TED2005
Robert Fischell: My wish: Three unusual medical inventions
羅伯．菲斯雪的醫學發明
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在2005年接受TED獎時，發明家羅伯．菲斯雪許了三個願望：重新設計一個可攜帶的儀器來治療偏頭痛、尋找新的治療憂鬱症的方法，及重整處理醫療失誤的系統。
Robert Fischell - Biomedical inventor
Robert Fischell invented the rechargeable pacemaker, the implantable insulin pump, and devices that warn of epileptic seizures and heart attacks. Yet it's not just his inventive genius that makes him fascinating, but his determination to make the world a better place. Full bio
Robert Fischell invented the rechargeable pacemaker, the implantable insulin pump, and devices that warn of epileptic seizures and heart attacks. Yet it's not just his inventive genius that makes him fascinating, but his determination to make the world a better place. Full bio
Double-click the English transcript below to play the video.
00:25
I'm going to discuss with you three of my inventions
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我將要和你們討論我的三個發明
00:29
that can have an effect on 10 to a 100 million people,
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他們的影響會遍及數以萬計的人，
00:34
which we will hope to see happen.
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也是我們所樂見的。
00:37
We discussed, in the prior film, some of the old things that we did,
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我們在之前的影片已經討論過一些我們曾做過的東西，
00:41
like stents and insulin pumps for the diabetic.
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例如為糖尿病人作的血管支架和胰島素幫浦
00:44
And I'd like to talk very briefly about three new inventions
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而我想簡短地討論三個新的發明
00:49
that will change the lives of many people.
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那將會改變很多人的生活。
00:53
At the present time, it takes an average of three hours
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從病人µo²{第一個心臟病µoªº症狀¶}©l¡M
00:56
after the first symptoms of a heart attack are recognized by the patient,
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平均要花上三個¤p®É，
00:59
before that patient arrives at an emergency room.
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病人才到達急診室。
01:03
And people with silent ischemia --
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而當人們患無症狀心肌缺血—
01:05
which, translated into English, means they don't have any symptoms --
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翻譯成英文時，即是指他們不會有任何的症狀—
01:09
it takes even longer for them to get to the hospital.
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病人將會花更長的時間前往醫院就醫。
01:12
The AMI, Acute Myocardial Infarction,
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AMI，即急性心肌阻塞，
01:16
which is a doctor's big word so they can charge you more money --
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也是醫生用的難字﹐以便他們可以跟你收比較多錢—
01:19
(Laughter)
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（笑聲）
01:21
-- means a heart attack. Annual incidence: 1.2 million Americans.
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—指的就是心臟病發作。年發生率：120萬的美國人。
01:25
Mortality: 300,000 people dying each year.
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死亡率：每年30萬人。
01:29
About half of them, 600,000, have permanent damage to their heart
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大概有一半的人，即60萬人，心臟將會有永久的損傷
01:35
that will cause them to have very bad problems later on.
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這也會造成他們之後會有很嚴重的問題。
01:40
Thus 900,000 people either have died
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因此90萬人不是死亡
01:43
or have significant damage to their heart muscle.
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就是患有嚴重的心肌損傷。
01:46
Symptoms are often denied by the patient, particularly us men,
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病人通常會否認症狀，尤其是我們男人，
01:50
because we are very brave. We are very brave,
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因為我們非常勇敢。我們非常的勇敢，
01:53
and we don't want to admit that I'm having a hell of a chest pain.
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我們不想承認我有該死的胸悶。
01:57
Then, approximately 25 percent of all patients never have any symptoms.
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接著，大約有25%的病人從來都沒有任何症狀。
02:02
What are we going to do about them? How can we save their lives?
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那我們能對他們做什麼？我們要如何救他們的命？
02:05
It's particularly true of diabetics and elderly women.
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這也特別是針對糖尿病人及年長的婦女。
02:09
Well, what is needed for the earliest possible warning of a heart attack?
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嗯，我們到底需要甚麼才能偵測最早期的心臟病警報？
02:14
A means to determine if there's a complete blockage of a coronary artery.
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一個可以確定冠狀動脈是否完全阻塞的方法？
02:18
That, ladies and gentlemen, is a heart attack.
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各位先生和女士，那就是心臟病發作。
02:22
The means consist of noting something a little technical,
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這方法是需要注意到一點有關於技術層面的東西
02:26
ST segment elevation of the electrogram --
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就是心電圖ST節段的上升。
02:29
translated into English, that means that
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翻成英文，指的就是
02:32
if there's an electrical signal in the heart, and one part of the ECG --
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如果心臟有一個電子訊號，而心電圖其中一個部份—
02:38
which we call the ST segment -- elevates,
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我們管它叫ST節段的一部份—上升，
02:42
that is a sure sign of a heart attack.
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那就是確定的心臟病發作。
02:44
And if we had a computer put into the body of a person who's at risk,
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所以如果我們把一個電腦放在有潛在危險的人的身體裡面，
02:49
we could know, before they even have symptoms,
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我們甚至可以在他們有症狀之前知道，
02:52
that they're having a heart attack, to save their life.
