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

譯者: zhang haohan 審譯者: Cheng Stephanie

幾年前

A couple of years ago,

when I was attending the TED conference in Long Beach,

當我參加TED長灘會議的時候

我遇見了哈里特。

I met Harriet.

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

我們之前在網路上就遇到過

不是你們想的那種遇見方式。

We were introduced because we both knew Linda Avey,

其實我們遇見是因為我們都認識琳達.埃維

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

她是最早的線上私人基因組公司的創始人之一。

因為琳達知道我們兩人的基因訊息

And because we shared our genetic information with Linda,

she could see that Harriet and I shared

所以她發現我們兩個都有一種罕見的線粒體DNA

a very rare type of mitochondrial DNA, haplotype K1a1b1a,

叫做單倍體基因型 K1a 1b 1a

這說明了我們是遠親。

which meant we were distantly related.

其實我們和冰人奧茲也有血緣關係

We actually share the same genealogy with Ötzi the Iceman.

所以，奧茲、哈裏特和我算是親戚。

So -- Ötzi, Harriet and me.

因為現在大家都使用臉書，我們當然也設立了自己的臉書群組。

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

我們歡迎你們加入。

隔年當我在TED會議上遇到哈里特時

You're all welcome to join.

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

她早就已經上網訂做了我們自己的快樂單倍體T恤。

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

為什麼我要告訴你們這件事呢?

這和我們未來的健康又有什麼關係呢?

(Laughter)

Why am I telling you this story?

我和哈裏特相遇的過程其實充分地說明了一件事

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

那就是跨學科的研究、突飛猛進的科技

Well, the way I met Harriet is an example

正影響我們將來的身心健康——

of how leveraging cross-disciplinary, exponentially growing technologies

這些研究和科技包含了低成本的基因分析

有能力運用功能強大的生物信息學

is affecting our future of health and wellness --

以及網路和社會網絡之間的關聯。

from low-cost gene analysis

今天我想談的就是我們應該了解這些指數科技。

to the ability to do powerful bioinformatics

我們的思考經常是直線的。

to the connection of the Internet and social networking.

但是你想像一下，如果你有一片蓮花葉子

What I'd like to talk about today

而且它每天都分裂一次

is understanding these exponential technologies.

兩片，四片，八片，十六片

We often think linearly.

15天後你就有三萬兩千片葉子。

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

那一個月後你認為會有多少葉子？答案是10億。

and it just divided every single day --

所以如果我們開始學著「次方性思考」

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

我們就可以讓我們身邊所有的科技有所不同。

許多這些科技，就我醫生的角色和想創新的人來說，

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

是我們真的能用來改變我們未來的健康以及保健發展

We're at a billion.

If we start to think exponentially,

解決我們現今在保健發展遇到的主要難題

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

例如說保健制度的巨額成本

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

老年人口

沒能非常有效地運用資訊、整合保健制度

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

還有採用創新技術時

and of health care,

過程也經常是困難重重。

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

我們能做的一件重要的事，這我們今天也剛談了一些

ranging from the exponential costs to the aging population,

就是把這條曲線向左移。

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

我們把大多數金錢花費在生命階段的最後百分之二十。

如果我們將錢花在保健制度和我們自身的健康管理中

the fragmentation of care

and the often very difficult course of adoption of innovation.

透過科技親自參予這些系統運作和管理

將曲線向左移、改善我們的健康，那會怎樣呢？

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

我最喜歡的科技是「次方科技」

我們大家現在都在使用這種科技了。

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

想想看，這些科技現在正突飛猛進。

打個比方，iPhone4已經是這樣了

What if we could incentivize physicians in the health care system

想像一下iPhone8的功能會有多強大。

and our own selves

我對這項技術已經有一些心得。

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

我在矽谷一家辛格蘭若堤大學的醫學部門工作

leveraging technology as well?

我們會在每個夏天從全世界找來一百個傑出的學生

Now my favorite example of exponential technology,

we all have in our pocket.

