What your breath could reveal about your health | Julian Burschka

Translator: Joseph Geni Reviewer: Camille Martínez

譯者: 于雍 歐 審譯者: Melody Tang

I have a tendency to assume the worst,

我總喜歡先去設想最壞的結果，

and once in a while, this habit plays tricks on me.

這種習慣偶爾會把我搞糊塗。

For example, if I feel unexpected pain in my body

如果我身體上有莫名的疼痛，

that I have not experienced before and that I cannot attribute,

以前未曾經歷過， 我也找不到原因。

then all of a sudden, my mind might turn a tense back into heart disease

然後突然間，我可能會 將我僵直的背想成是心臟病。

or calf muscle pain into deep vein thrombosis.

或是將小腿肚疼痛， 想成是深部靜脈血栓。

But so far, I haven't been diagnosed with any deadly or incurable disease.

不過到目前為止，我還沒有 被診斷出有致命的或不治之症。

Sometimes things just hurt for no clear reason.

有時我們就是會有不明原因的疼痛。

But not everyone is as lucky as me.

但不是每個人都像我這麼幸運。

Every year, more than 50 million people die worldwide.

全世界每年有超過 5000 萬人死亡。

Especially in high-income economies like ours,

特別在高所得國家，如我們國家；

a large fraction of deaths is caused by slowly progressing diseases:

進展緩慢的疾病 占了死亡人數的大部分。

heart disease, chronic lung disease, cancer, Alzheimer's, diabetes,

例如：心臟病、慢性肺病、 癌症、阿茲海默症及糖尿病。

just to name a few.

但這只是少數的一些例子。

Now, humanity has made tremendous progress in diagnosing and treating many of these.

現今，人類在檢測及治療許多 這些疾病上，已經有了重大的進展。

But we are at a stage where further advancement in health

不過我們正處於 要在健康有更進一步的發展，

cannot be achieved only by developing new treatments.

不能只靠研發新的療法的階段。

And this becomes evident when we look at one aspect

當我們看到許多疾病有共同點的 這個方面時，

that many of these diseases have in common:

這就變得更顯而易見了。

the probability for successful treatment

這個共同點就是 疾病被治癒的機率，

strongly depends on when treatment is started.

與開始治療的時間點有很大的關聯。

But a disease is typically only detected once symptoms occur.

不過通常只有在症狀出現時 疾病才會被發現。

The problem here is that, in fact, many diseases can remain asymptomatic,

問題是：其實許多疾病沒有症狀，

hence undetected, for a long period of time.

因此，疾病會有很長一段時間 沒有被發現。

Because of this, there is a persisting need for new ways

因此，我們必需有一個新的方法

of detecting disease at early stage,

能在疾病早期以及症狀出現以前， 就檢測到疾病。

way before any symptoms occur.

In health care, this is called screening.

在醫療保健，這就是篩檢。

And as defined by the World Health Organization,

世界衛生組織對它的定義是：

screening is "the presumptive identification of unrecognized disease

「利用可迅速及簡單操作的檢查，

在看似健康的人身上

in an apparently healthy person,

by means of tests ... that can be applied rapidly and easily ..."

找出疑似的病症。」

That's a long definition, so let me repeat it:

這個定義有點長， 我們再重複一次，篩選的定義是：

identification of unrecognized disease

「利用可迅速及簡單操作的檢查，

in an apparently healthy person

在看似健康的人身上

找出疑似的病例。」

by means of tests that can be applied both rapidly and easily.

And I want to put special emphasis on the words "rapidly" and "easily"

我想強調它所說的 「迅速」及「簡單」。

because many of the existing screening methods

因為與目前現行的篩檢相比，

are exactly the opposite.

恰恰是完全相反的。

And those of you who have undergone colonoscopy

那些曾做過結腸鏡檢查，

as part of a screening program for colorectal cancer

那是結腸癌篩選的其中一項，

will know what I mean.

就知道我要表達的意思。

Obviously, there's a variety of medical tools available

目前有許多可用的醫療工具種類，

to perform screening tests.

能夠用來做篩檢。

This ranges from imaging techniques such as radiography

從醫療成像技術，如射線照相術，

or magnetic resonance imaging

或是核磁共振成像，

to the analysis of blood or tissue.

和血液分析及組織分析，

We have all had such tests.

我們一直都有這些技術。

But there's one medium that for long has been overlooked:

不過另外還有個篩選方法， 一直被我們給忽略了。

a medium that is easily accessible,

一個更為容易取得的方法，

basically nondepletable,

它的來源很充足，

and it holds tremendous promise for medical analysis.

而且它在醫學分析的前景很被看好，

And that is our breath.

