A couple of years ago, when I was attending the TED conference in Long Beach, I met Harriet. We'd actually met online before -- not the way you're thinking. We were introduced because we both knew Linda Avey, one of the founders of the first online personal genomic companies. And because we shared our genetic information with Linda, she could see that Harriet and I shared a very rare type of mitochondrial DNA, haplotype K1a1b1a, which meant we were distantly related. We actually share the same genealogy with Ötzi the Iceman. So -- Ötzi, Harriet and me. And being the current day, of course, we started our own Facebook group. You're all welcome to join. When I met Harriet in person the next year at the TED conference, she'd gone online and ordered our own happy haplotype T-shirts.
Pred nekaj leti, na TED konferenci v Long Beachu, sem spoznal Harriet. Dejansko sva se srečala prej na spletu - ne tako, kot si mislite. Oba sva poznala Lindo Avey, ki je ena od ustanoviteljev prve spletne osebne genomske družbe. In ker sva najine genetske informacije delila z Lindo, je ona lahko videla, da si s Harriet deliva zelo redek tip mitohondrijske DNK - Haplotip K1a1b1a - kar je pomenilo, da sva v daljnem sorodu. Dejansko deliva isto rodoslovje z Oetzijem, ledenim človekom. Torej Oetzi, Harriet in jaz. Ustanovila sva skupino na Facebook-u. Vsi ste dobrodošli, da se pridružite. Ko sem naslednje leto srečal Harriet osebno na konferenci TED, nama je naročila srečne Haplotip majice.
(Laughter)
(Smeh)
Why am I telling you this story? What does it have to do with the future of health? Well, the way I met Harriet is an example of how leveraging cross-disciplinary, exponentially growing technologies is affecting our future of health and wellness -- from low-cost gene analysis to the ability to do powerful bioinformatics to the connection of the Internet and social networking. What I'd like to talk about today is understanding these exponential technologies. We often think linearly. But if you think about it, if you have a lily pad and it just divided every single day -- two, four, eight, sixteen -- in 15 days, you'd have 32,000. What do you think you'd have in a month? We're at a billion. If we start to think exponentially, we can see how this is starting to affect all the technologies around us.
Zakaj vam pripovedujem to zgodbo in kaj ima to s prihodnostjo zdravja? Kako sem spoznal Harriet, je primer, kako interdisciplinarno dopolnjevane, skokovito rastoče tehnologije vplivajo na prihodnost zdravja in počutja - od nizkocenovnih genskih analiz do priložnosti v zmogljivi bioinformatiki in do internetne povezave in socialnih mreženj. Danes bi rad govoril o razumevanju teh eksponentnih tehnologij. Pogosto mislimo linearno. Ampak, če imate plavajoč lokvanjev list, ki se razdeli vsak dan - dva, štiri, osem, 16 - v 15 dneh jih imate 32.000. Koliko mislite, da jih bo v enem mesecu? Prišli smo do milijarde. Če začnemo misliti eksponentno, vidimo, kako to začenja vplivati na vse tehnologije okoli nas. In veliko teh tehnologij - govorim kot zdravnik in inovator -
Many of these technologies, speaking as a physician and innovator, we can start to leverage, to impact the future of our own health and of health care, and to address many of the major challenges in health care today, ranging from the exponential costs to the aging population, the way we really don't use information very well today, the fragmentation of care and the often very difficult course of adoption of innovation. And one of the major things we can do is move the curve to the left. We spend most of our money on the last 20 percent of life. What if we could incentivize physicians in the health care system and our own selves to move the curve to the left and improve our health, leveraging technology as well? Now my favorite example of exponential technology, we all have in our pocket. If you think about it, these are really dramatically improving. I mean, this is the iPhone 4. Imagine what the iPhone 8 will be able to do.
res lahko začnemo izkoriščati, da vplivamo na prihodnost lastnega zdravja in zdravstvenega varstva in da se lotimo glavnih izzivov, ki jih imamo v zdravstvu danes, od res skokovitih stroškov, do staranja prebivalstva, slabega načina uporabe informacij, razdrobljenosti oskrbe, in pogosto veliko težav v sprejemanju inovacij. Kar lahko naredimo, o čemer smo danes nekaj govorili, je premik krivulje v levo. Večino denarja porabimo na zadnjih 20 % življenja. Kaj če bi lahko porabili in spodbujali pozicije v sistemu zdravstvenega varstva in nas samih za premik krivulje v levo in izboljšanje zdravja, tudi z izkoriščanjem tehnologije? Mojo najljubšo tehnologijo, primer eksponentne tehnologije, imamo vsi v žepu. Torej, če o tem razmislite, to se res dramatično izboljšuje. Hočem reči, to je iPhone 4. Predstavljajte si, kaj bo sposoben narediti iPhone 8.
Now, I've gained some insight into this. I've been the track share for the medicine portion of a new institution called Singularity University, based in Silicon Valley. We bring together each summer about 100 very talented students from around the world. And we look at these exponential technologies from medicine, biotech, artificial intelligence, robotics, nanotechnology, space, and address how we can cross-train and leverage these to impact major unmet goals. We also have seven-day executive programs. And coming up next month is FutureMed, a program to help cross-train and leverage technologies into medicine.
