I want to share some personal friends and stories with you that I've actually never talked about in public before to help illustrate the idea and the need and the hope for us to reinvent our health care system around the world. Twenty-four years ago, I had -- a sophomore in college, I had a series of fainting spells. No alcohol was involved. And I ended up in student health, and they ran some labwork and came back right away, and said, "Kidney problems." And before I knew it, I was involved and thrown into this six months of tests and trials and tribulations with six doctors across two hospitals in this clash of medical titans to figure out which one of them was right about what was wrong with me. And I'm sitting in a waiting room some time later for an ultrasound, and all six of these doctors actually show up in the room at once, and I'm like, "Uh oh, this is bad news." And their diagnosis was this: They said, "You have two rare kidney diseases that are going to actually destroy your kidneys eventually, you have cancer-like cells in your immune system that we need to start treatment right away, and you'll never be eligible for a kidney transplant, and you're not likely to live more than two or three years."
我要分享一些我的朋友和故事 我从来没有公开谈过 我的目的是要说明一种想法、 一种需求、一种希望 以重塑全球的医疗照护系统 24年前,我还是个大二学生 我昏迷了好几次,不是因为酒醉 我被送到学生健康中心 做了一些检验后,立刻得知 是肾脏问题 我还没搞清楚状况,就开始了 六个月的检验、考验和折磨 由2家医院的6位医生诊治 这些医界权威互相争执 想厘清谁才正确 诊断出我的病情 做完超音波后,我坐在候诊室 6位医生同时出现 我想:「糟了,一定是坏消息!」 医生诊断说: 「你得了两种罕见的肾脏疾病, 最终会让你的肾脏坏死, 你的免疫系统中有类似癌症细胞, 必须立即治疗。 你永远不可能符合换肾资格, 最多还能活2到3年。」
Now, with the gravity of this doomsday diagnosis, it just sucked me in immediately, as if I began preparing myself as a patient to die according to the schedule that they had just given to me, until I met a patient named Verna in a waiting room, who became a dear friend, and she grabbed me one day and took me off to the medical library and did a bunch of research on these diagnoses and these diseases, and said, "Eric, these people who get this are normally in their '70s and '80s. They don't know anything about you. Wake up. Take control of your health and get on with your life." And I did.
这项诊断好像世界末日 让我立刻认定 自己就是病人 将在医生宣判的日期死亡 我在候诊室遇到另一位病人薇娜 (Verna) 她成了我的好友,有天她拉着我 带我到医学图书馆 仔细研究我的疾病和诊断 然后说:「得到这些疾病的人, 通常都是七、八十岁, 他们根本不了解你,醒醒吧, 掌握自己的健康、好好的生活!」 我真的这么做了
Now, these people making these proclamations to me were not bad people. In fact, these professionals were miracle workers, but they're working in a flawed, expensive system that's set up the wrong way. It's dependent on hospitals and clinics for our every care need. It's dependent on specialists who just look at parts of us. It's dependent on guesswork of diagnoses and drug cocktails, and so something either works or you die. And it's dependent on passive patients who just take it and don't ask any questions.
宣告我病症的人 都不是坏人 他们都是仁心仁术的专科医师 但他们在有缺陷、昂贵、错误 的系统下工作 所有的照护都依赖医院与诊所 依赖只看我们部分身体的专科医师 依赖基于猜测的诊断 以及乱枪打鸟的用药 他不成功,你就成仁 这系统也依赖消极的病人 默默承受、不问问题
Now the problem with this model is that it's unsustainable globally. It's unaffordable globally. We need to invent what I call a personal health system. So what does this personal health system look like, and what new technologies and roles is it going to entail?
以上这种模式是有问题的 以全球来说,是无法永续的 也是无法负担的 我们要发展「个人化健康系统」 个人化健康系统是什么? 有哪些新技术、新角色?
