Daniel Kraft: How COVID-19 transformed the future of medicine | TED

Transcriber:

As a small child, I was lucky to be at the launch of Apollo 17,

翻译人员: WEIZE Su 校对人员: suya f.

the last manned mission to the Moon,

在我小的时候，我很幸运能见证 阿波罗17号的发射

and I've remained enamored with space ever since.

那是迄今为止最后一次 载人的月球任务

And fortunate as a physician

从那之后我一直十分迷恋太空

to have contributed to NASA life sciences research

作为一位医生

and to practice aerospace medicine,

我有幸致力于美国航空航天局 （NASA）生命科学的研究工作

inspired by the cross-disciplinary teamwork required

从而得以在太空医药领域实践

to tackle audacious challenges

并且一直从这种跨学科的 团队工作中获得灵感

and how space is has often brought the world together

这项工作需要勇于面对 很多大胆的挑战

through the lens of seeing our planet as one without borders.

而且与太空相关的课题 常常需要着眼于整个世界

Now, just as the historic Apollo moon landings

让人们通过透镜看到 一个没有边界的星球

were transformational inflection points in history,

就像阿波罗号 在月球上的多次登陆

so too is the global health crisis of COVID-19,

是历史上的转折点一样

which, despite its many challenges and tragedies,

新型冠状病毒给全世界 带来的健康危机也同样如此

like the sinister Cold War setting, which launched the space race,

尽管它带来了许多挑战与悲剧

can have silver linings.

但与凶险的冷战 引发了太空竞赛类似

As Regina Dugan, former head of DARPA, wrote,

这次健康危机也可以给人类带来后福

“Sputnik set off the space age, COVID can spark the health age.”

美国国防部高级研究计划局 的前局长雷吉娜·杜根写道，

“斯普特尼克1号人造卫星 开启了太空时代，

The silver linings include

新型冠状病毒 可以开启健康新时代。“

the unprecedented acceleration

of innovation, collaboration and discovery,

这些后福包括

前所未有的全面推进

catalyzing a future of health and medicine that can help us reimagine

创新、合作和新发现的进程

and bring us a healthier, smarter, more equitable post-COVID world.

催化出可供人们重新构想的 健康科学和医药的未来

并带来一个更健康、更智能 和更公正的后新冠病毒世界

Now, many solutions ride the rails

of rapidly, exponentially developing technologies

目前，许多解决方案

that are rapidly doubling in their speed-price performance,

借着技术迅猛发展的东风

as exemplified by Moore's Law,

性能迅速翻倍，而价格快速下跌

which has enabled the billionfold improvements in memory and computation,

以摩尔定律为例

芯片的内存和计算能力 得到了十亿倍的提升

resulting in the ubiquitous supercomputer smartphones

most of us carry in our pockets.

结果是超级电脑和智能手机的普及

I still have my now ancient iPhone 2 here.

使得我们能随身携带这些设备

Still works, which felt magical 12 years ago

我还保留着古老的苹果手机2代

but now feels slow and kludgy.

它今天仍然能正常工作， 12年前这就像魔法一样神奇

And I'm sure my iPhone 11 will soon seem antique,

但如今却让人觉得笨拙缓慢

perhaps as its features dissolve into the rumored to soon arrive

我很肯定我的苹果手机11代 也会很快变成老古董

augmented reality smartglasses.

可能是因为它的功能 会被传闻中即将到来的

Now exponential technologies packed into our smart devices

增强现实智能眼镜全面替代

are becoming increasingly medicalized,

现在，迅猛发展的科技 可应用于智能设备

with sensors able to detect an ear infection and more.

也越来越支持医疗应用

So what used to fit on a desktop computer

比如可以检测耳内感染的传感器等等

now fits on our wrist

and these are now entering the domain of FDA-approved medical devices.

所以，以前只能安装 在台式电脑中的元件

现在可以缩小到适合手腕的尺寸

并且还可以安装到美国食品 和药物管理局批准的医疗设备中。

But the future isn't about any one technology,

but their convergence as they get faster, cheaper, better.

但随着科技变得更快、 更便宜、更强大

In fact, creating entire new fields at their interfaces,

未来不只是关于一种科技， 而是各种技术的融合

from computational biology, robotic surgery,

实际上，要在各项技术 结合点创造全新领域

digiceuticals, telemedicine to AI-enabled radiology.

