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.
幾年前 當我參加TED長灘會議的時候 我遇見了哈里特。 我們之前在網路上就遇到過 不是你們想的那種遇見方式。 其實我們遇見是因為我們都認識琳達.埃維 她是最早的線上私人基因組公司的創始人之一。 因為琳達知道我們兩人的基因訊息 所以她發現我們兩個都有一種罕見的線粒體DNA 叫做單倍體基因型 K1a 1b 1a 這說明了我們是遠親。 其實我們和冰人奧茲也有血緣關係 所以,奧茲、哈裏特和我算是親戚。 因為現在大家都使用臉書,我們當然也設立了自己的臉書群組。 我們歡迎你們加入。 隔年當我在TED會議上遇到哈里特時 她早就已經上網訂做了我們自己的快樂單倍體T恤。 為什麼我要告訴你們這件事呢?
(Laughter)
這和我們未來的健康又有什麼關係呢?
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.
我和哈裏特相遇的過程其實充分地說明了一件事 那就是跨學科的研究、突飛猛進的科技 正影響我們將來的身心健康—— 這些研究和科技包含了低成本的基因分析 有能力運用功能強大的生物信息學 以及網路和社會網絡之間的關聯。 今天我想談的就是我們應該了解這些指數科技。 我們的思考經常是直線的。 但是你想像一下,如果你有一片蓮花葉子 而且它每天都分裂一次 兩片,四片,八片,十六片 15天後你就有三萬兩千片葉子。 那一個月後你認為會有多少葉子?答案是10億。 所以如果我們開始學著「次方性思考」 我們就可以讓我們身邊所有的科技有所不同。 許多這些科技,就我醫生的角色和想創新的人來說, 是我們真的能用來改變我們未來的健康以及保健發展 解決我們現今在保健發展遇到的主要難題 例如說保健制度的巨額成本 老年人口
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.
沒能非常有效地運用資訊、整合保健制度 還有採用創新技術時 過程也經常是困難重重。 我們能做的一件重要的事,這我們今天也剛談了一些 就是把這條曲線向左移。 我們把大多數金錢花費在生命階段的最後百分之二十。 如果我們將錢花在保健制度和我們自身的健康管理中 透過科技親自參予這些系統運作和管理 將曲線向左移、改善我們的健康,那會怎樣呢? 我最喜歡的科技是「次方科技」 我們大家現在都在使用這種科技了。 想想看,這些科技現在正突飛猛進。 打個比方,iPhone4已經是這樣了 想像一下iPhone8的功能會有多強大。 我對這項技術已經有一些心得。 我在矽谷一家辛格蘭若堤大學的醫學部門工作 我們會在每個夏天從全世界找來一百個傑出的學生 研究這些關於醫學,生物科技 人工智能,機器人技術,納米技術,空間技術的整合科技, 解決跨學科訓練的問題 並利用這些技術來影響還沒有實現的重大目標。
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.
我們也有七天的執行計畫。 接下來的幾個月是「未來醫學」 這個計畫能協助跨學科訓練並將技術運用到醫學上。 我剛提到了手機。 這些手機擁有超過兩萬個不同的應用程序 甚至英國還設計了一種應用程式 你可以把一片小晶片連上你的 iPhone,然後在晶片上小便 看看你是不是得了性病。 我不知道我會不會試,不過是有這樣的程式可以用。 還有其他的應用程式能讓手機有診斷功能。 例如說如果你有糖尿病 你可以用iPhone來測量血脂 然後把數據發給你的醫師
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.
所以你和醫生都能更了解你的血糖狀況。 讓我們看看整合科技是如何應用在保健用途上。 讓我們從速度開始。 我們都知道,就如摩爾定律所說的 電腦運作的速度越來越快了。 所以我們能夠運用它們來做更多事。 電腦的能力越來越接近人腦的能力 很多情況下甚至超越了人腦。 但我認為電腦的速度對成像技術的好處最大。 這種用非常高畫素即時地呈現身體內部的技術 進步真的是越來越驚人。 我們正在綜合多種技術, PET掃描、CT掃描和分子診斷 來發現和尋找所在位置不同的東西。 你現在看到的是今天MRI掃描技術以極高畫素重建的馬克.霍頓希的頭像 他是TED醫學會議的管理者。 現在我們可以以前所未有的的像素和能力來看大腦內部
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.
