George Whitesides: A lab the size of a postage stamp

譯者: Fumin Chiu 審譯者: Michelle Fan

The problem I want to talk with you about is really the problem of:

我想跟各位討論的問題

其實真正的問題

How does one supply health care in a world in which cost is everything?

是如何提供健康照護

一方面又要顧及成本

How do you do that?

要如何處理這問題呢？

And the basic paradigm we want to suggest to you,

在此我們要推薦一種基本模式

I want to suggest to you,

我要推薦的是

is one in which you say that in order to treat disease,

如果你需要醫治某種疾病

首先，你得知道，治療對象是什麼

you have to first know what you're treating, that's diagnostics,

這就是診斷，之後才能有對策

and then you have to do something.

The program we're involved in is something we call "Diagnostics for All,"

因此，我們將這個計畫

稱為全民診斷，或是免費診斷

or "zero-cost diagnostics."

How do you provide medically relevant information

如何用幾近於零的費用

at as close as possible to zero cost?

又能提供醫療相關資料，如何能做到這點呢?

How do you do it?

Let me just give you two examples.

讓我為你們舉兩個例子

The rigors of military medicine are not so dissimilar from the third world:

例如軍隊醫療，往往稍嫌粗糙

就和第三世界的醫療沒什麼不同

poor resources, a rigorous environment -- a series of problems --

資源貧乏，環境惡劣

還有體重過輕，或是種種類似的問題

light weight and things of this kind.

And also they're not so different from the home health care

也和有家庭照護與診斷系統的世界

and diagnostic system world.

沒什麼差異

So, the technology I want to talk about is for the third world,

因此，我在此要提及的科技

是為了第三世界國家，開發中國家

for the developing world,

but it has, I think, much broader application,

但我想，它還有更廣的運用

because information is so important in the health care system.

因為資訊對健康醫療非常重要

So you see two examples here.

所以，你們來看這兩個例子

One is a lab that is actually a fairly high-end laboratory in Africa.

首先這是一個實驗室，在非洲這是個相當高級的實驗室

The second is basically an entrepreneur who is set up and doing who-knows-what

再來，這是個創業家

他正在桌邊不知道做什麼

at a table in a market.

I don't know what kind of health care is delivered there.

我不知道這對健康醫療有何貢獻

But it's not really what is probably most efficient.

但這實在不是最有效率的

What is our approach?

我們的對策是什麼呢?

The way in which one typically approaches a problem of lowering cost,

一個人採取的典型策略

要解決成本問題時

starting from the perspective of the United States,

都是先從聯合國的角度出發

is to take our solution,

採用我們的解決方案

and then try to cut cost out of it.

之後再設法降低成本

不論你如何著手

No matter how you do that,

you're not going to start with a $100,000 instrument

你不會是一開始就使用十萬元的儀器

and bring it down to no cost.

再把成本降至極低，這樣是行不通的

It isn't going to work.

So the approach we took was the other way around, to ask:

因此，我們的策略是從另一方向來的

What is the cheapest possible stuff

是要問：「什麼會是最便宜的材料

可以用來製作診斷系統

that you could make a diagnostic system out of,

and get useful information and add function?

並得到有用的資訊

還有附加功能呢？」 為此我們選用紙張

And what we've chosen is paper.

What you see here is a prototypic device.

你現在看到的就是這器材原型

It's about a centimeter on the side.

它一邊約一公分

It's about the size of a fingernail.

大小約如指甲一般

The lines around the edges are a polymer.

這邊緣上的線

是一種高分子物質

It's made of paper.

它的材質是紙，紙當然會吸水

And paper, of course, wicks fluid, as you know, paper, cloth --

大家都知道，紙料 布料...若桌巾上有酒滴

drop wine on the tablecloth,

and the wine wicks all over everything.

會滲得到處都是

Put it on your shirt, it ruins the shirt.

若滴到襯衫，襯衫就報銷了

That's what a hydrophilic surface does.

這就是親水性表面的特色

So in this device, the idea is that you drip the bottom end of it

因此，這器材的構想是讓你

在它的底端滴上一滴

in a drop of, in this case, urine.

這裡使用的是尿液

The fluid wicks its way into those chambers at the top.

