TEDxMaastricht
Daniel Kraft: Medicine's future? There's an app for that
丹尼尔·克拉夫特：医学的未来？也许是手机上的一个应用程序
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在马斯特里赫特的TED会议上，丹尼尔·克拉夫特快速展示了在未来几年医学上的革新，通过新工具，测试和应用程序把诊断信息直接带到患者的床边。
Daniel Kraft - Physician scientist
Daniel Kraft is a physician-scientist, inventor and entrepreneur. He is the founder and chair of Exponential Medicine and has served as faculty chair for Medicine at Singularity University since its inception, exploring the impact and potential of rapidly developing technologies as applied to health and medicine. Full bio
Daniel Kraft is a physician-scientist, inventor and entrepreneur. He is the founder and chair of Exponential Medicine and has served as faculty chair for Medicine at Singularity University since its inception, exploring the impact and potential of rapidly developing technologies as applied to health and medicine. Full bio
Double-click the English transcript below to play the video.
00:15
A couple of years ago
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几年前
00:17
when I was attending the TED Conference in Long Beach,
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我参加在长滩TED会议的时候，
00:19
I met Harriet.
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我遇到了哈里特。
00:21
We'd actually met online before --
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实际上我们以前在网上遇到过--
00:23
not the way you're thinking.
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不是像你们想的那样。
00:25
We were actually introduced because we both knew Linda Avey,
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我们认识是因为我们都认识琳达·埃维，
00:27
one of the founders of the first online personal genomic companies.
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首家私营基因公司创始人之一。
00:30
And because we shared our genetic information with Linda,
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并且因为我们和琳达分享我们的基因信息，
00:33
she could see that Harriet and I
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她知道哈里特和我
00:35
shared a very rare type of mitochondrial DNA --
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都有一种很稀有的线粒体DNA --
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Haplotype K1a1b1a --
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K1a1b1a 单模标本 --
00:39
which meant that we were distantly related.
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这意味着我们是远亲。
00:41
We actually share the same genealogy with Ozzie the iceman.
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实际上，我们都和冰人奥兹有亲缘关系。
00:44
So Ozzie, Harriet and me.
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没错，奥兹，哈里特和我。
00:46
And being the current day, of course, we started our own Facebook group.
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当然，如今我们有了自己的脸书网群组。
00:48
You're all welcome to join.
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欢迎你们加入。
00:50
And when I met Harriet in person the next year at the TED Conference,
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当我在第二年TED会议遇见哈里特的时候，
00:53
she'd gone online and ordered our own happy Haplotype T-shirts.
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她在线订购了我们自己快乐的单模标本T恤衫。
00:55
(Laughter)
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(笑声）
00:57
Now why am I telling you this story,
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为什么我要告诉你们这个故事，
00:59
and what does this have to do with the future of health?
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这和未来健康有什么关系呢？
01:01
Well the way I met Harriet is actually an example
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实际上，我遇见哈里特的经过是一个很好的例子
01:03
of how leveraging cross-disciplinary,
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关于怎样利用学科交叉，
01:05
exponentially-growing technologies
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指数增长的技术
01:07
is affecting our future of health and wellness --
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来影响我们将来的健康和保健事业--
01:09
from low-cost gene analysis
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从低成本的基因分析
01:11
to the ability to do powerful bio-informatics
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到做强大生物信息学的能力
01:13
to the connection of the Internet and social networking.
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到互联网和社会网络间的联系。
01:16
What I'd like to talk about today
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我今天想谈的
01:18
is understanding these exponential technologies.
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是理解这些指数增长的技术。
01:20
We often think linearly.
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我们经常线性思考。
01:22
But if you think about it, if you have a lily pad
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但是如果想像一下，如果你有一个睡莲叶子
01:24
and it just divided every single day --
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它每天分裂一次--
01:26
two, four, eight, 16 --
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2，4，8，16 --
01:28
in 15 days you have 32,000.
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15天以后会有32000个叶子。
01:30
What do you think you have in a month? We're at a billion.
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你认为1个月以后有多少？我们会有10亿。
01:33
So if we start to think exponentially,
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如果我们开始指数思考，
01:35
we can see how this is starting to affect all the technologies around us.
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我们会看到这会怎样影响到我们周围的技术。
01:38
And many of these technologies -- speaking as a physician and innovator --
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许多技术--像一位物理学家和革新者所说的--
01:41
we can really start to leverage
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我们能真正开始去利用它们
01:43
to impact the future of our own health and of health care,
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影响我们的未来健康和卫生保健，
01:45
and to address many of the major challenges that we have in health care today,
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和谈论如今许多卫生保健面临的主要困难
01:48
ranging from the really exponential costs
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从巨额投入
01:50
to the aging population,
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到高龄人群，
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the way we really don't use information very well today,
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我们没有真正很好地使用信息的现状，
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the fragmentation of care
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保健不均衡
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and often the very difficult course
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和常常面对困难棘手的经历
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of adoption of innovation.
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例如采用革新的历程。
02:00
And one of the major things we can do we've talked a bit about here today
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今天我们谈到主要的事情之一
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is moving the curve to the left.
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是把曲线向左移。
02:04
We spend most of our money on the last 20 percent of life.
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我们在生命的最后20%时间里花费了大部分的钱。
02:06
What if we could spend and incentivize positions
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如果我们能够投资和激励岗位
02:08
in the health care system and our own self
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在健康保健系统和我们自身
02:10
to move the curve to the left and improve our health,
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来向左移动这条曲线从而改善我们的健康，
02:12
leveraging technology as well?
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利用技术，会怎么样呢？
02:14
Now my favorite technology, example of exponential technology,
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我最喜爱的技术，指数技术的例子，
02:17
we all have in our pocket.