那就是我們的呼氣。

Human breath is essentially composed of five components:

我們的呼氣主要由五種成分組成 ：

nitrogen, oxygen, carbon dioxide, water and argon.

氮氣、氧氣、二氧化碳、水及氬。

But besides these five, there are hundreds of other components

除了這主要的五種之外，

還有其他數百種極少量的成分。

that are present in very low quantity.

These are called volatile organic compounds,

這些被稱為「揮發性有機化合物」。

and we release hundreds, even thousands of them

每當我們吐氣時，

我們釋放出成千上百種的 揮發性有機化合物。

every time we exhale.

The analysis of these volatile organic compounds in our breath

這些揮發性有機化合物的分析，

is called breath analysis.

我們稱為呼氣分析。

In fact, I believe that many of you have already experienced breath analysis.

其實在場就有許多聽眾 做過這種呼氣分析。

Imagine: you're driving home late at night,

想像一下：在深夜你驅車回家，

when suddenly, there's a friendly police officer

突然間有個友善的警察將你攔住，

who asks you kindly but firmly

以和善但堅定的口氣，請你停車。

to pull over and blow into a device like this one.

請你對著類似這個裝置吐氣。

This is an alcohol breath tester

這是一個酒精濃度探測器，

that is used to measure the ethanol concentration in your breath

用來測量你體內的酒精濃度，

and determine whether driving in your condition is a clever idea.

以確認你目前的身體情況 是否適合開車。

Now, I'd say my driving was pretty good,

我得說我的開車技術還算出色，

but let me check.

不過讓我檢測看看。

(Beep)

（嗶）

0.0, so nothing to worry about, all fine.

酒精濃度為零 ， 沒有什麼好擔心的。

(Laughter)

（笑聲）

Now imagine a device like this one,

想像一下類似這種的裝置，

that does not only measure alcohol levels in your breath,

它不只能夠檢測酒精濃度，

but that detects diseases like the ones I've shown you

還可以檢測我前面提到的疾病，

and potentially many more.

甚至可能檢測到更多的疾病。

The concept of correlating the smell of a person's breath

一個人呼氣的氣味，

with certain medical conditions,

與特定身體狀況有關聯的概念，

in fact, dates back to Ancient Greece.

其實可以追朔到古希臘時期。

But only recently, research efforts on breath analysis have skyrocketed,

不過一直到了最近， 呼氣分析的研究才有飛速的進展.

and what once was a dream is now becoming reality.

我們曾有的夢想已經實現。

And let me pull up this list again that I showed you earlier.

讓我們再看一次 我先前顯示在螢幕的列表。

For the majority of diseases listed here,

在這清單內大多數的疾病，

there's substantial scientific evidence

它們本質上的科學跡象，

suggesting that the disease could be detected by breath analysis.

顯示它們能以呼氣分析檢測出來。

But how does it work, exactly?

這是如何運作的呢？

The essential part is a sensor device

其中最重要的部分是，

一台能夠偵測 揮發性有機化合物的感測器。

that detects the volatile organic compounds in our breath.

Simply put: when exposed to a breath sample,

簡單來說：當偵測到呼氣樣本時，

the sensor outputs a complex signature

來自我們呼氣裡的 揮發性有機化合物，

that results from the mixture of volatile organic compounds that we exhale.

能夠使感測器 產生一種複雜的信號。

Now, this signature represents a fingerprint of your metabolism,

這種信號就像是體內的新陳代謝，

your microbiome

、微生物、

and the biochemical processes that occur in your body.

以及生化過程的鑑別性標記。

If you have a disease,

如果你的身上有疾病，

your organism will change,

你身上的有機物將會產生變化，

and so will the composition of your exhaled breath.

其中也包括了 你呼氣時的氣體成分，

And then the only thing that is left to do is to correlate a certain signature

最後你唯一要做的事就是 檢測那些特定的信號，

with the presence or absence of certain medical conditions.

查看它是否符合那些 特定的身體狀況。

The technology promises several undeniable benefits.

這種科技會帶來許多 不可否認的好處。

Firstly, the sensor can be miniaturized

首先，感測器能夠微型化，

and integrated into small, handheld devices

並結合至手提式的裝置，

like this alcohol breath tester.

就像是酒精濃度探測器一樣。

This would allow the test to be used in many different settings

這使得我們能夠 在許多地點進行檢測，

and even at home,

甚至在家裡也可以。

so that a visit at the doctor's office

因此，我們再也不需要每當要檢測時，

is not needed each time a test shall be performed.

就跑到診所或醫院進行。

Secondly, breath analysis is noninvasive

其次，呼氣分析為非侵入式，

and can be as simple as blowing into an alcohol breath tester.