當這液體滲佈到上端的這些小格子

The brown color indicates the amount of glucose in the urine,

若呈褐色表示這尿液含有葡萄糖

the blue color indicates the amount of protein in the urine.

若呈藍色表示這尿液含有蛋白質

若是兩種都有

And the combination of those two is a first-order shot

那麼你可是得到了炙手可熱

at a number of useful things that you want.

的第一手資料呢

So, this is an example of a device made from a simple piece of paper.

在此，提到的是一則僅由紙片作成的器材

Now, how simple can you make the production?

那麼，又是如何才能簡單容易的製作呢？

Why do we choose paper?

為什麼我們選擇紙張呢？

There's an example of the same thing on a finger,

這裡有個樣本，就在這指頭上

showing you basically what it looks like.

成品就像你們這兒看到的

One reason for using paper is that it's everywhere.

採用紙張，原因之一是它到處都有

We have made these kinds of devices using napkins and toilet paper

紙張已經用在各處

就像是紙巾 衛廁用紙

and wraps, and all kinds of stuff.

包裝紙 及各種用品.

So the production capability is there.

所以，製作上是沒問題的

The second is, you can put lots and lots of tests in a very small place.

第二個原因是，是這小小的面積中

可以置入許多的測試

I'll show you in a moment that the stack of paper there

待會兒，我會讓大家看到，這疊紙片

大約包含了

would probably hold something like 100,000 tests,

十萬個測試呢

something of that kind.

And then finally, a point you don't think of so much

最後呢，有一點之前並沒有料到的是

in developed world medicine:

在已開發國家的醫藥中

it eliminates sharps.

它使尖銳物消失了

And what sharps means is needles, things that stick.

這裡說的尖銳物，是指針筒

If you've taken a sample of someone's blood

如果你要取樣某人的血液

and the someone might have hepatitis C,

而這人也許有C型肝炎

you don't want to make a mistake and stick it in you.

而你可不希望不小心感染到

You don't want to do that.

事實上，你是完全不希望有那種可能

So how do you dispose of that?

所以，要如何防止呢？各地都有這種問題

It's a problem everywhere, and here, you simply burn it.

很簡單，把它燒掉就解決了

So it's a sort of a practical approach to starting on things.

因此這算是以非常務實的觀點

來設計器具

Now, you say, "If paper is a good idea,

現在你會問，若紙材是個好主意

別人應該早就想到了

other people have surely thought of it."

答案是，是的

And the answer is, of course, yes.

Those half of you, roughly, who are women,

在座的大約有一半

是女性

at some point may have had a pregnancy test.

某個時候，也許會驗孕

And the most common of these is in a device

最普遍的

就是像左方的這種器材

that looks like the thing on the left.

It's something called a lateral-flow immunoassay.

這是所謂的側向流動疫試檢驗

In that particular test,

在這特定的檢驗

urine, either containing a hormone called hCG,

使用的尿液，會是含有 或是沒有

一種稱作HCG的賀爾蒙

does or does not flow across a piece of paper.

當流過這紙片

And there are two bars; one bar indicates that the test is working,

在這兩條顯示線，第一條顯示這測試是否有效

and if the second bar shows up, you're pregnant.

若第二條線也出現，表示你懷孕了

This is a terrific kind of test in a binary world,

在非黑即白的情況中，這是個很棒的測試方法

and the nice thing about pregnancy is either you are pregnant

而在是否懷孕上

答案只有懷孕了或是沒懷孕

or you're not pregnant;

you're not partially pregnant or thinking about being pregnant

不可能是部份懷孕或是也許有懷孕之類

模擬兩可的

or something of that sort.

所以，應用在這裡很適合

So it works very well there, but it doesn't work very well

但是若應用在比較量化的資訊上就不合適

when you need more quantitative information.

另有一種是探棒型

There are also dipsticks,

but if you look at the dipsticks,

若使用探棒，那是

they're for another kind of urine analysis.

另一種尿液分析

There are an awful lot of colors and things like that.

那會呈現許許多多的顏色之類的

What do you actually do about that in a difficult circumstance?

碰到這種糟糕的情形，你該做些什麼呢？

為此，我們又要提出問題

So the approach we started with is to ask:

Is it really practical to make things of this sort?

