Daniel Kraft: Medicine's future? There's an app for that

Translator: Nika Kotnik Reviewer: Matej Divjak

A couple of years ago,

Pred nekaj ​​leti, na TED konferenci v Long Beachu,

when I was attending the TED conference in Long Beach,

I met Harriet.

sem spoznal Harriet.

We'd actually met online before -- not the way you're thinking.

Dejansko sva se srečala prej na spletu - ne tako, kot si mislite.

We were introduced because we both knew Linda Avey,

Oba sva poznala Lindo Avey,

one of the founders of the first online personal genomic companies.

ki je ena od ustanoviteljev prve spletne osebne genomske družbe.

And because we shared our genetic information with Linda,

In ker sva najine genetske informacije delila z Lindo,

she could see that Harriet and I shared

je ona lahko videla, da si s Harriet deliva zelo redek tip mitohondrijske DNK -

a very rare type of mitochondrial DNA, haplotype K1a1b1a,

Haplotip K1a1b1a - kar je pomenilo, da sva v daljnem sorodu.

which meant we were distantly related.

We actually share the same genealogy with Ötzi the Iceman.

Dejansko deliva isto rodoslovje z Oetzijem, ledenim človekom.

So -- Ötzi, Harriet and me.

Torej Oetzi, Harriet in jaz.

And being the current day, of course, we started our own Facebook group.

Ustanovila sva skupino na Facebook-u. Vsi ste dobrodošli, da se pridružite.

You're all welcome to join.

When I met Harriet in person the next year at the TED conference,

Ko sem naslednje leto srečal Harriet osebno na konferenci TED,

she'd gone online and ordered our own happy haplotype T-shirts.

nama je naročila srečne Haplotip majice.

(Laughter)

(Smeh)

Why am I telling you this story?

Zakaj vam pripovedujem to zgodbo in kaj ima to s prihodnostjo zdravja?

What does it have to do with the future of health?

Well, the way I met Harriet is an example

Kako sem spoznal Harriet, je primer,

of how leveraging cross-disciplinary, exponentially growing technologies

kako interdisciplinarno dopolnjevane, skokovito rastoče tehnologije

is affecting our future of health and wellness --

vplivajo na prihodnost zdravja in počutja -

from low-cost gene analysis

od nizkocenovnih genskih analiz do priložnosti v zmogljivi bioinformatiki

to the ability to do powerful bioinformatics

to the connection of the Internet and social networking.

in do internetne povezave in socialnih mreženj.

What I'd like to talk about today

Danes bi rad govoril o razumevanju teh eksponentnih tehnologij.

is understanding these exponential technologies.

We often think linearly.

Pogosto mislimo linearno.

But if you think about it, if you have a lily pad

Ampak, če imate plavajoč lokvanjev list, ki se razdeli vsak dan -

and it just divided every single day --

two, four, eight, sixteen -- in 15 days, you'd have 32,000.

dva, štiri, osem, 16 - v 15 dneh jih imate 32.000.

What do you think you'd have in a month?

Koliko mislite, da jih bo v enem mesecu? Prišli smo do milijarde.

We're at a billion.

If we start to think exponentially,

Če začnemo misliti eksponentno,

we can see how this is starting to affect all the technologies around us.

vidimo, kako to začenja vplivati ​​na vse tehnologije okoli nas.

Many of these technologies, speaking as a physician and innovator,

In veliko teh tehnologij - govorim kot zdravnik in inovator -

res lahko začnemo izkoriščati,

we can start to leverage, to impact the future of our own health

da vplivamo na prihodnost lastnega zdravja in zdravstvenega varstva

and of health care,

in da se lotimo glavnih izzivov, ki jih imamo v zdravstvu danes,

and to address many of the major challenges in health care today,

od res skokovitih stroškov, do staranja prebivalstva,

ranging from the exponential costs to the aging population,

the way we really don't use information very well today,

slabega načina uporabe informacij,

the fragmentation of care

razdrobljenosti oskrbe,

and the often very difficult course of adoption of innovation.

in pogosto veliko težav v sprejemanju inovacij.

And one of the major things we can do is move the curve to the left.

Kar lahko naredimo, o čemer smo danes nekaj govorili,

je premik krivulje v levo.

We spend most of our money on the last 20 percent of life.

Večino denarja porabimo na zadnjih 20 % življenja.

Kaj če bi lahko porabili in spodbujali pozicije

What if we could incentivize physicians in the health care system

v sistemu zdravstvenega varstva in nas samih

and our own selves

to move the curve to the left and improve our health,

za premik krivulje v levo in izboljšanje zdravja,

leveraging technology as well?

tudi z izkoriščanjem tehnologije?

Now my favorite example of exponential technology,

Mojo najljubšo tehnologijo, primer eksponentne tehnologije, imamo vsi v žepu.

we all have in our pocket.

If you think about it, these are really dramatically improving.

Torej, če o tem razmislite, to se res dramatično izboljšuje.

I mean, this is the iPhone 4.

Hočem reči, to je iPhone 4.

Imagine what the iPhone 8 will be able to do.

Predstavljajte si, kaj bo sposoben narediti iPhone 8.

Now, I've gained some insight into this.

Dobil sem nekaj uvida v to.

I've been the track share for the medicine portion

Sem eden od udeležencev

na medicinskem delu nove institucije, imenovane Singularity University,

of a new institution called Singularity University,

based in Silicon Valley.

s sedežem v Silicijevi dolini.