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在我们所有人的口袋里。
02:19
So if you think about it, these are really dramatically improving.
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因此如果你想一下，你会发现这些技术真的显著提高了。
02:22
I mean this is the iPhone 4.
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我指的是iPhone 4.
02:24
Imagine what the iPhone 8 will be able to do.
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想像iPhone 8将能做什么。
02:27
Now, I've gained some insight into this.
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现在，我有了一些见解。
02:29
I've been the track share
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我追踪观察
02:31
for the medicine portion of a new institution called Singularity University
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新成立的奇点大学的医学院
02:34
based in Silicon Valley.
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它座落在硅谷。
02:36
And we bring together every summer
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每个夏天我们召集
02:38
about 100 very talented students from around the world.
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世界各地100名非常有天赋的学生。
02:40
And we look at these exponential technologies from medicine, biotech,
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我们研究这些指数技术从医学，生物技术，
02:42
artificial intelligence, robotics, nanotechnology, space,
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人工智能，机器人技术，纳米技术，太空技术，
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and address how can we cross-train
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来发现如何能多项培训
02:47
and leverage these to impact major unmet goals.
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并利用这些技术去影响重大未实现的目标。
02:49
We also have seven-day executive programs.
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我们也有一个7天执行方案。
02:51
And coming up next month is actually Future Med,
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接下来几个月的方案是“未来医学”，
02:54
a program to help cross-train and leverage technologies into medicine.
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一个帮助多项培训和把技术应用到医学的项目。
02:57
Now I mentioned the phone.
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现在我来说电话。
02:59
These mobile phones have over 20,000 different mobile apps available --
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这些手机有超过20000个不同的应用程序--
03:02
to the point where there's one out of the U.K.
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从这点上说，有一个与众不同，
03:04
where you can pee on a little chip connected to your iPhone
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那就是你可以通过在你的iPhone相连的一小块芯片上小便
03:06
and check yourself for an STD.
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来自查是否有性传染病。
03:08
I don't know if I'd try that yet, but that's available.
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我不知道我是否会这样做，但是它确实可用。
03:10
There are all other sorts of applications,
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还有很多种应用，
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merging your phone and diagnostics, for example --
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把你的电话和诊断联系在一起，例如--
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measuring your blood glucose on your iPhone
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用你的iPhone测量你的血糖
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and sending that, potentially, to your physician
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并可能把数据发给你的医生
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so they can better understand and you can better understand
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使得他们和你都能更好得了解
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your blood sugars as a diabetic.
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你作为一个糖尿病人的血糖。
03:23
So let's see now how exponential technologies are taking health care.
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现在让我们看看指数技术怎样进行健康保健。
03:25
Let's start with faster.
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让我们从速度开始。
03:27
Well it's no secret that computers, through Moore's law,
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我们都知道，根据摩尔定律，计算机
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are speeding up faster and faster.
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运算速度越来越快。
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We have the ability to do more powerful things with them.
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因此我们能够做更强大的事情。
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They're really approaching, in many cases surpassing,
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他们正在接近，在很多情况超越
03:35
the ability of the human mind.
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人类思维的能力。
03:37
But where I think computational speed is most applicable
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但是我认为计算速度最适用的地方
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is in that of imaging.
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是在于成像技术。
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The ability now to look inside the body in real time
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这种技术能即时的观察身体内部
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with very high resolution is really becoming incredible.
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用非常高的分辨率，真的很神奇。
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And we're layering multiple technologies -- PET scans, CT scans
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我们正在综合多种技术--PET扫描，CT扫描
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and molecular diagnostics --
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和分子诊断--
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to find and to seek things at different levels.
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来发现和寻找不同层面的东西。
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Here you're going to see the very highest resolution MRI scan done today,
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今天在这里你们将会看到非常高分辨率的MRI扫描，
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reconstructed of Marc Hodosh, the curator of TEDMED.
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它是由TEDMED的主持者马克·霍道什重建的。
04:01
And now we can see inside of the brain
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现在我们能看到大脑内部
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with a resolution and ability that was never before available,
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用一种以前没有过的分辨率和能力，
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and essentially learn how to reconstruct,
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本质上学会如何重建，
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and maybe even re-engineer,
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也许甚至再设计，
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or backwards engineer, the brain
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或者逆向设计大脑，
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so we can better understand pathology, disease and therapy.
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因此我们能更好的理解病理学，疾病，和治疗。
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We can look inside with real time fMRI -- in the brain at real time.
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我们能用fMRI即时查看内部--即时在大脑内部。
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And by understanding these sorts of processes and these sorts of connections,
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通过了解这些过程和联系，
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we're going to understand the effects of medication or meditation
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我们能够理解药物治疗或者冥想的影响
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and better personalize and make effective, for example,
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从而更好的提供个人化有效的治疗，例如，
04:27
psychoactive drugs.
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精神药物。
04:29
The scanners for these are getting small, less expensive and more portable.
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用于这些研究的扫描器变得更小，更便宜，更便携。
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And this sort of data explosion available from these
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来自这种研究的数据爆炸
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is really almost becoming a challenge.
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几乎真的成为一种挑战。
04:37
The scan of today takes up about 800 books, or 20 gigabytes.
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今天的扫描占用了大约800本书的空间，或者20GB。
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The scan in a couple of years will be one terabyte, or 800,000 books.
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这种扫描在几年之内将会是1TB，或者80万本书。
04:43
How do you leverage that information?
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你怎样利用这些信息？
04:45
Let's get personal. I won't ask who here's had a colonoscopy,
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让我们从个案分析。我不会问在这里谁做过结肠镜检查，
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but if you're over age 50, it's time for your screening colonoscopy.