从计算生物学、机器人手术、

数字药剂学、远程医疗到 支持人工智能的放射学

And while many industries have been disrupted

and breached the fourth industrial age,

虽然许多产业已经被影响

health and medicine often feel stuck in the second or third.

并且突破了第四工业时代

卫生和医学时常还感到 在第二或第三工业时代动弹不得

Critical data is still stuck being shared on fax machines, paper forms.

重要的数据任然仅限于 在传真机和纸质媒介上被分享

We're stuck in waiting rooms waiting for our visits.

I recently had my own echocardiogram

我们被困于等待我们来访的等候室里

only made available to share with me on a CD-ROM.

我最近有了我自己的超声波心动图

I don't even own a CD-ROM player anymore.

但它只能在一个只读光盘 存储器（CD-ROM）上分享给我

Tools for managing pandemics in 2020

可我甚至连一个CD-ROM都没有

rely on the same core technologies used in the pandemic of 1918:

在2020年用于管理新冠疫情的手段

face masks, social distancing,

和在1918年西班牙大流感中 所依赖的核心技术是一样的：

handwashing.

So part of the challenge in advancing global, local health

口罩、扩大社交距离、

和洗手

are our models, our mindsets.

所以提升全球和 地方卫生的一部分挑战

We don't really practice health care. We practice sick care.

是我们的模式，我们的心态

我们不是真的在练习医疗保健 我们在练习伤病护理

Sick care is based on intermittent episodic data,

usually only obtained within the four walls of the clinic

疾病护理基于间歇性的、不定期的数据

or hospital bed,

能够获取的通常只有诊所之内

and leads to our reactive sick care model,

或是病床之上

where we wait for the patient to show up in the emergency room with a heart attack,

这导致了我们的 反应性疾病护理模式，

stroke or late-stage cancer

我们等待病人在急救室出现， 突发心脏病的、

or for the pandemic to arrive on our shores.

中风的或是癌症晚期的病人

I believe the convergence of many of the accelerating technologies

或者是因为大流行病而至的病人

and approaches being catalyzed by COVID

我相信许多正在飞速发展 的技术的收敛性

will bring us from intermittent sick care

和新冠疫情下发展的解决问题方式

to an age of continuous, proactive, personalized,

会带我们脱离间歇性的疾病护理

crowdsourced health care

来到一个拥有持续的， 先发制人的、个性化的

that can increasingly bring care anytime, anywhere more effectively

众包医疗保健的时代

and lower costs around the planet.

这可以逐渐在任何时候、 任何地方更有效的带来护理

For example, the convergence of ever smaller interconnected devices

并且降低全球各地的医疗成本

比方说，更小的互连接设备的融合

now riding 5G

is creating not just an Internet of Things

but an Internet of Medical Things.

现在依靠5G

创造的不仅仅是一个物联网

Much of this convergence is in the field of digital health,

更是一个医疗物联网

the ability to connect the dots between data sources

这种融合大部分是在数字健康领域

from personal genomics and medical records

在数据源之间连接数据点的能力

with apps and services that match the needs

则来自私人的基因组学和医学记录

of an individual, patient or caregiver.

通过应用和服务来匹配个人、病人

And as incentives and reimbursements align,

或医生的需求

COVID has pushed us to an increasingly virtualized care,

作为激励和补偿

from the hospital to home to our phone

新冠肺炎已经推动了 美国日益虚拟化的护理模式

to on and even inside our bodies.

从医院到家里，再到我们的手机

The age of hospital to home-spital is upon us.

甚至是我们的身体内外

Now, the challenge of this hyperconnected age

从医院到家庭的时代已经降临

is that we're creating exponential amounts of big data

现在，这个超联通时代的挑战在于

that's too often siloed in formats that can't even talk to each other.

我们正在制造指数级的大数据

但它常常被条块分割以至于不能相互沟通

So we need to narrow that gap between data,

turning that into actual information for the patient, physician,

所以我们要缩小数据之间的差距

public health worker,

把它变为真正的信息提供给病人、医生

and speed its safe and effective use in the community clinic and bedside.