製作這樣的東西真的實用嗎？

And that problem is now, in a purely engineering way, solved.

現在這個問題，在工程面上算是解決了

And the procedure that we have is simply to start with paper.

製作程續就由紙張開始

You run it through a new kind of printer called a wax printer.

當你將它放入一種印表機，叫蠟質印表機

The wax printer does what looks like printing.

它看來就像一般印表機

It is printing.

它執行列印，你將紙張放入加熱

You put that on, you warm it a little bit,

the wax prints through, so it absorbs into the paper,

這蠟質經由列印，被紙張吸入

and you end up with the device you want.

你要的器材就完成了

這台印表機價位是八百美元

The printers cost 800 bucks now.

We estimate that if you were to run them 24 hours a day,

若是它一天24小時不停地運作，我們估計

一年下來總共可以作一千萬個測試

they'd make about 10 million tests a year.

So it's a solved problem. That particular problem is solved.

因此，這問題解決了

And there is an example of the kind of thing that you see.

這還有一個例子要讓你們參考

這張8x12的紙上

That's on a piece of 8 by 12 paper.

That takes about two seconds to make.

只需花兩秒鐘就成了

And so I regard that as done.

這部分，算是大功告成

還有一個重要議題

There's a very important issue here,

which is that because it's a printer, a color printer, it prints colors.

就是因為它是一臺印表機

彩色印表機，可以印出不同顏色。這是它的功能

That's what color printers do.

I'll show you in a moment, that's actually quite useful.

我等一下會讓各位看到，這一點非常實用

Now, the next question that you would like to ask is:

接下來，你可能會問

What would you like to measure? What would you like to analyze?

你到底想要測量什麼？分析什麼？

And the thing you'd most like to analyze, we're a fair distance from.

你最想要分析的東西

我們快要成功了

It's what's called "fever of undiagnosed origin."

就是所謂的「不明原因發燒」

Someone comes into the clinic, they have a fever, they feel bad.

當某人走進診所

說他發燒，不舒服。會是得了什麼病？

What do they have?

會是肺結核？或是愛滋病嗎？

Do they have TB? Do they have AIDS? Do they have a common cold?

或只是普通感冒呢？

The triage problem.

這是個難解的三角習題

That's a hard problem for reasons I won't go through.

有些太複雜的我就不多說

There are an awful lot of things that you'd like to distinguish among.

因為太多的細節需要釐清

另外有些疾病

But then there are a series of things --

例如愛滋病 肝炎 虐疾

AIDS, hepatitis, malaria, TB, others --

肺結核之類的

and simpler ones, such as guidance of treatment.

或是像一些治療指導

Now, even that's more complicated than you think.

這些都比你想像中複雜多了

A friend of mine works in transcultural psychiatry,

我的一位朋友從事跨文化精神諮詢

and he is interested in the question

他感興趣的問題是

of why people do and don't take their meds.

為什麼人們想吃藥或不想吃藥

So Dapsone, or something like that, you have to take for a while.

例如戴普松之類的藥物

你得連續服用一段時間的藥物

He has a wonderful story of talking to a villager in India

有個關於印度村民的故事

and saying,

你問村民：「你有服用戴普松嗎？」 「有」

"Have you taken your Dapsone?" "Yes."

「是否有每天服用？」 「是的」

"Have you taken it every day?" "Yes."

"Have you taken if for a month?" "Yes."

「有連續服用一個月嗎？」 「有的」

What the guy actually meant

事實上，這村民的意思是

was that he'd fed a 30-day dose of Dapsone to his dog that morning.

將他那三十天份量的戴普松

在當天早上都餵給他的狗吃了

(Laughter)

(笑聲)

And he was telling the truth, because in a different culture,

他講的是實話

因為在不同的文化中

the dog is a surrogate for you;

家犬就是你的替身

"today," "this month," "since the rainy season" --

你也知道，像「今天」 「 這個月」 「這個雨季以來」

there are lots of opportunities for misunderstanding.

這些都是可能造成誤解的

(Laughter)

所以接下來這議題是

And so an issue here is to, in some cases, figure out

讓我們解決一些

how to deal with matters that seem uninteresting, like compliance.