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但是如果你年过50，是时候做结肠镜检查了。
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How would you like to avoid the pointy end of the stick?
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你怎么能避免结肠镜的尖端呢？
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Well now there's essentially a virtual colonoscopy.
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现在有一种虚拟结肠镜检查。
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Compare those two pictures, and now as a radiologist,
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比较这两张图，现在作为一个放射学家，
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you can essentially fly through your patient's colon
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你可以浏览你病人的结肠
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and, augmenting that with artificial intelligence,
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用人工智能协助，
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identify potentially, as you see here, a lesion.
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确定潜在的，像你这里看到的，这是一个损伤。
05:04
Oh, we might have missed it, but using A.I. on top of radiology,
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哦，我们可能漏掉它，但是在放射学上用人工智能，
05:07
we can find lesions that were missed before.
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我们能找到以前漏掉的损伤。
05:09
And maybe this will encourage people to get colonoscopies
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这也许会鼓励人们做结肠镜检查
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that wouldn't have otherwise.
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以前人们反而不愿意做它。
05:13
And this is an example of this paradigm shift.
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这是一个根本变化的例子。
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We're moving to this integration of biomedicine, information technology,
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我们转到集成了生物医学，信息技术，
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wireless and, I would say, mobile now -- this era of digital medicine.
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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。
05:21
So even my stethoscope is now digital.
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因此甚至我的听诊器现在也是数字化的。
05:23
And of course, there's an app for that.
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当然，它有个应用程序。
05:25
We're moving, obviously, to the era of the tricorder.
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明显我们正走向分析仪时代。
05:28
So the handheld ultrasound
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因此手持式超声机
05:30
is basically surpassing and supplanting the stethoscope.
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基本上超越并取代了听诊器。
05:33
These are now at a price point
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目前的价位
05:35
of -- what used to be 100,000 euros or a couple of hundred-thousand dollars --
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--以前是10万欧元或者几十万美元--
05:37
for about 5,000 dollars, I can have the power
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现在大约5000美元，我就能买得起
05:39
of a very powerful diagnostic device in my hand.
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一个非常强大的诊断装置。
05:42
And merging this now with the advent of electronic medical records --
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把这个装置和电子医疗记录结合起来--
05:45
in the United States, we're still less than 20 percent electronic.
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在美国，电子化仍然少于百分之二十。
05:48
Here in the Netherlands, I think it's more than 80 percent.
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在荷兰，我想这数据要多于百分之八十。
05:50
But now that we're switching to merging medical data,
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但是现在我们转到合并医疗数据，
05:52
making it available electronically,
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使它电子化，
05:54
we can crowd source that information,
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我们能够集中信息资源。
05:56
and now as a physician, I can access my patients' data from wherever I am
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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
05:59
just through my mobile device.
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仅通过我的手机。
06:01
And now, of course, we're in the era of the iPad, even the iPad 2.
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当然，如今我们处在iPad，甚至iPad2时代。
06:04
And just last month the first FDA-approved application
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上个月首个FDA应用程序
06:07
was approved to allow radiologists
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证实可以让放射专家
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to do actual reading on these sorts of devices.
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在这些设备上直接读图。
06:11
So certainly, the physicians of today, including myself,
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可以确定的说，今天的医生，包括我自己，
06:14
are completely reliable on these devices.
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完全依赖这些设备。
06:16
And as you saw just about a month ago,
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正如你们大约一个月前看到的，
06:18
Watson from IBM beat the two champions in "Jeopardy."
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来自IBM的沃特森在“危险”中打败了2位冠军。
06:20
So I want you to imagine when in a couple of years,
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因此我想让你们想像当我们在未来几年内
06:22
when we've started to apply this cloud-based information,
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当我们开始采用这种基于云端的信息
06:25
when we really have the A.I. physician and leverage our brains to connectivity
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当我们真正地有了人工智能医生来利用我们的大脑连接
06:28
to make decisions and diagnostics
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去做决定和诊断
06:30
at a level never done.
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在一个前所未有的技术水平上。
06:32
Already today, you don't need to go to your physician in many cases.
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如今，在很多情况下你们已经不需要去看医生。
06:35
Only for about 20 percent of actual visits do you have to lay hands on the patient.
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只有大约20%情况下真的需要看医生。
06:38
We're now in the era of virtual visits --
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我们正处在虚拟看病时代--
06:40
from sort of the Skype-type visits you can do with American Well,
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从通过某种Skype视频语聊式的“American Well" 看病，
06:43
to Cisco that's developed a very complex health presence system.
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到思科研制的非常复杂的健康诊断系统。
06:46
The ability to interact with your health care provider is different.
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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。
06:49
And these are being augmented even by our devices again today.
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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。
06:52
Here my friend Jessica sent me a picture of her head laceration
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这是我的朋友杰西卡寄给我的她头部裂伤的照片
06:54
so I can save her a trip to the emergency room -- I can do some diagnostics that way.
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因此她不用来急诊室--我可以通过看照片做诊断。
06:57
Or might we be able to leverage today's gaming technology,
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或者我们也许能利用今天的游戏技术，
06:59
like the Microsoft Kinect,
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比如微软Kinect，
07:01
and hack that to enable diagnostics, for example,
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使其能进行诊断，比如，
07:03
in diagnosing stroke,
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诊断中风，
07:05
using simple motion detection, using hundred-dollar devices.
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用简单的移动检测，用几百元的设备。
07:08
We can actually now visit our patients robotically --
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我们实际上现在能用机器人诊断病人--
07:11
this is the RP7; if I'm a hematologist,
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这是RP7；如果我是一个血液病专家，
07:13
visit another clinic, visit a hospital.
