George Whitesides: A lab the size of a postage stamp

33,283 views ・ 2010-02-03

TED


Please double-click on the English subtitles below to play the video.

00:15
The problem I want to talk with you about is really the problem of:
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How does one supply health care in a world in which cost is everything?
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How do you do that?
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And the basic paradigm we want to suggest to you,
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I want to suggest to you,
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is one in which you say that in order to treat disease,
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you have to first know what you're treating, that's diagnostics,
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and then you have to do something.
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The program we're involved in is something we call "Diagnostics for All,"
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or "zero-cost diagnostics."
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How do you provide medically relevant information
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at as close as possible to zero cost?
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How do you do it?
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Let me just give you two examples.
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The rigors of military medicine are not so dissimilar from the third world:
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poor resources, a rigorous environment -- a series of problems --
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light weight and things of this kind.
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And also they're not so different from the home health care
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and diagnostic system world.
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So, the technology I want to talk about is for the third world,
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for the developing world,
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but it has, I think, much broader application,
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because information is so important in the health care system.
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So you see two examples here.
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One is a lab that is actually a fairly high-end laboratory in Africa.
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The second is basically an entrepreneur who is set up and doing who-knows-what
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at a table in a market.
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I don't know what kind of health care is delivered there.
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But it's not really what is probably most efficient.
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What is our approach?
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The way in which one typically approaches a problem of lowering cost,
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starting from the perspective of the United States,
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is to take our solution,
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and then try to cut cost out of it.
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No matter how you do that,
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you're not going to start with a $100,000 instrument
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and bring it down to no cost.
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It isn't going to work.
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So the approach we took was the other way around, to ask:
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What is the cheapest possible stuff
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that you could make a diagnostic system out of,
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and get useful information and add function?
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And what we've chosen is paper.
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What you see here is a prototypic device.
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It's about a centimeter on the side.
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It's about the size of a fingernail.
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The lines around the edges are a polymer.
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It's made of paper.
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And paper, of course, wicks fluid, as you know, paper, cloth --
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drop wine on the tablecloth,
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and the wine wicks all over everything.
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Put it on your shirt, it ruins the shirt.
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That's what a hydrophilic surface does.
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So in this device, the idea is that you drip the bottom end of it
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in a drop of, in this case, urine.
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The fluid wicks its way into those chambers at the top.
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The brown color indicates the amount of glucose in the urine,
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the blue color indicates the amount of protein in the urine.
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And the combination of those two is a first-order shot
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at a number of useful things that you want.
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So, this is an example of a device made from a simple piece of paper.
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Now, how simple can you make the production?
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Why do we choose paper?
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There's an example of the same thing on a finger,
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showing you basically what it looks like.
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One reason for using paper is that it's everywhere.
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We have made these kinds of devices using napkins and toilet paper
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and wraps, and all kinds of stuff.
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So the production capability is there.
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The second is, you can put lots and lots of tests in a very small place.
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I'll show you in a moment that the stack of paper there
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would probably hold something like 100,000 tests,
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something of that kind.
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And then finally, a point you don't think of so much
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in developed world medicine:
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it eliminates sharps.
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And what sharps means is needles, things that stick.
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If you've taken a sample of someone's blood
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and the someone might have hepatitis C,
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you don't want to make a mistake and stick it in you.
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You don't want to do that.
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So how do you dispose of that?
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It's a problem everywhere, and here, you simply burn it.
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So it's a sort of a practical approach to starting on things.
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Now, you say, "If paper is a good idea,
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other people have surely thought of it."
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And the answer is, of course, yes.
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Those half of you, roughly, who are women,
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at some point may have had a pregnancy test.
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And the most common of these is in a device
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that looks like the thing on the left.
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It's something called a lateral-flow immunoassay.
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In that particular test,
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urine, either containing a hormone called hCG,
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does or does not flow across a piece of paper.
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And there are two bars; one bar indicates that the test is working,
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and if the second bar shows up, you're pregnant.
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This is a terrific kind of test in a binary world,
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and the nice thing about pregnancy is either you are pregnant
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or you're not pregnant;
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you're not partially pregnant or thinking about being pregnant
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or something of that sort.
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So it works very well there, but it doesn't work very well
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when you need more quantitative information.
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There are also dipsticks,
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but if you look at the dipsticks,
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they're for another kind of urine analysis.
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There are an awful lot of colors and things like that.
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What do you actually do about that in a difficult circumstance?
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So the approach we started with is to ask:
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Is it really practical to make things of this sort?