研究這些關於醫學，生物科技

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

人工智能，機器人技術，納米技術，空間技術的整合科技，

I mean, this is the iPhone 4.

解決跨學科訓練的問題

Imagine what the iPhone 8 will be able to do.

並利用這些技術來影響還沒有實現的重大目標。

Now, I've gained some insight into this.

我們也有七天的執行計畫。

I've been the track share for the medicine portion

接下來的幾個月是「未來醫學」

這個計畫能協助跨學科訓練並將技術運用到醫學上。

of a new institution called Singularity University,

based in Silicon Valley.

我剛提到了手機。

We bring together each summer about 100 very talented students

這些手機擁有超過兩萬個不同的應用程序

甚至英國還設計了一種應用程式

from around the world.

And we look at these exponential technologies from medicine,

你可以把一片小晶片連上你的 iPhone，然後在晶片上小便

看看你是不是得了性病。

biotech, artificial intelligence, robotics, nanotechnology, space,

我不知道我會不會試，不過是有這樣的程式可以用。

and address how we can cross-train and leverage these

還有其他的應用程式能讓手機有診斷功能。

to impact major unmet goals.

例如說如果你有糖尿病

We also have seven-day executive programs.

你可以用iPhone來測量血脂

And coming up next month is FutureMed,

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

然後把數據發給你的醫師

所以你和醫生都能更了解你的血糖狀況。

Now, I mentioned the phone.

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

讓我們看看整合科技是如何應用在保健用途上。

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

讓我們從速度開始。

我們都知道，就如摩爾定律所說的

connect it to your iPhone,

電腦運作的速度越來越快了。

and check for an STD.

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

所以我們能夠運用它們來做更多事。

電腦的能力越來越接近人腦的能力

There are other sorts of applications.

Merging your phone and diagnostics, for example,

很多情況下甚至超越了人腦。

但我認為電腦的速度對成像技術的好處最大。

measuring your blood glucose on your iPhone

這種用非常高畫素即時地呈現身體內部的技術

and sending that to your physician,

so they can better understand and you can better understand

進步真的是越來越驚人。

your blood sugars as a diabetic.

我們正在綜合多種技術, PET掃描、CT掃描和分子診斷

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

來發現和尋找所在位置不同的東西。

你現在看到的是今天MRI掃描技術以極高畫素重建的馬克.霍頓希的頭像

Let's start with faster.

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

他是TED醫學會議的管理者。

現在我們可以以前所未有的的像素和能力來看大腦內部

are speeding up faster and faster.

We can do more powerful things with them.

從根本上學會如何重建、甚至重新設計、或是逆向設計大腦

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

因此我們能更了解病變，疾病和治療方法。

我們能用fMRI即時來觀察大腦內部。

the ability of the human mind.

通過理解這些過程和聯繫

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

我們能夠瞭解藥物和冥想所帶來的影響

The ability now to look inside the body in real time

改善個人化治療、提高功效

with very high resolution

例如說，更符合個人需求、更有效的精神藥物。

is really becoming incredible.

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

fMR用的掃描器現在變得更小更輕便，也不像過去那樣昂貴。

and molecular diagnostics --

從這些掃描器得到的數據實在太多

to find and seek things at different levels.

很快地會造成很大的問題。

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

現在的掃描佔用了800本書的空間或者20G。

幾年後的掃描將會佔用1T或者800000本書的空間。

of Marc Hodosh, the curator of TEDMED.

And now we can see inside of the brain

我們該如何去利用這些信息呢？

讓我們從自己的例子說起吧。我不會問這裡誰做過結腸檢查，

at a resolution and ability never before available,

and essentially learn how to reconstruct and maybe even reengineer

但是如果你大於50歲，那麼該是你檢查結腸的時候了。

你怎麼避開結腸鏡的尖端呢？

or backwards engineer the brain,

現在有一種虛擬的結腸鏡檢查。

so we can better understand pathology, disease and therapy.

