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

翻译人员: Hao Yu 校对人员: Angelia King

几年前

A couple of years ago,

when I was attending the TED conference in Long Beach,

我参加在长滩TED会议的时候，

我遇到了哈里特。

I met Harriet.

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

实际上我们以前在网上遇到过--

不是像你们想的那样。

We were introduced because we both knew Linda Avey,

我们认识是因为我们都认识琳达·埃维，

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

首家私营基因公司创始人之一。

并且因为我们和琳达分享我们的基因信息，

And because we shared our genetic information with Linda,

she could see that Harriet and I shared

她知道哈里特和我

a very rare type of mitochondrial DNA, haplotype K1a1b1a,

都有一种很稀有的线粒体DNA --

K1a1b1a 单模标本 --

which meant we were distantly related.

这意味着我们是远亲。

We actually share the same genealogy with Ötzi the Iceman.

实际上，我们都和冰人奥兹有亲缘关系。

So -- Ötzi, Harriet and me.

没错，奥兹，哈里特和我。

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

当然，如今我们有了自己的脸书网群组。

欢迎你们加入。

You're all welcome to join.

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

当我在第二年TED会议遇见哈里特的时候，

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

她在线订购了我们自己快乐的单模标本T恤衫。

(笑声）

(Laughter)

Why am I telling you this story?

为什么我要告诉你们这个故事，

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

这和未来健康有什么关系呢？

Well, the way I met Harriet is an example

实际上，我遇见哈里特的经过是一个很好的例子

of how leveraging cross-disciplinary, exponentially growing technologies

关于怎样利用学科交叉，

指数增长的技术

is affecting our future of health and wellness --

来影响我们将来的健康和保健事业--

from low-cost gene analysis

从低成本的基因分析

to the ability to do powerful bioinformatics

到做强大生物信息学的能力

to the connection of the Internet and social networking.

到互联网和社会网络间的联系。

What I'd like to talk about today

我今天想谈的

is understanding these exponential technologies.

是理解这些指数增长的技术。

We often think linearly.

我们经常线性思考。

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

但是如果想像一下，如果你有一个睡莲叶子

and it just divided every single day --

它每天分裂一次--

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

2，4，8，16 --

15天以后会有32000个叶子。

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

你认为1个月以后有多少？我们会有10亿。

We're at a billion.

If we start to think exponentially,

如果我们开始指数思考，

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

我们会看到这会怎样影响到我们周围的技术。

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

许多技术--像一位物理学家和革新者所说的--

我们能真正开始去利用它们

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

影响我们的未来健康和卫生保健，

and of health care,

和谈论如今许多卫生保健面临的主要困难

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

从巨额投入

ranging from the exponential costs to the aging population,

到高龄人群，

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

我们没有真正很好地使用信息的现状，

保健不均衡

the fragmentation of care

and the often very difficult course of adoption of innovation.

和常常面对困难棘手的经历

例如采用革新的历程。

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

今天我们谈到主要的事情之一

是把曲线向左移。

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

我们在生命的最后20%时间里花费了大部分的钱。

如果我们能够投资和激励岗位

What if we could incentivize physicians in the health care system

在健康保健系统和我们自身

and our own selves

来向左移动这条曲线从而改善我们的健康，

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

利用技术，会怎么样呢？

leveraging technology as well?

我最喜爱的技术，指数技术的例子，

Now my favorite example of exponential technology,

we all have in our pocket.

在我们所有人的口袋里。

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

因此如果你想一下，你会发现这些技术真的显著提高了。

I mean, this is the iPhone 4.

我指的是iPhone 4.

Imagine what the iPhone 8 will be able to do.

想像iPhone 8将能做什么。

Now, I've gained some insight into this.

现在，我有了一些见解。

I've been the track share for the medicine portion

我追踪观察

新成立的奇点大学的医学院

of a new institution called Singularity University,

based in Silicon Valley.

它座落在硅谷。

We bring together each summer about 100 very talented students

每个夏天我们召集

世界各地100名非常有天赋的学生。

from around the world.

And we look at these exponential technologies from medicine,

我们研究这些指数技术从医学，生物技术，

人工智能，机器人技术，纳米技术，太空技术，

biotech, artificial intelligence, robotics, nanotechnology, space,

来发现如何能多项培训

and address how we can cross-train and leverage these

并利用这些技术去影响重大未实现的目标。

to impact major unmet goals.