公共卫生工作者

并且在社区诊所和病床旁 加速它安全且高效的使用

The pandemic has instigated an immense amount of international sharing

这次新冠肺炎引发了 大量的国际共享以及

and collaboration amongst clinicians and researchers to narrow that gap.

临床医生和研究人员之间 的合作来缩小这一差距

What was learned in managing patients in Wuhan

and then in the intensive care units of Italy

我们在武汉管理病人方面所学到的

has helped New York City hospitals

and their learnings in turn have spread to centers around the world.

然后是在意大利的 重症监护室里所学到的

对纽约的医院都有所帮助

而他们所学反过来也 传递到了世界的每一个角落

Let's take a quick dive into some examples

of what's happening across the health care paradigm

让我们快速深入了解一些

in the age of COVID

and the implications for the future.

在新冠肺炎时期的医疗保健范式中

From new forms of data to help prediction of prevention

发生的例子

这些例子也影响到了未来

to faster diagnostics, more tailored therapy

从新形式的数据有助于预防预测

and increasingly crowdsourced discovery.

到更加快速的诊断、 更定制化的治疗方案

Let's start with prevention.

以及越来越多的众包式的发现

Now, while our genomes impact our health outcomes

and our health spans,

让我们从预防开始

our social determinants of health,

现在，虽然我们的基因组 影响我们的健康结果

our social, and our day-to-day behaviors drive most of our risk for disease

和我们的健康寿命

我们健康的社会性决定因素

我们的社交活动和日常行为 驱动了我们大部分的疾病风险

and associated costs.

And we now have an explosion of new tools

to help measure and improve our healthy behaviors.

以及相关花费

现在我们有了大量新的工具

The first Fitbit only launched in 2009.

来帮助测量和改善我们的健康行为

Wearables are now ubiquitous

第一个Fitbit(科技公司) 的产品于2009年推出

and can measure almost every element of our physiology,

可穿戴设备现在已经普遍存在

behavior and even mental health.

并且几乎可以测量 我们所有的生理因素、

And they're evolving all the way from disposable tattoos

行为甚至是心理健康

that can stream vital signs 24/7

它们从可以24小时显示生命体征

to an integration of big data that can --

的一次性纹身开始

Even small data from a simple wearable,

到无所不能的的大数据一体化

tracking the patient discharged home after a hip replacement

即使是来自简单可穿戴设备的小数据

or a coronavirus infection

也可以在一次髋关节置换手术 或是新冠病毒感染后

can determine if the patient is recovering as expected,

进行跟踪观察

walking more, doing great

它可以判断病人是否按预期康复

or not so great and trigger early intervention.

走得更多，做得很好

或者不是那么好并且 需要触发早期干预

We're evolving from a world of quantified self

where our digital data remains silent on our devices

我们正在从一个量化 自我的世界进化

to one of quantified health

在那里我们的数字数据 在我们的设备上保持沉默

where the data can be shared securely with clinical teams

到一个可量化的健康世界

and researchers to help optimize prevention,

在这里数据可以和 临床团队、研究人员安全共享

diagnose disease early

来帮助优化预防措施

and with feedback loops,

personalize and optimize therapy.

从而乘早诊断疾病

获得相应反馈

From wristband vitals,

以此来个性化和优化治疗方案

including blood pressure, now obtainable without a cuff,

从无需戴在手上

and soon sensors that will measure our blood oxygenation levels

就可以测量的腕部 关键信息，包括血压

to continuous blood sugar monitoring,

到不久的将来，从测量血氧饱和度

to shock'ables, hearables, ring'ables that can replace an entire sleep lab

以实现持续的血糖监测

到可以完全取代手指上的 睡眠测量器的可震动、可响铃的

fitting on our finger

to inside’ables, chips beneath our skin, to track our physiology and lab values,

传感器

再到可内置于我们皮肤之下来追踪 我们生理机能和实验室的评价值

to even underwear'ables,

Internet of Medical Things sensors so cheap today

甚至还有可置于内衣下的芯片

you can get a pack of ten of them, have one on each pair of your underwear,

互联网的医用传感器 在当今是如此便宜

now being used to do what's called remote patient monitoring

你可以轻松的获得一大包， 并在每一件内衣下都安装这些传感器

to help detect signs of respiratory decompensation

用来远程控制

of patients with bronchitis or COVID.