比較這兩張圖，作為放射科醫生

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

你可以檢查你病人結腸的內部

And by understanding these sorts of processes and these connections,

藉由人工智慧的協助

找出可能受傷的部位，就像你在這裡所看到的損傷。

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

我們以前可能會錯過這種損傷，但是藉由在放射科中用人工智能

and better personalize and make effective, for example,

psychoactive drugs.

我們能找到我們以前沒發現的損傷。

The scanners for these are getting smaller, less expensive

這可能會讓以前不願做結腸檢查的人願意檢查。

and more portable.

這是一個診療方式轉變的例子。

And this sort of data explosion available from these

is really almost becoming a challenge.

我們正朝向一個生物醫學、信息技術和無線網路的整合時代

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

而且我會說是「整合機動式」時代，也就是數位醫學的時代。

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

所以甚至我的聽診器都是數位的。

當然，它有個應用程序。

How do you leverage that information?

Let's get personal.

我們正走向《星際奇航記》裡出現的那個「影音分析儀」的時代。

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

這種手持超音波儀器正超越而且取代聽診器。

it's time for your screening colonoscopy.

這種儀器過去的價位是十萬英鎊或幾十萬美元

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

現在只要大約五千美元

Now there's essentially virtual colonoscopy.

Compare those two pictures.

我就能買得起這樣一個功能強大的診斷儀器。

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

我們正把這個裝置和電子醫療記錄結合起來

在美國，電子化醫療紀錄仍然少於百分之二十。

and augmenting that with artificial intelligence,

我想在荷蘭應該高於百分之八十。

potentially identify a lesion that we might have missed,

但是我們現在轉到結合醫療數據，

but using AI on top of radiology,

把數據電子化，

we can find lesions that were missed before.

如此我們就能整合資訊。

Maybe this will encourage people to get colonoscopies

現在作為一名醫生，不論在哪裡

that wouldn't have otherwise.

透過這些移動設備，我就能得到病人的數據。

This is an example of this paradigm shift.

當然，我們正處在iPad,甚至iPad2的時代。

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

就在上個月美國食品藥品管理局首度通過的應用程序

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

證實可以讓放射科醫生直接在這些設備上讀數據。

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

所以肯定的是，現今的醫生，包括我自己

已經完全離不開這些設備了。

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

正如你們大約一個月前所看到的

So the handheld ultrasound is basically surpassing

來自IBM的華生在益智節目「危險邊緣」中擊敗了兩位冠軍。

and supplanting the stethoscope.

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

因此我要你們想像當我們在幾年內開始採用雲端資訊

並真正有了人工智慧醫生連接到我們的大腦

or a couple hundred-thousand dollars.

我們做的決定和診斷會和過去全然不同。

For about 5,000 dollars,

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

你們現在在很多情況下已經不需要去看醫生了。

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

只有大約百分之二十的狀況下醫生才會用到手來做診療。

我們正處在虛擬診療的時代

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

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

從使用Skype到American Well來做線上看病

到思科研製的非常精密的健康診斷系統。

Now that we're switching to merging medical data,

這種和你的醫師的互動能力是有別於以往的。

making it available electronically,

現在因為有這些設備我們的能力更是提高了。

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

這是我的朋友傑西卡傳給我的她頭部裂傷的圖片

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

所以她不用來急診室，我能通過看照片來診斷。

just through my mobile device.

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

或許我們能利用現今的遊戲技術

比如微軟Kinect來進行診斷。

Just last month,

the first FDA-approved application was approved

例如在診斷中風時，

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

用簡單的移動偵測儀器和幾百元的設備就可以進行檢測。

我們現在實際上能用機器人來看病。

So certainly, the physicians of today, including myself,

are completely reliable on these devices.