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去另一个诊所，或医院。
07:16
These will be augmented by a whole suite of tools actually in the home now.
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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。
07:19
So imagine we already have wireless scales.
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想像一下我们已经有了无线网络体重计。
07:21
You can step on the scale.
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你可以站在体重计上。
07:23
You can Tweet your weight to your friends, and they can keep you in line.
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你可以用微博把你的体重告知朋友，他们能让你保持身材。
07:25
We have wireless blood pressure cuffs.
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我们有无线网络血压计。
07:27
A whole gamut of these technologies are being put together.
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一整套技术正在整合在一起。
07:29
So instead of wearing these kludgy devices, we can put on a simple patch.
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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。
07:32
This was developed by colleagues at Stanford, called the iRhythm --
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斯坦福的同事发明了iRhythm--
07:35
completely supplants the prior technology at a much lower price point
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在价格上远远低于以前的技术
07:38
with much more effectivity.
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但有效率得多。
07:40
Now we're also in the era, today, of quantified self.
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现在我们处在量化自我的时代。
07:42
Consumers now can buy basically hundred-dollar devices,
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人们可以买几百元的装置，
07:44
like this little FitBit.
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像这个小FitBit。
07:46
I can measure my steps, my caloric outtake.
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我可以计算出我的步数和热量消耗。
07:48
I can get insight into that on a daily basis.
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我能够每天都知道了解这数据。
07:50
I can share that with my friends, with my physician.
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我可以和朋友或医生分享这些数据。
07:52
There's watches coming out that will measure your heart rate, the Zeo sleep monitors,
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这些表可以测量心律，叫做Zeo睡眠监测仪，
07:55
a whole suite of tools that can enable you to leverage
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一整套工具能让你受益
07:57
and have insight into your own health.
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并了解你自己的健康。
07:59
And as we start to integrate this information,
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在我们开始整合信息时，
08:01
we're going to know better what to do with it and how better to have insight
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我们会更好的了解用它做什么和怎么更好的
08:04
into our own pathologies, health and wellness.
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了解我们自己的病理，健康和福利。
08:06
There's even mirrors today that can pick up your pulse rate.
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现在有镜子可以测量你的脉搏率。
08:09
And I would argue, in the future, we'll have wearable devices in our clothes,
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我要说，在将来，我们将有穿在衣服里的装置，
08:12
monitoring ourselves 24/7.
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全天候检测我们的身体。
08:14
And just like we have the OnStar system in cars,
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就像我们现在车里用的OnStar系统，
08:16
your red light might go on -- it won't say "check engine" though.
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你的红灯会亮起来--它虽然不会说“检查发动机”。
08:18
It's going to be "check your body" light,
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它将会是“检查身体”灯，
08:20
and go in and get it taken care of.
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亮起来就得小心。
08:22
Probably in a few years, you'll check into your mirror
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也许几年之后，你照镜子的时候
08:24
and it's going to be diagnosing you.
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它就会诊断你。
08:26
(Laughter)
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（笑声）
08:28
For those of you with kiddos at home,
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对于你们中在家带小孩的，
08:30
how would you like to have the wireless diaper that supports your ...
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你会觉得无线网络尿布会帮你大忙。。。
08:33
too much information, I think, than you might need.
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我认为有比你需要的多得多的信息。
08:35
But it's going to be here.
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但是会是这里。
08:37
Now we've heard a lot today about new technology and connection.
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现在我们已经听了太多技术和连接，
08:40
And I think some of these technologies
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我认为一些技术
08:42
will enable us to be more connected with our patients,
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将会使我们和病人联系得更好，
08:44
and take more time
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节约更多的时间，
08:46
and actually do the important human touch elements of medicine,
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实际上增进医学交流中重要的人与人之间的交互，
08:48
as augmented by these sorts of technologies.
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这些技术都能增强这些交流。
08:50
Now we've talked about augmenting the patient, to some degree.
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现在我们在某种程度上谈过了与患者的增进交流。
08:52
How about augmenting the physician?
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那与医生的增进交流呢？
08:54
We're now in the era of super-enabling the surgeon
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我们正处在超能医生时代
08:56
who can now go inside the body
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他们能进入身体内部
08:58
and do things with robotic surgery, which is here today,
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用机器人做手术，如今成为现实，
09:00
at a level that was not really possible
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在过去这是不可能完成的
09:02
even five years ago.
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即使在5年前。
09:04
Now this is being augmented with further layers of technology
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现在这种技术被多重技术所增强
09:06
like augmented reality.
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就像增强现实一样。
09:08
So the surgeon can see inside the patient, through their lens,
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医生能通过镜头看到患者身体内部，
09:11
where the tumor is, where the blood vessels are.
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肿瘤在哪里，血管在哪里。
09:13
This can be integrated with decisions support.
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这可以和决策支持合并在一起。
09:15
A surgeon in New York can be helping a surgeon in Amsterdam, for example.
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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。
09:18
And we're entering an era
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我们正处在一个
09:20
of really, truly scarless surgery called NOTES,
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叫做NOTES的真正无疤手术时代，
09:22
where the robotic endoscope can come out the stomach
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机器人的内窥镜能穿过胃部
09:24
and pull out that gallbladder
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切除胆囊
09:26
all in a scarless way and robotically.
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全程都是机器人化无疤方式。
09:28
And this is called NOTES, and this is coming --
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这就叫做NOTES，这就是--
09:30
basically scarless surgery,
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基本无疤手术，
09:32
as mediated by robotic surgery.
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通过机器人手术来实现。
09:34
Now how about controlling other elements?