We bring together each summer about 100 very talented students

In tukaj vsako poletje združimo

približno 100 zelo nadarjenih študentov z vsega sveta.

from around the world.

And we look at these exponential technologies from medicine,

In obravnavamo te tehnologije iz medicine, biotehnologije,

umetne inteligence, robotike, nanotehnologije, vesolja,

biotech, artificial intelligence, robotics, nanotechnology, space,

in iščemo, kako bi jih navzkrižno usposobili

and address how we can cross-train and leverage these

in izkoristili za vpliv na glavne neizpolnjene cilje.

to impact major unmet goals.

We also have seven-day executive programs.

Imamo tudi sedem-dnevne izvedbene programe.

And coming up next month is FutureMed,

In naslednji mesec je pravzaprav Future Med,

a program to help cross-train and leverage technologies into medicine.

program interdisciplinarnega usposabljanja in izkoriščanja tehnologij v medicini.

Now, I mentioned the phone.

Omenil sem telefon.

These mobile phones have over 20,000 different mobile apps available.

Ti mobilni telefoni imajo na voljo več kot 20.000 različnih mobilnih aplikacij -

There's one out of the UK where you can pee on a little chip,

vse do tiste iz VB,

kjer lahko lulate na mali čip priključen na vaš iPhone

connect it to your iPhone,

and check for an STD.

in preverite sami za SPB.

I don't know if I'd try that, but it's available.

Ne vem, če bi sam že poskusil, ampak je na voljo.

Obstajajo vse vrste aplikacij,

There are other sorts of applications.

Merging your phone and diagnostics, for example,

ki združujejo vaš telefon in diagnostiko, na primer -

merjenje glukoze v krvi na vašemu iPhonu

measuring your blood glucose on your iPhone

in pošiljanje vašemu zdravniku,

and sending that to your physician,

so they can better understand and you can better understand

da oni in vi lahko bolje razumete

your blood sugars as a diabetic.

vaš krvni sladkor, če imate sladkorno bolezen.

So let's see how exponential technologies are taking health care.

Poglejmo zdaj, kako skokovite tehnologije prevzemajo zdravstvo.

Let's start with faster.

Začnimo s tem, da so hitrejše.

It's no secret that computers, through Moore's law,

Ni skrivnost, da so, po Moorovemu zakonu, računalniki vse hitrejši in hitrejši.

are speeding up faster and faster.

We can do more powerful things with them.

Z njimi lahko naredimo bolj zmogljive stvari.

They're really approaching -- in many cases, surpassing --

Oni res dohajajo, v mnogih primerih presegajo,

the ability of the human mind.

sposobnost človeškega uma.

But where I think computational speed is most applicable is in imaging.

Ampak mislim, da je računska hitrost najbolj uporabna za slikanje.

The ability now to look inside the body in real time

Možnost vpogleda v telo v realnem času

with very high resolution

z zelo visoko ločljivostjo res postaja neverjetna.

is really becoming incredible.

And we're layering multiple technologies -- PET scans, CT scans

In uporabljamo različne tehnologije - PET skeniranje, CT skeniranje

and molecular diagnostics --

in molekularno diagnostiko -

to find and seek things at different levels.

da najdemo in poiščemo stvari na različnih ravneh.

Here you're going to see the very highest resolution MRI scan done today,

Tukaj boste videli najvišjo ločljivost MRI skeniranja danes,

rekonstrukcijo Marca Hodosha, skrbnika TEDMED-a.

of Marc Hodosh, the curator of TEDMED.

And now we can see inside of the brain

In zdaj lahko vidimo notranjost možganov

at a resolution and ability never before available,

z do sedaj nedosegljivo ločljivostjo in zmogljivostjo,

and essentially learn how to reconstruct and maybe even reengineer

in se naučimo rekonstrukcije in morda celo reinženiringa

or backwards engineer the brain,

ali povratnega inženiringa možganov,

so we can better understand pathology, disease and therapy.

da bi bolje razumeli patologijo, bolezni in zdravljenje.

We can look inside with real-time fMRI in the brain at real time.

Notranjost možganov lahko gledamo v realnemu času z fMRI.

And by understanding these sorts of processes and these connections,

In z razumevanjem te vrste procesov in povezav

we're going to understand the effects of medication or meditation

bomo razumeli učinke zdravil ali meditacije

and better personalize and make effective, for example,

in bolje in učinkoviteje bomo personalizirali, na primer,

psychoactive drugs.

pri psihoaktivnih zdravilih.

The scanners for these are getting smaller, less expensive

Ti skenerji so vse manjši, cenejši in bolj prenosni.

and more portable.

In te vrste eksplozija podatkov, ki je na voljo, res skoraj postaja izziv.

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.

Skeniranje danes zavzame približno 800 knjig ali 20 gigabajtov.

The scan in a couple of years will be one terabyte, or 800,000 books.

Skeniranje bo v nekaj letih en terabajt ali 800.000 knjig.

How do you leverage that information?

Kako izkoristite te informacije?

Let's get personal.

Postanimo osebni. Ne bom vprašal, kdo je bil na kolonoskopiji,

I won't ask who here's had a colonoscopy, but if you're over age 50,

a če ste stari nad 50 let, je čas za presejalno kolonoskopijo.

it's time for your screening colonoscopy.

Kako bi vam bila všeč možnost da se temu izognete?

How'd you like to avoid the pointy end of the stick?

Now there's essentially virtual colonoscopy.