就像是對著 酒精濃度探測機呼氣那麼簡單。

Such simplicity and ease of use would reduce patient burden

如此簡單的使用方法 能夠減輕病人的負擔，

and provide an incentive for broad adoption of the technology.

同時也是一個能讓大家能 廣泛接受這項技術的誘因。

And thirdly, the technology is so flexible

第三點，這項技術非常靈活。

that the same device could be used

同部裝置，

to detect a broad range of medical conditions.

能夠同時被用來檢測 各式各樣的身體狀況。

Breath analysis could be used to screen for multiple diseases at the same time.

呼氣分析能同時篩檢多種疾病。

Nowadays, each disease typically requires a different medical tool

現今，每種疾病通常需要 不同的醫療工具

to perform a screening test.

才能進行那個疾病的篩檢。

But this means you can only find what you're looking for.

但是這表示你只能篩檢出 你想找到的疾病。

With all of these features, breath analysis is predestined

有了這些特點 呼氣分析技術註定將取代

to deliver what many traditional screening tests are lacking.

那些傳統篩檢儀器所沒有的部分。

And most importantly,

更重要的是，

all of these features should eventually provide us

這些特點最終將提供給我們

with a platform for medical analysis

一個醫療分析平台

能夠以吸引人的低廉價格做測試。

that can operate at attractively low cost per test.

On the contrary, existing medical tools

相對地，現有的醫療工具，

often lead to rather high cost per test.

單次使用的費用都相當高昂。

Then, in order to keep costs down,

為了降低檢測的費用，

the number of tests needs to be restricted,

篩檢的數量必須被限制，

and this means (a) that the tests can only be performed

這表示（ａ）：

只有少數的人，像是高風險族群， 才能夠接受篩檢。

on a narrow part of the population, for example, the high-risk population;

and (b) that the number of tests per person needs to be kept at a minimum.

以及（ｂ）：每個人的篩檢項目總數 必須盡量減到最低。

But wouldn't it actually be beneficial

如果能夠讓更多的民眾

if the test was performed on a larger group of people,

在長時間內做更頻繁的篩檢

and more often and over a longer period of time for each individual?

實際上不是才更有益處嗎？

Especially the latter would give access to something very valuable

尤其是後者會帶給 我們相當重要的價值，

that is called longitudinal data.

那就是長時間的數據。

Longitudinal data is a data set that tracks the same patient

長時間的數據 是紀錄同一個病患的病況

數月甚至數年的資料庫。

over the course of many months or years.

Nowadays, medical decisions are often based on a limited data set,

現今，醫療決策通常是根據患者

where only a glimpse of a patient's medical history

有限的醫療病史，

is available for decision-making.

來決定的。

In such a case,

在這種情況下，

abnormalities are typically detected

我們只能藉由

by comparing a patient's health profile

將患者的健康狀況

to the average health profile of a reference population.

和平均參考人口的健康狀況做比較 來偵測到病患的異常狀態。

Longitudinal data would open up a new dimension

長時間的數據 為我們打開了嶄新的空間，

and allow abnormalities to be detected

使我們能夠根據患者的醫療病史，

based on a patient's own medical history.

檢測出患者身上的異常情況。

This will pave the way for personalized treatment.

這將爲客製化的療程鋪路。

Sounds pretty great, right?

聽起來很棒，不是嗎？

Now you will certainly have a question that is something like,

現在你們一定都有這個問題，如：

"If the technology is as great as he says, then why aren't we using it today?"

「如果這項技術真如你所說的這麼好， 為什麼現今還無人使用呢？」

And the only answer I can give you is:

我只能給你們答案是：

not everything is as easy as it sounds.

不是每件事都像 它聽起來的這麼簡單。

There are technical challenges, for example.

這中間存在了技術的挑戰，例如：

There's the need for extremely reliable sensors

我們需要一個極其可靠的感測器，

that can detect mixtures of volatile organic compounds

能夠偵測到揮發性 有機化合物的混合體，

with sufficient reproducibility.

並有著充足的再現性，

And another technical challenge is this:

另一個技術的挑戰是：

How do you sample a person's breath in a very defined manner

你如何以非常明確的方式 採集患者的呼氣樣本，

so that the sampling process itself

以使採集樣本的過程中，

does not alter the result of the analysis?

不會改變樣本分析的結果呢？

And there's the need for data.

然後，我們需要數據資料。

Breath analysis needs to be validated in clinical trials,

呼氣分析需要用臨床實驗來佐證，

and enough data needs to be collected

我們需要收集足夠多的數據資料，

so that individual conditions can be measured against baselines.