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And that problem is now, in a purely engineering way, solved.
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And the procedure that we have is simply to start with paper.
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You run it through a new kind of printer called a wax printer.
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The wax printer does what looks like printing.
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It is printing.
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You put that on, you warm it a little bit,
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the wax prints through, so it absorbs into the paper,
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and you end up with the device you want.
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The printers cost 800 bucks now.
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We estimate that if you were to run them 24 hours a day,
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they'd make about 10 million tests a year.
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So it's a solved problem. That particular problem is solved.
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And there is an example of the kind of thing that you see.
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That's on a piece of 8 by 12 paper.
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That takes about two seconds to make.
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And so I regard that as done.
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There's a very important issue here,
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which is that because it's a printer, a color printer, it prints colors.
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That's what color printers do.
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I'll show you in a moment, that's actually quite useful.
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Now, the next question that you would like to ask is:
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What would you like to measure? What would you like to analyze?
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And the thing you'd most like to analyze, we're a fair distance from.
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It's what's called "fever of undiagnosed origin."
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Someone comes into the clinic, they have a fever, they feel bad.
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What do they have?
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Do they have TB? Do they have AIDS? Do they have a common cold?
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The triage problem.
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That's a hard problem for reasons I won't go through.
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There are an awful lot of things that you'd like to distinguish among.
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But then there are a series of things --
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AIDS, hepatitis, malaria, TB, others --
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and simpler ones, such as guidance of treatment.
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Now, even that's more complicated than you think.
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A friend of mine works in transcultural psychiatry,
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and he is interested in the question
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of why people do and don't take their meds.
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So Dapsone, or something like that, you have to take for a while.
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He has a wonderful story of talking to a villager in India
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and saying,
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"Have you taken your Dapsone?" "Yes."
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"Have you taken it every day?" "Yes."
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"Have you taken if for a month?" "Yes."
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What the guy actually meant
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was that he'd fed a 30-day dose of Dapsone to his dog that morning.
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(Laughter)
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And he was telling the truth, because in a different culture,
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the dog is a surrogate for you;
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"today," "this month," "since the rainy season" --
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there are lots of opportunities for misunderstanding.
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(Laughter)
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And so an issue here is to, in some cases, figure out
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how to deal with matters that seem uninteresting, like compliance.
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Now, take a look at what a typical test looks like.
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Prick a finger, you get some blood -- about 50 microliters.
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That's about all you're going to get,
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because you can't use the usual sort of systems.
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You can't manipulate it very well;
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I'll show something about that in a moment.
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So you take the drop of blood, no further manipulations,
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you put it on a little device,
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the device filters out the blood cells, lets the serum go through,
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and you get a series of colors down in the bottom there.
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And the colors indicate "disease" or "normal."
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But even that's complicated,
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because to me, colors might indicate "normal,"
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but after all, we're all suffering from probably an excess of education.
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What do you do about something which requires quantitative analysis?
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And so the solution that we and many other people
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are thinking about there,
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and at this point, there is a dramatic flourish,
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and out comes the universal solution to everything these days,
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which is a cell phone --
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in this particular case, a camera phone.
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They're everywhere -- six billion a month in India.
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And the idea is that what one does is to take the device,
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you dip it, you develop the color,
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you take a picture, the picture goes to a central laboratory.
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You don't have to send out a doctor,
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you send out somebody who can just take the sample,
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and in the clinic either a doctor, or ideally, a computer in this case,
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does the analysis.
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Turns out to work actually quite well,
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particularly when your color printer has printed the color bars
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that indicate how things work.
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So my view of the health care worker of the future
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is not a doctor, but an 18-year-old,
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otherwise unemployed, who has two things:
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a backpack full of these tests and a lancet
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to occasionally take a blood sample,
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and an AK-47.
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And these are the things that get him through his day.
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(Laughter)
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There's another very interesting connection here,
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and that is, that what one wants to do is pass through useful information
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over what is generally a pretty awful telephone system.
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It turns out there's an enormous amount of information
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already available on that subject, which is the Mars Rover problem.
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How do you get back an accurate view of the color on Mars
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if you have a really terrible bandwidth to do it with?
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And the answer is not complicated,
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but it's one which I don't want to go through here,
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other than to say that the communication systems for doing this
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are really pretty well understood.
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Also, a fact which you may not know
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is that the compute capability of this thing is not so different
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from the compute capability of your desktop computer.
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This is a fantastic device which is only beginning to be tapped.