如果我是一名血液病專家

And as you saw just about a month ago,

可以用這台RP7到另一家診所或醫院看診。

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

這種能提升診療效率的整套工具其實現在在家就找的到。

所以想像一下，我們已經擁有無線網路體重計。

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

你可以站在體重計上

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

你可以把你的體重用Tweet告訴你的朋友，他們能幫你保持身材。

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

我們有無線網絡血壓器。

to make decisions and diagnostics at a level never done.

我們正在整合這所有的技術。

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

所以我們不用戴這些雜七雜八的裝置，而是可以把他們變成一個貼片。

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

這是我在史丹福的一個同事發明的iRhythm。

它完全取代了先前的技術，而且價格低很多，效率更好。

We're now in the era of virtual visits.

現在我們正處於自我量化的時代。

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

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

人們可以買幾百元的裝置

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

像這個小FitBit。

我可以量化我的步數和我的卡路里消耗。

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

我可以每天都從這些數據了解一些事情。

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

我可以把數據和朋友，醫生分享。

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

現在有一種手錶可以測量你的心律，叫Zeo睡眠偵測器。

and do diagnostics that way.

Or maybe we can leverage today's gaming technology,

它能讓你使用這些資訊對自身的健康更了解。

當我們開始整合這些資訊

like the Microsoft Kinect,

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

我們就會更知道用它做什麼，更了解我們的病狀和身心健康。

現在甚至有一種鏡子可以測量你的脈搏率。

using simple motion detection, using $100 devices.

我認為，在未來，我們衣服裡會有可以穿戴的裝置

We can actually now visit our patients robotically.

全天候檢測我們的身體。

This is the RP7;

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

就像我們現在車裏的OnStar系統，

These are being augmented by a whole suite of tools

紅燈會亮起，雖然它不會說「去檢查引擎」

actually in the home now.

但它會說去「檢查你的身體」

We already have wireless scales.

回家好好照顧自己。

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

也許幾年後

they can keep you in line.

你照鏡子時鏡子會幫你看病。

We have wireless blood pressure cuffs.

A whole gamut of technologies are being put together.

家裡有小孩的

你會想要這種會幫你的無線尿布吧...

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

我想你不需要這麼多資訊。

This was developed at Stanford.

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

但是這一天會來的。

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

今天我們已經聽了很多新技術和技術整合。

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

我認為有些技術會使我們和病人更接近

有更多時間表達我們對病人的關懷。

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

這些技術能夠提供這樣的幫助。

I can measure my steps, my caloric outtake.

我們談到了一些能幫助患者的科技

I can get insight into that on a daily basis

那麼科技如何幫助醫生呢？

and share it with my friends or physician.

我們正處在「超強化外科醫生」的時代。

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

他們能進入身體內部

a suite of tools that enable you to leverage

用機器人做手術，這現在已經可以做到了。

這種水平即使是短短五年前都不太可能達到的。

and have insight into your own health.

As we start to integrate this information,

現在這種技術還因為多重影像技術，例如「增像技術」得到提升。

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

所以醫生能通過他們的鏡頭看到患者的內部

into our own pathologies, health and wellness.

看腫瘤在哪裡，血管在哪裡。

除此之外，「決策支持」這個技術也可以和「機器手術」做整合。

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

And I would argue, in the future,

例如說，在紐約的醫生可以幫阿姆茲特丹的醫生。

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

我們正在步入一個叫做NOTES的真正無疤手術的時代。

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

機器內窺鏡能穿過胃部切除膽囊

不會留下疤痕，過程也是機器化的。

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

這是即將被採用的技術。

基本上是一種無疤手術

and you'll go get it taken care of.

拜機器化手術之賜。

Probably in a few years,

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

除了控制機器手，我們還能控制其他東西嗎？

對於身障人士，那些半身不遂的人

(Laughter)

For those of you with kiddos at home,

有一種能讓人腦和電腦互動的技術叫做BCI。

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

在四肢癱瘓者的大腦皮層運動區植入晶片

(Laughter)

他們就能控制滑鼠指標、輪椅或者機器手臂。

More information, I think, than you might need,

這些晶片現在做得越來越小

but it's going to be here.