我们也有一个7天执行方案。

We also have seven-day executive programs.

接下来几个月的方案是“未来医学”，

And coming up next month is FutureMed,

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

一个帮助多项培训和把技术应用到医学的项目。

现在我来说电话。

Now, I mentioned the phone.

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

这些手机有超过20000个不同的应用程序--

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

从这点上说，有一个与众不同，

那就是你可以通过在你的iPhone相连的一小块芯片上小便

connect it to your iPhone,

来自查是否有性传染病。

and check for an STD.

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

我不知道我是否会这样做，但是它确实可用。

还有很多种应用，

There are other sorts of applications.

Merging your phone and diagnostics, for example,

把你的电话和诊断联系在一起，例如--

用你的iPhone测量你的血糖

measuring your blood glucose on your iPhone

并可能把数据发给你的医生

and sending that to your physician,

so they can better understand and you can better understand

使得他们和你都能更好得了解

your blood sugars as a diabetic.

你作为一个糖尿病人的血糖。

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

现在让我们看看指数技术怎样进行健康保健。

让我们从速度开始。

Let's start with faster.

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

我们都知道，根据摩尔定律，计算机

运算速度越来越快。

are speeding up faster and faster.

We can do more powerful things with them.

因此我们能够做更强大的事情。

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

他们正在接近，在很多情况超越

人类思维的能力。

the ability of the human mind.

但是我认为计算速度最适用的地方

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

是在于成像技术。

The ability now to look inside the body in real time

这种技术能即时的观察身体内部

with very high resolution

用非常高的分辨率，真的很神奇。

is really becoming incredible.

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

我们正在综合多种技术--PET扫描，CT扫描

and molecular diagnostics --

和分子诊断--

to find and seek things at different levels.

来发现和寻找不同层面的东西。

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

今天在这里你们将会看到非常高分辨率的MRI扫描，

它是由TEDMED的主持者马克·霍道什重建的。

of Marc Hodosh, the curator of TEDMED.

And now we can see inside of the brain

现在我们能看到大脑内部

用一种以前没有过的分辨率和能力，

at a resolution and ability never before available,

and essentially learn how to reconstruct and maybe even reengineer

本质上学会如何重建，

也许甚至再设计，

or backwards engineer the brain,

或者逆向设计大脑，

so we can better understand pathology, disease and therapy.

因此我们能更好的理解病理学，疾病，和治疗。

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

我们能用fMRI即时查看内部--即时在大脑内部。

And by understanding these sorts of processes and these connections,

通过了解这些过程和联系，

我们能够理解药物治疗或者冥想的影响

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

从而更好的提供个人化有效的治疗，例如，

and better personalize and make effective, for example,

psychoactive drugs.

精神药物。

The scanners for these are getting smaller, less expensive

用于这些研究的扫描器变得更小，更便宜，更便携。

and more portable.

来自这种研究的数据爆炸

And this sort of data explosion available from these

is really almost becoming a challenge.

几乎真的成为一种挑战。

The scan of today takes up about 800 books, or 20 gigabytes.

今天的扫描占用了大约800本书的空间，或者20GB。

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

这种扫描在几年之内将会是1TB，或者80万本书。

你怎样利用这些信息？

How do you leverage that information?

Let's get personal.

让我们从个案分析。我不会问在这里谁做过结肠镜检查，

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

但是如果你年过50，是时候做结肠镜检查了。

it's time for your screening colonoscopy.

你怎么能避免结肠镜的尖端呢？

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

现在有一种虚拟结肠镜检查。

Now there's essentially virtual colonoscopy.

Compare those two pictures.

比较这两张图，现在作为一个放射学家，

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

你可以浏览你病人的结肠

用人工智能协助，

and augmenting that with artificial intelligence,

确定潜在的，像你这里看到的，这是一个损伤。

potentially identify a lesion that we might have missed,

哦，我们可能漏掉它，但是在放射学上用人工智能，

but using AI on top of radiology,

我们能找到以前漏掉的损伤。

we can find lesions that were missed before.

这也许会鼓励人们做结肠镜检查

Maybe this will encourage people to get colonoscopies

以前人们反而不愿意做它。

that wouldn't have otherwise.

这是一个根本变化的例子。

This is an example of this paradigm shift.