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他們正在心臟病發作，來挽救他們的生命。
02:55
Well, the doctor can program a level of this ST elevation voltage
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於是，醫生可以预先設定會引發緊急警告的
03:01
that will trigger an emergency alarm,
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ST伏特上升的程度，
03:04
vibration like your cell phone, but right by your clavicle bone.
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震動得就像你的手機，只是位於你鎖骨的旁邊。
03:09
And when it goes beep, beep, beep, you better do something about it,
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且當它發出嗶、嗶、嗶時，你最好有所行動，
03:13
because if you want to live you have to get to some medical treatment.
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因為如果你想要活下去你需要接受治療。
03:19
So we have to try these devices out
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話說我們要試試這些儀器
03:21
because the FDA won't just let us use them on people
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因為食品及藥物管理局不會隨便讓我們把它們用在人身上
03:24
unless we try it out first,
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除非我們有先試過，
03:26
and the best model for this happens to be pigs.
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而最好的模範剛好是豬隻。
03:30
And what we tried with the pig was external electrodes on the skin,
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而我們試在豬身上的 就是把外接電極放在皮膚上，
03:35
like you see in an emergency room,
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就像你會在急診室看到的一樣，
03:37
and I'm going to show you why they don't work very well.
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而我將要告訴你為什麼他們的效果不太好。
03:40
And then we put a lead, which is a wire, in the right ventricle inside the heart,
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接著我們放一條導線，也就是一條電線，在心臟的右心室裡，
03:45
which does the electrogram, which is the signal voltage from inside the heart.
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用作描繪心電圖，也就是從心臟發出的伏特訊號。
03:49
Well, with the pig, at the baseline,
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於是，用豬隻作實驗時，在基準線上，
03:52
before we blocked the pig's artery to simulate a heart attack, that was the signal.
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在我們阻斷豬的動脈來模擬心臟病發之前，這就是那個訊號。
03:57
After 43 seconds, even an expert couldn't tell the difference,
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在43秒後，甚至是專家都不能分辨有什麼差異，
04:02
and after three minutes -- well,
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再三分鐘後—這麼嘛，
04:04
if you really studied it, you'd see a difference.
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如果你真的研究它，你會看到有一些不同。
04:06
But what happened when we looked inside the pig's heart, to the electrogram?
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但當我們注意豬的心臟內的時候，對心電圖到底發生了甚麼事？
04:11
There was the baseline -- first of all, a much bigger and more reliable signal.
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首先﹐有那個基準線—一個較大且較穩定的訊號。
04:16
Second of all, I'll bet even you people who are untrained can see the difference,
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再來，我賭甚至你們這些沒有受過訓練的人也能看出差異，
04:21
and we see here an ST segment elevation right after this sharp line.
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我們看到這條斜率很陡的線之後﹐出現了一個ST節段的上升。
04:26
Look at the difference there. It doesn't take much --
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看看這裡的差異—很輕易便能做到，
04:30
every layperson could see that difference,
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每個普通人都能看出那個差異，
04:32
and computers can be programmed to easily detect it.
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而且我們也可以輕易地將電腦設定去輕易偵測它。
04:37
Then, look at that after three minutes.
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接著，看看再三分鐘之後。
04:39
We see that the signal that's actually in the heart,
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我們看到那個實際在心臟裡的訊號，
04:43
we can use it to tell people that they're having a heart attack
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我們可以利用它來告訴人們他們正心臟病發，
04:47
even before they have symptoms so we can save their life.
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甚至是在他們有症狀之前，可讓我們可以拯救他們的生命。
04:51
Then we tried it with my son, Dr. Tim Fischell,
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接著我們把它試驗在我的兒子身上，提姆．菲斯雪醫師，
04:54
we tried it on some human patients who had to have a stent put in.
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我們把它試驗在一些體內裝有支架的病人身上。
04:58
Well, he kept the balloon filled to block the artery,
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於是，他把氣球維持在充氣的狀態來阻斷動脈，
05:01
to simulate a blockage, which is what a heart attack is.
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來模擬阻塞，也就是心臟病發時的模樣。
05:04
And it's not hard to see that -- the baseline
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而且要看到那條基準線也不難
05:07
is the first picture on the upper left.
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就是在左上角的第一張圖。
05:09
Next to it, at 30 seconds, you see this rise here,
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在它旁邊，在30秒時，你會看到這裡有一個上升，
05:13
then this rise -- that's the ST elevation.
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接著這個上升—那就是ST節段的上升。
05:17
And if we had a computer that could detect it,
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所以如果我們有一個能夠偵測它的電腦，
05:20
we could tell you you're having a heart attack so early
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我們可以盡早告訴你你正在心臟病發作，
05:23
it could save your life and prevent congestive heart failure.