越來越多患者體內都能夠放入這種晶片。

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

這種技術仍在臨床階段，但想像一下

And I think some of these technologies

當我們將這些技術結合令人驚歎的仿生學假肢

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

像卡門院長和他的同事設計的DEKA手臂

and do the important human-touch elements of medicine,

有17種不同的移動方式和靈活度

能使失去肢體的人比以前更靈巧。

as augmented by these technologies.

Now, we've talked about augmenting the patient.

我們實際上真正進入到了可穿的機器人時代。

如果你手腳完好，但是你得了中風

How about augmenting the physician?

你可以穿這些假肢。

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

或者假如你下半身癱瘓，像我在巴克力仿生物公司拜訪的朋友們

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

他們發明了eLEGS。

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

我上週拍了這段影片。

影片中這位半身癱瘓的人因為穿上這些仿生裝備正在走路。

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

如果不穿這些盔甲，他完全得依賴輪椅。

這些機器裝備現在還在發展初期。

like augmented reality.

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

我認為藉由這些技術

where the tumor is, where the blood vessels are.

我們能改變對殘疾的定義

在某些情況下甚至能將「殘疾」轉變成「超能」。

This can be integrated with decision support.

這是艾米.馬林斯，她在小時候就失去了雙腿。

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

這是休.赫爾，麻省理工的教授

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

他也在一次攀岩事故中失去了雙腿。

where the robotic endoscope can come out the stomach

現在他們通過修復手術可以比正常人爬得更好，動得更快

用不同的方式游泳。

and pull out that gallbladder,

all in a scarless way and robotically.

再說說其他的整合科技吧。

很明顯地，肥胖趨勢朝著錯誤的方向快速發展

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

包括肥胖症造成的支出也是越來越龐大。

as mediated by robotic surgery.

但是醫學儀器卻有種越做越迷你的趨勢。

Now, how about controlling other elements?

例如說，我們可以用這種電子藥丸來做一趟「奇幻航行」。

For those who have disabilities -- the paraplegic,

你可以吞下這個麻雀雖小卻五臟俱全的裝置。

當它通過你的消化道時

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

where chips have been put on the motor cortex

能在消化道裡拍照，並且進行診斷和治療。

我們還做了更小的微型機器人

of completely quadriplegic patients,

他們能自動通過你的消化系統

and they can control a cursor or a wheelchair

or, potentially, a robotic arm.

用一種更溫和的方式來做外科醫師做不到的事。

These devices are getting smaller

and going into more and more of these patients.

有時這些裝置會在你的消化系統內自行組裝

從而提升使用價值。

Still in clinical trials,

but imagine when we can connect these, for example,

在心臟儀器方面，起搏器越來越容易植入

to the amazing bionic limb,

因此不需要訓練一位介入性心臟科醫師來植入這些儀器。

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

你可以用移動裝置再次的無線遙控這些儀器。

which has 17 degrees of motion and freedom,

所以你可以去任何地方而不影響對儀器的遠程遙控。

and can allow the person who's lost a limb

我們甚至還要把它做得更小。

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

這是一個Medtrinic製作的樣品，比一分錢還小。

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

另外，我們能將人工視網膜放到眼球後面

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

使盲人回復視力。

雖然這還在早期實驗階段，但成功的機率是很大的。

you can wear these augmented limbs.

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

這些將會是革命性的改變。

或著對我們這些視力正常的人

they've developed eLEGS.

I took this video last week.

有了這些輔助生活的隱形眼鏡會怎樣？

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

我們現在有藍牙、無線網絡，可以將圖像投射到你的眼睛。

He's otherwise completely wheelchair-bound.

如果你維持飲食有困難

This is the early era of wearable robotics.