帮助测试气管炎病人的呼吸代谢失调

或是新冠肺炎

Breath'ables are showing promise.

Nanonoses that can detect molecules in our breath correlating to cancer,

有关呼吸的设备也展示出了好的前景

可以探测分子的纳米鼻 在我们有关癌症、代谢疾病

metabolic disease and even diagnosing infectious disease.

的呼吸中可以诊断传染病

In fact, we now don't need to wear anything.

Invisibles, ambient sensing from AI-enabled cameras

实际上，我们不需要穿任何东西

can track her vital signs.

通过人工智能的隐形、 环境感应的摄像机

To voice as a biomarker to manage and detect mental health challenges,

可以跟踪她的生命体征

作为生物标志化合物来管理 和探测心理健康问题

signs of heart disease,

now being able to differentiate between a cough from a common cold

心脏病的标志

to that one caused by coronavirus.

现在可以区分由普通感冒引起的咳嗽

And we'll soon be exuding our digital exhaust 24/7,

和由新冠引起的咳嗽之间的区别

our digitome.

我们很快就可以发出 我们24小时的数字排气

How do we make sense and truly leverage it?

我们的数字化

One path is through crowdsourcing.

我们如何使其合理化并真正利用它？

The million-participant All of Us trial

一种方式是通过众包

from the National Institutes of Health is doing just that

来自美国国立卫生研究院的

where data donors, and I'm one, can contribute our medical records,

万人参与的“我们所有人” 试验正是在这样做

genomes and wearable data

数据捐赠者，我也是其中之一， 可以贡献我们的医疗记录、

to build a much better and diverse data set,

基因组和可穿戴数据

crossing racial and socioeconomic groups

以建立一个更好的 系统以及不同的数据集

to help foster better precision medicine for all of us.

跨种族和社会经济群体，

来帮助我们所有人发展更好的精确医学

Integrating this information for the individual and public health

will lead to predictalitics,

为个人和公共健康整合这些信息

our own personal check engine lights

that can give us early proactive warning.

将引领预测

我们自己的个人检查引擎灯

And recent work is demonstrating that wearables can detect presymptomatically

可以给我们提供早期预警

最近的工作阐明了 可穿戴设备可以在症状前

the onset of the flu,

or, as recently published by Stanford,

in 83 percent of COVID patients

检测流感的爆发

smartwatches can detect COVID infections early,

或者，正如最近斯坦福所发布的那样

在83%的新冠肺炎病人中

often days before onset of symptoms.

智能手表可以提前 检测出新冠肺炎的感染

Self-reporting websites like Covid Near You

通常是在产生症状的几天之前

enable us to locally generate infections maps,

自我报告的网站例如 “你身边的新冠病毒”

and combined with our social graphs and contact tracing apps,

使我们能够在本土生成感染地图

may provide us detailed suggestions about who we might want to consider

并结合我们的社交图表 和联系人跟踪应用程序，

being near or socially distanced from.

会提供关于我们可能要考虑靠近

What about advancements in diagnostics and monitoring?

或在社交上远离的人的详细建议

What used to require a full clinic or laboratory

那么诊断和监测方面的进步如何呢？

can now fit into a digital doctor's bag

过去需要一个完整诊所 或实验室的东西

or the pocket of a patient.

现在可以被装进一个数字医生的包里

From COVID quarantine kits

enabling tracking of oxygen saturation, temperature and lung sounds,

或者是一个病人的口袋里

从能够跟踪血氧饱和度、

温度和肺部声音的新冠病毒检疫包，

we're starting to integrate these into virtual visits,

providing real-time enhancements of a virtual physical exam.

我们开始将这些整合进虚拟访问

提供虚拟体检的实时增强功能

And the diagnostic tools are becoming increasingly infused

with AI machine learning,

随着诊断工具也越来越普及

including consumer ultrasounds,

which can bring diagnostics anywhere at very low cost,

通过人工智能机器学习

包括消费超声

including the ability to evaluate the lungs

它可以以极低的成本 将诊断带到任何地方

in suspected COVID patients.