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以至可以救你一命且預防充血性心臟衰竭。
05:28
And then he did it again. We filled the balloon again a few minutes later
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而且他又重複了一次。我們把氣球在幾分鐘後又填滿了一次
05:33
and here you see, even after 10 seconds, a great rise in this piece,
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在這裡你可以看到，甚至在10秒鐘之後，在這裡有一個很大的起伏，
05:37
which we can have computers inside, under your chest like a pacemaker,
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這我們可以放電腦在裡面，在你的胸腔下像一個節律器，
05:42
with a wire into your heart like a pacemaker.
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像一個節律器般﹐以一條電線穿進你的心臟裡。
05:45
And computers don't go to sleep.
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而且電腦不會睡著。
05:47
We have a little battery and on this little battery
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我們有一個小電池，而憑這小電池
05:51
that computer will run for five years without needing replacement.
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這電腦可以運作個五年都不必把它替換。
05:55
What does the system look like?
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這個系統是甚麼樣子呢？
05:57
Well, on the left is the IMD, which is Implantable Medical Device,
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這個嘛，在左手邊的是IMD，也就是可植入式醫療儀器，
06:01
and tonight in the tent you can see it -- they've exhibited it.
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而在今晚的帳篷裡你可以看到它—他們已將它展覽出來。
06:05
It's about this big, the size of a pacemaker.
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這是它的大小，節律器般的大。
06:08
It's implanted with very conventional techniques.
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它是透過非常傳統的技術植入。
06:11
And the EXD is an External Device that you can have on your night table.
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而這EXD，是一個讓你可以放在你的床頭桌上的外接儀器。
06:15
It'll wake you up and tell you to get your tail to the emergency room
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當這東西響起時，它會把你吵醒並告訴你，
06:20
when the thing goes off because, if you don't, you're in deep doo-doo.
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你該趕快到急診室，因為如果你不這麼作，麻煩就可大了。
06:24
And then, finally, a programmer that will set the level of the stimulation,
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接著，最後的，一個程式設定器，去設定會引起刺激的電壓，
06:29
which is the level which says you are having a heart attack.
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也就是顯示你正心臟病發作的電壓。
06:34
The FDA says, OK, test this final device after it's built in some animal,
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食品及藥物管理局說，好吧，在這最終版本儀器製造好後，拿去於動物身上試試看，
06:41
which we said is a pig, so we had to get this pig to have a heart attack.
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即是我們曾提及的是豬隻，所以我們就要讓這隻豬心臟病發作。
06:45
And when you go to the farmyard, you can't easily get pigs to have heart attacks,
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只是當你去農場時，要讓豬隻心臟病發作其實不易，
06:49
so we said, well, we're experts in stents.
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所以我們說，這麼嘛，我們是支架的專家。
06:52
Tonight you'll see some of our invented stents.
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今晚你將會看到一些我們發明的支架。
06:54
We said, so we'll put in a stent,
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我們說，那我們就放一個支架進去，
06:57
but we're not going to put in a stent that we'd put in people.
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只是我們放進去的支架不會是我們放在人身上的那種。
06:59
We're putting in a copper stent,
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我們放的將是一個銅製的支架，
07:01
and this copper stent erodes the artery and causes heart attacks.
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且這個銅製支架會侵蝕動脈並引起心臟病發。
07:05
That's not very nice, but, after all, we had to find out what the answer is.
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這不太仁慈，但是，畢竟，我們必須找出答案。
07:08
So we took two copper stents and we put it in the artery of this pig,
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所以我們拿兩個銅製支架，再把它放進這隻豬的動脈裡，
07:13
and let me show you the result that's very gratifying
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接著讓我來展示給你這個非常令人開心的結果
07:17
as far as people who have heart disease are concerned.
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尤其是涉及有心臟病的人。
07:20
So there it was, Thursday morning we stopped the pig's medication
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這就是了，星期四早上我們停掉豬的用藥
07:26
and there is his electrogram, the signal from inside the pig's heart
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而這是它的心電圖，從豬的心臟發出的訊號
07:31
coming out by radio telemetry.
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從無線電遙測儀發出。
07:33
Then, on Friday at 6:43, he began to get certain signs,
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接著，在星期五6點43分，它開始有某些徵兆，
07:38
which later we had the pig run around --
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也就是我們之後讓這隻豬跑了一陣—
07:41
I'm not going to go into this early stage.
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我不打算追訴到這早期的階段。
07:44
But look what happened at 10:06 after we removed this pig's medication
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但看看在10點06分時，當我們移除防止它心臟病發的藥物後
07:50
that kept him from having a heart attack.
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所發生了的事。
07:52
Any one of you now is an expert on ST elevation. Can you see it there?
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現在你們任何一個人都是ST節段上升的專家。你可以看到它在這裡嗎？
07:57
Can you see it in the picture after the big rise of the QRS -- you see ST elevation?
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你有看到它在圖片裡 在QRS陡升之後 你有看到ST節段上升？
08:02
This pig at 10:06 was having a heart attack.
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這隻豬在10點06分時正在心臟病發。
08:07
What happens after you have the heart attack, this blockage?