Zdaj v bistvu obstaja virtualna kolonoskopija.

Compare those two pictures.

Primerjajte ti dve sliki in kot radiolog

As a radiologist, you can basically fly through your patient's colon,

lahko poletite skozi bolnikovo debelo črevo

in z uporabo umetne inteligence (U.I.)

and augmenting that with artificial intelligence,

prepoznate potencialno lezijo, kot vidite tukaj.

potentially identify a lesion that we might have missed,

Mogoče smo jo spregledali, a z uporabo U.I. pri radiologiji,

but using AI on top of radiology,

najdemo lezije, ki smo jih spregledali.

we can find lesions that were missed before.

In morda bo to spodbudilo ljudi,

Maybe this will encourage people to get colonoscopies

da opravijo kolonoskopijo, ki je sicer ne bi.

that wouldn't have otherwise.

In to je primer spremembe paradigme.

This is an example of this paradigm shift.

Gibljemo se k integraciji biomedicine, informacijske tehnologije,

We're moving to this integration of biomedicine, information technology,

brezžične in, rekel bi, mobilne - v ero digitalne medicine.

wireless and, I would say, mobile now -- this era of digital medicine.

Celo moj stetoskop je zdaj digitalni. In seveda tudi za to obstaja aplikacija.

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.

Očitno se gibljemo k eri trikorderja.

Ročni ultrazvok je v bistvu presegel in izpodrinil stetoskop.

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

Sedaj imajo ceno - včasih je bila 100.000 € ali nekaj 100.000 $ -

or a couple hundred-thousand dollars.

za približno 5.000 $ lahko imam moč

For about 5,000 dollars,

I can have the power of a very powerful diagnostic device in my hand.

zelo zmogljive diagnostične naprave v roki.

Merging this now with the advent of electronic medical records --

In združevanje tega s pojavom elektronskih zdravstvenih kartotek -

v ZDA je še vedno manj kot 20 odstotkov elektronskih.

in the US, we're still less than 20 percent electronic;

here in the Netherlands, I think it's more than 80 percent.

Tukaj na Nizozemskem, mislim, da je več kot 80 %.

Now that we're switching to merging medical data,

A zdaj, ko prehajamo na združevanje zdravstvenih podatkov,

making it available electronically,

da so dostopni elektronsko,

we can crowd-source the information, and as a physician,

lahko te podatke damo v množično zunanje izvajanje

in kot zdravnik, lahko od kjerkoli dostopam do podatkov svojih bolnikov

I can access my patients' data from wherever I am,

just through my mobile device.

le s svojo mobilno napravo.

And now, of course, we're in the era of the iPad, even the iPad 2.

Zdaj pa smo, seveda, v dobi iPada, celo iPada 2.

Just last month,

In ravno prejšnji mesec je FDA odobrila prvo aplikacijo,

the first FDA-approved application was approved

ki bo radiologu omogočila, da dejansko odčitava s tovrstne naprave.

to allow radiologists to do actual reading on these sorts of devices.

So certainly, the physicians of today, including myself,

Vsekakor so današnji zdravniki, z mano vred,

are completely reliable on these devices.

popolnoma zanesljivi na teh napravah.

And as you saw just about a month ago,

In kot ste videli, le kakšen mesec nazaj,

Watson from IBM beat the two champions in "Jeopardy."

je IBM-ov Watson premagal dva prvaka v kvizu "Jeopardy".

So I want you to imagine when, in a couple of years,

Rad bi, da si zamislite, kako bomo v nekaj letih,

we've started to apply this cloud-based information,

po začetku uporabe informacij "iz oblaka",

res imeli U.I. zdravnika in bomo svoje možgane povezali,

when we really have the AI physician and leverage our brains to connectivity

da bi sprejemali odločitve in diagnostike

to make decisions and diagnostics at a level never done.

na ravni, ki je še nikoli ni bilo.

Already today, you don't need to go to your physician in many cases.

Že danes vam v mnogih primerih ni treba iti do zdravnika.

Only in about 20 percent of visits do you need to lay hands on the patient.

Le v približno 20 % obiskov je fizični kontakt z bolnikom nujen.

Zdaj smo v eri virtualnih obiskov -

We're now in the era of virtual visits.

od obiskov tipa Skype, ki jih lahko storite z "American Well",

From Skype-type visits you can do with American Well,

to Cisco, that's developed a very complex health presence system,

do "Cisca", ki je razvil kompleksen sistem zdravstvene prisotnosti.

the ability to interact with your health care provider is different.

Možnost interakcije s svojim izvajalcem zdravstvenih storitev je drugačna.

And these are being augmented even by our devices, again, today.

In naše sedanje naprave to še naprej spreminjajo.

Prijateljica Jessica mi je poslala sliko raztrganine na glavi

My friend Jessica sent me a picture of her head laceration,

so I can save her a trip to the emergency room,

in lahko ji prihranim pot na urgenco in nekaj diagnosticiram na ta način.

and do diagnostics that way.

Mogoče bi lahko izkoristili igričarsko tehnologijo,

Or maybe we can leverage today's gaming technology,

kot je Microsoft Kinect, in jo shekamo za potrebe diagnostike,

like the Microsoft Kinect,

hack that to enable diagnostics, for example, in diagnosing stroke,

na primer za diagnosticiranje kapi

s preprosto zaznavo gibov z napravami za sto dolarjev.

using simple motion detection, using $100 devices.

We can actually now visit our patients robotically.