Dobil sem nekaj uvida v to. Sem eden od udeležencev na medicinskem delu nove institucije, imenovane Singularity University, s sedežem v Silicijevi dolini. In tukaj vsako poletje združimo približno 100 zelo nadarjenih študentov z vsega sveta. In obravnavamo te tehnologije iz medicine, biotehnologije, umetne inteligence, robotike, nanotehnologije, vesolja, in iščemo, kako bi jih navzkrižno usposobili in izkoristili za vpliv na glavne neizpolnjene cilje. Imamo tudi sedem-dnevne izvedbene programe. In naslednji mesec je pravzaprav Future Med, program interdisciplinarnega usposabljanja in izkoriščanja tehnologij v medicini.
Now, I mentioned the phone. These mobile phones have over 20,000 different mobile apps available. There's one out of the UK where you can pee on a little chip, connect it to your iPhone, and check for an STD. I don't know if I'd try that, but it's available. There are other sorts of applications. Merging your phone and diagnostics, for example, measuring your blood glucose on your iPhone and sending that to your physician, so they can better understand and you can better understand your blood sugars as a diabetic. So let's see how exponential technologies are taking health care. Let's start with faster. It's no secret that computers, through Moore's law, are speeding up faster and faster.
Omenil sem telefon. Ti mobilni telefoni imajo na voljo več kot 20.000 različnih mobilnih aplikacij - vse do tiste iz VB, kjer lahko lulate na mali čip priključen na vaš iPhone in preverite sami za SPB. Ne vem, če bi sam že poskusil, ampak je na voljo. Obstajajo vse vrste aplikacij, ki združujejo vaš telefon in diagnostiko, na primer - merjenje glukoze v krvi na vašemu iPhonu in pošiljanje vašemu zdravniku, da oni in vi lahko bolje razumete vaš krvni sladkor, če imate sladkorno bolezen. Poglejmo zdaj, kako skokovite tehnologije prevzemajo zdravstvo. Začnimo s tem, da so hitrejše. Ni skrivnost, da so, po Moorovemu zakonu, računalniki vse hitrejši in hitrejši. Z njimi lahko naredimo bolj zmogljive stvari.
We can do more powerful things with them. They're really approaching -- in many cases, surpassing -- the ability of the human mind. But where I think computational speed is most applicable is in imaging. The ability now to look inside the body in real time with very high resolution is really becoming incredible. And we're layering multiple technologies -- PET scans, CT scans and molecular diagnostics -- to find and seek things at different levels. Here you're going to see the very highest resolution MRI scan done today, of Marc Hodosh, the curator of TEDMED. And now we can see inside of the brain at a resolution and ability never before available, and essentially learn how to reconstruct and maybe even reengineer or backwards engineer the brain, so we can better understand pathology, disease and therapy. We can look inside with real-time fMRI in the brain at real time. And by understanding these sorts of processes and these connections, we're going to understand the effects of medication or meditation and better personalize and make effective, for example, psychoactive drugs.
Oni res dohajajo, v mnogih primerih presegajo, sposobnost človeškega uma. Ampak mislim, da je računska hitrost najbolj uporabna za slikanje. Možnost vpogleda v telo v realnem času z zelo visoko ločljivostjo res postaja neverjetna. In uporabljamo različne tehnologije - PET skeniranje, CT skeniranje in molekularno diagnostiko - da najdemo in poiščemo stvari na različnih ravneh. Tukaj boste videli najvišjo ločljivost MRI skeniranja danes, rekonstrukcijo Marca Hodosha, skrbnika TEDMED-a. In zdaj lahko vidimo notranjost možganov z do sedaj nedosegljivo ločljivostjo in zmogljivostjo, in se naučimo rekonstrukcije in morda celo reinženiringa ali povratnega inženiringa možganov, da bi bolje razumeli patologijo, bolezni in zdravljenje. Notranjost možganov lahko gledamo v realnemu času z fMRI. In z razumevanjem te vrste procesov in povezav bomo razumeli učinke zdravil ali meditacije in bolje in učinkoviteje bomo personalizirali, na primer, pri psihoaktivnih zdravilih.
The scanners for these are getting smaller, less expensive and more portable. And this sort of data explosion available from these is really almost becoming a challenge. The scan of today takes up about 800 books, or 20 gigabytes. The scan in a couple of years will be one terabyte, or 800,000 books. How do you leverage that information? Let's get personal. I won't ask who here's had a colonoscopy, but if you're over age 50, it's time for your screening colonoscopy. How'd you like to avoid the pointy end of the stick? Now there's essentially virtual colonoscopy. Compare those two pictures. As a radiologist, you can basically fly through your patient's colon, and augmenting that with artificial intelligence, potentially identify a lesion that we might have missed, but using AI on top of radiology, we can find lesions that were missed before. Maybe this will encourage people to get colonoscopies that wouldn't have otherwise.