Now, I'm going to start by actually sharing with you a new friend of mine, Libby, somebody I've become quite attached to over the last six months. This is Libby, or actually, this is an ultrasound image of Libby. This is the kidney transplant I was never supposed to have. Now, this is an image that we shot a couple of weeks ago for today, and you'll notice, on the edge of this image, there's some dark spots there, which was really concerning to me. So we're going to actually do a live exam to sort of see how Libby's doing. This is not a wardrobe malfunction. I have to take my belt off here. Don't you in the front row worry or anything. (Laughter) I'm going to use a device from a company called Mobisante. This is a portable ultrasound. It can plug into a smartphone. It can plug into a tablet. Mobisante is up in Redmond, Washington, and they kindly trained me to actually do this on myself. They're not approved to do this. Patients are not approved to do this. This is a concept demo, so I want to make that clear. All right, I gotta gel up. Now the people in the front row are very nervous. (Laughter)
我现在要与各位分享 我的新朋友「利比」(Libby) 过去半年我们关系密切 这就是利比 也可说是利比的超音波影像 是我本来永远等不到的移植肾脏 这是几周前照的影像 请注意角落 那里有些阴影,我很担心 我要在现场进行检验 看看利比的状况好不好 不是衣服有问题,我要脱掉皮带 前排的请不要担心 (笑声) 我要开始使用行动检测公司 (Mobisante) 所开发的仪器 叫做行动超音波 可连接手机或平板计算机 行动检测公司在华盛顿州雷德蒙市 他们好心训练我自助使用 他们没有获准这么做 病人也没获准这么用 先讲清楚,这只是概念的展示 涂上凝胶 现在前排观众很紧张了 (笑声)
And I want to actually introduce you to Dr. Batiuk, who's another friend of mine. He's up in Legacy Good Samaritan Hospital in Portland, Oregon. So let me just make sure. Hey, Dr. Batiuk. Can you hear me okay? And actually, can you see Libby?
我要介绍贝谢克医师 (Dr. Thomas Batiuk) 他是我的另一位朋友 在奥勒冈州波特兰市的撒马里亚 慈善医院 (Legacy Good Samaritan) 先确认一下,贝医生,听得到吗? 还有,你看得到「利比」吗?
Thomas Batuik: Hi there, Eric. You look busy. How are you?
贝医师:嗨!艾瑞克,你好 (即演讲者 Eric Dishman) 你看起来好忙啊!你好!
Eric Dishman: I'm good. I'm just taking my clothes off in front of a few hundred people. It's wonderful. So I just wanted to see, is this the image you need to get? And I know you want to look and see if those spots are still there.
艾瑞克:我很好,我刚脱了衣服 有几百位观众在看,感觉真好! 我想知道这是不是你要看的影像? 请帮我检查那些阴影还在不在?
TB: Okay. Well let's scan around a little bit here, give me a lay of the land.
贝医师:请往周围扫描一下 我先看一下整体状况
ED: All right.TB: Okay. Turn it a little bit inside, a little bit toward the middle for me. Okay, that's good. How about up a little bit? Okay, freeze that image. That's a good one for me.
艾瑞克:好的 贝医师:往里面一点 往中间一点点 好,很好,往上一点点 停,这个影像正是我要的
ED: All right. Now last week, when I did this, you had me measure that spot to the right. Should I do that again?
艾瑞克:上周停住时 你要我量阴影的大小 现在要做吗?
TB: Yeah, let's do that.
贝医师:没错,量一下
ED: All right. This is kind of hard to do with one hand on your belly and one hand on measuring, but I've got it, I think, and I'll save that image and send it to you. So tell me a little bit about what this dark spot means. It's not something I was very happy about.
艾瑞克:这有点难 一手在腹部,另一手还要操作 我想我做到了 我把影像存盘,再寄给你 请告诉我那个阴影是什么 我不太安心
TB: Many people after a kidney transplant will develop a little fluid collection around the kidney. Most of the time it doesn't create any kind of mischief, but it does warrant looking at, so I'm happy we've got an opportunity to look at it today, make sure that it's not growing, it's not creating any problems. Based on the other images we have, I'm really happy how it looks today.
