I have a tendency to assume the worst, and once in a while, this habit plays tricks on me. For example, if I feel unexpected pain in my body that I have not experienced before and that I cannot attribute, then all of a sudden, my mind might turn a tense back into heart disease or calf muscle pain into deep vein thrombosis. But so far, I haven't been diagnosed with any deadly or incurable disease. Sometimes things just hurt for no clear reason.
Ja imam običaj da pretpostavljam najgore, i s vremena na vreme, ta navika se poigra sa mnom. Na primer, ako osetim iznenadni bol u telu koji pre toga nisam doživeo i koji ne mogu da identifikujem, moj mozak ga tada iznenada može pretvoriti u srčano oboljenje, a bol u mišićima u trombozu dubokih vena. Do sada mi nije dijagnostikovana smrtonosna ili neizlečiva bolest. Ponekad nešto jednostavno boli bez ikakvog jasnog razloga.
But not everyone is as lucky as me. Every year, more than 50 million people die worldwide. Especially in high-income economies like ours, a large fraction of deaths is caused by slowly progressing diseases: heart disease, chronic lung disease, cancer, Alzheimer's, diabetes, just to name a few.
Ali nisu svi te sreće kao ja. Svake godine, širom sveta umre 50 miliona ljudi. Pogotovo u bogatim zemljama, kao što je naša, veliki broj smrtnih slučajeva uzrokuju bolesti koje se sporo razvijaju: srčana oboljenja, hronične bolesti pluća, rak, Alchajmerova bolest i dijabetes su samo neke od njih.
Now, humanity has made tremendous progress in diagnosing and treating many of these. But we are at a stage where further advancement in health cannot be achieved only by developing new treatments. And this becomes evident when we look at one aspect that many of these diseases have in common: the probability for successful treatment strongly depends on when treatment is started. But a disease is typically only detected once symptoms occur. The problem here is that, in fact, many diseases can remain asymptomatic, hence undetected, for a long period of time. Because of this, there is a persisting need for new ways of detecting disease at early stage, way before any symptoms occur. In health care, this is called screening.
Čovečanstvo je ostvarilo ogroman napredak u otkrivanju i lečenju većine ovih bolesti. Trenutno se nalazimo u fazi gde se budući napredak u zdravstvu ne može postići samo razvojem novih lekova. Ovo postaje očigledno ako posmatramo jedan aspekt koji mnoge od ovih bolesti dele. Verovatnoća uspešnog lečenja veoma zavisi od momenta kada je lečenje započeto. Ali bolest se obično uoči tek kada se pojave simptomi. Problem je što, u stvari, mnoge bolesti ostaju bez simptoma, a samim tim i neotkrivene jako dug period. Upravo zbog ovoga, postoji stalna potreba za novim načinima otkrivanja bolesti u ranoj fazi, pre nego što se bilo koji simptom pojavi. U zdravstvenoj zaštiti, ovo se zove skrining.
And as defined by the World Health Organization, screening is "the presumptive identification of unrecognized disease in an apparently healthy person, by means of tests ... that can be applied rapidly and easily ..." That's a long definition, so let me repeat it: identification of unrecognized disease in an apparently healthy person by means of tests that can be applied both rapidly and easily. And I want to put special emphasis on the words "rapidly" and "easily" because many of the existing screening methods are exactly the opposite. And those of you who have undergone colonoscopy as part of a screening program for colorectal cancer will know what I mean.
Kako je definisan od strane Svetske zdravstvene organizacije, skrining je „pretpostavljena identifikacija neprepoznate bolesti kod naizgled zdrave osobe, kroz razne testove koji se mogu primeniti brzo i lako." To je dugačka definicija, pa ću je ponoviti. Identifikacija neprepoznatih bolesti kod naizgled zdravih osoba kroz razne testove koji se mogu primeniti brzo i lako. Želim posebno da naglasim reči „brzo" i „lako" zato su što mnoge od postojećih metoda skrininga upravo suprotno. A oni koji su bili podvrgnuti koloskopiji kao delu skrininga za rak debelog creva znaju o čemu govorim.