Dejansko lahko sedaj robotsko obiščemo svoje bolnike -

This is the RP7;

to je RP7; če sem hematolog,

if I'm a hematologist, I can visit another clinic or hospital.

lahko obiščem drugo kliniko, bolnišnico.

These are being augmented by a whole suite of tools

To bo obogateno s celo vrsto orodij, ki jih imamo doma že zdaj.

actually in the home now.

Zamislite si, brezžične tehtnice že imamo.

We already have wireless scales.

Lahko stopite na tehtnico.

You step on the scale, tweet your weight to your friends,

Lahko tvitnete svojo težo prijateljem, ki vas lahko nadzirajo.

they can keep you in line.

We have wireless blood pressure cuffs.

Imamo brezžične manšete krvnega tlaka.

A whole gamut of technologies are being put together.

Cel razpon tehnologij se združuje.

Namesto nošenja teh nerodnih naprav, lahko nadenemo preprost obliž.

Instead of wearing kludgy devices, we put on a simple patch.

To so razvili kolegi na Stanfordu, imenuje se iRhythm -

This was developed at Stanford.

It's called iRhythm; it completely supplants the prior technology

povsem je izpodrinil prejšnjo tehnologijo, po precej nižji ceni

at a much lower price point, with much more effectivity.

z veliko več učinkovitosti.

We're also in the era today of quantified self.

Zdaj smo tudi v eri, t. i. določanja sebe.

Potrošniki lahko zdaj kupijo stodolarske naprave, kot je ta majhni FitBit.

Consumers now can basically buy $100 devices, like this little Fitbit.

I can measure my steps, my caloric outtake.

Lahko merim svoje korake, svojo porabo kalorij.

I can get insight into that on a daily basis

To lahko dnevno nadziram.

and share it with my friends or physician.

Lahko delim s prijatelji, s svojim zdravnikom.

There's watches that measure your heart rate, Zeo sleep monitors,

Prihajajo ure, ki bodo merile srčni utrip, Zeo monitorji spanja,

a suite of tools that enable you to leverage

celotna zbirka orodij, ki vam omogoča vpogled v lastno zdravje.

and have insight into your own health.

As we start to integrate this information,

In ko začnemo integrirati te informacije,

we'll know better what to do with it, and have better insight

bomo bolje vedeli, kaj naj z njimi počnemo, in kako izboljšati vpogled

into our own pathologies, health and wellness.

v lastne bolezni, zdravje in dobro počutje.

There's even mirrors that can pick up your pulse rate.

Obstajajo celo ogledala, ki lahko zaznajo vaš srčni utrip.

And I would argue, in the future,

In trdim, da bomo v prihodnosti imeli nosljive naprave v naših oblekah,

we'll have wearable devices in our clothes, monitoring us 24/7.

in se nenehno nadzirali.

And just like the OnStar system in cars, your red light might go on.

In tako kot imamo OnStar sistem v avtomobilih,

se vam bo prižgala rdeča lučka - a ne bo "preveri motor",

It won't say "check engine"; it'll be a "check your body" light,

ampak "preveri svoje telo" in za "pojdi in poskrbi za to".

and you'll go get it taken care of.

Verjetno se boste čez nekaj let gledali v svojem ogledalu

Probably in a few years,

you'll look in your mirror and it'll be diagnosing you.

in le-to vas bo diagnosticiralo.

(Smeh)

(Laughter)

For those of you with kiddos at home,

Za tiste, ki ste doma z otroci,

how would you like a wireless diaper that supports your --

kako bi vam bilo všeč, da imate brezžično plenico, ki podpira vaš...

(Laughter)

More information, I think, than you might need,

več informacij, kot jih potrebujete.

but it's going to be here.

Ampak to bo tukaj.

Now, we've heard a lot today about technology and connection.

Danes smo veliko slišali o novi tehnologiji in povezavo z njo.

And I think some of these technologies

Mislim, da bo nekaj od teh tehnologij

will enable us to be more connected with our patients, to take more time

omogočilo večjo povezanost z našimi bolniki,

da si bomo vzeli več časa

and do the important human-touch elements of medicine,

in dejansko izvajali, kar je pomembno, humano medicino,

obogateno s tovrstnimi tehnologijami.

as augmented by these technologies.

Now, we've talked about augmenting the patient.

Govorili smo o, do neke mere, izboljševanju bolnika.

How about augmenting the physician?

Kaj pa izboljševanje zdravnika?

Zdaj smo v eri, ko je kirurg super opremljen,

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,

da lahko gre v telo

in operira z robotsko kirurgijo, ki je danes tukaj,

at a level that was not really possible even five years ago.

na ravni, ki ni bila mogoča celo pred petimi leti.

And now this is being augmented with further layers of technology,

Zdaj je to razširjeno z dodatnimi plastmi tehnologije

kot je obogatena resničnost.

like augmented reality.

So the surgeon can see inside the patient, through their lens,

Tako da lahko kirurg vidi notranjost bolnika skozi leče,

where the tumor is, where the blood vessels are.

kje je tumor, kje so krvne žile.

To je lahko integrirano s podporo za odločitve.

This can be integrated with decision support.

Kirurg v New Yorku lahko pomaga kirurgu v Amsterdamu, na primer.

A surgeon in New York can help a surgeon in Amsterdam, for example.

In prehajamo v ero

And we're entering an era of truly scarless surgery called NOTES,

kirurgije resnično brez brazgotin imenovane NOTES,

where the robotic endoscope can come out the stomach

kjer lahko gre robotski endoskop ven iz želodca

and pull out that gallbladder,

in izvleče žolčnik

all in a scarless way and robotically.

robotsko in brez brazgotin.