包括在新冠肺炎疑似感染者中

The laboratory has shrunk to microfluidic platforms

评估肺部的能力

that can be attached to our smartphones

实验室已经缩小为微流控平台

and enable anyone to take measurements from blood or saliva.

它可以连接到我们的手机上

使任何人都能对血液和唾液进行测量

Many of these diagnostics are leveraging the smartphone and its camera

for a medical selfie.

许多诊断都是利用 智能手机及其摄像头

For example, instead of taking your urine to the lab

进行医学自拍

to diagnose a potential urinary tract infection,

例如，与其带你的尿液去实验室

in the privacy of your home simply dip the urine dipstick,

从而诊断潜在的尿路感染

take a picture with your smartphone camera

你不如在你自己的家里蘸一下尿尺

and have the results made available immediately to your doctor and pharmacy.

并用你的手机摄像头拍一张照片

然后将结果立即提供给您 的医生和药房。

Similar phone-based apps and approaches are being used and developed

for fast, frequent, cheap and easy COVID testing.

类似的基于手机的应用程序 和方法正在被使用和开发

用于快速、频繁、便宜 和便捷的新冠病毒检测

Novel approaches to community level diagnostics are also being explored,

including next gen sequencing of sewage for early detection of COVID-19,

社区层面的新诊断方法也正在被探索

包括对污物进行下一代测序 来对新冠病毒进行早期发现

identifying hotspots and predicted outbreaks a week or more early.

提前一周或更早的识别热点并预测疫情

The explosion of data sources, however,

is really beyond the capacity of the human mind

然而，数据的爆炸性增长

to effectively integrate.

We're now getting help from AI,

确实超过了人类思维

or as I call it, IA, intelligence augmentation.

有效整合的能力

我们现在正在从人工智能寻求帮助

IA is being leveraged in reading CT scans to diagnose COVID,

我又称之为IA，即智能增强

IA被用来读取CT 扫描结果以诊断新冠

to enhancing the vision of a gastroenterologist

performing a colonoscopy

提高肠胃科医生通过结肠镜检查

to identify lesions they might have missed.

And AI is playing an active role in helping identify

来确定

他们可能错过的病变的能力

and develop new antivirals.

并且AI技术在帮助识别 和研发新的抗病毒药中

And while AI is often perceived as a threat by some clinicians,

扮演重要角色

虽然AI技术经常被一些 临床医生视为威胁

it can't replace the human touch or empathy.

And I don't think doctors or nurses will be replaced by AI,

但它不会取代人类的触摸或者共情

我并不认为医生 或护士会被AI技术所取代

but doctors and health care systems

who’re collaborating with AI in the future will be replacing those who don’t.

但和AI技术合作的医生和医疗系统

将来会取代那些没有 合作的医生和系统

Finally, therapy.

The pandemic has dramatically accelerated the use of virtual visits.

最后，治疗方法

Telemedicine visits are up on the order of a thousand percent in many settings.

新冠疫情极大地促进了 虚拟访问的使用

And I don't think we'll ever revert to pre-COVID levels

在许多情况下，远程医疗 就诊率上升了1000%。

as patients and clinicians are discovering the compelling convenience and efficacy.

我不认为我们会恢复到 新冠病毒感染前的水平

随着患者和临床医生发现 其令人信服的便利性和有效性

Even before virtual zoom or facetime with the clinician,

asynchronous screening and support has been provided

甚至在临床医生使用 虚拟缩放或视频聊天之前

by ever-smarter chat bots that can help discern symptoms

越来越智能的聊天机器人

and triage problems effectively at lower cost.

已经提供了异步筛选和支持， 帮助我们以更低的成本

This includes virtualization

有效地识别症状和解决伤者分流问题

and virtual augmentation to meet our mental health crisis,

这包括虚拟化

exacerbated by the many economic and other stressors

和虚拟增强，以应对我们 的心理健康危机，

which accompany this pandemic.

而伴随新冠疫情的 许多经济和其他压力因素

3D-printing is finding a role in health care,

加剧了这一危机

with newfound applications

from printing personal masks to critical parts of ventilators

3-D打印在医疗保健中 也有了一席之地，

新发现的应用

and being leveraged by the growing maker movement,

从打印个人口罩到 呼吸机的关键部件

which is playing a major role in pandemic response,

并被不断增多的 制造者运动所利用

from making face shields and masks

这一运动在新冠疫情 应对中发挥着重要作用

to improvising do-it-yourself ventilators.

