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.
我總喜歡先去設想最壞的結果, 這種習慣偶爾會把我搞糊塗。 如果我身體上有莫名的疼痛, 以前未曾經歷過, 我也找不到原因。 然後突然間,我可能會 將我僵直的背想成是心臟病。 或是將小腿肚疼痛, 想成是深部靜脈血栓。 不過到目前為止,我還沒有 被診斷出有致命的或不治之症。 有時我們就是會有不明原因的疼痛。
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.
但不是每個人都像我這麼幸運。 全世界每年有超過 5000 萬人死亡。 特別在高所得國家,如我們國家; 進展緩慢的疾病 占了死亡人數的大部分。 例如:心臟病、慢性肺病、 癌症、阿茲海默症及糖尿病。 但這只是少數的一些例子。
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.
現今,人類在檢測及治療許多 這些疾病上,已經有了重大的進展。 不過我們正處於 要在健康有更進一步的發展, 不能只靠研發新的療法的階段。 當我們看到許多疾病有共同點的 這個方面時, 這就變得更顯而易見了。 這個共同點就是 疾病被治癒的機率, 與開始治療的時間點有很大的關聯。 不過通常只有在症狀出現時 疾病才會被發現。 問題是:其實許多疾病沒有症狀, 因此,疾病會有很長一段時間 沒有被發現。 因此,我們必需有一個新的方法 能在疾病早期以及症狀出現以前, 就檢測到疾病。 在醫療保健,這就是篩檢。
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.
世界衛生組織對它的定義是: 「利用可迅速及簡單操作的檢查, 在看似健康的人身上 找出疑似的病症。」 這個定義有點長, 我們再重複一次,篩選的定義是: 「利用可迅速及簡單操作的檢查, 在看似健康的人身上 找出疑似的病例。」 我想強調它所說的 「迅速」及「簡單」。 因為與目前現行的篩檢相比, 恰恰是完全相反的。 那些曾做過結腸鏡檢查, 那是結腸癌篩選的其中一項, 就知道我要表達的意思。
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.
目前有許多可用的醫療工具種類, 能夠用來做篩檢。 從醫療成像技術,如射線照相術, 或是核磁共振成像, 和血液分析及組織分析, 我們一直都有這些技術。 不過另外還有個篩選方法, 一直被我們給忽略了。 一個更為容易取得的方法, 它的來源很充足, 而且它在醫學分析的前景很被看好, 那就是我們的呼氣。
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.
我們的呼氣主要由五種成分組成 : 氮氣、氧氣、二氧化碳、水及氬。 除了這主要的五種之外, 還有其他數百種極少量的成分。 這些被稱為「揮發性有機化合物」。 每當我們吐氣時, 我們釋放出成千上百種的 揮發性有機化合物。 這些揮發性有機化合物的分析, 我們稱為呼氣分析。 其實在場就有許多聽眾 做過這種呼氣分析。 想像一下:在深夜你驅車回家, 突然間有個友善的警察將你攔住, 以和善但堅定的口氣,請你停車。 請你對著類似這個裝置吐氣。 這是一個酒精濃度探測器, 用來測量你體內的酒精濃度, 以確認你目前的身體情況 是否適合開車。 我得說我的開車技術還算出色, 不過讓我檢測看看。
(Beep)
(嗶)
0.0, so nothing to worry about, all fine.
酒精濃度為零 , 沒有什麼好擔心的。
(Laughter)
(笑聲)
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.
想像一下類似這種的裝置, 它不只能夠檢測酒精濃度, 還可以檢測我前面提到的疾病, 甚至可能檢測到更多的疾病。 一個人呼氣的氣味, 與特定身體狀況有關聯的概念, 其實可以追朔到古希臘時期。 不過一直到了最近, 呼氣分析的研究才有飛速的進展. 我們曾有的夢想已經實現。 讓我們再看一次 我先前顯示在螢幕的列表。 在這清單內大多數的疾病, 它們本質上的科學跡象, 顯示它們能以呼氣分析檢測出來。
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.
這是如何運作的呢? 其中最重要的部分是, 一台能夠偵測 揮發性有機化合物的感測器。 簡單來說:當偵測到呼氣樣本時, 來自我們呼氣裡的 揮發性有機化合物, 能夠使感測器 產生一種複雜的信號。 這種信號就像是體內的新陳代謝, 、微生物、 以及生化過程的鑑別性標記。 如果你的身上有疾病, 你身上的有機物將會產生變化, 其中也包括了 你呼氣時的氣體成分, 最後你唯一要做的事就是 檢測那些特定的信號, 查看它是否符合那些 特定的身體狀況。
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.
這種科技會帶來許多 不可否認的好處。 首先,感測器能夠微型化, 並結合至手提式的裝置, 就像是酒精濃度探測器一樣。 這使得我們能夠 在許多地點進行檢測, 甚至在家裡也可以。 因此,我們再也不需要每當要檢測時, 就跑到診所或醫院進行。
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.