This is called NOTES, and it's coming -- basically scarless surgery,

To se imenuje NOTES in to prihaja - v bistvu kirurgija brez brazgotin,

as mediated by robotic surgery.

kot jo omogoča robotska kirurgija.

Now, how about controlling other elements?

Kako je pa s kontroliranjem drugih delov?

For those who have disabilities -- the paraplegic,

Za tiste, ki so invalidi - paraplegike -

there's the brain-computer interface, or BCI,

smo v eri možganskih računalniških vmesnikov ali BCI,

where chips have been put on the motor cortex

kjer so čipi v motorični možganski skorji tetraplegika,

of completely quadriplegic patients,

ki lahko nadzorujejo kurzor ali voziček ali morebiti robotsko roko.

and they can control a cursor or a wheelchair

or, potentially, a robotic arm.

These devices are getting smaller

In te naprave so vse manjše, uporablja pa jih vse več teh bolnikov.

and going into more and more of these patients.

Še so v kliničnih preizkušanjih, a zamislite si, ko bodo povezane,

Still in clinical trials,

but imagine when we can connect these, for example,

na primer, z bioničnim udom,

to the amazing bionic limb,

kot je DEKA roka, ki so je zgradili Dean Kamen in kolegi,

such as the DEKA Arm, built by Dean Kamen and colleagues,

ki ima 17 prostostnih stopenj

which has 17 degrees of motion and freedom,

in lahko omogoči osebi, ki je izgubila ud,

and can allow the person who's lost a limb

da ima veliko višje nivoje spretnosti ali nadzora,

to have much higher dexterity or control than they've had in the past.

kot jih je imela v preteklosti.

So we're really entering the era of wearable robotics, actually.

Torej, res vstopamo v ero nosljive robotike.

If you haven't lost a limb but had a stroke,

Če niste izgubili uda - imeli ste možgansko kap, na primer -

you can wear these augmented limbs.

bi lahko nosili te zmogljive okončine,

Or if you're a paraplegic -- I've visited the folks at Berkeley Bionics --

ali, če ste paraplegik - obiskal sem ljudi na Berkley Bionics -

they've developed eLEGS.

oni so razvili eLEGS.

I took this video last week.

Prejšnji teden sem posnel ta video. Tukaj je paraplegik, ki dejansko hodi

Here's a paraplegic patient, walking by strapping on these exoskeletons.

s pomočjo jermenov na teh eksoskeletih.

He's otherwise completely wheelchair-bound.

Sicer je priklenjen na invalidski voziček.

This is the early era of wearable robotics.

In to je zdaj zgodnja era nosljive robotike.

And by leveraging these sorts of technologies,

Mislim, da bomo s tovrstnimi tehnologijami spremenili definicijo invalidnosti

we're going to change the definition of disability

to, in some cases, be superability, or super-enabling.

v super-zmogljivost ali super-opremljenost.

This is Aimee Mullins, who lost her lower limbs as a young child,

To je Aimee Mullins, ki je kot otrok izgubila svoje spodnje okončine,

in Hugh Herr, ki je profesor na MIT,

and Hugh Herr, who's a professor at MIT,

who lost his limbs in a climbing accident.

ki je izgubil svoje ude v plezalni nesreči.

And now both of them can climb better, move faster, swim differently

In sedaj oba lahko plezata bolje, se hitreje gibljeta, plavata drugače

with their prosthetics than us normal-abled persons.

s svojimi protezami od nas, z normalnimi sposobnostmi.

How about other exponentials?

Kako je z drugimi hitro naraščajočimi trendi?

Clearly the obesity trend is exponentially going in the wrong direction,

Trend debelosti gre skokovito v napačno smer,

vključno z velikimi stroški.

including with huge costs.

But the trend in medicine is to get exponentially smaller.

Ampak v medicini je trend skokovito zmanjševanje.

A few examples: we're now in the era of "Fantastic Voyage," the iPill.

Nekaj primerov: Zdaj smo v eri filma "Fantastic Voyage," t. i. iPill,

You can swallow this completely integrated device.

to popolnoma integrirano napravo, ki jo lahko pogoltnete

in bo lahko slikala vaša prebavila.

It can take pictures of your GI system,

help diagnose and treat as it moves through your GI tract.

Pomagala bo diagnostiki in zdravljenju, potujoč skozi vaša prebavila.

We get into even smaller micro-robots

Prišli smo do še manjših mikrorobotov,

that will eventually, autonomously, move through your system,

ki se bodo sčasoma samostojno premikali skozi vaš sistem

and be able to do things surgeons can't do

in delali stvari, ki jih kirurgi ne morejo početi,

in a much less invasive manner.

veliko manj invazivno.

Sometimes these might self-assemble in your GI system,

Včasih se bodo lahko sami sestavili v vaših prebavilih

and be augmented in that reality.

in se obogatili v tem okolju.

On the cardiac side, pacemakers are getting smaller

Glede srca, spodbujevalniki so vse manjši in jih je veliko lažje vstaviti,

and much easier to place,

so no need to train an interventional cardiologist to place them.

torej ni treba usposabljati interventnega kardiologa.

Brezžično se bodo povezali z vašimi mobilnimi napravami,

And they'll be wirelessly telemetered to your mobile devices,

da vas bodo lahko spremljali na daljavo.

so you can go places and be monitored remotely.