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在你心臟病發之後會發生甚麼事，這個阻斷？
08:11
Your rhythm becomes irregular, and that's what happened 45 minutes later.
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你的心節律變得不規則，而這正是45分鐘後發生的事。
08:18
Then, ventricular fibrillation, the heart quivers instead of beats --
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接著，心室震顫，心臟顫抖取代（有節奏的）跳動，
08:22
this is just before death of the pig -- and then the pig died; it went flat-line.
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這也正是在豬死掉之前，接著豬就死掉了，它變成沒有起伏的水平線。
08:28
But we had a little bit over an hour where we could've saved this pig's life.
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但我們其實有一個小時多的時間去挽救這隻豬的生命的。
08:31
Well, because of the FDA, we didn't save the pig's life,
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只是，因為食品及藥物管理局的原故，我們沒有救活這隻豬。
08:35
because we need to do this type of animal research for humans.
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因為我們需要為人類作這一類的動物實驗。
08:39
But when it comes to the sake of a human, we can save their life.
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但當涉及人類時，我們可以拯救他們的性命。
08:43
We can save the lives of people who are at high risk for a heart attack.
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我們可以拯救那些有罹患心臟病高危險群的生命。
08:50
What is the response to acute myocardial infarction, a heart attack, today?
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在今天，得了急性心肌阻塞的反應，即心臟病發時，我們做甚麼？
08:56
Well, you feel some chest pain or indigestion.
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首先，你會感覺到些微的胸悶或消化不良。
08:59
It's not all that bad; you decide not to do anything.
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它其實沒有那麼糟；你決定甚麼也不作。
09:02
Several hours pass and it gets worse, and even the man won't ignore it.
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幾個小時過去後它變得更糟，甚至連男人都沒法忽略它。
09:07
Finally, you go to the emergency room.
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終於，你去急診室。
09:10
You wait as burns and other critical patients are treated,
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你等著讓燒燙傷以及其他危急的病人先被診治，
09:13
because 75 percent of the patients who go to an emergency room with chest pains
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因為有百分之七十五到急診室有胸悶的病人，
09:18
don't have AMI, so you're not taken very seriously.
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都沒有AMI，所以你沒有把它看得很嚴重。
09:22
They finally see you. It takes more time
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他們終於看到你。這需要更多的時間
09:24
to get your electrocardiogram on your skin and diagnose it,
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才能讓你的皮膚接上心電圖病診斷它，
09:27
and it's hard to do because they don't have the baseline data,
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且要作這個（診斷）很難 因為他們沒有基準線的資料，
09:30
which the computer we put in you gets.
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而我們把你的資料輸入的電腦會有。
09:34
Finally, if you're lucky, you are treated in three or four hours after the incident,
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最後，如果你很幸運，你在事發的三到四個小時後被診治，
09:37
but the heart muscle has died.
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但心臟肌肉已經死了。
09:39
And that is the typical treatment in the advanced world -- not Africa --
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而這也是典型的處理。還是在已開發國家。不是非洲—
09:44
that's the typical treatment in the advanced world today.
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這是今天在已開發國家一般典型的處理。
09:48
So we developed the AngelMed Guardian System
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所以我們發明了天使醫療護衛系統
09:51
and we have a device inside this patient, called the Implanted AngelMed Guardian.
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而且我們把一個儀器放在這位病人體內，稱作天使醫療護衛系統。
09:55
And when you have a blockage, the alarm goes off
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而且當你有阻塞時，警鈴會作響
09:59
and it sends the alarm and the electrogram to an external device,
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然後他會發送警報及心電圖到一個外接儀器，
10:03
which gets your baseline electrogram from 24 hours ago
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這儀器會取得你24小時之前的基準線心電圖
10:06
and the one that caused the alarm, so you can take it to the emergency room
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還有這個引起警報的心電圖，所以你可以把這訊號送到急診室
10:09
and show them, and say, take care of me right away.
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並拿給他們看，且說，立刻照顧我。
10:13
Then it goes to a network operations center,
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接著它會連到一個手術中心網絡，
10:16
where they get your data from your patient database
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在那他們可以從你病歷取得你的資料
10:18
that's been put in at some central location, say, in the United States.
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而這也已經在一些主要的地點實施，像是，在美國。
10:23
Then it goes to a diagnostic center, and within one minute of your heart attack,
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接著它會傳到一個診斷中心，而且是在你心臟病後的一分鐘之內，
10:27
your signal appears on the screen of a computer
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你的訊號會在電腦的螢幕上顯示
10:31
and the computer analyzes what your problem is.
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而且電腦可以分析你的問題是甚麼。
10:34
And the person who's there, the medical practitioner, calls you --
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而在那的專家，醫療人員，會叫你—
10:38
this is also a cell phone -- and says,
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這也是一個手機—並說，
10:40
"Mr. Smith, you're in deep doo-doo; you have a problem.
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史密斯先生，
10:43
We've called the ambulance. The ambulance is on the way.
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我們已經打電話給救護車。救護車也經在路上。
10:47
It'll pick you up, and then we're going to call your doctor, tell him about it.