其次,呼氣分析為非侵入式, 就像是對著 酒精濃度探測機呼氣那麼簡單。 如此簡單的使用方法 能夠減輕病人的負擔, 同時也是一個能讓大家能 廣泛接受這項技術的誘因。
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.
第三點,這項技術非常靈活。 同部裝置, 能夠同時被用來檢測 各式各樣的身體狀況。 呼氣分析能同時篩檢多種疾病。 現今,每種疾病通常需要 不同的醫療工具 才能進行那個疾病的篩檢。 但是這表示你只能篩檢出 你想找到的疾病。
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.
有了這些特點 呼氣分析技術註定將取代 那些傳統篩檢儀器所沒有的部分。 更重要的是, 這些特點最終將提供給我們 一個醫療分析平台 能夠以吸引人的低廉價格做測試。 相對地,現有的醫療工具, 單次使用的費用都相當高昂。 為了降低檢測的費用, 篩檢的數量必須被限制, 這表示(a): 只有少數的人,像是高風險族群, 才能夠接受篩檢。 以及(b):每個人的篩檢項目總數 必須盡量減到最低。 如果能夠讓更多的民眾 在長時間內做更頻繁的篩檢 實際上不是才更有益處嗎? 尤其是後者會帶給 我們相當重要的價值, 那就是長時間的數據。
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.
長時間的數據 是紀錄同一個病患的病況 數月甚至數年的資料庫。 現今,醫療決策通常是根據患者 有限的醫療病史, 來決定的。 在這種情況下, 我們只能藉由 將患者的健康狀況 和平均參考人口的健康狀況做比較 來偵測到病患的異常狀態。 長時間的數據 為我們打開了嶄新的空間, 使我們能夠根據患者的醫療病史, 檢測出患者身上的異常情況。 這將爲客製化的療程鋪路。
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.
聽起來很棒,不是嗎? 現在你們一定都有這個問題,如: 「如果這項技術真如你所說的這麼好, 為什麼現今還無人使用呢?」 我只能給你們答案是: 不是每件事都像 它聽起來的這麼簡單。 這中間存在了技術的挑戰,例如: 我們需要一個極其可靠的感測器, 能夠偵測到揮發性 有機化合物的混合體, 並有著充足的再現性, 另一個技術的挑戰是: 你如何以非常明確的方式 採集患者的呼氣樣本, 以使採集樣本的過程中, 不會改變樣本分析的結果呢? 然後,我們需要數據資料。 呼氣分析需要用臨床實驗來佐證, 我們需要收集足夠多的數據資料, 才能在基線資料上, 比較出個別患者的健康狀況。 呼氣分析只有在 有足夠多的數據資料 並能被廣泛的使用下才能成功。
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.
如果呼氣分析能實現它的承諾, 這項技術將幫助我們 翻轉我們的醫療照護體系, 從一個被動、 只有症狀出現時才會有反應的體系, 成為能在早期發現疾病, 早在症狀開始之前, 就能先偵測、診斷和治療的 醫療照護體系。
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?
這把我們帶到了 最後且最核心的問題: 究竟什麼是疾病? 想像一下呼氣分析能夠商業化, 早期的篩檢變成常規的身體檢查, 剩下的一個問題,其實也是 任何一個篩檢都要面對的問題, 就是疾病的種類極多, 你不可能百分之百的確定 你身上的疾病是否會出現症狀, 或者將置你於險地。 我們將這稱之為過度診斷, 這給了我們一個難題。 當我們診斷出有疾病時, 你可以決定不去治療它, 因為你有可能不會有病痛。 但是當你得知 你身上有可能致死的疾病時, 你的心理折磨 會被疾病本身來的小嗎? 你會不會後悔 當初你的病被診斷出來。
Your second option is to undergo early treatment with the hope for curing it. But often, this would not come without side effects.
你的第二種選擇 是去接受早期治療, 並祈禱能夠治好它。 不過治療通常也伴隨著副作用,
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.
更準確地說, 更大的問題不是過度診斷, 而是過度治療。 因為不是因為有治療方法, 你就需要立即去醫治疾病。 日益增加的常規篩檢, 將使另一個問題浮現: 我們該如何看待一個疾病 是需要治療, 還是不需要疑慮的身體異常而已? 我希望,常規的呼氣分析篩檢 能夠提供足夠的資料及見解 讓我們在未來能夠打破這種僵局, 並且有十足的把握預測 它是否需要或何時 該進行早期的治療。
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.
我們吐氣時的揮發性有機化合物, 蘊含著我們生理上的龐大資訊。 我們目前對它的理解只是冰山的一角。 當我們從更多人口中 收集更多數據資料, 包括所有的性別、年齡、 民族及生活方式, 呼氣分析的威力才能增強。 最後,呼氣分析應該不僅是 一個強而有力的工具, 它還能幫助我們主動偵測特定疾病, 最終使我們能夠 預測以及預防疾病。 這些應該提供足夠的動機 讓大家來擁抱這個呼氣分析 所帶來的機會和挑戰, 包括像我一樣的長期疑病症患者,
Thank you.
謝謝。
(Applause)
(掌聲)