贝医师:很多人在肾脏移植后 肾脏周围会积水 大部分不会造成伤害 但是需要注意 很高兴今天有机会检查 确认没有变大、不会造成问题 与先前影像比较 我很满意今天的状况
ED: All right. Well, I guess we'll double check it when I come in. I've got my six month biopsy in a couple of weeks, and I'm going to let you do that in the clinic, because I don't think I can do that one on myself.
艾瑞克:我去看诊时请再检查一次 再几周就要做6个月的切片检查 我会请你帮忙 因为我没办法自己作切片
TB: Good choice.ED: All right, thanks, Dr. Batiuk. All right. So what you're sort of seeing here is an example of disruptive technologies, of mobile, social and analytic technologies. These are the foundations of what's going to make personal health possible.
贝医师:没错 艾瑞克:谢谢你,贝医师 好的,各位刚才看到的 是革命性的创新技术 包括行动装置、社群、分析技术 是未来个人化健康照护的基础
Now there's really three pillars of this personal health I want to talk to you about now, and it's care anywhere, care networking and care customization. And you just saw a little bit of the first two with my interaction with Dr. Batiuk.
有三大支柱支撑着… 接下来要谈的个人化健康照护 就是照护行动化、网络化、客制化 刚才只匆匆一瞥前两项 看到我和贝医生的互动
So let's start with care anywhere. Humans invented the idea of hospitals and clinics in the 1780s. It is time to update our thinking. We have got to untether clinicians and patients from the notion of traveling to a special bricks-and-mortar place for all of our care, because these places are often the wrong tool, and the most expensive tool, for the job. And these are sometimes unsafe places to send our sickest patients, especially in an era of superbugs and hospital-acquired infections. And many countries are going to go brickless from the start because they're never going to be able to afford the mega-medicalplexes that a lot of the rest of the world has built. Now I personally learned that hospitals can be a very dangerous place at a young age. This was me in third grade. I broke my elbow very seriously, had to have surgery, worried that they were going to actually lose the arm. Recovering from the surgery in the hospital, I get bedsores. Those bedsores become infected, and they give me an antibiotic which I end up being allergic to, and now my whole body breaks out, and now all of those become infected. The longer I stayed in the hospital, the sicker I became, and the more expensive it became, and this happens to millions of people around the world every year. The future of personal health that I'm talking about says care must occur at home as the default model, not in a hospital or clinic. You have to earn your way into those places by being sick enough to use that tool for the job. Now the smartphones that we're already carrying can clearly have diagnostic devices like ultrasounds plugged into them, and a whole array of others, today, and as sensing is built into these, we'll be able to do vital signs monitor and behavioral monitoring like we've never had before. Many of us will have implantables that will actually look real-time at what's going on with our blood chemistry and in our proteins right now. Now the software is also getting smarter, right? Think about a coach, an agent online, that's going to help me do safe self-care. That same interaction that we just did with the ultrasound will likely have real-time image processing, and the device will say, "Up, down, left, right, ah, Eric, that's the perfect spot to send that image off to your doctor."