These are shrinking even further.

Velikosti se še naprej krčijo.

This one is in prototyping by Medtronic; it's smaller than a penny.

Tukaj je prototip Medtronica, ki je manjši od penija.

Artificial retinas, the ability to put arrays on the back of the eyeball

Umetna mrežnica, ki se lahko vgradi na zadnjo stran očesnega zrkla

in omogoča slepim, da vidijo.

and allow the blind to see --

also in early trials, but moving into the future.

Čeprav v zgodnjih preizkušanjih, a gre v prihodnost.

To bo popolna sprememba.

These are going to be game-changing.

Or for those of us who are sighted,

Ali pa za tiste med nami z dioptrijo,

kako se vam zdijo vseživljenjske kontaktne leče?

how about having the assisted-living contact lens?

Bluetooth, Wi-Fi available -- beams back images to your eye.

BlueTooth, WiFi so na voljo - teleportirajo žarke nazaj na oko.

(Laughter)

Zdaj, če imate težave z vzdrževanjem diete,

Now, if you have trouble maintaining your diet,

lahko pomagajo dodatne podobe,

it might help to have some extra imagery

to remind you how many calories are going to be coming at you.

da vas spomnijo, koliko kalorij boste zaužili.

How about enabling the pathologist to use their cell phone

Kaj, če bi patologa opremili, da preko svojega mobilnega telefona

to see at a microscopic level

vidi na mikroskopski ravni

in da te podatke vrne v oblak, da bi boljše diagnosticiral?

and to lumber that data back to the cloud and make better diagnostics?

V bistvu se celotna era laboratorijske medicine popolnoma spreminja.

In fact, the whole era of laboratory medicine

is completely changing.

We can now leverage microfluidics,

Sedaj lahko izkoristite mikrofluidne naprave

like this chip made by Steve Quake at Stanford.

kot je ta čip, ki ga je naredil Steve Quake na Stanfordu.

Microfluidics can replace an entire lab of technicians;

Mikrofluidiki lahko nadomestijo cel laboratorij tehnikov.

put it on a chip, enable thousands of tests at the point of care,

Na čipu omogočajo, da se naredi na tisoče testov

anywhere in the world.

na točki oskrbe, kjerkoli na svetu.

In to bo res tehnološki vzvod

This will really leverage technology to the rural and the underserved

na podeželju in za nezadostno preskrbljene,

and enable what used to be thousand-dollar tests to be done for pennies,

ker bodo testi, včasih vredni 1.000 $, narejeni za nekaj penijev

in to na kraju oskrbe.

and at the point of care.

If we go down the small pathway a little bit further,

Če gremo po poti majhnosti malo dlje, vstopamo v ero nanomedicine,

we're entering the era of nanomedicine,

the ability to make devices super-small,

možnosti izdelave super majhnih naprav,

to the point where we can design red blood cells

do točke, ko bomo lahko oblikovali rdeče krvne celice

ali mikro robote, ki bodo nadzirali naš krvni ali imunski sistem,

or microrobots that monitor our blood system or immune system,

or even those that might clear out the clots from our arteries.

ali celo takšne, ki bodo zmogli očistiti strdke v naših žilah.

Now how about exponentially cheaper?

Kaj če bi bilo skokovito cenejše?

Not something we usually think about in the era of medicine,

To ni nekaj, kar se običajno pomisli v eri medicine,

but hard disks used to be 3,400 dollars for 10 megabytes -- exponentially cheaper.

ampak trdi diski, nekoč po 3.400 $ za 10 megabajtov, so skokovito cenejši.

In genomics now, the genome cost about a billion dollars

V genomiki so bili stroški genoma okoli milijarde dolarjev

about 10 years ago, when the first one came out.

pred približno 10 leti, ko se je pojavil.

We're now approaching essentially a $1,000 genome, probably next year.

Zdaj se približujemo genomu po 1.000 $ -

verjetno naslednje leto, ali v dveh letih po 100 $.

And in two years, a $100 genome.

What will we do with $100 genomes?

Kaj bomo naredili s stodolarskimi genomi?

Soon we'll have millions of these tests available.

In kmalu bomo imeli na milijone teh testov.

Then it gets interesting, when we start to crowd-source that information,

In takrat postane zanimivo, ko bomo začeli s crowdsourcingom teh informacij.

and enter the era of true personalized medicine:

Vstopili bomo v ero osebne medicine -

pravo zdravilo za pravo osebo ob pravem času -

the right drug for the right person at the right time,

namesto tega, kar danes dajemo - enako zdravilo vsem -

instead of what we're doing now, which is the same drug for everybody,

neke vrste uspešnice zdravil,

blockbuster drug medications, which don't work for the individual.

zdravil, ki ne delajo za vas osebno.

Many different companies are working on leveraging these approaches.

In mnogo različnih podjetij dela na spodbujanju teh pristopov.

I'll show you a simple example, from 23andMe again.

Prikazal vam bom preprost primer podjetja 23andMe.

Moji podatki kažejo, da imam povprečno tveganje

My data indicates I've got about average risk

for developing macular degeneration, a kind of blindness.

za razvoj procesa degeneracije makule, neke vrste slepote.

A če vzamem iste podatke in jih naložim na deCODEme podjetje,

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.

lahko vidim svoje tveganje za diabetes tipa 2.

Imam skoraj dvakrat večje tveganje za diabetes tipa 2.