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它會來接你，而且我們會打電話給你的醫師並告訴他這件事。
10:52
We're going to send him the signal that we have, that says you have a heart attack,
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我們將會把這訊號傳給他，那是我們知道的，說你有心臟病。
10:56
and we're going to send the signal to the hospital
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而且我們將會把這訊號傳到醫院去。
10:58
and we're going to have it analyzed there,
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然後我們會在那裡作分析，
11:01
and there you're going to be with your doctor
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而且在那你就會和你的醫師在一起
11:03
and you'll be taken care of so you won't die of a heart attack."
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而且你就會受到照護所以你不會死於心臟病。』
11:05
That's the first invention that I wanted to describe.
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那這是我第一個要描述的發明。
11:09
(Applause)
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（鼓掌）
11:13
And now I want to talk about something entirely different.
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現在我要說說完全不一樣的東西。
11:16
At first I didn't think migraine headaches were a big problem
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剛開始我不認為偏頭痛是一個大問題
11:20
because I'd never had a migraine headache,
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因為我自己從來沒有過偏頭痛，
11:22
but then I spoke to some people who have three or four every week of their life,
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直到我和一些人的生活當中是每星期會發生三到四次
11:27
and their lives are being totally ruined by it.
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而且他們的生活是完全被它給毀了。
11:30
We have a mission statement for our company doing migraine, which is,
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我們公司有一個宗旨專門處理偏頭痛，它是，
11:34
"Prevent or ameliorate migraine headaches
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『預防或減輕偏頭痛
11:36
by the application of a safe, controlled magnetic pulse
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藉由實施一安全，控制下的磁性脈搏
11:40
applied, as needed, by the patient."
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由病人來決定需要的時候施用。』
11:43
Now, you're probably very few physicists here.
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現在，你們這裡有些人大概是物理學家。
11:46
If you're a physicist you'd know there's a certain Faraday's Law,
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如果你是物理學家你大概會知道有幾個特定的法拉第定律，
11:49
which says if I apply a magnetic pulse on salt water --
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它說如果我對鹽水施加一磁性脈搏—
11:54
that's your brains by the way --
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而那打個比方是你的腦—
11:56
it'll generate electric currents, and the electric current in the brain
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它會產生電訊號，而那在腦裡的電訊號
12:01
can erase a migraine headache.
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可以消除一偏頭痛。
12:03
That's what we have discovered.
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那也正是我們所發現的。
12:05
So here's a picture of what we're doing.
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所以這是一張我們正在作的事。
12:08
The patients who have a migraine preceded by an aura
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病人在有偏頭痛之前會有預兆的光暈
12:13
have a band of excited neurons -- that's shown in red --
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會有一環被激起的神經—在這是紅色的—
12:17
that moves at three to five millimeters a minute towards the mid-brain.
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他是以一分鐘三到五毫米移往中腦。
12:22
And when it hits the mid-brain, that's when the headache begins.
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而當它到達中腦，那正是頭痛開始的時候。
12:27
There's this migraine that is preceded by a visual aura,
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在這偏頭痛之前會有一個視覺的光暈，
12:32
and this visual aura, by the way -- and I'll show you a picture --
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而這個視覺的光暈，順便說一下—而且我會展示給你們看一張照片—
12:35
but it sort of begins with little dancing lights,
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但它開始時是很小的，還帶著小的跳動光影，
12:38
gets bigger and bigger until it fills your whole visual field.
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漸漸的變大再變大直到它填滿你整個視野。
12:41
And what we tried was this; here is a device called the Cadwell Model MES10.
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而我們試的這個，這是一個儀器我們稱作卡特威爾模型 MES10。
12:48
Weighs about 70 pounds, has a wire about an inch in diameter.
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大約重七十磅，有一個直徑約一吋的電線。
12:52
And here's one of the patients who has an aura
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而這是其中一個病人有預兆的光暈
12:55
and always has a headache, bad one, after the aura. What do we do?
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而且總是會頭痛，而且是很糟糕的那一種，再光暈之後。那我們怎麼辦？
13:01
This is what an aura looks like.
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這是一個光暈長得樣子。
13:03
It's sort of funny dancing lights, shown there on the left and right side.
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他就像室有趣跳動的光線，在這裡
13:07
And that's a fully developed visual aura, as we see on top.
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而這是一個發展完全的視覺光暈，也就是我們在這上面看到的。
13:11
In the middle, our experimentalist, the neurologist, who said,
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在中間，我們的實驗者，神經學家，他說，
13:17
"I'm going to move this down a little and I'm going to erase half your aura."
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我將要往下移一點點而且我將要移除你半個光暈』
13:20
And, by God, the neurologist did erase it, and that's the middle picture:
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而且，藉由神的力量，那神經學家確實移除它，而這就是中間的照片，
13:25
half of the aura erased by a short magnetic pulse.
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半個光暈藉著一個短的磁性脈搏移除了。
13:28
What does that mean?