我们转到集成了生物医学，信息技术，

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

无线网络的交互应用，我想说，现在是移动电话--数字化医学的时代。

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

因此甚至我的听诊器现在也是数字化的。

Even my stethoscope is now digital, and of course, there's an app for that.

当然，它有个应用程序。

明显我们正走向分析仪时代。

We're moving, obviously, to the era of the tricorder.

因此手持式超声机

So the handheld ultrasound is basically surpassing

基本上超越并取代了听诊器。

and supplanting the stethoscope.

These are now at a price point of what used to be 100,000 euros

目前的价位

--以前是10万欧元或者几十万美元--

or a couple hundred-thousand dollars.

现在大约5000美元，我就能买得起

For about 5,000 dollars,

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

一个非常强大的诊断装置。

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

把这个装置和电子医疗记录结合起来--

在美国，电子化仍然少于百分之二十。

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

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

在荷兰，我想这数据要多于百分之八十。

但是现在我们转到合并医疗数据，

Now that we're switching to merging medical data,

使它电子化，

making it available electronically,

我们能够集中信息资源。

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

现在作为一名医生，我可以从任何地方查看我的病人的数据

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

仅通过我的手机。

just through my mobile device.

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

当然，如今我们处在iPad，甚至iPad2时代。

上个月首个FDA应用程序

Just last month,

the first FDA-approved application was approved

证实可以让放射专家

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

在这些设备上直接读图。

可以确定的说，今天的医生，包括我自己，

So certainly, the physicians of today, including myself,

are completely reliable on these devices.

完全依赖这些设备。

And as you saw just about a month ago,

正如你们大约一个月前看到的，

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

来自IBM的沃特森在“危险”中打败了2位冠军。

因此我想让你们想像当我们在未来几年内

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

当我们开始采用这种基于云端的信息

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

当我们真正地有了人工智能医生来利用我们的大脑连接

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

去做决定和诊断

to make decisions and diagnostics at a level never done.

在一个前所未有的技术水平上。

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

如今，在很多情况下你们已经不需要去看医生。

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

只有大约20%情况下真的需要看医生。

我们正处在虚拟看病时代--

We're now in the era of virtual visits.

从通过某种Skype视频语聊式的“American Well" 看病，

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

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

到思科研制的非常复杂的健康诊断系统。

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

这与给你提供健康保健医师之间的交流能力是有所不同的。

如今我们这些交流能力甚至正在被这些技术设备又增强了。

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

这是我的朋友杰西卡寄给我的她头部裂伤的照片

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

因此她不用来急诊室--我可以通过看照片做诊断。

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

或者我们也许能利用今天的游戏技术，

and do diagnostics that way.

Or maybe we can leverage today's gaming technology,

比如微软Kinect，

使其能进行诊断，比如，

like the Microsoft Kinect,

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

诊断中风，

用简单的移动检测，用几百元的设备。

using simple motion detection, using $100 devices.

我们实际上现在能用机器人诊断病人--

We can actually now visit our patients robotically.

这是RP7；如果我是一个血液病专家，

This is the RP7;

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

去另一个诊所，或医院。

These are being augmented by a whole suite of tools

如果现在在家里有一整套工具，这些工具会帮助我们增强彼此的交流。

actually in the home now.

想像一下我们已经有了无线网络体重计。

We already have wireless scales.

你可以站在体重计上。

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

你可以用微博把你的体重告知朋友，他们能让你保持身材。

they can keep you in line.

我们有无线网络血压计。

We have wireless blood pressure cuffs.

A whole gamut of technologies are being put together.

一整套技术正在整合在一起。

所以我们不用戴这些分离的装置，我们可以把它们放在一个简单的小片上。

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

斯坦福的同事发明了iRhythm--

This was developed at Stanford.

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

在价格上远远低于以前的技术

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

但有效率得多。

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

现在我们处在量化自我的时代。

人们可以买几百元的装置，

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

像这个小FitBit。

I can measure my steps, my caloric outtake.

我可以计算出我的步数和热量消耗。

I can get insight into that on a daily basis

我能够每天都知道了解这数据。

and share it with my friends or physician.

我可以和朋友或医生分享这些数据。

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

这些表可以测量心律，叫做Zeo睡眠监测仪，

a suite of tools that enable you to leverage

一整套工具能让你受益

并了解你自己的健康。

and have insight into your own health.