從根本上學會如何重建、甚至重新設計、或是逆向設計大腦 因此我們能更了解病變,疾病和治療方法。 我們能用fMRI即時來觀察大腦內部。 通過理解這些過程和聯繫 我們能夠瞭解藥物和冥想所帶來的影響 改善個人化治療、提高功效 例如說,更符合個人需求、更有效的精神藥物。 fMR用的掃描器現在變得更小更輕便,也不像過去那樣昂貴。 從這些掃描器得到的數據實在太多 很快地會造成很大的問題。 現在的掃描佔用了800本書的空間或者20G。 幾年後的掃描將會佔用1T或者800000本書的空間。 我們該如何去利用這些信息呢? 讓我們從自己的例子說起吧。我不會問這裡誰做過結腸檢查, 但是如果你大於50歲,那麼該是你檢查結腸的時候了。 你怎麼避開結腸鏡的尖端呢? 現在有一種虛擬的結腸鏡檢查。 比較這兩張圖,作為放射科醫生 你可以檢查你病人結腸的內部 藉由人工智慧的協助 找出可能受傷的部位,就像你在這裡所看到的損傷。 我們以前可能會錯過這種損傷,但是藉由在放射科中用人工智能 我們能找到我們以前沒發現的損傷。
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.
這可能會讓以前不願做結腸檢查的人願意檢查。 這是一個診療方式轉變的例子。 我們正朝向一個生物醫學、信息技術和無線網路的整合時代 而且我會說是「整合機動式」時代,也就是數位醫學的時代。 所以甚至我的聽診器都是數位的。 當然,它有個應用程序。 我們正走向《星際奇航記》裡出現的那個「影音分析儀」的時代。 這種手持超音波儀器正超越而且取代聽診器。 這種儀器過去的價位是十萬英鎊或幾十萬美元 現在只要大約五千美元 我就能買得起這樣一個功能強大的診斷儀器。 我們正把這個裝置和電子醫療記錄結合起來 在美國,電子化醫療紀錄仍然少於百分之二十。 我想在荷蘭應該高於百分之八十。 但是我們現在轉到結合醫療數據, 把數據電子化, 如此我們就能整合資訊。 現在作為一名醫生,不論在哪裡
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.
透過這些移動設備,我就能得到病人的數據。 當然,我們正處在iPad,甚至iPad2的時代。 就在上個月美國食品藥品管理局首度通過的應用程序 證實可以讓放射科醫生直接在這些設備上讀數據。 所以肯定的是,現今的醫生,包括我自己 已經完全離不開這些設備了。 正如你們大約一個月前所看到的 來自IBM的華生在益智節目「危險邊緣」中擊敗了兩位冠軍。 因此我要你們想像當我們在幾年內開始採用雲端資訊 並真正有了人工智慧醫生連接到我們的大腦 我們做的決定和診斷會和過去全然不同。 你們現在在很多情況下已經不需要去看醫生了。 只有大約百分之二十的狀況下醫生才會用到手來做診療。 我們正處在虛擬診療的時代 從使用Skype到American Well來做線上看病
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,
到思科研製的非常精密的健康診斷系統。 這種和你的醫師的互動能力是有別於以往的。 現在因為有這些設備我們的能力更是提高了。 這是我的朋友傑西卡傳給我的她頭部裂傷的圖片 所以她不用來急診室,我能通過看照片來診斷。 或許我們能利用現今的遊戲技術 比如微軟Kinect來進行診斷。 例如在診斷中風時, 用簡單的移動偵測儀器和幾百元的設備就可以進行檢測。 我們現在實際上能用機器人來看病。 如果我是一名血液病專家 可以用這台RP7到另一家診所或醫院看診。 這種能提升診療效率的整套工具其實現在在家就找的到。 所以想像一下,我們已經擁有無線網路體重計。 你可以站在體重計上 你可以把你的體重用Tweet告訴你的朋友,他們能幫你保持身材。 我們有無線網絡血壓器。 我們正在整合這所有的技術。 所以我們不用戴這些雜七雜八的裝置,而是可以把他們變成一個貼片。 這是我在史丹福的一個同事發明的iRhythm。 它完全取代了先前的技術,而且價格低很多,效率更好。 現在我們正處於自我量化的時代。 人們可以買幾百元的裝置
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.