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這代表的甚麼？
13:30
That means that the magnetic pulse is generating an electric current
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這代表那個磁性脈搏正在產生一電流
13:34
that's interfering with the erroneous electrical activity in the brain.
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那是正在干擾腦內錯誤的電活動
13:39
And finally he says, "OK, now I'm going to -- "
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接著終於他說，『好，現在我將要—』
13:41
all of the aura get erased with an appropriately placed magnetic pulse.
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全部的光暈都被正確的磁脈動移除
13:46
What is the result? We designed a magnetic depolarizer
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那結果是甚麼？我們設計了一個磁的去極器，
13:50
that looks like this, that you could have -- a lady, in her pocket book --
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它看起來像這樣，就是你可以擁有—一個淑女，在她的記事簿裡，
13:55
and when you get an aura you can try it and see how it works.
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而且當你發生光暈時你可以試試看再看看它是怎麼運作的。
13:59
Well, the next thing they have to show is what was on ABC News,
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這個嘛，下一個他們要展示的就是在ABC新聞上的
14:03
Channel 7, last week in New York City, in the 11 o'clock news.
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第7頻道，上星期在紐約市，在11點鐘的新聞。
14:07
Anchor: For anyone who suffers from migraine headaches --
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主軸：為任何飽受偏頭痛之苦的人們—
14:09
and there are 30 million Americans who do -- tonight: a possible answer.
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還有三千萬有（偏頭痛的）美國人們—今晚一個可能的答案。
14:13
Eyewitness news reporter Stacy Sager tonight, with a small and portable machine
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新聞目擊者記者史黛西．塞赭今晚，和一個小而且可攜帶式的機器
14:17
that literally zaps your migraines away.
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那可以說是處理掉你的偏頭痛。
14:21
Christina Sidebottom: Well, my first reaction was that it was --
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克莉絲緹娜．塞德芭特：這個嘛，我當初的第一個反應是這個—
14:23
looked awfully gun-like, and it was very strange.
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看起來非常像槍，而且這是非常的奇怪。
14:27
Stacy Sager: But for Christina Sidebottom, almost anything was worth trying
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史黛西．塞赭：但是對克莉絲緹娜．塞德芭特來說，幾乎任何事情都值得一試
14:31
if it could stop a migraine.
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如果它能停止偏頭痛。
14:33
It may look silly or even frightening as you walk around with it in your purse,
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當你把它放在你的皮包內帶著走時它可能看起來很可笑或甚至是很嚇人，
14:39
but researchers here in Ohio organizing clinical trials for this migraine zapper,
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但在愛荷華州這的研究員為解決偏頭痛停止器組織臨床試驗，
14:44
say it is scientifically sound --
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說這是科學上合理的。
14:47
that, in fact, when the average person gets a migraine,
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而這，事實上，當一般人得到偏頭痛，
14:49
it's caused by something similar to an electrical impulse.
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它和電衝動所造成的東西很類似。
14:53
The zapper creates a magnetic field to counteract that.
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停止器製造一個磁場來反治它。
14:57
Yousef Mohammed: In other words, we're treating electricity with electricity,
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約瑟夫．木哈曼：換句話說，我們正用電來治療電，
15:00
rather than treating electricity with the chemicals that we're using nowadays.
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而不是我們現今用化學的方式來治療電。
15:05
SS: But is it safe to use everyday?
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史黛西．塞赭 (史)：但是它要天天使用是安全的嗎？
15:07
Experts say the research has actually been around for more than a decade,
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專家說這研究已經存在超過十年，
15:11
and more long-term studies need to be done. Christina now swears by it.
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而且我們還需要更長期的研究。克莉絲緹娜正信誓旦旦的說。
15:16
CS: It's been the most wonderful thing for my migraine.
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克莉絲緹娜．塞德芭特 (克)：這可以說是對我的偏頭痛來說最美好的事情。
15:19
SS: Researchers are hoping to present their studies to the FDA this summer.
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史：研究員希望他們能在今年把研究展示給食品及藥物管理局
15:23
Robert Fischell: And that is the invention to treat migraines.
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羅伯．費爾雪：而這就是治療偏頭痛的發明。
15:25
(Applause)
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（鼓掌）
15:27
You see, the problem is, 30 million Americans have migraine headaches,
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你看，問題是，有三千萬的美國人有偏頭痛，
15:32
and we need a means to treat it, and I think that we now have it.
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而我們需要一個方法來治療它，而我想我們現在終於有了。
15:36
And this is the first device that we did, and I'm going to talk about my second wish,
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而這也是我們所擁有的第一個儀器，而我們要談談我們的第二個願望，
15:41
which has something to do with this.
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那也和這個有關。
15:43
Our conclusions from our studies so far, at three research centers,
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我們在三個研究中心從實驗中得到目前的結論，
15:46
is there is a marked improvement in pain levels after using it just once.