Ti skenerji so vse manjši, cenejši in bolj prenosni. In te vrste eksplozija podatkov, ki je na voljo, res skoraj postaja izziv. Skeniranje danes zavzame približno 800 knjig ali 20 gigabajtov. Skeniranje bo v nekaj letih en terabajt ali 800.000 knjig. Kako izkoristite te informacije? Postanimo osebni. Ne bom vprašal, kdo je bil na kolonoskopiji, a če ste stari nad 50 let, je čas za presejalno kolonoskopijo. Kako bi vam bila všeč možnost da se temu izognete? Zdaj v bistvu obstaja virtualna kolonoskopija. Primerjajte ti dve sliki in kot radiolog lahko poletite skozi bolnikovo debelo črevo in z uporabo umetne inteligence (U.I.) prepoznate potencialno lezijo, kot vidite tukaj. Mogoče smo jo spregledali, a z uporabo U.I. pri radiologiji, najdemo lezije, ki smo jih spregledali. In morda bo to spodbudilo ljudi, da opravijo kolonoskopijo, ki je sicer ne bi.
This is an example of this paradigm shift. We're moving to this integration of biomedicine, information technology, wireless and, I would say, mobile now -- this era of digital medicine. Even my stethoscope is now digital, and of course, there's an app for that. We're moving, obviously, to the era of the tricorder. So the handheld ultrasound is basically surpassing and supplanting the stethoscope. These are now at a price point of what used to be 100,000 euros or a couple hundred-thousand dollars. For about 5,000 dollars, I can have the power of a very powerful diagnostic device in my hand. Merging this now with the advent of electronic medical records -- in the US, we're still less than 20 percent electronic; here in the Netherlands, I think it's more than 80 percent.
In to je primer spremembe paradigme. Gibljemo se k integraciji biomedicine, informacijske tehnologije, brezžične in, rekel bi, mobilne - v ero digitalne medicine. Celo moj stetoskop je zdaj digitalni. In seveda tudi za to obstaja aplikacija. Očitno se gibljemo k eri trikorderja. Ročni ultrazvok je v bistvu presegel in izpodrinil stetoskop. Sedaj imajo ceno - včasih je bila 100.000 € ali nekaj 100.000 $ - za približno 5.000 $ lahko imam moč zelo zmogljive diagnostične naprave v roki. In združevanje tega s pojavom elektronskih zdravstvenih kartotek - v ZDA je še vedno manj kot 20 odstotkov elektronskih. Tukaj na Nizozemskem, mislim, da je več kot 80 %.
Now that we're switching to merging medical data, making it available electronically, we can crowd-source the information, and as a physician, I can access my patients' data from wherever I am, just through my mobile device. And now, of course, we're in the era of the iPad, even the iPad 2. Just last month, the first FDA-approved application was approved to allow radiologists to do actual reading on these sorts of devices. So certainly, the physicians of today, including myself, are completely reliable on these devices. And as you saw just about a month ago, Watson from IBM beat the two champions in "Jeopardy." So I want you to imagine when, in a couple of years, we've started to apply this cloud-based information, when we really have the AI physician and leverage our brains to connectivity to make decisions and diagnostics at a level never done. Already today, you don't need to go to your physician in many cases. Only in about 20 percent of visits do you need to lay hands on the patient. We're now in the era of virtual visits. From Skype-type visits you can do with American Well, to Cisco, that's developed a very complex health presence system,
A zdaj, ko prehajamo na združevanje zdravstvenih podatkov, da so dostopni elektronsko, lahko te podatke damo v množično zunanje izvajanje in kot zdravnik, lahko od kjerkoli dostopam do podatkov svojih bolnikov le s svojo mobilno napravo. Zdaj pa smo, seveda, v dobi iPada, celo iPada 2. In ravno prejšnji mesec je FDA odobrila prvo aplikacijo, ki bo radiologu omogočila, da dejansko odčitava s tovrstne naprave. Vsekakor so današnji zdravniki, z mano vred, popolnoma zanesljivi na teh napravah. In kot ste videli, le kakšen mesec nazaj, je IBM-ov Watson premagal dva prvaka v kvizu "Jeopardy". Rad bi, da si zamislite, kako bomo v nekaj letih, po začetku uporabe informacij "iz oblaka", res imeli U.I. zdravnika in bomo svoje možgane povezali, da bi sprejemali odločitve in diagnostike na ravni, ki je še nikoli ni bilo. Že danes vam v mnogih primerih ni treba iti do zdravnika. Le v približno 20 % obiskov je fizični kontakt z bolnikom nujen. Zdaj smo v eri virtualnih obiskov - od obiskov tipa Skype, ki jih lahko storite z "American Well", do "Cisca", ki je razvil kompleksen sistem zdravstvene prisotnosti.
the ability to interact with your health care provider is different. And these are being augmented even by our devices, again, today. My friend Jessica sent me a picture of her head laceration, so I can save her a trip to the emergency room, and do diagnostics that way. Or maybe we can leverage today's gaming technology, like the Microsoft Kinect, hack that to enable diagnostics, for example, in diagnosing stroke, using simple motion detection, using $100 devices. We can actually now visit our patients robotically. This is the RP7; if I'm a hematologist, I can visit another clinic or hospital. These are being augmented by a whole suite of tools actually in the home now. We already have wireless scales. You step on the scale, tweet your weight to your friends, they can keep you in line.