现在从第一点开始,照护行动化 建立医院和诊所的构想,起源自 1780年,现在该重新思考了 我们该将医生和病人 都要走到一栋专用 建筑物进行医疗的做法中 释放出来 对医疗目的而言,这往往是错误的 而且昂贵的 对重病患者有时并不安全 尤其是这个超级细菌、 及院内感染横行的时代 许多国家想直接跳过实体医院 因为太贵了,永远负担不起… 已开发国家的这种大型医学中心 我个人的经验是,医院 对小孩来说,是个很危险的地方 这是小学三年级的我 手肘严重骨折,需要动手术 我很怕会失去整只手臂 手术后的住院期间,我得了褥疮 褥疮受到感染 抗生素治疗造成严重过敏 最后全身爆发… 全面性的感染 住院越久,我病得越重 医药费也越高 全球每年数百万人都是相同情形 我讲的未来个人化健康照护 是以居家照护为优先 不是目前的医院或诊所 你想进医院或诊所 要病到有必要的程度才行 现在我们用的智能型手机 已可外接各种诊断装置,如超音波 及其他许多装置 智能型手机还内建多种传感器 可进行生命迹像监测 及过去没听过的行为监测 未来我们之中许多人可能会植入 实时监控血液中化学物质 及蛋白质的装置 软件越来越聪明,对吧? 就像是在线的教练或经纪人 可帮我们安全的自我照顾 像我刚才展示超音波的互动 未来可能会有实时图像处理 机器会指挥我上下左右 说:「就是这个位置,影像存盘, 传给你的医生吧!」
Now, if we've got all these networked devices that are helping us to do care anywhere, it stands to reason that we also need a team to be able to interact with all of that stuff, and that leads to the second pillar I want to talk about, care networking. We have got to go beyond this paradigm of isolated specialists doing parts care to multidisciplinary teams doing person care. Uncoordinated care today is expensive at best, and it is deadly at worst. Eighty percent of medical errors are actually caused by communication and coordination problems amongst medical team members. I had my own heart scare years ago in graduate school, when we're under treatment for the kidney, and suddenly, they're like, "Oh, we think you have a heart problem." And I have these palpitations that are showing up. They put me through five weeks of tests -- very expensive, very scary -- before the nurse finally notices the piece of the paper, my meds list that I've been carrying to every single appointment, and says, "Oh my gosh." Three different specialists had prescribed three different versions of the same drug to me. I did not have a heart problem. I had an overdose problem. I had a care coordination problem. And this happens to millions of people every year. I want to use technology that we're all working on and making happen to make health care a coordinated team sport. Now this is the most frightening thing to me. Out of all the care I've had in hospitals and clinics around the world, the first time I've ever had a true team-based care experience was at Legacy Good Sam these last six months for me to go get this. And this is a picture of my graduation team from Legacy. There's a couple of the folks here. You'll recognize Dr. Batiuk. We just talked to him. Here's Jenny, one of the nurses, Allison, who helped manage the transplant list, and a dozen other people who aren't pictured, a pharmacist, a psychologist, a nutritionist, even a financial counselor, Lisa, who helped us deal with all the insurance hassles. I wept the day I graduated. I should have been happy, because I was so well that I could go back to my normal doctors, but I wept because I was so actually connected to this team.
如果我们有了这些网络装置 照护行动化就可以达成 当然,我们需要一个团队 来进行相关互动 这就需要我说的第二根支柱 照护网络化 我们要突破传统模式 也就是独立专科医师 分别进行部分看护 进而由多科别团队进行个人化照护 今日缺乏协调的照护,不仅昂贵 还可能致命 80%的医疗错误是因为 沟通协调问题 存在医疗团队成员间 在念研究所时我有心惊胆颤的经验 那时在治疗肾脏 突然有人说:「你得了心脏病!」 接着我出现了心悸 进行了5个星期检验 又贵又可怕- 最后有位护士注意到 一张纸,我的药单 我每次约诊都带的单子 他说:「天哪!」 有三位专科医师开了 三种同等药效的不同处方药 我心脏没病,是用药过量 是看护缺乏协调的问题 这每年发生在数百万人身上 我想用现有的科技 使健康照护成为合作的团队运动 才能解决这件让我最害怕的事 我曾在世界各地的医院及诊所诊治 我第一次感受到 真正的医疗团队照护 就是过去半年在撒马里亚慈善医院 (Legacy Good Samaritan) 让我有此感受 这是我在医院的毕业团队照片 有好几位,这位是贝医师 刚和他通电话 这是珍妮,其中一位护士 这是艾利森,他帮忙处理移植清单 还有十几位不在相片中 有药师、心理医师、营养师 甚至还有财务顾问,莉萨 她帮我们处理所有保险事务 我毕业那天哭了 我应该要高兴,因为病已好到 可以回去看一般的医师了 我哭是因为和团队感情深厚
And here's the most important part. The other people in this picture are me and my wife, Ashley. Legacy trained us on how to do care for me at home so that they could offload the hospitals and clinics. That's the only way that the model works. My team is actually working in China on one of these self-care models for a project we called Age-Friendly Cities. We're trying to help build a social network that can help track and train the care of seniors caring for themselves as well as the care provided by their family members or volunteer community health workers, as well as have an exchange network online, where, for example, I can donate three hours of care a day to your mom, if somebody else can help me with transportation to meals, and we exchange all of that online. The most important point I want to make to you about this is the sacred and somewhat over-romanticized doctor-patient one-on-one is a relic of the past. The future of health care is smart teams, and you'd better be on that team for yourself.