I might want to watch how much dessert I have at lunch, for example.

Mogoče bi želel paziti, koliko sladic lahko pojem za kosilo.

It might change my behavior.

To lahko spremeni moje vedenje.

Leveraging my knowledge of my pharmacogenomics:

Z izkoriščanjem znanja o svoji farmakogenomiki -

how my genes modulate, what my drugs do and what doses I need

kako moji geni modulirajo, učinke in odmerke mojih zdravil

will become increasingly important,

bo postalo izredno pomembno

in ko bo enkrat v rokah posameznika in bolnika,

and once in the hands of individuals and patients,

will make better drug dosing and selection available.

bo boljše odmerjanje in izbor zdravila.

Torej še enkrat, ne gre samo za gene, ampak za različne podrobnosti -

So again, it's not just genes, it's multiple details --

our habits, our environmental exposures.

za naše navade, našo okoljsko izpostavljenost.

When was the last time your doctor asked where you've lived?

Kdaj vas je zdravnik nazadnje vprašal, kje živite?

Geomedicine: where you live, what you've been exposed to,

Geomedicina: kje ste živeli, čemu ste bili izpostavljeni,

can dramatically affect your health.

lahko močno vpliva na vaše zdravje. Lahko ujamemo te informacije.

We can capture that information.

Genomics, proteomics, the environment --

Torej genomika, proteomika, okolje,

vsi ti podatki se zlivajo k nam posamično in mi, kot ubogi zdravniki,

all this data streaming at us individually and as physicians:

How do we manage it?

kako lahko to obvladamo?

We're now entering the era of systems medicine, systems biology,

Vstopamo v ero sistemske medicine ali sistemske biologije,

where we can start to integrate all this information.

kjer bomo lahko začeli integrirati vse te informacije.

In na vzorcih, na primer v naši krvi,

And by looking at the patterns, for example, in our blood,

10.000 biomarkerjev v enem testu,

of 10,000 biomarkers in a single test,

lahko začnemo gledati te majhne vzorce

we can look at patterns and detect disease at a much earlier stage.

in bolezni bomo odkrili veliko prej.

This is called by Lee Hood, the father of the field, P4 Medicine.

To je imenovano po Lee Hoodu, očetu področja, P4 medicina.

Lahko bomo napovedovali, vedeli bomo od česa boste verjetno zboleli.

We'll be predictive and know what you're likely to have.

We can be preventative; that prevention can be personalized.

Lahko smo preventivni; preventiva je lahko personalizirana;

More importantly, it'll be increasingly participatory.

in še pomembneje, vedno bolj bo participativna.

Through websites like PatientsLikeMe

Prek spletnih strani, kot je Patients Like Me,

or managing your data on Microsoft HealthVault or Google Health,

ali z upravljanjem vaših podatkov na Microsoft HealthVault ali Google Health,

leveraging this together in participatory ways

bo izkoriščanje tega na participativni način postalo izredno pomembno.

will be increasingly important.

I'll finish up with exponentially better.

Končal bom s skokovito na boljše.

We'd like to get therapies better and more effective.

Radi bi dobili boljše in učinkovitejše terapije.

Danes zdravimo visok krvni tlak predvsem s tabletami.

Today we treat high blood pressure mostly with pills.

What if we take a new device,

Kaj pa, če vzamemo novo napravo

in nokavtiramo živčne prenašalce, ki pomagajo uravnavati krvni tlak,

knock out the nerve vessels that help mediate blood pressure,

and in a single therapy, basically cure hypertension?

in v eni terapiji ozdravimo hipertenzijo?

This is a new device doing essentially that.

To je nova naprava, ki, pravzaprav, to dela.

It should be on the market in a year or two.

Na trgu bo v letu ali dveh.

Kaj, če bo več ciljnih terapij za rak?

How about more targeted therapies for cancer?

Da, jaz sem onkolog

I'm an oncologist and know that most of what we give is essentially poison.

in moram reči, večina tega, kar dajemo, je v bistvu strup.

We learned at Stanford and other places that we can discover cancer stem cells,

Na Stanfordu in drugje smo se naučili,

da lahko odkrijemo izvorne rakave celice,

the ones that seem to be really responsible for disease relapse.

tiste, ki se zdijo res odgovorne za ponovitev bolezni.

So if you think of cancer as a weed,

Torej, če razmišljate o raku, kot o plevelu,

we often can whack the weed away and it seems to shrink,

se pogosto lahko znebimo plevela.

Zdi se, da se skrči, vendar se pogosto vrne.

but it often comes back.

So we're attacking the wrong target.

Torej napadamo napačno tarčo.

The cancer stem cells remain,

Matične celice raka ostanejo

in tumor se lahko vrne čez nekaj mesecev ali let.

and the tumor can return months or years later.

We're now learning to identify the cancer stem cells

Zdaj se učimo identificirati izvorne celice raka

and identify those as targets and go for the long-term cure.

in, ko jih prepoznamo kot tarče, gremo na dolgoročno zdravilo.

We're entering the era of personalized oncology,

In prehajamo v dobo osebne onkologije

z možnostjo uporabe vseh teh podatkov skupaj,

the ability to leverage all of this data together,

analyze the tumor

analize tumorja in določanja

and come up with a real, specific cocktail for the individual patient.

pravega, posebnega koktajla za posameznega bolnika.

I'll close with regenerative medicine.

Zaključil bom s regenerativno medicino.

Veliko sem študiral o matičnih celicah -

I've studied a lot about stem cells.