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现如今控制其他元素会怎么样呢？
09:36
For those who have disabilities -- the paraplegic --
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对于残疾人--半身不遂--
09:38
there's the era of brain-computer interface, or BCI,
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这是大脑-计算机交互时代，或者叫BCI，
09:41
where chips have been put on the motor cortex
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在大脑皮层运动区放置芯片
09:43
of completely quadriplegic patients
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对四肢瘫痪者
09:45
and they can control a curser or a wheelchair or, eventually, a robotic arm.
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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。
09:49
And these devices are getting smaller
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这些装置变得越来越小
09:51
and going into more and more of these patients.
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可以植入越来越多的患者体内。
09:53
Still in clinical trials, but imagine when we can connect these,
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虽然仍在临床实验阶段，但是设想当我们能连接这些技术，
09:55
for example, to the amazing bionic limb,
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例如，令人惊叹的仿生学假肢，
09:57
such as the DEKA Arm built by Dean Kamen and colleagues,
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像迪安·卡门和他的同事们所设计的DEKA手臂，
10:00
which has 17 degrees of motion and freedom
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它有17度的移动和灵活度
10:03
and can allow the person who's lost a limb
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能够让失去一个肢体的人
10:05
to have much higher levels of dexterity or control
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有更高水平的灵活和控制度
10:07
than they've had in the past.
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比起他们过去曾有过的手臂。
10:09
So we're really entering the era of wearable robotics actually.
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我们实际上真正进入了可穿用的机器人时代。
10:12
If you haven't lost a limb -- you've had a stroke, for example --
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如果你没有失去一个肢体--比方说，你有过中风--
10:14
you can wear these augmented limbs.
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你可以穿用这些假肢。
10:16
Or if you're a paraplegic -- like I've visited the folks at Berkley Bionics --
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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--
10:19
they've developed eLEGS.
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他们发明了电子腿eLEGS。
10:21
I took this video last week. Here's a paraplegic patient actually walking
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我上周拍了这段视频。这是一个半身不遂患者正在走路
10:24
by strapping on these exoskeletons.
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通过穿上这些盔甲。
10:26
He's otherwise completely wheelchair-bound.
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如果不穿这些盔甲他完全得依靠轮椅。
10:28
And now this is the early era of wearable robotics.
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现在是可穿用机器人时代的早期。
10:30
And I think by leveraging these sorts of technologies,
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我认为通过采用这些技术，
10:32
we're going to change the definition of disability
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我们能够改变残疾的定义
10:34
to in some cases be superability, or super-enabling.
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在某些情况下成为超常或者超能。
10:37
This is Aimee Mullins, who lost her lower limbs as a young child,
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这是艾米·马林斯，在小时候她失去了下肢，
10:40
and Hugh Herr, who's a professor at MIT
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休·贺尔，麻省理工的教授
10:43
who lost his limbs in a climbing accident.
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在一次攀岩事故中失去了肢体。
10:45
And now both of these can climb better, move faster, swim differently
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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
10:48
with their prosthetics than us normal-abled persons.
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通过修复手术。
10:51
Now how about other exponentials?
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其他的指数技术怎么样呢？
10:53
Clearly the obesity trend is exponentially going in the wrong direction,
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很明显肥胖趋势朝错误的方向指数发展，
10:56
including with huge costs.
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包括巨额支出。
10:58
But the trend in medicine actually is to get exponentially smaller.
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但是在医学上这种趋势正在指数减少。
11:01
So a few examples: we're now in the era
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有几个例子：我们现在处在
11:03
of "Fantastic Voyage," the iPill.
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“奇异旅程”时代，iPill。
11:05
You can swallow this completely integrated device.
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你可以吞下这个完全集成的装置。
11:07
It can take pictures of your GI system,
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它能在你的消化道里拍照片，
11:09
help diagnose and treat as it moves through your GI tract.
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当它通过你的消化道的时候帮助你诊断和治疗。
11:12
We get into even smaller micro-robots
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我们感兴趣更小的微型机器人
11:14
that will eventually autonomously move through your system again
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将会最终自动通过你的消化系统
11:16
and be able to do things that surgeons can't do
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能做到医生做不到的事情
11:18
in a much less invasive manner.
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用一种痛苦少得多的方式。
11:20
Sometimes these might self-assemble in your GI system
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有时这些装置也许可以在你的消化系统自行组装
11:23
and be augmented in that reality.
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从而增强其使用价值。
11:25
On the cardiac side, pacemakers are getting smaller
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对于心脏手术，起搏器正变得
11:27
and much easier to place
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更容易放置，
11:29
so you don't need to train an interventional cardiologist to place them.
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因此你不需要训练一个介入心脏医师去放置它们。
11:31
And they're going to be wirelessly telemetered again to your mobile devices
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它们将会被你的手机遥控，
11:34
so you can go places and be monitored remotely.
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你可以去任何地方并远程遥控。
11:37
These are shrinking even further.
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这些装置正在被变得更小。
11:39
Here's one that's in prototyping by Medtronic that's smaller than a penny.
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这是一个Medtronic制作的样品，比一分硬币还小。
11:42
Artificial retinas, the ability to put these arrays on the back of the eyeball
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人工视网膜的功能是把光线集中在眼球后面
11:45
and allow the blind to see.
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从而让失明者恢复视力。
11:47
Again, in early trials, but moving into the future.
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虽然仍在早期试验阶段，但是有很好的前景。
11:49
These are going to be game changing.
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这些技术将会是革命性的。
11:51
Or for those of us who are sighted,
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对于我们中的那些视力有问题的人，
11:53
how about having the assisted-living contact lens?
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有了这些辅助生活的隐形眼镜会怎样呢？
11:55
BlueTooth, WiFi available -- beams back images to your eye.