这才是最重要的部份 照片上还有我,以及我太太艾希莉 医院训练我们在家自行照护 医院和诊所就不必那么忙碌 这是这种模式成功的唯一方式 我的团队其实在中国工作 从事自助看护模式 称为「年龄友善城市」计划 我们尝试建立社群网络 以帮助追踪并且训练年长者 能自已照顾自己 以及由家人提供看护 还有小区的健康看护志愿者 另外还有在线照护交换网站 例如我每天照顾你妈三小时 而有人可以帮我送餐点 大家在网络上交换工作 我要强调的重点是 神圣而又太理想化的 一对一医病关系 是过去的遗留 健康照护的未来是智慧团队 而你自己最好就是团队的一员
Now, the last thing that I want to talk to you about is care customization, because if you've got care anywhere and you've got care networking, those are going to go a long way towards improving our health care system, but there's still too much guesswork. Randomized clinical trials were actually invented in 1948 to help invent the drugs that cured tuberculosis, and those are important things, don't get me wrong. These population studies that we've done have created tons of miracle drugs that have saved millions of lives, but the problem is that health care is treating us as averages, not unique individuals, because at the end of the day, the patient is not the same thing as the population who are studied. That's what's leading to the guesswork. The technologies that are coming, high-performance computing, analytics, big data that everyone's talking about, will allow us to build predictive models for each of us as individual patients. And the magic here is, experiment on my avatar in software, not my body in suffering.
我要谈的最后一件事是 通行证个性化 因为通行证行动化与通行证网络化 要改善医疗系统,无法一蹴而就 但现有医疗存在太多猜测 随机临床实验是在1948年发明的 用来发明治疗结核病的药 那是很重要的事,别误会 这些全民研究帮忙创造了 许多新药,救治了数百万的生命 问题是,这种医疗通行证 把我们当成平均数 而不是独立的个人 终究来说 病人和研究的平均数并不相同 所以必须要用猜的 新科技已经来临 计算机的高速运算、分析 大家都在讲的大数据运算 (big data) 可针对每个人建立预测模型 把每个人当作个别病人 更神奇的是可拿我的计算机分身实验 不必让我身体受苦
Now, I've had two examples I want to quickly share with you of this kind of care customization on my own journey. The first was quite simple. I finally realized some years ago that all my medical teams were optimizing my treatment for longevity. It's like a badge of honor to see how long they can get the patient to live. I was optimizing my life for quality of life, and quality of life for me means time in snow. So on my chart, I forced them to put, "Patient goal: low doses of drugs over longer periods of time, side effects friendly to skiing." And I think that's why I achieved longevity. I think that time-in-snow therapy was as important as the pharmaceuticals that I had. Now the second example of customization -- and by the way, you can't customize care if you don't know your own goals, so health care can't know those until you know your own health care goals. But the second example I want to give you is, I happened to be an early guinea pig, and I got very lucky to have my whole genome sequenced. Now it took about two weeks of processing on Intel's highest-end servers to make this happen, and another six months of human and computing labor to make sense of all of that data. And at the end of all of that, they said, "Yes, those diagnoses of that clash of medical titans all of those years ago were wrong, and we have a better path forward." The future that Intel's working on now is to figure out how to make that computing for personalized medicine go from months and weeks to even hours, and make this kind of tool available, not just in the mainframes of tier-one research hospitals around the world, but in the mainstream -- every patient, every clinic with access to whole genome sequencing. And I tell you, this kind of care customization for everything from your goals to your genetics will be the most game-changing transformation that we witness in health care during our lifetime.