从制作面罩和口罩

All together, these efforts are enabling the potential

到即兴制作自己动手的呼吸机

for democratization of health and medicine across the planet

所有这些努力合在一起，

and access to information and care that was previously inaccessible.

有可能在全球范围内 实现卫生和医疗的民主化，

Clinical trials are being reshaped, leveraging smart devices,

并有可能获得以前 无法获得的信息和护理。

利用智能设备、基于云的分析平台

cloud-based analytic platforms and collaborators around the world.

和世界各地的合作伙伴， 正在重塑临床试验

That's at this convergence of many rapidly developing

and exponential technologies

正是由于许多快速发展的

that we have the real potential to reshape

and scale health care at our pandemic age.

指数技术的融合

我们才有真正的潜力在新冠疫情时代

One where we can dramatically expand access to basic health care,

重塑和扩大医疗保健

increasingly personalized and proactive,

在这一平台上，我们可以极大 地扩大基本医疗服务的普及，

leveraging the scale of digital platforms and technologies,

越来越个性化和主动

enhancing digital connection and empathy,

利用数字平台和技术的规模

and the ability to blend virtual and in-person care,

增强数字连接和同理心

and leveraging the power of the crowd to share and build better maps

以及融合虚拟和面对面护理的能力

that guide our individual health

并利用人群的力量共享 和构建更好的地图

and public health journeys,

and to develop validated and scaled solutions.

来引导我们的个人健康

和公共卫生之旅

So imagine a new generation of volunteers,

并开发经验证和缩放的解决方案

a global health corps

similar to the volunteer paramedics and firemen of today

所以想象一下新一代的志愿者，

一个全球健康军团

that can be upskilled,

use the powerful new tools to respond early

与现代的支援护理和消防员相类似

他们具备高技能

and collectively to enhance contact tracing, isolation and quarantine,

利用有效的新工具来乘早做出反应

共同加强接触者追踪、隔离和检疫，

and to help identify and address social and other disparities.

并帮助识别和解决社交和其他障碍

So coming full circle.

Twenty four years after I was at the launch of Apollo 17,

所以一个全循环之后

I found myself as a medical student on a research clerkship

在我见证阿波罗17号 发射之后的第24年，

at Johnson Space Center.

我发现自己是一名医科学生， 在约翰逊航天中心

And much to my surprise, one day in the clinic,

I ran right into Gene Cernan,

从事研究工作

让我十分惊喜的是，有一天在诊所

the Apollo 17 commander and the last man to walk on the Moon.

我遇见了尤金·塞尔南 （Gene Cernan）

After enthusiastically sharing my childhood memories of his launch,

阿波罗17号指挥官 也是最后一个在月球上行走的人

he shared one of his famous lines:

在我激动的和他分享 我有关那次发射的儿时记忆之后

"I walked on the Moon. What can't you do?"

他说出了他的一句名言：

Indeed, what can't we do if we work together as one

“我能在月球上行走。 你又有什么不能做的呢？”

in the face of this pandemic?

实际上，面对疫情， 如果我们团结一心

And just as the near tragedy of Apollo 13

有什么是不能做到的呢？

rallied NASA to work creatively and collectively,

正如近乎悲剧般的阿波罗13号

so too can this in our pandemic age lead to our finest hour,

促使美国宇航局团结一致， 创造性地开展工作

在我们这个疫情肆虐的时代， 我们也能迎来最美好的时刻，

bring on a true health age.

I believe this is possible if we all get out of our linear mindsets,

迎来真正的健康时代

take exponential steps and collaboratively go forth collectively,

我相信这是可能的， 如果我们都摆脱线性思维，

采取指数级的步骤，共同努力

not only to solve the challenges of this pandemic

and predict the future of health and medicine,

不仅仅是解决新冠疫情带来的挑战

but boldly to go forth together

预测健康和医学的未来

to accelerate a far better one for everyone on Spaceship Earth.

而是勇敢地一起走下去

为地球飞船上的 每个人创建一个更美好的未来

Thanks.

谢谢。