As we start to integrate this information,

在我们开始整合信息时，

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

我们会更好的了解用它做什么和怎么更好的

into our own pathologies, health and wellness.

了解我们自己的病理，健康和福利。

现在有镜子可以测量你的脉搏率。

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

And I would argue, in the future,

我要说，在将来，我们将有穿在衣服里的装置，

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

全天候检测我们的身体。

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

就像我们现在车里用的OnStar系统，

你的红灯会亮起来--它虽然不会说“检查发动机”。

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

它将会是“检查身体”灯，

亮起来就得小心。

and you'll go get it taken care of.

也许几年之后，你照镜子的时候

Probably in a few years,

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

它就会诊断你。

（笑声）

(Laughter)

For those of you with kiddos at home,

对于你们中在家带小孩的，

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

你会觉得无线网络尿布会帮你大忙。。。

(Laughter)

我认为有比你需要的多得多的信息。

More information, I think, than you might need,

但是会是这里。

but it's going to be here.

现在我们已经听了太多技术和连接，

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

我认为一些技术

And I think some of these technologies

将会使我们和病人联系得更好，

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

节约更多的时间，

and do the important human-touch elements of medicine,

实际上增进医学交流中重要的人与人之间的交互，

这些技术都能增强这些交流。

as augmented by these technologies.

Now, we've talked about augmenting the patient.

现在我们在某种程度上谈过了与患者的增进交流。

那与医生的增进交流呢？

How about augmenting the physician?

我们正处在超能医生时代

We're now in the era of super-enabling the surgeon,

他们能进入身体内部

who can now go into the body and do robotic surgery, which is here today,

用机器人做手术，如今成为现实，

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

在过去这是不可能完成的

即使在5年前。

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

现在这种技术被多重技术所增强

就像增强现实一样。

like augmented reality.

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

医生能通过镜头看到患者身体内部，

where the tumor is, where the blood vessels are.

肿瘤在哪里，血管在哪里。

这可以和决策支持合并在一起。

This can be integrated with decision support.

例如，纽约的一个医生能帮助阿姆斯特丹的另一个医生做手术。

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

我们正处在一个

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

叫做NOTES的真正无疤手术时代，

where the robotic endoscope can come out the stomach

机器人的内窥镜能穿过胃部

切除胆囊

and pull out that gallbladder,

all in a scarless way and robotically.

全程都是机器人化无疤方式。

这就叫做NOTES，这就是--

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

基本无疤手术，

as mediated by robotic surgery.

通过机器人手术来实现。

Now, how about controlling other elements?

现如今控制其他元素会怎么样呢？

For those who have disabilities -- the paraplegic,

对于残疾人--半身不遂--

这是大脑-计算机交互时代，或者叫BCI，

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

where chips have been put on the motor cortex

在大脑皮层运动区放置芯片

对四肢瘫痪者

of completely quadriplegic patients,

他们能够控制一个遥控器或者一个轮椅或者，最终，一个机器手臂。

and they can control a cursor or a wheelchair

or, potentially, a robotic arm.

这些装置变得越来越小

These devices are getting smaller

and going into more and more of these patients.

可以植入越来越多的患者体内。

虽然仍在临床实验阶段，但是设想当我们能连接这些技术，

Still in clinical trials,

but imagine when we can connect these, for example,

例如，令人惊叹的仿生学假肢，

to the amazing bionic limb,

像迪安·卡门和他的同事们所设计的DEKA手臂，

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

它有17度的移动和灵活度

which has 17 degrees of motion and freedom,

能够让失去一个肢体的人

and can allow the person who's lost a limb

有更高水平的灵活和控制度

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

比起他们过去曾有过的手臂。

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

我们实际上真正进入了可穿用的机器人时代。

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

如果你没有失去一个肢体--比方说，你有过中风--

你可以穿用这些假肢。

you can wear these augmented limbs.

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

或者如果你是一个半身不遂患者--像我拜访过的在伯克利仿生学实验室工作的同事们--

他们发明了电子腿eLEGS。

they've developed eLEGS.

I took this video last week.

我上周拍了这段视频。这是一个半身不遂患者正在走路

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

通过穿上这些盔甲。

He's otherwise completely wheelchair-bound.

如果不穿这些盔甲他完全得依靠轮椅。

This is the early era of wearable robotics.