不是那麼有趣的一些事

就像是一些標準程序

Now, take a look at what a typical test looks like.

例如，讓我們看一些典型的試驗

Prick a finger, you get some blood -- about 50 microliters.

刺一下手指頭，擠些血

約50毫升

That's about all you're going to get,

大約只有這麼多

because you can't use the usual sort of systems.

因為你不能用一般的方法

You can't manipulate it very well;

你並不能操作得很準確

I'll show something about that in a moment.

待會兒我再讓各位看個東西

So you take the drop of blood, no further manipulations,

好，你擠出了一些血，沒有進一步操作

you put it on a little device,

你將這血放入這小器材

the device filters out the blood cells, lets the serum go through,

這小器材會過濾掉血球細胞，讓血清流過

and you get a series of colors down in the bottom there.

之後，你會看到一系列顏色

陳列在底部那裡

And the colors indicate "disease" or "normal."

這顏色會是代表有疾病或是正常

But even that's complicated,

這樣仍是有些複雜

because to me, colors might indicate "normal,"

因為對你我來說，有顏色也可能表示是正常

but after all, we're all suffering from probably an excess of education.

畢竟我們共同的問題

就是可能都受了太多教育

What do you do about something which requires quantitative analysis?

當你需要量化分析結果的時候

你會怎麼作呢？

And so the solution that we and many other people

這個答案 就在我們和一些其他人

are thinking about there,

不斷思考的情形下

and at this point, there is a dramatic flourish,

有了一個戲劇性的好結果

and out comes the universal solution to everything these days,

也造就了今天這個讓大家看到的結果

就是手機，應該說是有照相功能的手機

which is a cell phone --

in this particular case, a camera phone.

現在人手一機。在印度，一個月可以賣出六百萬支

They're everywhere -- six billion a month in India.

And the idea is that what one does is to take the device,

這構想是讓一個人

拿這器材

浸入試液後，就會看到顏色

you dip it, you develop the color,

you take a picture, the picture goes to a central laboratory.

你把結果照下來，照片會送入中央實驗室

You don't have to send out a doctor,

你不需要把它送到醫生那裡

you send out somebody who can just take the sample,

而是送給專收樣本的某個人

and in the clinic either a doctor, or ideally, a computer in this case,

然後在某間診所的一位醫師，更好一點是一台電腦

does the analysis.

就會像這樣，進行分析

Turns out to work actually quite well,

這種流程很順利，特別是

particularly when your color printer has printed the color bars

當你的彩色印表機能印出有顏色的條碼

代表運作的狀況

that indicate how things work.

So my view of the health care worker of the future

所以，我對未來健康醫療工作人員的看法

不再是醫生了

is not a doctor, but an 18-year-old,

而是一個十八歲的年輕人，不再失業

otherwise unemployed, who has two things:

身上有兩件東西。一樣是一個背包，裝滿了這種測試品

a backpack full of these tests and a lancet

及一根刺絡針，偶爾可以抽取血液樣本

to occasionally take a blood sample,

and an AK-47.

另一樣是俄製突擊步槍

And these are the things that get him through his day.

這些夠他們忙一整天呢

(Laughter)

There's another very interesting connection here,

這裡還有另一個十分有趣的關聯

and that is, that what one wants to do is pass through useful information

當一個人想要

把這些重要的資訊

經由一個相當糟糕的電話系統傳送時

over what is generally a pretty awful telephone system.

It turns out there's an enormous amount of information

你會發現，在某個主題上匯集了許多資料

already available on that subject, which is the Mars Rover problem.

情形就像火星探險號的資料

How do you get back an accurate view of the color on Mars

若是你的頻寬嚴重不足

if you have a really terrible bandwidth to do it with?

你要如何得到火星上的正確的顏色呢？

And the answer is not complicated,

這個答案並不複雜

but it's one which I don't want to go through here,

但我並不想在此多贅言

只想說像那種溝通系統上的問題

other than to say that the communication systems for doing this

是大家都很瞭解的

are really pretty well understood.

Also, a fact which you may not know

然而有樣事情你卻可能不知道

is that the compute capability of this thing is not so different

要完成傳送這事所需的計算功能

和普通的電腦上使用的計算功能

from the compute capability of your desktop computer.