像這個小FitBit。 我可以量化我的步數和我的卡路里消耗。 我可以每天都從這些數據了解一些事情。 我可以把數據和朋友,醫生分享。 現在有一種手錶可以測量你的心律,叫Zeo睡眠偵測器。 它能讓你使用這些資訊對自身的健康更了解。 當我們開始整合這些資訊 我們就會更知道用它做什麼,更了解我們的病狀和身心健康。 現在甚至有一種鏡子可以測量你的脈搏率。 我認為,在未來,我們衣服裡會有可以穿戴的裝置 全天候檢測我們的身體。 就像我們現在車裏的OnStar系統, 紅燈會亮起,雖然它不會說「去檢查引擎」 但它會說去「檢查你的身體」 回家好好照顧自己。 也許幾年後 你照鏡子時鏡子會幫你看病。
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.
家裡有小孩的 你會想要這種會幫你的無線尿布吧... 我想你不需要這麼多資訊。 但是這一天會來的。 今天我們已經聽了很多新技術和技術整合。 我認為有些技術會使我們和病人更接近 有更多時間表達我們對病人的關懷。 這些技術能夠提供這樣的幫助。 我們談到了一些能幫助患者的科技 那麼科技如何幫助醫生呢? 我們正處在「超強化外科醫生」的時代。 他們能進入身體內部 用機器人做手術,這現在已經可以做到了。 這種水平即使是短短五年前都不太可能達到的。
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.
現在這種技術還因為多重影像技術,例如「增像技術」得到提升。 所以醫生能通過他們的鏡頭看到患者的內部 看腫瘤在哪裡,血管在哪裡。 除此之外,「決策支持」這個技術也可以和「機器手術」做整合。 例如說,在紐約的醫生可以幫阿姆茲特丹的醫生。 我們正在步入一個叫做NOTES的真正無疤手術的時代。 機器內窺鏡能穿過胃部切除膽囊 不會留下疤痕,過程也是機器化的。 這是即將被採用的技術。 基本上是一種無疤手術 拜機器化手術之賜。 除了控制機器手,我們還能控制其他東西嗎?
(Laughter)
對於身障人士,那些半身不遂的人
For those of you with kiddos at home, how would you like a wireless diaper that supports your --
有一種能讓人腦和電腦互動的技術叫做BCI。 在四肢癱瘓者的大腦皮層運動區植入晶片
(Laughter)
他們就能控制滑鼠指標、輪椅或者機器手臂。
More information, I think, than you might need, but it's going to be here.
這些晶片現在做得越來越小 越來越多患者體內都能夠放入這種晶片。
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.
這種技術仍在臨床階段,但想像一下 當我們將這些技術結合令人驚歎的仿生學假肢 像卡門院長和他的同事設計的DEKA手臂 有17種不同的移動方式和靈活度 能使失去肢體的人比以前更靈巧。 我們實際上真正進入到了可穿的機器人時代。 如果你手腳完好,但是你得了中風 你可以穿這些假肢。 或者假如你下半身癱瘓,像我在巴克力仿生物公司拜訪的朋友們 他們發明了eLEGS。 我上週拍了這段影片。 影片中這位半身癱瘓的人因為穿上這些仿生裝備正在走路。 如果不穿這些盔甲,他完全得依賴輪椅。 這些機器裝備現在還在發展初期。 我認為藉由這些技術 我們能改變對殘疾的定義 在某些情況下甚至能將「殘疾」轉變成「超能」。 這是艾米.馬林斯,她在小時候就失去了雙腿。 這是休.赫爾,麻省理工的教授 他也在一次攀岩事故中失去了雙腿。 現在他們通過修復手術可以比正常人爬得更好,動得更快 用不同的方式游泳。 再說說其他的整合科技吧。 很明顯地,肥胖趨勢朝著錯誤的方向快速發展 包括肥胖症造成的支出也是越來越龐大。 但是醫學儀器卻有種越做越迷你的趨勢。
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.