现在是可穿用机器人时代的早期。

And by leveraging these sorts of technologies,

我认为通过采用这些技术，

我们能够改变残疾的定义

we're going to change the definition of disability

在某些情况下成为超常或者超能。

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

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

这是艾米·马林斯，在小时候她失去了下肢，

休·贺尔，麻省理工的教授

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

who lost his limbs in a climbing accident.

在一次攀岩事故中失去了肢体。

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

现在他们可以比我们正常人爬得更好，移动得更快，以不同的姿势游泳

with their prosthetics than us normal-abled persons.

通过修复手术。

其他的指数技术怎么样呢？

How about other exponentials?

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

很明显肥胖趋势朝错误的方向指数发展，

包括巨额支出。

including with huge costs.

But the trend in medicine is to get exponentially smaller.

但是在医学上这种趋势正在指数减少。

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

有几个例子：我们现在处在

“奇异旅程”时代，iPill。

You can swallow this completely integrated device.

你可以吞下这个完全集成的装置。

它能在你的消化道里拍照片，

It can take pictures of your GI system,

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

当它通过你的消化道的时候帮助你诊断和治疗。

We get into even smaller micro-robots

我们感兴趣更小的微型机器人

that will eventually, autonomously, move through your system,

将会最终自动通过你的消化系统

能做到医生做不到的事情

and be able to do things surgeons can't do

用一种痛苦少得多的方式。

in a much less invasive manner.

有时这些装置也许可以在你的消化系统自行组装

Sometimes these might self-assemble in your GI system,

and be augmented in that reality.

从而增强其使用价值。

On the cardiac side, pacemakers are getting smaller

对于心脏手术，起搏器正变得

and much easier to place,

更容易放置，

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

因此你不需要训练一个介入心脏医师去放置它们。

它们将会被你的手机遥控，

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

你可以去任何地方并远程遥控。

so you can go places and be monitored remotely.

These are shrinking even further.

这些装置正在被变得更小。

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

这是一个Medtronic制作的样品，比一分硬币还小。

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

人工视网膜的功能是把光线集中在眼球后面

从而让失明者恢复视力。

and allow the blind to see --

also in early trials, but moving into the future.

虽然仍在早期试验阶段，但是有很好的前景。

这些技术将会是革命性的。

These are going to be game-changing.

Or for those of us who are sighted,

对于我们中的那些视力有问题的人，

how about having the assisted-living contact lens?

有了这些辅助生活的隐形眼镜会怎样呢？

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

用蓝牙，无线网络--投射图像到你的眼球上。

(Laughter)

如果你不能保持节食，

Now, if you have trouble maintaining your diet,

一些图像也许会有助于

it might help to have some extra imagery

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

提醒你食物里有多少热量。

How about enabling the pathologist to use their cell phone

让病理学家能用他们的手机

在显微水平观察

to see at a microscopic level

把数据放回云端信息来做更好的诊断会怎样？

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

实际上，整个实验医学时代

In fact, the whole era of laboratory medicine

完全变了。

is completely changing.

We can now leverage microfluidics,

我们能利用微流体，

like this chip made by Steve Quake at Stanford.

像斯坦福的Steve Quake公司制造的芯片。

微流体能替代整个实验室的技术员。

Microfluidics can replace an entire lab of technicians;

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

把它放在一个芯片上，能做几千个测试

在世界任何地方都可以做。

anywhere in the world.

这将真正地从技术上获益

This will really leverage technology to the rural and the underserved

那些农村和保障不发达地区

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

能让过去上千块的测试减到几分钱

在护理方面上讲。

and at the point of care.

如果在这条小路上走得稍微远一点，

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

we're entering the era of nanomedicine,

我们将来到纳米医学时代，

the ability to make devices super-small,

能将装置做得超小

to the point where we can design red blood cells

小到我们可以设计血红细胞

或者微型机器人来监测我们的血液系统或免疫系统，

or microrobots that monitor our blood system or immune system,

或者甚至清除动脉里的血栓。

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

如果指数更加便宜会怎样？

Now how about exponentially cheaper?

在医学领域，这种便宜不是我们通常认为的那样，

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

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

而是10MB硬盘过去3400美元--指数便宜。

在基因组学，

In genomics now, the genome cost about a billion dollars

基因组价值约10亿美元

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

10年前当第一个基因组出现的时候。

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

我们现在基本上可以1000美元买到。

也许今后一两年，100美元的基因组会出现。

And in two years, a $100 genome.