並沒有什麼不同

This is a fantastic device which is only beginning to be tapped.

人們才剛剛開始研究這個極佳的裝置

I don't know whether the idea of one computer, one child

我不知道「一個兒童一台電腦」這個想法

makes any sense.

是否是個好主意。這是未來的電腦

Here's the computer of the future,

because this screen is already there and they're ubiquitous.

因為這種螢幕已經存在，非常普遍

All right, let me show you just a little bit about advanced devices.

現在讓我來展示一下較先進的器材

我們也會提出一些問題

And we'll start by posing a little problem.

What you see here is another centimeter-sized device,

在此，你所看到的是另一個一公分見方的器材

and the different colors are different colors of dye.

上有不同成色的染料

And you notice something

這時你可能已經注意到了

which might strike you as a little bit interesting,

有些不同

which is, the yellow seems to disappear,

這裡的黃色似乎消失了

get through the blue, and then get through the red.

它經過藍色區，經過紅色區

How does that happen?

這是怎麼一回事呢？你如何讓這道流經那道呢？

How do you make something flow through something?

答案當然是「不可能」

And, of course the answer is, "You don't."

你是讓它們流經下面或上面

You make it flow under and over.

下一個問題，你如何讓它們

But now the question is:

How do you make it flow under and over in a piece of paper?

在一張紙上頭上下流動呢?

The answer is that what you do --

答案是你的作法

and the details are not terribly important here --

細節我就不多講了

is to make something more elaborate:

簡單地說

You take several different layers of paper,

你拿好幾張不同的紙疊起來

each one containing its own little fluid system,

每層有它不同的流道

and you separate them by pieces of, literally, double-sided carpet tape,

你把它們隔開

用雙面膠隔開

the stuff you use to stick the carpets onto the floor.

就是用來把地毯黏在地板上的東西

And the fluid will flow from one layer into the next.

液體就會從一層流到另一層

It distributes itself, flows through further holes,

液體自己會分散，流過孔洞

distributes itself.

四處流散

And what you see, at the lower right-hand side there,

你看在這右邊下方

is a sample in which a single sample of blood has been put on the top,

就是一個成品

上面已有血液樣本，

and it has gone through and distributed itself

經過一段時間

into these 16 holes on the bottom,

流佈到底部這十六個洞內

in a piece of paper -- basically, it looks like a chip,

在一張紙內部的情形，就像是一片晶體

厚度約有兩張紙一般

two pieces of paper thick.

And in this particular case,

這個特例中，我們最感興趣的

we were just interested in the replicability of that.

是它的可複製性

But that is, in principle, the way you solve

這點基本上就像是你在解決

the "fever of unexplained origin" problem,

「不明原因發燒」的問題

because each one of those spots then becomes a test

因為這上面每個點

都代表一個疾病

for a particular set of markers of disease,

某些徵狀

and this will work in due course.

早晚會解決的

Here is an example of a slightly more complicated device.

另外這有一個較為複雜器材的例子

There's the chip.

這塊晶片

You dip in a corner.

將一角浸入，讓液體流到中央

The fluid goes into the center.

It distributes itself out into these various wells or holes

它將自動流佈到

不同的洞穴，呈現不同顏色.

and turns color,

all done with paper and carpet tape.

只需要紙和雙面膠就做得到

So it's, I think, as low-cost

所以，我想它的成本之低

as we're likely to be able to come up and make things.

低到我們一定可以做出點名堂來

Now, I have two last little stories to tell you

這裡我還有一兩個小故事

想要為這個主題作個收尾

in finishing off this business.

This is one:

這是一樣東西。之前作測試時

One of the things you occasionally need to do

通常是需要將血液和血漿分開

is separate blood cells from serum.

問題是

And the question was,

here we do it by taking a sample,

現在我們先將一個血樣

we put it in a centrifuge, we spin it,

放入離心機

旋轉之後，血球就被分離出來了。太好了

and you get blood cells out.

Terrific.

但若是沒有電力，

What happens if you don't have electricity, a centrifuge, and whatever?