Obviously, there's a variety of medical tools available to perform screening tests. This ranges from imaging techniques such as radiography or magnetic resonance imaging to the analysis of blood or tissue. We have all had such tests. But there's one medium that for long has been overlooked: a medium that is easily accessible, basically nondepletable, and it holds tremendous promise for medical analysis. And that is our breath.
Očigledno, postoje brojni medicinski alati da bi se izvršio test skrininga. Od tehnika snimanja, kao što je npr. radiografija, ili magnetna rezonanca, do analiza krvi i tkiva. Svi smo prošli takve testove. Ali postoji jedan način koji je dugo vremena bio zapostavljen, način koji je lako dostupan, koji je u suštini neiscrpan, i ima neverovatan potencijal za medicinske analize. A to je naš dah.
Human breath is essentially composed of five components: nitrogen, oxygen, carbon dioxide, water and argon. But besides these five, there are hundreds of other components that are present in very low quantity. These are called volatile organic compounds, and we release hundreds, even thousands of them every time we exhale. The analysis of these volatile organic compounds in our breath is called breath analysis. In fact, I believe that many of you have already experienced breath analysis. Imagine: you're driving home late at night, when suddenly, there's a friendly police officer who asks you kindly but firmly to pull over and blow into a device like this one. This is an alcohol breath tester that is used to measure the ethanol concentration in your breath and determine whether driving in your condition is a clever idea. Now, I'd say my driving was pretty good, but let me check.
Ljudski dah je u osnovi sačinjen od pet komponenti: azot, kiseonik, ugljen-dioksid, voda i argon. Pored ovih pet, postoje stotine drugih sastojaka koji su prisutni u veoma malim količinama. Oni se nazivaju isparljiva organska jedinjenja, i mi ih ispuštamo na stotine, ako ne i hiljade sa svakim izdahom. Analiza ovih isparljivih organskih jedinjenja iz našeg daha naziva se analiza daha. U stvari, ja verujem da je dosta vas već imalo iskustva sa analizom daha. Zamislite: vozite se kući kasno noću, kad odjednom, prijatan policajac vas ljubazno, ali odlučno, zamoli da stanete i da duvate u napravu sličnu ovoj. Ovo je alko-tester na dah, koji se koristi kako bi se izmerio nivo etanola u vašem dahu da bi se videlo da li je vožnja u vašem stanju pametna ideja. Rekao bih da sam dobro vozio, ali hajde da proverim.
(Beep)
(Bip)
0.0, so nothing to worry about, all fine.
Pokazuje 0,0 - znači, nema potrebe za brigom, sve je u redu.
(Laughter)
(Smeh)
Now imagine a device like this one, that does not only measure alcohol levels in your breath, but that detects diseases like the ones I've shown you and potentially many more. The concept of correlating the smell of a person's breath with certain medical conditions, in fact, dates back to Ancient Greece. But only recently, research efforts on breath analysis have skyrocketed, and what once was a dream is now becoming reality. And let me pull up this list again that I showed you earlier. For the majority of diseases listed here, there's substantial scientific evidence suggesting that the disease could be detected by breath analysis.
Sad zamislite napravu sličnu ovoj, koja ne samo da meri nivo alkohola u vašem dahu, nego detektuje bolesti, kao one što sam vam pokazivao i možda još mnogo više. Koncept povezivanja mirisa iz nečijeg daha sa određenim medicinskim problemima u stvari datira iz drevne Grčke. Međutim, tek je nedavno napor istraživača vezan za analizu daha urodio plodom, te ono što je nekada bilo san sada postaje stvarnost. Dozvolite mi da vratim listu koju sam vam pokazao ranije. Za većinu ovde nabrojanih bolesti, postoje značajni naučni dokazi koji upućuju na to da se bolest može otkriti analizom daha.