Možnost interakcije s svojim izvajalcem zdravstvenih storitev je drugačna. In naše sedanje naprave to še naprej spreminjajo. Prijateljica Jessica mi je poslala sliko raztrganine na glavi in lahko ji prihranim pot na urgenco in nekaj diagnosticiram na ta način. Mogoče bi lahko izkoristili igričarsko tehnologijo, kot je Microsoft Kinect, in jo shekamo za potrebe diagnostike, na primer za diagnosticiranje kapi s preprosto zaznavo gibov z napravami za sto dolarjev. Dejansko lahko sedaj robotsko obiščemo svoje bolnike - to je RP7; če sem hematolog, lahko obiščem drugo kliniko, bolnišnico. To bo obogateno s celo vrsto orodij, ki jih imamo doma že zdaj. Zamislite si, brezžične tehtnice že imamo. Lahko stopite na tehtnico. Lahko tvitnete svojo težo prijateljem, ki vas lahko nadzirajo.
We have wireless blood pressure cuffs. A whole gamut of technologies are being put together. Instead of wearing kludgy devices, we put on a simple patch. This was developed at Stanford. It's called iRhythm; it completely supplants the prior technology at a much lower price point, with much more effectivity. We're also in the era today of quantified self. Consumers now can basically buy $100 devices, like this little Fitbit. I can measure my steps, my caloric outtake. I can get insight into that on a daily basis and share it with my friends or physician. There's watches that measure your heart rate, Zeo sleep monitors, a suite of tools that enable you to leverage and have insight into your own health.
Imamo brezžične manšete krvnega tlaka. Cel razpon tehnologij se združuje. Namesto nošenja teh nerodnih naprav, lahko nadenemo preprost obliž. To so razvili kolegi na Stanfordu, imenuje se iRhythm - povsem je izpodrinil prejšnjo tehnologijo, po precej nižji ceni z veliko več učinkovitosti. Zdaj smo tudi v eri, t. i. določanja sebe. Potrošniki lahko zdaj kupijo stodolarske naprave, kot je ta majhni FitBit. Lahko merim svoje korake, svojo porabo kalorij. To lahko dnevno nadziram. Lahko delim s prijatelji, s svojim zdravnikom. Prihajajo ure, ki bodo merile srčni utrip, Zeo monitorji spanja, celotna zbirka orodij, ki vam omogoča vpogled v lastno zdravje. In ko začnemo integrirati te informacije,
As we start to integrate this information, we'll know better what to do with it, and have better insight into our own pathologies, health and wellness. There's even mirrors that can pick up your pulse rate. And I would argue, in the future, we'll have wearable devices in our clothes, monitoring us 24/7. And just like the OnStar system in cars, your red light might go on. It won't say "check engine"; it'll be a "check your body" light, and you'll go get it taken care of. Probably in a few years, you'll look in your mirror and it'll be diagnosing you.
bomo bolje vedeli, kaj naj z njimi počnemo, in kako izboljšati vpogled v lastne bolezni, zdravje in dobro počutje. Obstajajo celo ogledala, ki lahko zaznajo vaš srčni utrip. In trdim, da bomo v prihodnosti imeli nosljive naprave v naših oblekah, in se nenehno nadzirali. In tako kot imamo OnStar sistem v avtomobilih, se vam bo prižgala rdeča lučka - a ne bo "preveri motor", ampak "preveri svoje telo" in za "pojdi in poskrbi za to". Verjetno se boste čez nekaj let gledali v svojem ogledalu in le-to vas bo diagnosticiralo.
(Laughter)
(Smeh)
For those of you with kiddos at home, how would you like a wireless diaper that supports your --
Za tiste, ki ste doma z otroci, kako bi vam bilo všeč, da imate brezžično plenico, ki podpira vaš...
(Laughter)
več informacij, kot jih potrebujete.
More information, I think, than you might need, but it's going to be here.
Ampak to bo tukaj.
Now, we've heard a lot today about technology and connection. And I think some of these technologies will enable us to be more connected with our patients, to take more time and do the important human-touch elements of medicine, as augmented by these technologies. Now, we've talked about augmenting the patient. How about augmenting the physician? We're now in the era of super-enabling the surgeon, who can now go into the body and do robotic surgery, which is here today, at a level that was not really possible even five years ago. And now this is being augmented with further layers of technology, like augmented reality. So the surgeon can see inside the patient, through their lens, where the tumor is, where the blood vessels are. This can be integrated with decision support. A surgeon in New York can help a surgeon in Amsterdam, for example. And we're entering an era of truly scarless surgery called NOTES, where the robotic endoscope can come out the stomach and pull out that gallbladder, all in a scarless way and robotically. This is called NOTES, and it's coming -- basically scarless surgery, as mediated by robotic surgery.
Danes smo veliko slišali o novi tehnologiji in povezavo z njo. Mislim, da bo nekaj od teh tehnologij omogočilo večjo povezanost z našimi bolniki, da si bomo vzeli več časa in dejansko izvajali, kar je pomembno, humano medicino, obogateno s tovrstnimi tehnologijami. Govorili smo o, do neke mere, izboljševanju bolnika. Kaj pa izboljševanje zdravnika? Zdaj smo v eri, ko je kirurg super opremljen, da lahko gre v telo in operira z robotsko kirurgijo, ki je danes tukaj, na ravni, ki ni bila mogoča celo pred petimi leti. Zdaj je to razširjeno z dodatnimi plastmi tehnologije kot je obogatena resničnost. Tako da lahko kirurg vidi notranjost bolnika skozi leče, kje je tumor, kje so krvne žile. To je lahko integrirano s podporo za odločitve. Kirurg v New Yorku lahko pomaga kirurgu v Amsterdamu, na primer. In prehajamo v ero kirurgije resnično brez brazgotin imenovane NOTES, kjer lahko gre robotski endoskop ven iz želodca in izvleče žolčnik robotsko in brez brazgotin. To se imenuje NOTES in to prihaja - v bistvu kirurgija brez brazgotin, kot jo omogoča robotska kirurgija.