這些額外的圖像也許能提醒你食物裡有多少卡路里。

And by leveraging these sorts of technologies,

如果病理學家能把他們的手機當做顯微鏡使用

把資料傳回主機，進行更好的診斷，這會是怎樣的局面呢？

we're going to change the definition of disability

實際上，現在整個實驗醫學界的情況已經完全改變了。

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

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

我們現在能利用微流體

像斯坦福大學的史提夫. 奎克做的這片晶片。

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

who lost his limbs in a climbing accident.

微流體技術能取代整個實驗室的技術員。

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

把它放在晶片上

with their prosthetics than us normal-abled persons.

它能在世界上任何地方的照護站同時做上千個檢測。

這些技術對農村和醫療不發達的地方會非常有幫助。

How about other exponentials?

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

它能把上千元的檢測成本縮減到幾分錢

而且在任何的照護站都能做。

including with huge costs.

But the trend in medicine is to get exponentially smaller.

如果我們沿著這條「微科技之路」再稍微往前走一點

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

我們就會進入奈米醫學時代。

奈米科技讓我們能將儀器做的超級迷你

You can swallow this completely integrated device.

迷你到我們可以設計紅血球細胞

或者設計微型機器人來檢測我們的血液或免疫系統

It can take pictures of your GI system,

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

或者甚至清除動脈裏的血栓。

We get into even smaller micro-robots

再來說到成本大減價這一點。

that will eventually, autonomously, move through your system,

不是我們通常在醫學時代裡想到的那種

而是過去10MB就要3400元的硬碟現在變得非常的便宜。

and be able to do things surgeons can't do

在基因組學裏

in a much less invasive manner.

十年前我們花了十億美元才發現第一組基因組

Sometimes these might self-assemble in your GI system,

and be augmented in that reality.

現在基本上找出基因組的成變成一千美元

On the cardiac side, pacemakers are getting smaller

也許今後一兩年就只要一百美元。

and much easier to place,

我們能用一百元換來的基因組做什麼呢？

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

很快的我們能用這些基因組來做數以百萬種的檢測。

當我們集中這些基因組資訊的時候，事情就變得很有意思了。

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

我們會開始進入了真正的個人化的醫學時代

so you can go places and be monitored remotely.

These are shrinking even further.

在正確的時間為正確的人做正確的藥

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

而不是像現在這樣，給每個人同樣的藥

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

有點像是胡亂開藥似的

開給對病人沒用的藥。

and allow the blind to see --

also in early trials, but moving into the future.

很多不同的公司正在努力利用這些方法。

我來舉一個簡單的例子，還是來自「23和我」的例子。

These are going to be game-changing.

Or for those of us who are sighted,

我的數據顯示我已經到了會得視網膜斑點退化的危險期

how about having the assisted-living contact lens?

這是會導致失明的疾病。

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

但是如果我把同樣的數據上傳到deCODEme

(Laughter)

我還能看到我得到第二型糖尿病的風險有多高。

Now, if you have trouble maintaining your diet,

我得第二型糖尿病的風險幾乎高於標準值兩倍了。

it might help to have some extra imagery

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

所以我可能會開始注意我在午飯休息時間吃了多少甜點。

How about enabling the pathologist to use their cell phone

因此這種診斷也許會改變我的行為。

利用我對基因藥理學的知識

to see at a microscopic level

我的基因如何控制，我的藥物作用是什麼，甚麼可以滿足我的需求

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

這些都將變得越來越重要

In fact, the whole era of laboratory medicine

一旦人們和患者有了這些資訊

is completely changing.

We can now leverage microfluidics,

就能提升藥物劑量和藥物選擇的品質。

like this chip made by Steve Quake at Stanford.

所以不是只有基因重要

我們的習慣和環境都很重要。

Microfluidics can replace an entire lab of technicians;

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

上次你的醫生問你住在哪裡是什麼時侯？

在風土醫學裡

anywhere in the world.