But how does it work, exactly? The essential part is a sensor device that detects the volatile organic compounds in our breath. Simply put: when exposed to a breath sample, the sensor outputs a complex signature that results from the mixture of volatile organic compounds that we exhale. Now, this signature represents a fingerprint of your metabolism, your microbiome and the biochemical processes that occur in your body. If you have a disease, your organism will change, and so will the composition of your exhaled breath. And then the only thing that is left to do is to correlate a certain signature with the presence or absence of certain medical conditions.
Kako to tačno funkcioniše? Osnovni deo je senzor naprave koji detektuje isparljiva organska jedinjenja u našem dahu. Jednostavno rečeno, kada se izloži uzorku daha, senzor izbacuje složen šablon koji je rezultat mešavine isparljivih organskih jedinjenja koje smo izdahnuli. Ovaj šablon je otisak našeg metabolizma, vašeg mikrobioma i biohemijskih procesa koji se javljaju u vašem telu. Ako imate neku bolest, vaš organizam će se promeniti, a isto tako i struktura vašeg izdaha. Sve što tada ostaje da se uradi je da se poveže određeni šablon sa prisustvom ili odsustvom određenog medicinskog stanja.
The technology promises several undeniable benefits. Firstly, the sensor can be miniaturized and integrated into small, handheld devices like this alcohol breath tester. This would allow the test to be used in many different settings and even at home, so that a visit at the doctor's office is not needed each time a test shall be performed.
Ova tehnologija nudi nekoliko nepobitnih koristi. Prvo, senzor može biti minijaturan i stavljen u ručne naprave kao što je ovaj alko-test na dah. To bi omogućilo da se ovaj test koristi u različitim okruženjima, čak i kod kuće, što znači da posete doktoru nisu potrebne svaki put kad se ovaj test radi.
Secondly, breath analysis is noninvasive and can be as simple as blowing into an alcohol breath tester. Such simplicity and ease of use would reduce patient burden and provide an incentive for broad adoption of the technology.
Drugo, analiza daha je neinvazivna i može biti jednostavna kao duvanje u alko-tester. Ovakva jednostavnost i lako korišćenje bi smanjilo teret pacijenta i podstaklo širu upotrebu ove tehnologije.
And thirdly, the technology is so flexible that the same device could be used to detect a broad range of medical conditions. Breath analysis could be used to screen for multiple diseases at the same time. Nowadays, each disease typically requires a different medical tool to perform a screening test. But this means you can only find what you're looking for.
Treće, ova tehnologija je tako fleksibilna da se jedna naprava može koristiti za otkrivanje širokog spektra medicinskih stanja. Analiza daha može se koristiti za skrining više bolesti u isto vreme. U današnje vreme, svaka bolest obično zahteva drugačiji medicinski alat da bi se izvršio test skrininga. Što znači da možete naći samo ono za čim tragate.
With all of these features, breath analysis is predestined to deliver what many traditional screening tests are lacking. And most importantly, all of these features should eventually provide us with a platform for medical analysis that can operate at attractively low cost per test. On the contrary, existing medical tools often lead to rather high cost per test. Then, in order to keep costs down, the number of tests needs to be restricted, and this means (a) that the tests can only be performed on a narrow part of the population, for example, the high-risk population; and (b) that the number of tests per person needs to be kept at a minimum. But wouldn't it actually be beneficial if the test was performed on a larger group of people, and more often and over a longer period of time for each individual? Especially the latter would give access to something very valuable that is called longitudinal data.
Uz sve ove karakteristike, analiza daha je predodređena da pruži ono što mnogim tradicionalnim testovima skrininga manjka. A ono što je najvažnije, sve ove karakteristike bi jednom trebalo da nam obezbede platformu za medicinsku analizu koja može da funkcioniše sa veoma niskom cenom po testu. Suprotno tome, postojeći medicinski alati obično vode ka skupoj ceni po testu. Onda, da bi se snizili troškovi, broj testova mora biti ograničen, što znači, pod a, da se testovi mogu sprovesti samo na malom delu populacije, npr. u visokorizičnim grupama; i pod b, da broj testova po osobi treba držati na minimumu. Zar ne bi bilo korisno da se test izvodi na većoj grupi ljudi, češće i u dužem periodu za svakog ponaosob? Ovo drugo bi dalo pristup nečem veoma vrednom, a to su longitudinalni podaci.