我有两个案例很快和各位分享 关于我亲身经历的照护客制化 第一个很简单,我几年前才了解 我的整个医疗团队都在为 延长我的寿命而精进治疗 能让病人活得更久 他们就像得到荣誉徽章一样 那时我想改善生活质量 对我来说,生活质量就是 在雪地的时光 我强迫他们在病历上写: 「病人的目标为, 长时间低剂量的用药, 副作用不影响滑雪。」 我想这就是我活得较久的原因 「雪地的时光」这项治疗很重要 跟其他药品一样重要 第二样个体化的案例是…顺道一提 如果你没有目标,是无法个体化的 你要先有目标,医疗小组才会知道 但我要说的第二个案例 我刚好是个早期的白老鼠 我很幸运拥有完整的基因体定序 目前大约要花两星期 用英特尔最高速的服务器定序 再加上6个月的人工与计算机运算 以解读所有数据 最后他们说:「成功了, 医界权威争执多年的诊断 全都错了, 现在有更好的方向可以迈进。」 英特尔正努力,希望能找出方法 让个人化医疗的运算 由几个月缩短到几周,甚至几小时 让更多人可使用 不仅限于全球一流的教学医院 而能成为主流- 让每个病人、每间诊所都可使用 这种完整的基因体定序 这种通行证个体化 从个人目标到基因体定序 将是改变游戏规则的大革命 我们有生之年就可见证到
So these three pillars of personal health, care anywhere, care networking, care customization, are happening in pieces now, but this vision will completely fail if we don't step up as caregivers and as patients to take on new roles. It's what my friend Verna said: Wake up and take control of your health. Because at the end of the day these technologies are simply about people caring for other people and ourselves in some powerful new ways.
健康照护的三大支柱 通行证行动化、网络化、客制化 正逐步发生 但这个愿景可能完全失败,如果 医护人员和患者不愿扮演新的角色 我朋友薇娜说得好: 醒醒吧!你要主导自己的健康, 有了这些科技 最后还是「人」在照顾别人与自己 只是运用更好更新的方法
And it's in that spirit that I want to introduce you to one last friend, very quickly. Tracey Gamley stepped up to give me the impossible kidney that I was never supposed to have.
这正是接下来我要很快介绍的 最后一位朋友的精神 翠西甘姆利(Tracey Gamley) 挺身而出,她捐出了 我本来不可能得到的肾脏
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So Tracey, just tell us a little bit quickly about what the donor experience was like with you.
翠西,请很快分享一下 作为捐赠者的体会
Tracey Gamley: For me, it was really easy. I only had one night in the hospital. The surgery was done laparoscopically, so I have just five very small scars on my abdomen, and I had four weeks away from work and went back to doing everything I'd done before without any changes.
翠西:对我来说,真的很简单 我只在医院住了一夜 手术是以腹腔镜进行的 我的腹部只留下5个很小的疤痕 我有4个星期不能工作 之后就完全回复到我原来的生活 没有任何改变
ED: Well, I probably will never get a chance to say this to you in such a large audience ever again. So "thank you" feel likes a really trite word, but thank you from the bottom of my heart for saving my life.
艾瑞克:我可能再也没有机会 在这么多人面前对你说… 「谢谢你!」 感觉上好像老掉牙了 但我打从心底感谢你救了我一命
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This TED stage and all of the TED stages are often about celebrating innovation and celebrating new technologies, and I've done that here today, and I've seen amazing things coming from TED speakers, I mean, my gosh, artificial kidneys, even printable kidneys, that are coming. But until such time that these amazing technologies are available to all of us, and even when they are, it's up to us to care for, and even save, one another. I hope you will go out and make personal health happen for yourselves and for everyone. Thanks so much.
在 TED 讲台上 大多都是赞扬创新发明 以及新科技 这正是我刚才所做的 我也目睹了其他演讲者的惊人成就 天啊!人工肾脏、打印肾脏 可能都不再是梦想 但在那些惊人科技实现 还有普及之前,甚至于之后 都要靠我们彼此关爱,互相救助 希望各位今后能够让 个人化健康照护实现 为了你,也为了每个人。 非常感谢!
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