例如說,我們可以用這種電子藥丸來做一趟「奇幻航行」。 你可以吞下這個麻雀雖小卻五臟俱全的裝置。 當它通過你的消化道時 能在消化道裡拍照,並且進行診斷和治療。 我們還做了更小的微型機器人 他們能自動通過你的消化系統 用一種更溫和的方式來做外科醫師做不到的事。 有時這些裝置會在你的消化系統內自行組裝 從而提升使用價值。 在心臟儀器方面,起搏器越來越容易植入 因此不需要訓練一位介入性心臟科醫師來植入這些儀器。 你可以用移動裝置再次的無線遙控這些儀器。 所以你可以去任何地方而不影響對儀器的遠程遙控。 我們甚至還要把它做得更小。 這是一個Medtrinic製作的樣品,比一分錢還小。
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.
另外,我們能將人工視網膜放到眼球後面 使盲人回復視力。 雖然這還在早期實驗階段,但成功的機率是很大的。 這些將會是革命性的改變。 或著對我們這些視力正常的人 有了這些輔助生活的隱形眼鏡會怎樣? 我們現在有藍牙、無線網絡,可以將圖像投射到你的眼睛。 如果你維持飲食有困難 這些額外的圖像也許能提醒你食物裡有多少卡路里。 如果病理學家能把他們的手機當做顯微鏡使用 把資料傳回主機,進行更好的診斷,這會是怎樣的局面呢? 實際上,現在整個實驗醫學界的情況已經完全改變了。 我們現在能利用微流體 像斯坦福大學的史提夫. 奎克做的這片晶片。 微流體技術能取代整個實驗室的技術員。 把它放在晶片上 它能在世界上任何地方的照護站同時做上千個檢測。
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.
這些技術對農村和醫療不發達的地方會非常有幫助。 它能把上千元的檢測成本縮減到幾分錢 而且在任何的照護站都能做。 如果我們沿著這條「微科技之路」再稍微往前走一點 我們就會進入奈米醫學時代。 奈米科技讓我們能將儀器做的超級迷你 迷你到我們可以設計紅血球細胞 或者設計微型機器人來檢測我們的血液或免疫系統 或者甚至清除動脈裏的血栓。 再來說到成本大減價這一點。 不是我們通常在醫學時代裡想到的那種 而是過去10MB就要3400元的硬碟現在變得非常的便宜。 在基因組學裏 十年前我們花了十億美元才發現第一組基因組 現在基本上找出基因組的成變成一千美元
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.
也許今後一兩年就只要一百美元。 我們能用一百元換來的基因組做什麼呢? 很快的我們能用這些基因組來做數以百萬種的檢測。 當我們集中這些基因組資訊的時候,事情就變得很有意思了。 我們會開始進入了真正的個人化的醫學時代 在正確的時間為正確的人做正確的藥 而不是像現在這樣,給每個人同樣的藥 有點像是胡亂開藥似的 開給對病人沒用的藥。 很多不同的公司正在努力利用這些方法。 我來舉一個簡單的例子,還是來自「23和我」的例子。 我的數據顯示我已經到了會得視網膜斑點退化的危險期 這是會導致失明的疾病。 但是如果我把同樣的數據上傳到deCODEme
(Laughter)
我還能看到我得到第二型糖尿病的風險有多高。
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.
我得第二型糖尿病的風險幾乎高於標準值兩倍了。 所以我可能會開始注意我在午飯休息時間吃了多少甜點。 因此這種診斷也許會改變我的行為。
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.
利用我對基因藥理學的知識 我的基因如何控制,我的藥物作用是什麼,甚麼可以滿足我的需求 這些都將變得越來越重要 一旦人們和患者有了這些資訊 就能提升藥物劑量和藥物選擇的品質。 所以不是只有基因重要 我們的習慣和環境都很重要。 上次你的醫生問你住在哪裡是什麼時侯? 在風土醫學裡 你住在哪裡,你接觸過什麼對你的健康有極大的影響。 我們能抓住這些信息。 因此基因組學,蛋白組學,環境, 所有這些數據都湧向我們和可憐的醫生。 我們該如何管理它? 我們正在進入系統醫學或者系統生物學時代 也就是說我們能開始整合這些資訊。 例如,做檢測時可以在我們的血液中發現一萬個生物標記 透過觀察這些標記 我們能看到這些小標記
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.