Longitudinal data is a data set that tracks the same patient over the course of many months or years. Nowadays, medical decisions are often based on a limited data set, where only a glimpse of a patient's medical history is available for decision-making. In such a case, abnormalities are typically detected by comparing a patient's health profile to the average health profile of a reference population. Longitudinal data would open up a new dimension and allow abnormalities to be detected based on a patient's own medical history. This will pave the way for personalized treatment.
Longitudinalni podaci su skup podataka koji se odnose na jednog pacijenta, prikupljenih tokom mnogo meseci ili godina. Medicinske odluke danas su često zasnovane na ograničenom skupu podataka, pri čemu je samo delić pacijentove medicinske istorije dostupan za donošenje odluke. U ovakvim slučajevima, anomalije se obično otkrivaju poređenjem zdravstvenog profila pacijenta sa prosečnim zdravstvenim profilom referentne populacije. Longitudalni podaci bi otvorili sasvim novu dimenziju i dozvolili anomalijama da budu otkrivene na osnovu medicinske istorije pacijenta. Ovo će trasirati put ka personalizovanom lečenju.
Sounds pretty great, right? Now you will certainly have a question that is something like, "If the technology is as great as he says, then why aren't we using it today?" And the only answer I can give you is: not everything is as easy as it sounds. There are technical challenges, for example. There's the need for extremely reliable sensors that can detect mixtures of volatile organic compounds with sufficient reproducibility. And another technical challenge is this: How do you sample a person's breath in a very defined manner so that the sampling process itself does not alter the result of the analysis? And there's the need for data. Breath analysis needs to be validated in clinical trials, and enough data needs to be collected so that individual conditions can be measured against baselines. Breath analysis can only succeed if a large enough data set can be generated and made available for broad use.
Zvuči odlično, zar ne? Sada ćete verovatno pitati sledeće: „Ako je ta tehnologija tako dobra kao što tvrdi, zašto je ne koristimo?” Jedini odgovor koji vam mogu dati je: nije sve tako jednostavno kao što zvuči. Postoje tehnički izazovi. Na primer, potrebni su veoma pouzdani senzori koji mogu otkriti mešavine isparljivih organskih jedinjenja sa dovoljnom mogućnošću ponavljanja rezultata. A tu je još jedan tehnički izazov: kako uzimati uzorak daha na veoma određen način da sam proces uzimanja uzorka ne menja rezultate analize? Takođe postoji i potreba za podacima. Analiza daha treba da bude potvrđena kliničkim ispitivanjima i potrebno je prikupiti dovoljno podataka kako bi se pojedinačna stanja mogla uporediti sa osnovnim parametrom. Analiza daha može biti uspešna samo ako može da se prikupi dovoljno velika baza podataka koja će biti dostupna za širu upotrebu.
If breath analysis holds up to its promises, this is a technology that could truly aid us to transform our health care system -- transform it from a reactive system where treatment is triggered by symptoms of disease to a proactive system, where disease detection, diagnosis and treatment can happen at early stage, way before any symptoms occur.
Ako analiza daha ispuni očekivanja, onda je ovo tehnologija koja nam stvarno može pomoći da transformišemo naš zdravstveni sistem - transformišemo ga iz reaktivnog sistema, gde je lečenje inicirano simptomima bolesti, u proaktivni sistem, gde se bolest otkriva, dijagnostikuje i leči u ranoj fazi, mnogo pre nego što se simptomi pojave.