Now, how about controlling other elements? For those who have disabilities -- the paraplegic, there's the brain-computer interface, or BCI, where chips have been put on the motor cortex of completely quadriplegic patients, and they can control a cursor or a wheelchair or, potentially, a robotic arm. These devices are getting smaller and going into more and more of these patients. Still in clinical trials, but imagine when we can connect these, for example, to the amazing bionic limb, such as the DEKA Arm, built by Dean Kamen and colleagues, which has 17 degrees of motion and freedom, and can allow the person who's lost a limb to have much higher dexterity or control than they've had in the past.
Kako je pa s kontroliranjem drugih delov? Za tiste, ki so invalidi - paraplegike - smo v eri možganskih računalniških vmesnikov ali BCI, kjer so čipi v motorični možganski skorji tetraplegika, ki lahko nadzorujejo kurzor ali voziček ali morebiti robotsko roko. In te naprave so vse manjše, uporablja pa jih vse več teh bolnikov. Še so v kliničnih preizkušanjih, a zamislite si, ko bodo povezane, na primer, z bioničnim udom, kot je DEKA roka, ki so je zgradili Dean Kamen in kolegi, ki ima 17 prostostnih stopenj in lahko omogoči osebi, ki je izgubila ud, da ima veliko višje nivoje spretnosti ali nadzora, kot jih je imela v preteklosti.
So we're really entering the era of wearable robotics, actually. If you haven't lost a limb but had a stroke, you can wear these augmented limbs. Or if you're a paraplegic -- I've visited the folks at Berkeley Bionics -- they've developed eLEGS. I took this video last week. Here's a paraplegic patient, walking by strapping on these exoskeletons. He's otherwise completely wheelchair-bound. This is the early era of wearable robotics. And by leveraging these sorts of technologies, we're going to change the definition of disability to, in some cases, be superability, or super-enabling. This is Aimee Mullins, who lost her lower limbs as a young child, and Hugh Herr, who's a professor at MIT, who lost his limbs in a climbing accident. And now both of them can climb better, move faster, swim differently with their prosthetics than us normal-abled persons.
Torej, res vstopamo v ero nosljive robotike. Če niste izgubili uda - imeli ste možgansko kap, na primer - bi lahko nosili te zmogljive okončine, ali, če ste paraplegik - obiskal sem ljudi na Berkley Bionics - oni so razvili eLEGS. Prejšnji teden sem posnel ta video. Tukaj je paraplegik, ki dejansko hodi s pomočjo jermenov na teh eksoskeletih. Sicer je priklenjen na invalidski voziček. In to je zdaj zgodnja era nosljive robotike. Mislim, da bomo s tovrstnimi tehnologijami spremenili definicijo invalidnosti v super-zmogljivost ali super-opremljenost. To je Aimee Mullins, ki je kot otrok izgubila svoje spodnje okončine, in Hugh Herr, ki je profesor na MIT, ki je izgubil svoje ude v plezalni nesreči. In sedaj oba lahko plezata bolje, se hitreje gibljeta, plavata drugače s svojimi protezami od nas, z normalnimi sposobnostmi.
How about other exponentials? Clearly the obesity trend is exponentially going in the wrong direction, including with huge costs. But the trend in medicine is to get exponentially smaller. A few examples: we're now in the era of "Fantastic Voyage," the iPill. You can swallow this completely integrated device. It can take pictures of your GI system, help diagnose and treat as it moves through your GI tract. We get into even smaller micro-robots that will eventually, autonomously, move through your system, and be able to do things surgeons can't do in a much less invasive manner. Sometimes these might self-assemble in your GI system, and be augmented in that reality.
Kako je z drugimi hitro naraščajočimi trendi? Trend debelosti gre skokovito v napačno smer, vključno z velikimi stroški. Ampak v medicini je trend skokovito zmanjševanje. Nekaj primerov: Zdaj smo v eri filma "Fantastic Voyage," t. i. iPill, to popolnoma integrirano napravo, ki jo lahko pogoltnete in bo lahko slikala vaša prebavila. Pomagala bo diagnostiki in zdravljenju, potujoč skozi vaša prebavila. Prišli smo do še manjših mikrorobotov, ki se bodo sčasoma samostojno premikali skozi vaš sistem in delali stvari, ki jih kirurgi ne morejo početi, veliko manj invazivno. Včasih se bodo lahko sami sestavili v vaših prebavilih in se obogatili v tem okolju.
On the cardiac side, pacemakers are getting smaller and much easier to place, so no need to train an interventional cardiologist to place them. And they'll be wirelessly telemetered to your mobile devices, so you can go places and be monitored remotely. These are shrinking even further. This one is in prototyping by Medtronic; it's smaller than a penny. Artificial retinas, the ability to put arrays on the back of the eyeball and allow the blind to see -- also in early trials, but moving into the future. These are going to be game-changing. Or for those of us who are sighted, how about having the assisted-living contact lens? Bluetooth, Wi-Fi available -- beams back images to your eye.