才能在基線資料上， 比較出個別患者的健康狀況。

Breath analysis can only succeed

呼氣分析只有在

if a large enough data set can be generated

有足夠多的數據資料

and made available for broad use.

並能被廣泛的使用下才能成功。

If breath analysis holds up to its promises,

如果呼氣分析能實現它的承諾，

this is a technology that could truly aid us

這項技術將幫助我們

to transform our health care system --

翻轉我們的醫療照護體系，

transform it from a reactive system

從一個被動、

where treatment is triggered by symptoms of disease

只有症狀出現時才會有反應的體系，

to a proactive system,

成為能在早期發現疾病，

where disease detection, diagnosis and treatment

早在症狀開始之前，

can happen at early stage,

就能先偵測、診斷和治療的

way before any symptoms occur.

醫療照護體系。

Now this brings me to my last point, and it's a fundamental one.

這把我們帶到了 最後且最核心的問題：

What exactly is a disease?

究竟什麼是疾病？

Imagine that breath analysis can be commercialized as I describe it,

想像一下呼氣分析能夠商業化，

and early detection becomes routine.

早期的篩檢變成常規的身體檢查，

A problem that remains is, in fact, a problem

剩下的一個問題，其實也是

that any screening activity has to face

任何一個篩檢都要面對的問題，

because, for many diseases,

就是疾病的種類極多，

it is often impossible to predict with sufficient certainty

你不可能百分之百的確定

whether the disease would ever cause any symptoms

你身上的疾病是否會出現症狀，

or put a person's life at risk.

或者將置你於險地。

This is called overdiagnosis,

我們將這稱之為過度診斷，

and it leads to a dilemma.

這給了我們一個難題。

If a disease is identified,

當我們診斷出有疾病時，

you could decide not to treat it

你可以決定不去治療它，

because there's a certain probability that you would never suffer from it.

因為你有可能不會有病痛。

But how much would you suffer

但是當你得知 你身上有可能致死的疾病時，

just from knowing that you have a potentially deadly disease?

你的心理折磨 會被疾病本身來的小嗎？

And wouldn't you actually regret that the disease was detected

你會不會後悔

當初你的病被診斷出來。

in the first place?

Your second option is to undergo early treatment

你的第二種選擇 是去接受早期治療，

with the hope for curing it.

並祈禱能夠治好它。

But often, this would not come without side effects.

不過治療通常也伴隨著副作用，

To be precise:

更準確地說，

the bigger problem is not overdiagnosis,

更大的問題不是過度診斷，

it's overtreatment,

而是過度治療。

because not every disease has to be treated immediately

因為不是因為有治療方法，

just because a treatment is available.

你就需要立即去醫治疾病。

The increasing adoption of routine screening

日益增加的常規篩檢，

will raise the question:

將使另一個問題浮現：

What do we call a disease that can rationalize treatment,

我們該如何看待一個疾病 是需要治療，

and what is just an abnormality that should not be a source of concern?

還是不需要疑慮的身體異常而已？

My hopes are that routine screening using breath analysis

我希望，常規的呼氣分析篩檢

can provide enough data and insight

能夠提供足夠的資料及見解

so that at some point, we'll be able to break this dilemma

讓我們在未來能夠打破這種僵局，

and predict with sufficient certainty

並且有十足的把握預測

whether and when to treat at early stage.

它是否需要或何時 該進行早期的治療。

Our breath and the mixture of volatile organic compounds that we exhale

我們吐氣時的揮發性有機化合物，

hold tremendous amounts of information on our physiological condition.

蘊含著我們生理上的龐大資訊。

With what we know today, we have only scratched the surface.

我們目前對它的理解只是冰山的一角。

As we collect more and more data and breath profiles across the population,

當我們從更多人口中 收集更多數據資料，

including all varieties of gender, age, origin and lifestyle,

包括所有的性別、年齡、 民族及生活方式，

the power of breath analysis should increase.

呼氣分析的威力才能增強。

And eventually, breath analysis should provide us with a powerful tool

最後，呼氣分析應該不僅是 一個強而有力的工具，

not only to proactively detect specific diseases

它還能幫助我們主動偵測特定疾病，

but to predict and ultimately prevent them.

最終使我們能夠 預測以及預防疾病。

And this should be enough motivation

這些應該提供足夠的動機

to embrace the opportunities and challenges

讓大家來擁抱這個呼氣分析 所帶來的機會和挑戰，

that breath analysis can provide,

even for people that are not part-time hypochondriacs like me.

包括像我一樣的長期疑病症患者，

Thank you.

謝謝。

(Applause)

（掌聲）