你住在哪裡，你接觸過什麼對你的健康有極大的影響。

This will really leverage technology to the rural and the underserved

我們能抓住這些信息。

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

因此基因組學，蛋白組學，環境，

所有這些數據都湧向我們和可憐的醫生。

and at the point of care.

我們該如何管理它？

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

we're entering the era of nanomedicine,

我們正在進入系統醫學或者系統生物學時代

the ability to make devices super-small,

也就是說我們能開始整合這些資訊。

to the point where we can design red blood cells

例如，做檢測時可以在我們的血液中發現一萬個生物標記

透過觀察這些標記

or microrobots that monitor our blood system or immune system,

我們能看到這些小標記

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

讓我們更早發現疾病。

Now how about exponentially cheaper?

這個領域的創始人李.胡德稱這種方法為P4醫學。

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.

我們將能預測我們可能會得甚麼病。

我們能預防,這種預防性可以針對個人需求。

In genomics now, the genome cost about a billion dollars

更重要的是，每個人都能夠參予其中。

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

透過一些如「Patients Like Me」這樣的網站

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

或是使用微軟HealthVault或谷歌健康軟體來管理你的數據，

病人能利用這些方法參予預防診斷過程

And in two years, a $100 genome.

這點會變得越來越重要。

What will we do with $100 genomes?

Soon we'll have millions of these tests available.

再來我要以「品質」來作為結束。

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

我們的治療會更好、更有效。

現在高血壓大部分是通過吃藥來治療。

and enter the era of true personalized medicine:

如果我們用一種新裝置

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

麻醉調節血壓的神經血管

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

一次就能治好高血壓。

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

這新裝置已經能做到這種治療了。

Many different companies are working on leveraging these approaches.

再一、兩年內應該就可以上市。

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

還有更有目標性的癌症療法。

我是腫瘤科醫生

My data indicates I've got about average risk

for developing macular degeneration, a kind of blindness.

我必須說大多數我們開的藥其實是毒藥。

我們斯坦福和其他地方發現

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.

我們能找到癌症幹細胞

就是可能引起癌症復發的細胞。

如果你把癌症看成是一個種子

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

我們通常能除掉這些種子。

It might change my behavior.

Leveraging my knowledge of my pharmacogenomics:

它看似萎縮，但經常又長回來。

所以我們瞄準的目標是錯誤的。

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

癌症幹細胞依然存在

will become increasingly important,

腫瘤能在幾個月後或幾年後再長出來。

and once in the hands of individuals and patients,

我們現在學會了鑒定癌症幹細胞

will make better drug dosing and selection available.

將它們設為長期治療的目標。

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

our habits, our environmental exposures.

我們正在進入個人化腫瘤學時代

我們有能力會整、利用這些資訊

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

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

有能力分析腫瘤

為每一個患者量身制做出一套有效的雞尾酒式療法。

can dramatically affect your health.

最後我要說的是再生醫學。

We can capture that information.

Genomics, proteomics, the environment --

我對幹細胞研究很多

all this data streaming at us individually and as physicians:

胚胎幹細胞再生能力特別強。

我們體內也遍佈成體的幹細胞。

How do we manage it?

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

我們把這些幹細胞運用在骨髓移植領域。

where we can start to integrate all this information.

就在去年傑龍做了第一次嘗試

他用人類的胚胎幹細胞治療脊髓神經傷害。

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

雖然仍在實驗階段，但有進展。

of 10,000 biomarkers in a single test,

我們在臨床實驗運用成體幹細胞大概有十五年了

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

用它來治療許多不同的疾病，尤其是心血管病。

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

我們取出自己的骨髓細胞治療心臟病病人

病人心臟病發後用了我們自己的骨髓細胞

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

我們發現病人的心臟功能改蓋，而且活得更好。

We can be preventative; that prevention can be personalized.

我發明了一種叫MarrowMiner的裝置

More importantly, it'll be increasingly participatory.