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用蓝牙，无线网络--投射图像到你的眼球上。
11:58
Now if you have trouble maintaining your diet,
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如果你不能保持节食，
12:01
it might help to have some extra imagery
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一些图像也许会有助于
12:03
to remind you how many calories are going to be coming at you.
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提醒你食物里有多少热量。
12:07
How about enabling the pathologist to use their cell phone again
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让病理学家能用他们的手机
12:09
to see at a microscopic level
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在显微水平观察
12:11
and to lumber that data back to the cloud and make better diagnostics?
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把数据放回云端信息来做更好的诊断会怎样？
12:14
In fact, the whole era of laboratory medicine
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实际上，整个实验医学时代
12:16
is completely changing.
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完全变了。
12:18
We can now leverage microfluidics,
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我们能利用微流体，
12:20
like this chip made by Steve Quake at Stanford.
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像斯坦福的Steve Quake公司制造的芯片。
12:22
Microfluidics can replace an entire lab of technicians.
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微流体能替代整个实验室的技术员。
12:25
Put it on a chip, enable thousands of tests to be done
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把它放在一个芯片上，能做几千个测试
12:27
at the point of care, anywhere in the world.
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在世界任何地方都可以做。
12:29
And this is really going to leverage technology
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这将真正地从技术上获益
12:31
to the rural and the under-served
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那些农村和保障不发达地区
12:33
and enable what used to be thousand-dollar tests to be done at pennies
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能让过去上千块的测试减到几分钱
12:35
and at the point of care.
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在护理方面上讲。
12:37
If we go down the small pathway a little bit farther,
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如果在这条小路上走得稍微远一点，
12:40
we're entering the era of nanomedicine,
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我们将来到纳米医学时代，
12:42
the ability to make devices super small
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能将装置做得超小
12:44
to the point where we can design red blood cells
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小到我们可以设计血红细胞
12:46
or microrobots that will monitor our blood system or immune system,
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或者微型机器人来监测我们的血液系统或免疫系统，
12:49
or even those that might clear out the clots from our arteries.
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或者甚至清除动脉里的血栓。
12:52
Now how about exponentially cheaper?
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如果指数更加便宜会怎样？
12:54
Not something we usually think about in the era of medicine,
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在医学领域，这种便宜不是我们通常认为的那样，
12:57
but hard disks used to be 3,400 dollars for 10 megabytes -- exponentially cheaper.
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而是10MB硬盘过去3400美元--指数便宜。
13:00
In genomics now,
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在基因组学，
13:02
the genome cost about a billion dollars
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基因组价值约10亿美元
13:04
about 10 years ago when the first one came out.
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10年前当第一个基因组出现的时候。
13:06
We're now approaching essentially a thousand-dollar genome --
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我们现在基本上可以1000美元买到。
13:08
probably next year to two years, probably a hundred-dollar genome.
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也许今后一两年，100美元的基因组会出现。
13:10
What are we going to do with hundred-dollar genomes?
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我们能用100美元的基因组做什么呢?
13:13
And soon we'll have millions of these tests available.
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不久以后我们可以进行上百万的测试。
13:15
And that's when it gets interesting, when we start to crowdsource that information.
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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。
13:18
And we enter the era of true personalized medicine --
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我们进入了真正的个人化医学时代--
13:20
the right drug for the right person at the right time --
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在正确的时间为正确的人制造正确的药--
13:23
instead of what we're doing today, which is the same drug for everybody --
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而不是像现在我们这样，给每个人同样的药物--
13:26
sort of blockbuster drug medications,
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一种药物治疗的混乱，
13:28
medications which don't work for you, the individual.
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对你个人不一定有效。
13:30
And many, many different companies are working on leveraging these approaches.
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很多不同的公司正在利用这些方法。
13:33
And I'll also show you a simple example, from 23andMe again.
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我会给你一个简单的例子，还是来自23andMe。
13:35
My data indicates that I've got about average risk
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我的数据表明我已经达到平均风险系数
13:38
for developing macular degeneration, a kind of blindness.
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对于黄斑病变，一种失明病。
13:40
But if I take that same data, upload it to deCODEme,
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但是如果我把同样的数据上传到deCODEme，
13:43
I can look at my risk for sample type 2 diabetes.
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比如我能看到我得2型糖尿病的风险指数。
13:45
I'm at almost twice the risk for type 2 diabetes.
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我现在差不多有2倍的风险得2型糖尿病。
13:47
I might want to watch how much dessert I have at the lunch break for example.
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例如我也许想看到午饭的时候吃多少甜点。
13:50
It might change my behavior.
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这也许能改变我的行为。
13:52
Leveraging my knowledge of my pharmacogenomics --
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利用我基因测试学的知识--
13:54
how my genes modulate, what my drugs do and what doses I need
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我的基因怎样调整，我的药物作用是什么和我需要什么
13:57
are going to become increasingly important,
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将变得越来越重要，
13:59
and once in the hands of the individual and the patient,
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在个人和患者手中的时候，
14:01
will make better drug dosing and selection available.
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将使得可用的药物选择和服用更好。
14:04
So again, it's not just genes, it's multiple details --
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所以不仅是基因，有多种因素--
14:07
our habits, our environmental exposure.
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我们的习惯，我们的环境。
14:09
When was the last time your physician asked you where you've lived?
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上次医生问你住在哪里是什么时间？
14:12
Geomedicine: where you've lived, what you've been exposed to,
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风土医学：你住在哪里，你接触过什么
14:14
can dramatically affect your health.
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能极大影响你的健康。
14:16
We can capture that information.
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我们能抓住这些信息。
14:18
So genomics, proteomics, the environment,
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因此基因组学，蛋白组学，环境，
14:20
all this data streaming at us individually and us, as poor physicians,
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所有数据涌向我们作为个体人和医生们。
14:22
how do we manage it?