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那是只使用一次在疼痛程度上就有明顯的改善。
15:50
The most severe headaches responded better after we did it several times,
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在我們做了幾次以後，最嚴重的的頭痛也有很好的反應，
15:55
and the unexpected finding indicates that even established headaches,
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而且最意想不到的發現是 就算是已成型的偏頭痛，
15:59
not only those with aura, get treated and get diminished.
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不只是那些已有光暈的，能受到診治而減輕。
16:03
And auras can be erased and the migraine, then, does not occur.
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而光暈可以被消除還有偏頭痛，接著，就不再發生了。
16:08
And that is the migraine invention that we are talking about and that we are working on.
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而這就是我們所談到偏頭痛的發明而且我們還在作進一步的研究。
16:15
(Applause)
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（鼓掌）
16:17
The third and last invention began with an idea.
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第三個也是最後一個發明是開始於這個主意。
16:22
Epilepsy can best be treated by responsive electrical stimulation.
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診治癲癇最好的方式是利用反應性電刺激。
16:27
Now, why do we use -- add on, nearly, an epileptic focus?
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現在，為什麼我們還要用—或是加上，甚至是，在一個癲癇點上？
16:31
Now, unfortunately, us technical people, unlike Mr. Bono,
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現在，不幸的是，我們研究技術的人，不像布諾先生，
16:35
have to get into all these technical words.
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必須要去理解這些技術的字。
16:37
Well, "responsive electrical stimulation" means
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這個嘛，反應性電刺激的意思是
16:42
that we sense, at a place in your brain which is called an "epileptic focus,"
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我們可以偵察到，在你腦中的一個稱作癲癇點的地方，
16:47
which is where the epileptic seizure begins --
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這也就是癲癇—也就是癲癇開始的地方。
16:52
we sense there, that it's going to happen,
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我們感覺到，那它就要開始發生，
16:55
and then we respond by applying an electrical energy at that spot,
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而且我們對它做出的反應就是對那個點施加電能，
17:00
which erases the errant signal
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來消除那偏差的訊號
17:03
so that you don't get the clinical manifestations of the migraine headache.
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所以你就不會得到偏頭痛的臨床症狀。
17:08
We use current pacemaker defibrillator technology that's used for the heart.
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我們用的是專門用在心臟的電流節律的去極化科技。
17:13
We thought we could adapt it for the brain.
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我們想說我們可以把它應用在腦上面。
17:15
The device could be implanted under the scalp
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這儀器可以被植入在頭骨下
17:17
to be totally hidden and avoid wire breakage,
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這樣就可以完全藏住以預防電線斷裂，
17:21
which occurs if you put it in the chest and you try to move your neck around.
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如果你把它放在胸腔內那就會發生而且你可以試著動動你的脖子。
17:25
Form a company to develop a neuro-pacemaker for epilepsy,
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組成一個公司去製造針對癲癇的神經節律器，
17:28
as well as other diseases of the brain, because all diseases of the brain
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以及其它針對腦的疾病，因為所有腦的疾病
17:34
are a result of some electrical malfunction in it,
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都是起因於一些神經性的機能損傷，
17:38
that causes many, if not all, of brain disorders.
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那會造成很多，如果不是全部的，腦的疾病。
17:43
We formed a company called NeuroPace
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我們組成一個公司叫做神經節律
17:47
and we started work on responsive neurostimulation,
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而我們開始針對反應性的神經刺激，
17:50
and this is a picture of what the device looked like,
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而這是一張那儀器長什麼樣子的照片，
17:53
that's placed into the cranial bone.
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而這是放在顱骨內。
17:56
This is probably a better picture.
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這張可能是一張比較好的照片。
17:58
Here we have our device in which we put in a frame.
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這裡我們的儀器還加了一個框架。
18:03
There's a cut made in the scalp; it's opened; the neurosurgeon has a template;
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這是一個在頭骨內的缺口，他是開著的，神經外科醫師有一個模型，
18:09
he marks it around, and uses a dental burr
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他在上面作記號，用的是牙醫的圓頭鑽子
18:11
to remove a piece of the cranial bone exactly the size of our device.
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來移除一塊顱骨那剛好是我們儀器的大小。
18:16
And tonight, you'll be able to see the device in the tent.
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而且今晚，你會在帳篷內看到那個儀器。
18:19
And then with four screws, we put in a frame,
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接著我們—用四個螺絲，我們放進一個框架，
18:23
then we snap in the device and we run with wires --
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接著我們把儀器卡進去就讓電線跑跑看—
18:26
the one shown in green will go to the surface of the brain with electrodes,
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在這裡看到是綠色的部份就會帶著電極接到腦的表面，
18:31
to the epileptic focus, the origin of the epilepsy,
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通到癲癇點，癲癇的起源，
18:34
where we can sense the electrical signal
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也就是我們可以偵測到電訊號的地方
18:37
and have computer analysis that tells us when to hit it with some electrical current
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而且讓電腦分析好讓我們知道甚麼時候要用電流去電擊它
18:42
to prevent the clinical manifestation of the seizure.
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好預防癲癇的臨床症狀。
18:45
In the blue wire, we see what's called a deep brain electrode.