Glede srca, spodbujevalniki so vse manjši in jih je veliko lažje vstaviti, torej ni treba usposabljati interventnega kardiologa. Brezžično se bodo povezali z vašimi mobilnimi napravami, da vas bodo lahko spremljali na daljavo. Velikosti se še naprej krčijo. Tukaj je prototip Medtronica, ki je manjši od penija. Umetna mrežnica, ki se lahko vgradi na zadnjo stran očesnega zrkla in omogoča slepim, da vidijo. Čeprav v zgodnjih preizkušanjih, a gre v prihodnost. To bo popolna sprememba. Ali pa za tiste med nami z dioptrijo, kako se vam zdijo vseživljenjske kontaktne leče? BlueTooth, WiFi so na voljo - teleportirajo žarke nazaj na oko. Zdaj, če imate težave z vzdrževanjem diete,
(Laughter)
Now, if you have trouble maintaining your diet, it might help to have some extra imagery to remind you how many calories are going to be coming at you.
lahko pomagajo dodatne podobe, da vas spomnijo, koliko kalorij boste zaužili. Kaj, če bi patologa opremili, da preko svojega mobilnega telefona
How about enabling the pathologist to use their cell phone to see at a microscopic level and to lumber that data back to the cloud and make better diagnostics? In fact, the whole era of laboratory medicine is completely changing. We can now leverage microfluidics, like this chip made by Steve Quake at Stanford. Microfluidics can replace an entire lab of technicians; put it on a chip, enable thousands of tests at the point of care, anywhere in the world. This will really leverage technology to the rural and the underserved and enable what used to be thousand-dollar tests to be done for pennies, and at the point of care. If we go down the small pathway a little bit further, we're entering the era of nanomedicine, the ability to make devices super-small, to the point where we can design red blood cells or microrobots that monitor our blood system or immune system, or even those that might clear out the clots from our arteries.
vidi na mikroskopski ravni in da te podatke vrne v oblak, da bi boljše diagnosticiral? V bistvu se celotna era laboratorijske medicine popolnoma spreminja. Sedaj lahko izkoristite mikrofluidne naprave kot je ta čip, ki ga je naredil Steve Quake na Stanfordu. Mikrofluidiki lahko nadomestijo cel laboratorij tehnikov. Na čipu omogočajo, da se naredi na tisoče testov na točki oskrbe, kjerkoli na svetu. In to bo res tehnološki vzvod na podeželju in za nezadostno preskrbljene, ker bodo testi, včasih vredni 1.000 $, narejeni za nekaj penijev in to na kraju oskrbe. Če gremo po poti majhnosti malo dlje, vstopamo v ero nanomedicine, možnosti izdelave super majhnih naprav, do točke, ko bomo lahko oblikovali rdeče krvne celice ali mikro robote, ki bodo nadzirali naš krvni ali imunski sistem, ali celo takšne, ki bodo zmogli očistiti strdke v naših žilah.
Now how about exponentially cheaper? Not something we usually think about in the era of medicine, but hard disks used to be 3,400 dollars for 10 megabytes -- exponentially cheaper. In genomics now, the genome cost about a billion dollars about 10 years ago, when the first one came out. We're now approaching essentially a $1,000 genome, probably next year. And in two years, a $100 genome. What will we do with $100 genomes? Soon we'll have millions of these tests available. Then it gets interesting, when we start to crowd-source that information, and enter the era of true personalized medicine: the right drug for the right person at the right time, instead of what we're doing now, which is the same drug for everybody, blockbuster drug medications, which don't work for the individual. Many different companies are working on leveraging these approaches.
Kaj če bi bilo skokovito cenejše? To ni nekaj, kar se običajno pomisli v eri medicine, ampak trdi diski, nekoč po 3.400 $ za 10 megabajtov, so skokovito cenejši. V genomiki so bili stroški genoma okoli milijarde dolarjev pred približno 10 leti, ko se je pojavil. Zdaj se približujemo genomu po 1.000 $ - verjetno naslednje leto, ali v dveh letih po 100 $. Kaj bomo naredili s stodolarskimi genomi? In kmalu bomo imeli na milijone teh testov. In takrat postane zanimivo, ko bomo začeli s crowdsourcingom teh informacij. Vstopili bomo v ero osebne medicine - pravo zdravilo za pravo osebo ob pravem času - namesto tega, kar danes dajemo - enako zdravilo vsem - neke vrste uspešnice zdravil, zdravil, ki ne delajo za vas osebno. In mnogo različnih podjetij dela na spodbujanju teh pristopov.
I'll show you a simple example, from 23andMe again. My data indicates I've got about average risk for developing macular degeneration, a kind of blindness. But if I take that same data, upload it to deCODEme, I can look at my risk for type 2 diabetes; I'm at almost twice the risk. I might want to watch how much dessert I have at lunch, for example. It might change my behavior. Leveraging my knowledge of my pharmacogenomics: how my genes modulate, what my drugs do and what doses I need will become increasingly important, and once in the hands of individuals and patients, will make better drug dosing and selection available.
