age lead to our finest hour, bring on a true health age. I believe this is possible if we all get out of our linear mindsets, take exponential steps and collaboratively go forth collectively, not only to solve the challenges of this pandemic and predict the future of health and medicine, but boldly to go forth together to accelerate a far better one for everyone on Spaceship Earth.
所以一个全循环之后 在我见证阿波罗17号 发射之后的第24年, 我发现自己是一名医科学生, 在约翰逊航天中心 从事研究工作 让我十分惊喜的是,有一天在诊所 我遇见了尤金·塞尔南 (Gene Cernan) 阿波罗17号指挥官 也是最后一个在月球上行走的人 在我激动的和他分享 我有关那次发射的儿时记忆之后 他说出了他的一句名言: “我能在月球上行走。 你又有什么不能做的呢?” 实际上,面对疫情, 如果我们团结一心 有什么是不能做到的呢? 正如近乎悲剧般的阿波罗13号 促使美国宇航局团结一致, 创造性地开展工作 在我们这个疫情肆虐的时代, 我们也能迎来最美好的时刻, 迎来真正的健康时代 我相信这是可能的, 如果我们都摆脱线性思维, 采取指数级的步骤,共同努力 不仅仅是解决新冠疫情带来的挑战 预测健康和医学的未来 而是勇敢地一起走下去 为地球飞船上的 每个人创建一个更美好的未来
Thanks.
谢谢。