它能用比較溫和的方式來收集骨髓。

美國食品藥物管制局已經核准這個裝置

Through websites like PatientsLikeMe

預期將會在這一兩年內上市。

or managing your data on Microsoft HealthVault or Google Health,

希望你們能喜歡這個發明

leveraging this together in participatory ways

它能沿著患者的脊椎移除患者的骨髓

will be increasingly important.

I'll finish up with exponentially better.

以前需要穿刺兩百次，現在只要局部麻醉後作一次穿刺就可以。

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

但是現在幹細胞治療是朝什麼方向發展呢？

想一下，你身體裡每一個細胞都有同樣的DNA

Today we treat high blood pressure mostly with pills.

這在你還是一個胚胎的時候就有了。

What if we take a new device,

我們現在能重新構造你的皮膚細胞

knock out the nerve vessels that help mediate blood pressure,

讓它就像一個多功能的胚胎幹細胞

and in a single therapy, basically cure hypertension?

This is a new device doing essentially that.

利用這個技術能治療同一個患者的多個器官

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

製造你個人的幹細胞线。

我認為這將開啟個人幹細胞庫的新時代

How about more targeted therapies for cancer?

把你的心血管細胞、肌肉細胞、神經細胞存在冷凍櫃裡

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

在你將來需要的時候使用。

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

我們現在用這所有的細胞工程技術來整合這些資訊。

為3D器官影像列印整合技術

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

用細胞代替墨水來重建一個3D器官。

So if you think of cancer as a weed,

這是未來發展的方向，現在我們還在發展初期。

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

但我認為，就整合科技來說

這是最好的一個例子。

but it often comes back.

So we're attacking the wrong target.

所以在結束的時候，我想說說現在的技術趨勢

The cancer stem cells remain,

以及這些趨勢對健康和醫學會有怎樣的巨大影響。

and the tumor can return months or years later.

我們正進入微型化、分散化、個人化的時代。

We're now learning to identify the cancer stem cells

我認為如果我們能開始思考如何了解、利用這些技術

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

透過集中這些技術

我們就能讓病患對疾病更了解

We're entering the era of personalized oncology,

讓醫生更有能力，讓人們更健康

the ability to leverage all of this data together,

而且能夠防患於未然。

analyze the tumor

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

因為作為醫生我知道，如果某人在患病初期來看我

我會很高興，因為通常我們可以治好他們的病。

I'll close with regenerative medicine.

但是他們經常來得太晚，例如可能到了癌症三或四期才來。

I've studied a lot about stem cells.

Embryonic stem cells are particularly powerful.

所以通過利用這些整合技術

我認為我們可以進入一個新時代

We have adult stem cells throughout our body;

我稱之為「零期醫學」的時代。

we use those in bone marrow transplantation.

作為一名癌症醫生，我期待失業。

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

非常感謝。

謝謝，謝謝。

to treat spinal cord injuries.

Still a phase I trial, but evolving.

鞠躬，鞠躬。

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

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

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

we can see much improved heart function and better survival

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

I invented a device called the MarrowMiner,

a much less invasive way for harvesting bone marrow.

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

Hopefully you can appreciate the device

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

but with a single puncture, under local anesthesia.

Where is stem-cell therapy going?

If you think about it,

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

We can now reprogram your skin cells

to actually act like a pluripotent embryonic stem cell

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

making personalized stem cell lines.

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

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

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

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

and integrating exponential technologies for essentially 3D organ printing,

replacing the ink with cells,

and essentially building and reconstructing a 3D organ.

That's where things are heading.

Still very early days,

but I think, as integration of exponential technologies,

this is the example.

So in closing, as you think about technology trends

and how to impact health and medicine,

we're entering an era of miniaturization,

decentralization and personalization.

And by pulling these things together,

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

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

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,

I'm thrilled; we can often cure them.

But often it's too late,

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

So by leveraging these technologies together,

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

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

Thanks very much.

(Applause)

Host: Thank you. Thank you.

(Applause)

Take a bow, take a bow.