我们能用100美元的基因组做什么呢?

What will we do with $100 genomes?

Soon we'll have millions of these tests available.

不久以后我们可以进行上百万的测试。

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

那就是当它变得有趣的时候，当我们开始集中信息资源的时候。

我们进入了真正的个人化医学时代--

and enter the era of true personalized medicine:

在正确的时间为正确的人制造正确的药--

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

而不是像现在我们这样，给每个人同样的药物--

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

一种药物治疗的混乱，

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

对你个人不一定有效。

Many different companies are working on leveraging these approaches.

很多不同的公司正在利用这些方法。

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

我会给你一个简单的例子，还是来自23andMe。

我的数据表明我已经达到平均风险系数

My data indicates I've got about average risk

for developing macular degeneration, a kind of blindness.

对于黄斑病变，一种失明病。

但是如果我把同样的数据上传到deCODEme，

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.

比如我能看到我得2型糖尿病的风险指数。

我现在差不多有2倍的风险得2型糖尿病。

例如我也许想看到午饭的时候吃多少甜点。

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

这也许能改变我的行为。

It might change my behavior.

Leveraging my knowledge of my pharmacogenomics:

利用我基因测试学的知识--

我的基因怎样调整，我的药物作用是什么和我需要什么

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

将变得越来越重要，

will become increasingly important,

在个人和患者手中的时候，

and once in the hands of individuals and patients,

将使得可用的药物选择和服用更好。

will make better drug dosing and selection available.

所以不仅是基因，有多种因素--

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

our habits, our environmental exposures.

我们的习惯，我们的环境。

上次医生问你住在哪里是什么时间？

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

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

风土医学：你住在哪里，你接触过什么

能极大影响你的健康。

can dramatically affect your health.

我们能抓住这些信息。

We can capture that information.

Genomics, proteomics, the environment --

因此基因组学，蛋白组学，环境，

all this data streaming at us individually and as physicians:

所有数据涌向我们作为个体人和医生们。

我们怎样管理它们呢？

How do we manage it?

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

我们正在进入系统医学或者系统生物学时代，

where we can start to integrate all this information.

我们能开始集成这些信息。

通过这些式样，例如，在我们的血液中

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

一个测试中有10000个生物标记，

of 10,000 biomarkers in a single test,

我们能看这些小的式样

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

在非常早期发现疾病。

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

这个领域的创始人，李·胡德叫这种方法为

P4医学。

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

我们将能预测；我们能知道我们可能会怎样。

We can be preventative; that prevention can be personalized.

我们能预防；这种预防性可以个人化；

More importantly, it'll be increasingly participatory.

更重要的是，它将变得共享。

虽然一些网站像Patients Like Me，

Through websites like PatientsLikeMe

微软HealthVault或者谷歌Health可以管理数据，

or managing your data on Microsoft HealthVault or Google Health,

用共享的方式利用数据

leveraging this together in participatory ways

将变得越来越重要。

will be increasingly important.

I'll finish up with exponentially better.

我将以指数地更好前景来做结束。

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

我们会得到更好更有效的治疗。

如今我们通常通过吃药治疗高血压。

Today we treat high blood pressure mostly with pills.

如果我们用一种新装置

What if we take a new device,

敲打神经血管帮助调节血压

knock out the nerve vessels that help mediate blood pressure,

一次治疗就能治愈高血压。

and in a single therapy, basically cure hypertension?

This is a new device doing essentially that.

这是做这种治疗的一种新装置。

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

它应该能在一两年内投放市场。

更具目标性的癌症治疗会怎样呢？

How about more targeted therapies for cancer?

对，我是肿瘤学家

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

我不得不说大多数我们开的药实际上是毒药。

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

我们在斯坦福和其他地方学到

我们可以发现癌症干细胞，

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

可能是癌症复发的真正原因。

So if you think of cancer as a weed,

如果你把癌症看作一个种子，

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

我们通常能够去除这个种子。

它好像萎缩了，但它经常又重新复发。

but it often comes back.

So we're attacking the wrong target.

所以我们正在去除错误的目标体。

The cancer stem cells remain,

癌症干细胞仍存在，

and the tumor can return months or years later.