沒有離心機，怎麼辦？

And we thought for a while of how you might do this,

我們好好想過這時該怎麼辦

and the way, in fact, you do it, is what's shown here.

事實上解決方法，就像這裡看到的

用打蛋器就可以了

You get an eggbeater, which is everywhere, and you saw off a blade,

打蛋器很常見。你拿其中一支刀刃

and then you take tubing, and you stick it on that.

再拿起試管

把刀刃放進去，注入血液，攪拌之後就行了

You put the blood in, somebody sits there and spins it.

只要攪拌過之後

It works really, really well.

效果非常非常好

And we sat down, we did the physics of eggbeaters

我們這裡用的就是這種人工打蛋器原理

and self-aligning tubes and all the rest of that kind of thing,

試管自動排列之類的

and sent it off to a journal.

拿去期刊投稿

We were very proud of this,

我們都非常自傲，特別是標題

particularly the title, which was "Eggbeater as Centrifuge."

叫做「用打蛋器當離心機」

(Laughter)

(笑聲)

And we sent it off,

我們投給期刊，結果被退回來

and by return mail, it came back.

I called up the editor and I said,

我打電話給編輯說

"What's going on? How is this possible?"

「怎麼搞的？怎麼可能？」

The editor said, with enormous disdain,

編輯不以為然的說：

"I read this.

「我讀過了

And we're not going to publish it, because we only publish science."

決定不登載。因為本刊

只刊登科學類文章」

(Laughter)

這點十分重要

And it's an important issue,

because it means that we have to, as a society,

它代表著我們隨時

都得惦記著

think about what we value.

社會價值與責任

And if it's just papers and Phys. Rev. letters,

如果只是紙張和「物理報導期刊」

我們就糟糕了

we've got a problem.

Here is another example of something which is --

下一個例子是

this is a little spectrophotometer.

有關色層分析儀

It measures the absorption of light in a sample.

這儀器測量樣品所吸收的光譜

The neat thing about this is,

有趣的是，你可以調整光源

you have a light source that flickers on and off at about 1,000 hertz,

至一千赫茲

another light source that detects that light at 1,000 hertz,

另有一個光源可以測量這一千赫茲

and so you can run this system in broad daylight.

如此你即使在白天，也能使用這系統.

It performs about equivalently

這系統的執行效果

to a system that's on the order of 100,000 dollars.

和價值十萬元的系統

不相上下

It costs 50 dollars.

但它只需五十元，若是再改良

We can probably make it for 50 cents if we put our mind to it.

也許成本可降至五十分。

Why doesn't somebody do it?

那又為什麼不繼續改良呢？答案是

The answer is:

「若真能如此，你賺什麼？」

How do you make a profit in a capitalist system, doing that?

Interesting problem.

兩難的問題吧

So, let me finish by saying that we've thought about this

最後，我得說

這應算是工程上的問題吧

as a kind of engineering problem.

我們問說，這些東西背後共通的科學原理是什麼？

And we've asked: What is the scientific unifying idea here?

And we've decided we should think about this

我們了解重點不應該是

只看成本

not so much in terms of cost, but in terms of simplicity.

而是該看它的簡易性

Simplicity is a neat word.

簡易性是個意義深刻的字。你必須好好思考

You've got to think about what simplicity means.

它到底是甚麼意思

我知道簡易性是什麼，但我不知道它的意義

I know what it is,

but I don't actually know what it means.

So I actually was interested enough in this

為此，我興致勃勃地

to put together several groups of people.

找來幾群人

The most recent involved a couple of people at MIT,

近來也找了MIT的幾個人

one of them being an exceptionally bright kid

其中一人非常聰明

who is one of the very few people I would think of

是少數我覺得是屬於

天才型的

who's an authentic genius.

We all struggled for an entire day to think about simplicity.

足足花了一整天大家都在思考簡易性的定義

And I want to give you the answer of this deep scientific thought.

讓我把這個科學上頗難得到的答案

告訴各位吧

[What is simplicity?

(笑聲)

"It's impossible to f..k it up"]

(Laughter)

因此，某方面而言，你們得到的物超所值

So, in a sense, you get what you pay for.

Thank you very much.

十分感謝

(Applause)

(笑聲)