Prikazal vam bom preprost primer podjetja 23andMe. Moji podatki kažejo, da imam povprečno tveganje za razvoj procesa degeneracije makule, neke vrste slepote. A če vzamem iste podatke in jih naložim na deCODEme podjetje, lahko vidim svoje tveganje za diabetes tipa 2. Imam skoraj dvakrat večje tveganje za diabetes tipa 2. Mogoče bi želel paziti, koliko sladic lahko pojem za kosilo. To lahko spremeni moje vedenje. Z izkoriščanjem znanja o svoji farmakogenomiki - kako moji geni modulirajo, učinke in odmerke mojih zdravil bo postalo izredno pomembno in ko bo enkrat v rokah posameznika in bolnika, bo boljše odmerjanje in izbor zdravila.
So again, it's not just genes, it's multiple details -- our habits, our environmental exposures. When was the last time your doctor asked where you've lived? Geomedicine: where you live, what you've been exposed to, can dramatically affect your health. We can capture that information. Genomics, proteomics, the environment -- all this data streaming at us individually and as physicians: How do we manage it? We're now entering the era of systems medicine, systems biology, where we can start to integrate all this information. And by looking at the patterns, for example, in our blood, of 10,000 biomarkers in a single test, we can look at patterns and detect disease at a much earlier stage. This is called by Lee Hood, the father of the field, P4 Medicine. We'll be predictive and know what you're likely to have. We can be preventative; that prevention can be personalized. More importantly, it'll be increasingly participatory. Through websites like PatientsLikeMe or managing your data on Microsoft HealthVault or Google Health, leveraging this together in participatory ways will be increasingly important.
Torej še enkrat, ne gre samo za gene, ampak za različne podrobnosti - za naše navade, našo okoljsko izpostavljenost. Kdaj vas je zdravnik nazadnje vprašal, kje živite? Geomedicina: kje ste živeli, čemu ste bili izpostavljeni, lahko močno vpliva na vaše zdravje. Lahko ujamemo te informacije. Torej genomika, proteomika, okolje, vsi ti podatki se zlivajo k nam posamično in mi, kot ubogi zdravniki, kako lahko to obvladamo? Vstopamo v ero sistemske medicine ali sistemske biologije, kjer bomo lahko začeli integrirati vse te informacije. In na vzorcih, na primer v naši krvi, 10.000 biomarkerjev v enem testu, lahko začnemo gledati te majhne vzorce in bolezni bomo odkrili veliko prej. To je imenovano po Lee Hoodu, očetu področja, P4 medicina. Lahko bomo napovedovali, vedeli bomo od česa boste verjetno zboleli. Lahko smo preventivni; preventiva je lahko personalizirana; in še pomembneje, vedno bolj bo participativna. Prek spletnih strani, kot je Patients Like Me, ali z upravljanjem vaših podatkov na Microsoft HealthVault ali Google Health, bo izkoriščanje tega na participativni način postalo izredno pomembno.
I'll finish up with exponentially better. We'd like to get therapies better and more effective. Today we treat high blood pressure mostly with pills. What if we take a new device, knock out the nerve vessels that help mediate blood pressure, and in a single therapy, basically cure hypertension? This is a new device doing essentially that. It should be on the market in a year or two. How about more targeted therapies for cancer? I'm an oncologist and know that most of what we give is essentially poison. We learned at Stanford and other places that we can discover cancer stem cells, the ones that seem to be really responsible for disease relapse. So if you think of cancer as a weed, we often can whack the weed away and it seems to shrink, but it often comes back. So we're attacking the wrong target. The cancer stem cells remain, and the tumor can return months or years later. We're now learning to identify the cancer stem cells and identify those as targets and go for the long-term cure. We're entering the era of personalized oncology, the ability to leverage all of this data together, analyze the tumor and come up with a real, specific cocktail for the individual patient.
Končal bom s skokovito na boljše. Radi bi dobili boljše in učinkovitejše terapije. Danes zdravimo visok krvni tlak predvsem s tabletami. Kaj pa, če vzamemo novo napravo in nokavtiramo živčne prenašalce, ki pomagajo uravnavati krvni tlak, in v eni terapiji ozdravimo hipertenzijo? To je nova naprava, ki, pravzaprav, to dela. Na trgu bo v letu ali dveh. Kaj, če bo več ciljnih terapij za rak? Da, jaz sem onkolog in moram reči, večina tega, kar dajemo, je v bistvu strup. Na Stanfordu in drugje smo se naučili, da lahko odkrijemo izvorne rakave celice, tiste, ki se zdijo res odgovorne za ponovitev bolezni. Torej, če razmišljate o raku, kot o plevelu, se pogosto lahko znebimo plevela. Zdi se, da se skrči, vendar se pogosto vrne. Torej napadamo napačno tarčo. Matične celice raka ostanejo in tumor se lahko vrne čez nekaj mesecev ali let. Zdaj se učimo identificirati izvorne celice raka in, ko jih prepoznamo kot tarče, gremo na dolgoročno zdravilo. In prehajamo v dobo osebne onkologije z možnostjo uporabe vseh teh podatkov skupaj, analize tumorja in določanja pravega, posebnega koktajla za posameznega bolnika.