肿瘤能在几个月或几年后重新长出来。

We're now learning to identify the cancer stem cells

我们现在学会了鉴定癌症干细胞

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

作为鉴定目标体来进行长期治疗。

我们正在进入个人化肿瘤学时代，

We're entering the era of personalized oncology,

利用汇集所有数据的能力，

the ability to leverage all of this data together,

分析肿瘤并提出来

analyze the tumor

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

针对每一个患者而采用的一个真正的，明确的鸡尾酒疗法。

最后我会讲讲再生医学。

I'll close with regenerative medicine.

我对干细胞研究很多--

I've studied a lot about stem cells.

Embryonic stem cells are particularly powerful.

胚胎干细胞尤其强大。

我们有遍布我们身体的成体干细胞。

We have adult stem cells throughout our body;

我们把这些干细胞用于骨髓移植领域。

we use those in bone marrow transplantation.

杰龙去年开始第一次尝试

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

用人类的胚胎干细胞

治疗脊髓疾病。

to treat spinal cord injuries.

Still a phase I trial, but evolving.

仍在试验阶段，但是不断进展。

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

我们已经应用成体干细胞

在临床试验大约15年了

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

在不同的课题，尤其是心血管病。

我们取出自己的骨髓细胞

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

治疗心脏病人，

我们可以看到心脏功能改善了并且存活率提高了

we can see much improved heart function and better survival

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

在心脏病发作后用我们自己的骨髓细胞。

I invented a device called the MarrowMiner,

我发明了一种装置叫骨髓采集器MarrowMiner，

一种温和得多的收集骨髓的方式。

a much less invasive way for harvesting bone marrow.

它已经被FDA认证，

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

将会在一两年内投放市场。

Hopefully you can appreciate the device

希望你能重视这种装置

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

它沿着患者的身体曲线获取患者的骨髓，

以前需要200次穿刺，现在在局部麻醉的情况下只要一次穿刺。

but with a single puncture, under local anesthesia.

但是干细胞治疗的前景会怎样？

Where is stem-cell therapy going?

如果你考虑一下，身体里的每个细胞有同样的DNA

If you think about it,

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

在你还是胚胎的时候就形成了。

我们现在能重新构造你的皮肤细胞

We can now reprogram your skin cells

就像一个多能的胚胎干细胞

to actually act like a pluripotent embryonic stem cell

利用这种技术可能治疗同一个患者的多个器官--

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

制造你自己个人化的干细胞系。

making personalized stem cell lines.

我认为这将是你自己干细胞库的新时代

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

把你自己的心肌细胞存放在冰箱中，

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

还可以是肌肉细胞和神经细胞

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

在你将来需要它们的时候用。

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

我们现在集成这些技术作为一整个细胞工程学时代。

集成指数技术

and integrating exponential technologies for essentially 3D organ printing,

对于3D器官复制--

用细胞替代墨水

replacing the ink with cells,

and essentially building and reconstructing a 3D organ.

最终重建一个3D器官。

That's where things are heading.

这是未来的展望；仍然在初始阶段。

Still very early days,

但是我认为，作为指数技术集成，

but I think, as integration of exponential technologies,

这是一个例子。

this is the example.

近期，当你考虑技术趋势

So in closing, as you think about technology trends

and how to impact health and medicine,

怎样影响健康和医学，

we're entering an era of miniaturization,

我们正进入小型化

decentralization and personalization.

分散化和个性化时代。

And by pulling these things together,

我认为把这些特性结合在一起，

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

如果我们能开始思考怎样了解和利用这些技术，

我们将会使患者恢复地更好，

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

医生更有能力，增强福利

防患于未然。

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,

因为作为医生我知道，如果某人在患病初期找到我，

我很高兴--我们通常能治愈他们。

I'm thrilled; we can often cure them.

But often it's too late,

但是经常太晚了，比方说癌症3期或者4期。

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

通过集成这些技术，

So by leveraging these technologies together,

我认为我们将进入一个新时代

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

我愿意叫它零阶段医学。

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

作为一名癌症医生，我期待失业。

Thanks very much.

非常感谢。

(Applause)

主持人：谢谢。谢谢。

Host: Thank you. Thank you.

(Applause)

（掌声）

Take a bow, take a bow.

鞠躬。鞠躬。