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我们怎样管理它们呢？
14:24
Well we're now entering the era of systems medicine, or systems biology,
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我们正在进入系统医学或者系统生物学时代，
14:27
where we can start to integrate all of this information.
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我们能开始集成这些信息。
14:29
And by looking at the patterns, for example, in our blood
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通过这些式样，例如，在我们的血液中
14:32
of 10,000 biomarkers in a single test,
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一个测试中有10000个生物标记，
14:34
we can start to look at these little patterns
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我们能看这些小的式样
14:36
and detect disease at a much earlier stage.
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在非常早期发现疾病。
14:38
This has been called by Lee Hood, the father of the field,
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这个领域的创始人，李·胡德叫这种方法为
14:40
P4 medicine.
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P4医学。
14:42
We're going to be predictive; we're going to know what you're likely to have.
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我们将能预测；我们能知道我们可能会怎样。
14:44
We can be preventative; that prevention can be personalized;
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我们能预防；这种预防性可以个人化；
14:47
and more importantly, it's going to become increasingly participatory.
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更重要的是，它将变得共享。
14:49
Through websites like Patients Like Me
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虽然一些网站像Patients Like Me，
14:51
or managing your data on Microsoft HealthVault or Google Health,
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微软HealthVault或者谷歌Health可以管理数据，
14:54
leveraging this together in participatory ways
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用共享的方式利用数据
14:56
is going to become increasingly important.
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将变得越来越重要。
14:58
So I'll finish up with exponentially better.
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我将以指数地更好前景来做结束。
15:00
We'd like to get therapies better and more effective.
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我们会得到更好更有效的治疗。
15:02
Now today we treat high blood pressure mostly with pills.
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如今我们通常通过吃药治疗高血压。
15:04
What if we take a new device
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如果我们用一种新装置
15:06
and knock out the nerve vessels that help mediate blood pressure
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敲打神经血管帮助调节血压
15:09
and in a single therapy to cure hypertension?
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一次治疗就能治愈高血压。
15:12
This is a new device that is essentially doing that.
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这是做这种治疗的一种新装置。
15:14
It should be on the market within a year or two.
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它应该能在一两年内投放市场。
15:16
How about more targeted therapies for cancer?
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更具目标性的癌症治疗会怎样呢？
15:18
Right, I'm an oncologist
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对，我是肿瘤学家
15:20
and I have to say most of what we give is actually poison.
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我不得不说大多数我们开的药实际上是毒药。
15:22
We've learned at Stanford and other places
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我们在斯坦福和其他地方学到
15:24
that we can discover cancer stem cells,
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我们可以发现癌症干细胞，
15:26
the ones that seem to be really responsible for disease relapse.
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可能是癌症复发的真正原因。
15:29
So if you think of cancer as a weed,
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如果你把癌症看作一个种子，
15:31
we often can whack the weed away.
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我们通常能够去除这个种子。
15:33
It seems to shrink, but it often comes back.
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它好像萎缩了，但它经常又重新复发。
15:35
So we're attacking the wrong target.
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所以我们正在去除错误的目标体。
15:37
The cancer stem cells remain,
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癌症干细胞仍存在，
15:39
and the tumor can return months or years later.
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肿瘤能在几个月或几年后重新长出来。
15:41
We're now learning to identify the cancer stem cells
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我们现在学会了鉴定癌症干细胞
15:44
and identify those as targets and go for the long-term cure.
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作为鉴定目标体来进行长期治疗。
15:46
And we're entering the era of personalized oncology,
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我们正在进入个人化肿瘤学时代，
15:48
the ability to leverage all of this data together,
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利用汇集所有数据的能力，
15:50
analyze the tumor and come up with
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分析肿瘤并提出来
15:52
a real, specific cocktail for the individual patient.
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针对每一个患者而采用的一个真正的，明确的鸡尾酒疗法。
15:55
Now I'll close with regenerative medicine.
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最后我会讲讲再生医学。
15:57
So I've studied a lot about stem cells --
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我对干细胞研究很多--
15:59
embryonic stem cells are particularly powerful.
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胚胎干细胞尤其强大。
16:01
We also have adult stem cells throughout our body.
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我们有遍布我们身体的成体干细胞。
16:03
We use those in my field of bone marrow transplantation.
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我们把这些干细胞用于骨髓移植领域。
16:05
Geron, just last year, started the first trial
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杰龙去年开始第一次尝试
16:07
using human embryonic stem cells
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用人类的胚胎干细胞
16:09
to treat spinal cord injuries.
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治疗脊髓疾病。
16:11
Still a Phase I trial, but evolving.
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仍在试验阶段，但是不断进展。
16:13
We've been actually using adult stem cells
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我们已经应用成体干细胞
16:15
now in clinical trials for about 15 years
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在临床试验大约15年了
16:17
to approach a whole range of topics, particularly in cardiovascular disease.
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在不同的课题，尤其是心血管病。
16:20
We take our own bone marrow cells
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我们取出自己的骨髓细胞
16:22
and treat a patient with a heart attack,
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治疗心脏病人，
16:24
we can see much improved heart function and actually better survival
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我们可以看到心脏功能改善了并且存活率提高了
16:27
using our own bone marrow drive cells after a heart attack.
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在心脏病发作后用我们自己的骨髓细胞。
16:30
I invented a device called the MarrowMiner,
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我发明了一种装置叫骨髓采集器MarrowMiner，
16:32
a much less invasive way for harvesting bone marrow.
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一种温和得多的收集骨髓的方式。
16:34
It's now been FDA approved,
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它已经被FDA认证，
16:36
and it'll hopefully be on the market in the next year or so.