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I don't know whether the idea of one computer, one child
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makes any sense.
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Here's the computer of the future,
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because this screen is already there and they're ubiquitous.
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All right, let me show you just a little bit about advanced devices.
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And we'll start by posing a little problem.
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What you see here is another centimeter-sized device,
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and the different colors are different colors of dye.
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And you notice something
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which might strike you as a little bit interesting,
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which is, the yellow seems to disappear,
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get through the blue, and then get through the red.
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How does that happen?
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How do you make something flow through something?
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And, of course the answer is, "You don't."
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You make it flow under and over.
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But now the question is:
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How do you make it flow under and over in a piece of paper?
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The answer is that what you do --
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and the details are not terribly important here --
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is to make something more elaborate:
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You take several different layers of paper,
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each one containing its own little fluid system,
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and you separate them by pieces of, literally, double-sided carpet tape,
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the stuff you use to stick the carpets onto the floor.
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And the fluid will flow from one layer into the next.
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It distributes itself, flows through further holes,
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distributes itself.
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And what you see, at the lower right-hand side there,
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is a sample in which a single sample of blood has been put on the top,
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and it has gone through and distributed itself
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into these 16 holes on the bottom,
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in a piece of paper -- basically, it looks like a chip,
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two pieces of paper thick.
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And in this particular case,
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we were just interested in the replicability of that.
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But that is, in principle, the way you solve
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the "fever of unexplained origin" problem,
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because each one of those spots then becomes a test
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for a particular set of markers of disease,
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and this will work in due course.
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Here is an example of a slightly more complicated device.
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There's the chip.
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You dip in a corner.
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The fluid goes into the center.
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It distributes itself out into these various wells or holes
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and turns color,
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all done with paper and carpet tape.
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So it's, I think, as low-cost
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as we're likely to be able to come up and make things.
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Now, I have two last little stories to tell you
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in finishing off this business.
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This is one:
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One of the things you occasionally need to do
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is separate blood cells from serum.
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And the question was,
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here we do it by taking a sample,
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we put it in a centrifuge, we spin it,
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and you get blood cells out.
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Terrific.
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What happens if you don't have electricity, a centrifuge, and whatever?
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And we thought for a while of how you might do this,
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and the way, in fact, you do it, is what's shown here.
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You get an eggbeater, which is everywhere, and you saw off a blade,
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and then you take tubing, and you stick it on that.
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You put the blood in, somebody sits there and spins it.
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It works really, really well.
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And we sat down, we did the physics of eggbeaters
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and self-aligning tubes and all the rest of that kind of thing,
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and sent it off to a journal.
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We were very proud of this,
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particularly the title, which was "Eggbeater as Centrifuge."
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(Laughter)
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And we sent it off,
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and by return mail, it came back.
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I called up the editor and I said,
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"What's going on? How is this possible?"
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The editor said, with enormous disdain,
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"I read this.
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And we're not going to publish it, because we only publish science."
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(Laughter)
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And it's an important issue,
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because it means that we have to, as a society,
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think about what we value.
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And if it's just papers and Phys. Rev. letters,
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we've got a problem.
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Here is another example of something which is --
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this is a little spectrophotometer.
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It measures the absorption of light in a sample.
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The neat thing about this is,
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you have a light source that flickers on and off at about 1,000 hertz,
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another light source that detects that light at 1,000 hertz,
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and so you can run this system in broad daylight.
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It performs about equivalently
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to a system that's on the order of 100,000 dollars.
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It costs 50 dollars.
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We can probably make it for 50 cents if we put our mind to it.
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Why doesn't somebody do it?
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The answer is:
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How do you make a profit in a capitalist system, doing that?
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Interesting problem.
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So, let me finish by saying that we've thought about this
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as a kind of engineering problem.
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And we've asked: What is the scientific unifying idea here?
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And we've decided we should think about this
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not so much in terms of cost, but in terms of simplicity.
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Simplicity is a neat word.
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You've got to think about what simplicity means.
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I know what it is,
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but I don't actually know what it means.
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So I actually was interested enough in this
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to put together several groups of people.
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The most recent involved a couple of people at MIT,
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one of them being an exceptionally bright kid
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who is one of the very few people I would think of
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who's an authentic genius.
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We all struggled for an entire day to think about simplicity.
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And I want to give you the answer of this deep scientific thought.
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[What is simplicity?
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"It's impossible to f..k it up"]
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(Laughter)
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So, in a sense, you get what you pay for.
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Thank you very much.
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(Applause)
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