I'll close with regenerative medicine. I've studied a lot about stem cells. Embryonic stem cells are particularly powerful. We have adult stem cells throughout our body; we use those in bone marrow transplantation. Geron, last year, started the first trial using human embryonic stem cells to treat spinal cord injuries. Still a phase I trial, but evolving. We've been using adult stem cells in clinical trials for about 15 years to approach a whole range of topics, particularly cardiovascular disease. If we take our own bone marrow cells and treat a patient with a heart attack, we can see much improved heart function and better survival using our own bone marrow derived cells after a heart attack.
Zaključil bom s regenerativno medicino. Veliko sem študiral o matičnih celicah - embrionalne matične celice so še posebej močne. Imamo tudi odrasle matične celice. Te uporabljamo na mojem področju presaditev kostnega mozga. Lansko leto je Geron začel prvo preizkušanje z uporabo izvornih celic človeških zarodkov za zdravljenje poškodb hrbtenjače. Še vedno v prvi fazi preizkušanja, ampak se razvija. Uporabljali smo izvorne celice odraslih, ki so v kliničnih preskušanjih približno 15 let, da pristopimo celemu spektru vsebin, predvsem pri boleznih srca in ožilja. Vzamemo lastne celice kostnega mozga in zdravimo bolnika s srčnim napadom, lahko vidimo zelo izboljšano delovanje srca in boljše preživetje
I invented a device called the MarrowMiner, a much less invasive way for harvesting bone marrow. It's now been FDA approved; hopefully on the market in the next year. Hopefully you can appreciate the device going through the patient's body removing bone marrow, not with 200 punctures, but with a single puncture, under local anesthesia.
z uporabo lastne pogonske celice kostnega mozga po srčnemu napadu. Izumil sem t. i. MarrowMiner, ki dosti manj invazivno nabira kostni mozeg. Zdaj jo je FDA odobrila in upam, da bo prišla na trg naslednje leto. Upam, da boste lahko občudovali, kako se naprava krivi skozi bolnikovo telo in odstranjuje kostni mozeg, namesto z 200 punkcijami, z eno samo punkcijo pod lokalno anestezijo.
Where is stem-cell therapy going? If you think about it, every cell in your body has the same DNA you had when you were an embryo. We can now reprogram your skin cells to actually act like a pluripotent embryonic stem cell and utilize those, potentially, to treat multiple organs in the same patient, making personalized stem cell lines. I think there'll be a new era of your own stem cell banking to have in the freezer your own cardiac cells, myocytes and neural cells to use them in the future, should you need them. We're integrating this now with a whole era of cellular engineering, and integrating exponential technologies for essentially 3D organ printing, replacing the ink with cells, and essentially building and reconstructing a 3D organ.
Kam v resnici gre zdravljenje z matičnimi celicami? Če pomislite, vsaka celica v telesu ima enako DNK, kot ste jo imeli kot zarodek. Sedaj lahko reprogramiramo vaše kožne celice, da delujejo kot pluripotentne embrionalne matične celice in jih lahko uporabljamo za zdravljenje več organov v istem bolniku - za izdelavo vaše lastne, osebne linije izvornih celic. Mislim, da bo nova era lastnih bank za hrambo matičnih celic, da boste imeli v zamrzovalniku lastne srčne celice, miocite in nevronske celice, za primer, če jih boste potrebovali. In sedaj to integriramo s celotno ero mobilnega inženiringa in integriramo skokovite tehnologije za tiskanje 3D organov - nadomeščamo črnilo s celicami in pravzaprav gradimo in rekonstruiramo 3D organ.
That's where things are heading. Still very early days, but I think, as integration of exponential technologies, this is the example. So in closing, as you think about technology trends and how to impact health and medicine, we're entering an era of miniaturization, decentralization and personalization. And by pulling these things together, if we start to think about how to understand and leverage them, we're going to empower the patient, enable the doctor, enhance wellness and begin to cure the well before they get sick. Because I know as a doctor, if someone comes to me with stage I disease, I'm thrilled; we can often cure them. But often it's too late, and it's stage III or IV cancer, for example. So by leveraging these technologies together, I think we'll enter a new era that I like to call stage 0 medicine. And as a cancer doctor, I'm looking forward to being out of a job.
Stvari bodo šle v to smer - še zelo zgodnje obdobje. Ampak mislim, da je za vključevanje eksponentnih tehnologij, to primer. Tako na koncu, ko mislite o tehnoloških trendih in kako vplivajo na zdravje in medicino, vstopamo v ero miniaturizacije, decentralizacije in personalizacije. Če te stvari združimo, lahko začnemo razmišljati, kako jih razumeti in uporabiti, bomo opolnomočili bolnika, opremili zdravnika, izboljšali dobro počutje in začeli z zdravljenjem, še preden zbolijo. Ker kot zdravnik vem, če nekdo pride k meni z začetno stopnjo bolezni, sem navdušen - pogosto jih lahko ozdravimo. Toda pogosto je prepozno in je stopnja III ali IV raka, na primer. S skupnim izkoriščanjem teh tehnologij, mislim, da bomo vstopili v novo ero, ki ji rad rečem Medicina na stopnji 0. In kot onkologa me veseli, da bom ostal brez službe.
Thanks very much.
Hvala lepa.
(Applause)
Gostiteljica: Hvala. Hvala.
Host: Thank you. Thank you.
(Aplavz)
(Applause)
Poklon. Poklon.
Take a bow, take a bow.