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将会在一两年内投放市场。
16:38
Hopefully you can appreciate the device there
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希望你能重视这种装置
16:40
curving through the patient's body and removing the patient's bone marrow,
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它沿着患者的身体曲线获取患者的骨髓，
16:42
instead of with 200 punctures, with just a single puncture under local anesthesia.
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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。
16:45
But where is stem cell therapy really going?
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但是干细胞治疗的前景会怎样？
16:47
If you think about it, every cell in your body has the same DNA
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如果你考虑一下，身体里的每个细胞有同样的DNA
16:50
as you had when you were an embryo.
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在你还是胚胎的时候就形成了。
16:52
We can now reprogram your skin cells
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我们现在能重新构造你的皮肤细胞
16:54
to actually act like a pluripotent embryonic stem cell
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就像一个多能的胚胎干细胞
16:57
and to utilize those potentially to treat multiple organs in that same patient --
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利用这种技术可能治疗同一个患者的多个器官--
17:00
making your own personalized stem cell lines.
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制造你自己个人化的干细胞系。
17:02
And I think they'll be a new era of your own stem cell banking
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我认为这将是你自己干细胞库的新时代
17:05
to have in the freezer your own cardiac cells,
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把你自己的心肌细胞存放在冰箱中，
17:07
myocytes and neural cells
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还可以是肌肉细胞和神经细胞
17:09
to use them in the future, should you need them.
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在你将来需要它们的时候用。
17:12
And we're integrating this now with a whole era of cellular engineering,
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我们现在集成这些技术作为一整个细胞工程学时代。
17:14
and integrating exponential technologies
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集成指数技术
17:16
for essentially 3D organ printing --
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对于3D器官复制--
17:18
replacing the ink with cells
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用细胞替代墨水
17:20
and essentially building and reconstructing a 3D organ.
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最终重建一个3D器官。
17:23
That's where things are going to head -- still very early days.
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这是未来的展望；仍然在初始阶段。
17:25
But I think, as integration of exponential technologies,
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但是我认为，作为指数技术集成，
17:27
this is the example.
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这是一个例子。
17:29
So in close, as you think about technology trends
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近期，当你考虑技术趋势
17:32
and how to impact health and medicine,
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怎样影响健康和医学，
17:34
we're entering an era of miniaturization,
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我们正进入小型化
17:36
decentralization and personalization.
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分散化和个性化时代。
17:38
And I think by pulling these things together,
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我认为把这些特性结合在一起，
17:40
if we can start to think about how to understand and leverage these,
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如果我们能开始思考怎样了解和利用这些技术，
17:42
we're going to empower the patient,
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我们将会使患者恢复地更好，
17:44
enable the doctor, enhance wellness
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医生更有能力，增强福利
17:46
and begin to cure the well before they get sick.
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防患于未然。
17:49
Because I know as a doctor, if someone comes to me with Stage I disease,
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因为作为医生我知道，如果某人在患病初期找到我，
17:52
I'm thrilled -- we can often cure them.
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我很高兴--我们通常能治愈他们。
17:54
But often it's too late and it's Stage III or IV cancer, for example.
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但是经常太晚了，比方说癌症3期或者4期。
17:57
So by leveraging these technologies together,
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通过集成这些技术，
17:59
I think we'll enter a new era
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我认为我们将进入一个新时代
18:01
that I like to call Stage 0 medicine.
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我愿意叫它零阶段医学。
18:03
And as a cancer doctor, I'm looking forward to being out of a job.
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作为一名癌症医生，我期待失业。
18:06
Thanks very much.
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非常感谢。
18:09
Host: Thank you. Thank you.
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主持人：谢谢。谢谢。
18:11
(Applause)
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（掌声）
18:13
Take a bow. Take a bow.
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鞠躬。鞠躬。
ABOUT THE SPEAKER
Daniel Kraft - Physician scientistDaniel Kraft is a physician-scientist, inventor and entrepreneur. He is the founder and chair of Exponential Medicine and has served as faculty chair for Medicine at Singularity University since its inception, exploring the impact and potential of rapidly developing technologies as applied to health and medicine.
Why you should listen
Dr. Daniel Kraft is a Stanford and Harvard trained physician-scientist with more than 25 years of experience in clinical practice, biomedical research and innovation. He is Faculty Chair for Medicine at Singularity University and is the founder and chair for Exponential Medicine, a program which explores convergent, rapidly developing technologies and their potential to reshape the future of health and biomedicine.
After medical school at Stanford, Kraft was board certified in both Internal Medicine and Pediatrics following residency at the Massachusetts General Hospital & Boston Children's Hospital, and he completed Stanford fellowships in hematology/oncology & bone marrow transplantation. He is a member of the inaugural class of Aspen Institute Health Innovators Fellows.
Kraft has extensive research in stem cell biology and regenerative medicine with multiple scientific publications, medical device, immunology and stem cell-related patents through faculty positions with Stanford University School of Medicine and as clinical faculty for the pediatric bone marrow transplantation service at University of California San Francisco.
Kraft recently founded IntelliMedicine, focused on connected, data-driven and integrated personalized medicine. He is the inventor of the MarrowMiner, an FDA-approved device for the minimally invasive harvest of bone marrow, and he founded RegenMed Systems, a company developing technologies to enable adult stem cell-based regenerative therapies. He is an advisor the XPRIZE (having conceived of the Medical Tricorder XPRIZE and is helping lead a new Cancer focused prize), and advises several digital health and technology companies.
Kraft is an avid pilot and served for 14 years as an officer and flight surgeon with F-15 and F-16 fighter squadrons in the Air National Guard. He has conducted research on aerospace medicine that was published with NASA, with whom he was a finalist for astronaut selection.
Daniel Kraft | Speaker | TED.com