Embryonic stem cells are particularly powerful.

embrionalne matične celice so še posebej močne.

Imamo tudi odrasle matične celice.

We have adult stem cells throughout our body;

Te uporabljamo na mojem področju presaditev kostnega mozga.

we use those in bone marrow transplantation.

Geron, last year, started the first trial using human embryonic stem cells

Lansko leto je Geron začel prvo preizkušanje

z uporabo izvornih celic človeških zarodkov

to treat spinal cord injuries.

za zdravljenje poškodb hrbtenjače.

Still a phase I trial, but evolving.

Še vedno v prvi fazi preizkušanja, ampak se razvija.

We've been using adult stem cells in clinical trials for about 15 years

Uporabljali smo izvorne celice odraslih,

ki so v kliničnih preskušanjih približno 15 let,

to approach a whole range of topics, particularly cardiovascular disease.

da pristopimo celemu spektru vsebin, predvsem pri boleznih srca in ožilja.

If we take our own bone marrow cells and treat a patient with a heart attack,

Vzamemo lastne celice kostnega mozga in zdravimo bolnika s srčnim napadom,

we can see much improved heart function and better survival

lahko vidimo zelo izboljšano delovanje srca in boljše preživetje

using our own bone marrow derived cells after a heart attack.

z uporabo lastne pogonske celice kostnega mozga po srčnemu napadu.

I invented a device called the MarrowMiner,

Izumil sem t. i. MarrowMiner, ki dosti manj invazivno nabira kostni mozeg.

a much less invasive way for harvesting bone marrow.

It's now been FDA approved; hopefully on the market in the next year.

Zdaj jo je FDA odobrila in upam, da bo prišla na trg naslednje leto.

Hopefully you can appreciate the device

Upam, da boste lahko občudovali, kako se naprava krivi skozi bolnikovo telo

going through the patient's body removing bone marrow, not with 200 punctures,

in odstranjuje kostni mozeg, namesto z 200 punkcijami,

but with a single puncture, under local anesthesia.

z eno samo punkcijo pod lokalno anestezijo.

Where is stem-cell therapy going?

Kam v resnici gre zdravljenje z matičnimi celicami?

If you think about it,

Če pomislite, vsaka celica v telesu ima enako DNK, kot ste jo imeli kot zarodek.

every cell in your body has the same DNA you had when you were an embryo.

Sedaj lahko reprogramiramo vaše kožne celice,

We can now reprogram your skin cells

to actually act like a pluripotent embryonic stem cell

da delujejo kot pluripotentne embrionalne matične celice

in jih lahko uporabljamo za zdravljenje več organov v istem bolniku -

and utilize those, potentially, to treat multiple organs in the same patient,

making personalized stem cell lines.

za izdelavo vaše lastne, osebne linije izvornih celic.

I think there'll be a new era of your own stem cell banking

Mislim, da bo nova era lastnih bank za hrambo matičnih celic,

to have in the freezer your own cardiac cells, myocytes and neural cells

da boste imeli v zamrzovalniku lastne srčne celice, miocite in nevronske celice,

to use them in the future, should you need them.

za primer, če jih boste potrebovali.

We're integrating this now with a whole era of cellular engineering,

In sedaj to integriramo s celotno ero mobilnega inženiringa

in integriramo skokovite tehnologije za tiskanje 3D organov -

and integrating exponential technologies for essentially 3D organ printing,

nadomeščamo črnilo s celicami

replacing the ink with cells,

and essentially building and reconstructing a 3D organ.

in pravzaprav gradimo in rekonstruiramo 3D organ.

That's where things are heading.

Stvari bodo šle v to smer - še zelo zgodnje obdobje.

Still very early days,

Ampak mislim, da je za vključevanje eksponentnih tehnologij, to primer.

but I think, as integration of exponential technologies,

this is the example.

So in closing, as you think about technology trends

Tako na koncu, ko mislite o tehnoloških trendih

and how to impact health and medicine,

in kako vplivajo na zdravje in medicino,

we're entering an era of miniaturization,

vstopamo v ero miniaturizacije,

decentralization and personalization.

decentralizacije in personalizacije.

And by pulling these things together,

Če te stvari združimo,

if we start to think about how to understand and leverage them,

lahko začnemo razmišljati, kako jih razumeti in uporabiti,

we're going to empower the patient, enable the doctor, enhance wellness

bomo opolnomočili bolnika,

opremili zdravnika, izboljšali dobro počutje

in začeli z zdravljenjem, še preden zbolijo.

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,

Ker kot zdravnik vem, če nekdo pride k meni z začetno stopnjo bolezni,

I'm thrilled; we can often cure them.

sem navdušen - pogosto jih lahko ozdravimo.

But often it's too late,

Toda pogosto je prepozno in je stopnja III ali IV raka, na primer.

and it's stage III or IV cancer, for example.

So by leveraging these technologies together,

S skupnim izkoriščanjem teh tehnologij, mislim, da bomo vstopili v novo ero,

I think we'll enter a new era that I like to call stage 0 medicine.

ki ji rad rečem Medicina na stopnji 0.

And as a cancer doctor, I'm looking forward to being out of a job.

In kot onkologa me veseli, da bom ostal brez službe.

Thanks very much.

Hvala lepa.

(Applause)

Host: Thank you. Thank you.

Gostiteljica: Hvala. Hvala.

(Applause)

(Aplavz)

Take a bow, take a bow.

Poklon. Poklon.