Now this brings me to my last point, and it's a fundamental one. What exactly is a disease? Imagine that breath analysis can be commercialized as I describe it, and early detection becomes routine. A problem that remains is, in fact, a problem that any screening activity has to face because, for many diseases, it is often impossible to predict with sufficient certainty whether the disease would ever cause any symptoms or put a person's life at risk. This is called overdiagnosis, and it leads to a dilemma. If a disease is identified, you could decide not to treat it because there's a certain probability that you would never suffer from it. But how much would you suffer just from knowing that you have a potentially deadly disease? And wouldn't you actually regret that the disease was detected in the first place?
Što me dovodi do poslednje tačke, koja je najznačajnija. Šta je u stvari bolest? Zamislite da se analiza daha komercijalizuje, kao što sam opisao, i rano otkrivanje bolesti postane rutina. Problem koji ostaje je onaj sa kojim se suočava svaki skrining zato što je, za mnoge bolesti, često nemoguće predvideti sa sigurnošću da li će bolest uopšte izazvati neke simptome ili dovesti osobu u životnu opasnost. Ovo se zove hiperdijagnostika, koja stvara dilemu. Ako je bolest identifikovana, možete odlučiti da je ne lečite zato što postoji verovatnoća da nikada nećete oboleti od nje. Ali koliko biste patili od samog saznanja da imate potencijalno smrtonosnu bolest? Zar ne biste zažalili što vam je bolest uopšte i otkrivena?
Your second option is to undergo early treatment with the hope for curing it. But often, this would not come without side effects.
Vaša druga opcija je da prihvatite rano lečenje sa nadom da ćete je izlečiti. Ali često, ovo ne bi išlo bez nekih nuspojava.
To be precise: the bigger problem is not overdiagnosis, it's overtreatment, because not every disease has to be treated immediately just because a treatment is available. The increasing adoption of routine screening will raise the question: What do we call a disease that can rationalize treatment, and what is just an abnormality that should not be a source of concern? My hopes are that routine screening using breath analysis can provide enough data and insight so that at some point, we'll be able to break this dilemma and predict with sufficient certainty whether and when to treat at early stage.
Tačnije: veći problem od hiperdijagnostike je preterano lečenje, zato što ne zahteva svaka bolest trenutno lečenje samo zato što je lek dostupan. Usvajanje rutinskog skrininga je otvorilo pitanje: kako nazivamo bolest koja može opravdati lečenje, a šta je samo anomalija koja ne treba da nas brine? Ja se nadam da će rutinski skrining koji koristi analizu daha moći da obezbedi dovoljno podataka i uvida da ćemo u određenom momentu moći da rešimo ovu dilemu i sa dovoljnom preciznošću predvidimo da li i kada lečiti u ranoj fazi.
Our breath and the mixture of volatile organic compounds that we exhale hold tremendous amounts of information on our physiological condition. With what we know today, we have only scratched the surface. As we collect more and more data and breath profiles across the population, including all varieties of gender, age, origin and lifestyle, the power of breath analysis should increase. And eventually, breath analysis should provide us with a powerful tool not only to proactively detect specific diseases but to predict and ultimately prevent them. And this should be enough motivation to embrace the opportunities and challenges that breath analysis can provide, even for people that are not part-time hypochondriacs like me.
Naš dah i mešavina isparljivih organskih jedinjenja koje izdahnemo sadrže neverovatnu količinu informacija o našem fiziološkom stanju. Sa onim što znamo danas, samo smo zagrebali površinu. Skupljajući sve više podataka i profila analize daha širom populacije, uključujući različite polove, godine, poreklo i stil života, moć analize daha bi trebalo da se poveća. U jednom momentu, analiza daha bi trebalo da nam obezbedi moćan alat ne samo da proaktivno otkrijemo određene bolesti, nego i da ih predvidimo i na kraju sprečimo. Ovo bi trebalo da bude dovoljna motivacija da se prihvate šanse i izazovi koje analiza daha može da pruži, čak i kod ljudi koji nisu povremeni hipohondri, kao ja.
Thank you.
Hvala vam.
(Applause)
(Aplauz)