讓我們更早發現疾病。 這個領域的創始人李.胡德稱這種方法為P4醫學。 我們將能預測我們可能會得甚麼病。 我們能預防,這種預防性可以針對個人需求。 更重要的是,每個人都能夠參予其中。 透過一些如「Patients Like Me」這樣的網站 或是使用微軟HealthVault或谷歌健康軟體來管理你的數據, 病人能利用這些方法參予預防診斷過程 這點會變得越來越重要。 再來我要以「品質」來作為結束。 我們的治療會更好、更有效。 現在高血壓大部分是通過吃藥來治療。 如果我們用一種新裝置 麻醉調節血壓的神經血管 一次就能治好高血壓。 這新裝置已經能做到這種治療了。 再一、兩年內應該就可以上市。
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.
還有更有目標性的癌症療法。 我是腫瘤科醫生 我必須說大多數我們開的藥其實是毒藥。 我們斯坦福和其他地方發現 我們能找到癌症幹細胞 就是可能引起癌症復發的細胞。 如果你把癌症看成是一個種子 我們通常能除掉這些種子。 它看似萎縮,但經常又長回來。 所以我們瞄準的目標是錯誤的。 癌症幹細胞依然存在 腫瘤能在幾個月後或幾年後再長出來。 我們現在學會了鑒定癌症幹細胞
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.
將它們設為長期治療的目標。 我們正在進入個人化腫瘤學時代 我們有能力會整、利用這些資訊 有能力分析腫瘤 為每一個患者量身制做出一套有效的雞尾酒式療法。 最後我要說的是再生醫學。 我對幹細胞研究很多 胚胎幹細胞再生能力特別強。 我們體內也遍佈成體的幹細胞。 我們把這些幹細胞運用在骨髓移植領域。 就在去年傑龍做了第一次嘗試 他用人類的胚胎幹細胞治療脊髓神經傷害。 雖然仍在實驗階段,但有進展。 我們在臨床實驗運用成體幹細胞大概有十五年了 用它來治療許多不同的疾病,尤其是心血管病。 我們取出自己的骨髓細胞治療心臟病病人 病人心臟病發後用了我們自己的骨髓細胞 我們發現病人的心臟功能改蓋,而且活得更好。 我發明了一種叫MarrowMiner的裝置 它能用比較溫和的方式來收集骨髓。 美國食品藥物管制局已經核准這個裝置 預期將會在這一兩年內上市。 希望你們能喜歡這個發明 它能沿著患者的脊椎移除患者的骨髓
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.
以前需要穿刺兩百次,現在只要局部麻醉後作一次穿刺就可以。 但是現在幹細胞治療是朝什麼方向發展呢? 想一下,你身體裡每一個細胞都有同樣的DNA 這在你還是一個胚胎的時候就有了。 我們現在能重新構造你的皮膚細胞 讓它就像一個多功能的胚胎幹細胞 利用這個技術能治療同一個患者的多個器官 製造你個人的幹細胞线。 我認為這將開啟個人幹細胞庫的新時代 把你的心血管細胞、肌肉細胞、神經細胞存在冷凍櫃裡 在你將來需要的時候使用。 我們現在用這所有的細胞工程技術來整合這些資訊。 為3D器官影像列印整合技術 用細胞代替墨水來重建一個3D器官。 這是未來發展的方向,現在我們還在發展初期。 但我認為,就整合科技來說 這是最好的一個例子。 所以在結束的時候,我想說說現在的技術趨勢 以及這些趨勢對健康和醫學會有怎樣的巨大影響。 我們正進入微型化、分散化、個人化的時代。 我認為如果我們能開始思考如何了解、利用這些技術 透過集中這些技術 我們就能讓病患對疾病更了解 讓醫生更有能力,讓人們更健康 而且能夠防患於未然。 因為作為醫生我知道,如果某人在患病初期來看我
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.
我會很高興,因為通常我們可以治好他們的病。 但是他們經常來得太晚,例如可能到了癌症三或四期才來。 所以通過利用這些整合技術 我認為我們可以進入一個新時代 我稱之為「零期醫學」的時代。 作為一名癌症醫生,我期待失業。 非常感謝。 謝謝,謝謝。 鞠躬,鞠躬。
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.
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.
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.
Thanks very much.
(Applause)
Host: Thank you. Thank you.
(Applause)
Take a bow, take a bow.