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在藍色的電線裡，我們看到甚麼叫做一個深層腦電極。
18:48
If that's the source of the epilepsy, we can attack that as well.
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如果那是癲癇的源頭，我們可以也可以專門對付那。
18:53
The comprehensive solution: this is the device;
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最完整的對策：就是這個儀器，
18:56
it's about one inches by two inches and, oddly enough,
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它大約是一吋和兩吋而且，夠奇怪的，
18:59
just the thickness of most cranial bones.
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剛好是大部份顱骨的厚度。
19:03
The advantages of responsive neurostimulation:
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而反應性神經刺激的優點是：
19:06
It can detect and terminate seizures before the clinical symptoms occur,
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它可以偵測並在臨床症狀發生前終止癲癇，
19:10
provide stimulation only when needed,
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只在需要的時候提供刺激，
19:13
can be turned off if seizures disappear; it has minimal side effects --
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也可以在癲癇消失的時候關掉，它只有很輕微的副作用—
19:18
as a matter of fact, in all our clinical trials to date,
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事實上，在我們今天所有的臨床試驗，
19:21
we've seen no side effects in the 40 or so patients in whom it's been implanted --
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我們在約40個接受植入的病人身上並未看到副作用—
19:26
and it's invisible, cosmetically hidden,
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而且它是一個看不見，在美容上藏著的，
19:29
so, if you have epilepsy and you have the device,
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所以，如果你有癲癇而你有這個儀器，
19:32
no one will know it because you can't tell that it's there.
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沒有人會知道它因為你看不出它就在那裡。
19:35
And this shows what an electroencephalogram is,
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這裡告訴你什麼是腦波圖是甚麼，
19:39
and on the left is the signal of a spontaneous seizure of one of the patients.
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在左邊是其中一個病人自發性癲癇的訊號。
19:43
Then we stimulated, and you see how that heavy black line
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接著我們刺激，而你可以看到那條黑線有多粗
19:47
and then you see the electroencephalogram signal going to normal,
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而且接著你會看到腦波圖訊號變正常，
19:51
which means they did not get the epileptic seizure.
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那代表他們沒有得到癲癇發作。
19:54
That concludes my discussion of epilepsy,
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所以那幫我癲癇的討論作結論而且—
19:59
which is the third invention that I want to discuss here this afternoon.
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這也是我在這個下午所要討論的第三個發明。
20:03
(Applause)
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（鼓掌）
20:07
I have three wishes. Well, I can't do much about Africa.
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我有三個願望。這個嘛，我不太能為非洲做什麼。
20:12
I'm a tech; I'm into medical gadgetry,
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我是一個技術員，我的專門是醫療機件設計，
20:15
which is mostly high-tech stuff like Mr. Bono talked about.
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這些大部份都是高科技的東西像是布諾先生談到的。
20:19
The first wish is to use the epilepsy responsive neurostimulator,
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第一個願望是使用癲癇的反應性神經刺激器，
20:24
called RNS, for Responsive NeuroStimulator -- that's a brilliant acronym --
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稱作RNS，代表反應性神經刺激器—那是一個聰明的縮寫—
20:29
for the treatment of other brain disorders.
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為治療其它的腦疾病。
20:31
Well, if we're going to do it for epilepsy, why the hell not try it for something else?
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這個嘛，如果我們要治療癲癇，為什麼不能試在其它的東西？
20:36
Then you saw what that device looked like,
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接著你看到那個儀器長什麼樣子，
20:39
that the woman was using to fix her migraines?
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那位女士是用甚麼在治療她的偏頭痛？
20:41
I tell you this: that's something which some research engineer like me would concoct,
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我告訴你這個：那是一些像我的工程師想要策劃的，
20:46
not a real designer of good equipment.
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不是一個真正好的儀器的設計者。
20:48
(Laughter)
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（笑聲）
20:50
We want to have some people, who really know how to do this,
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我需要有一些人，是真正知道要怎麼作這個的，
20:53
perform human engineering studies to develop the optimum design
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執行人類工程學的研究以研發最佳的設計
20:57
for the portable device for treating migraine headaches.
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為設計可攜式的儀器來治療偏頭痛。
21:00
And some of the sponsors of this TED meeting are such organizations.
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還有一些贊助這個TED討論會的贊助商都是這樣的組織團體。
21:05
Then we're going to challenge the TED attendees
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而且我們將要挑戰TED的參加者。
21:08
to come up with a way to improve health care in the USA,
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來想出改善美國健康照護一個的方式，
21:12
where we have problems that Africa doesn't have.
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那是非洲所沒有的問題。
21:15
And by reducing malpractice litigation --
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而且藉由減少誤診的訴訟—
21:18
malpractice litigation is not an African problem; it's an American problem.
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誤診的訴訟也不是一個非洲的問題，它是一個美國的問題。
21:22
(Applause)
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（鼓掌）
21:25
So, to get quickly to my first wish --
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所以，想要快速達成我的第一個願望—
21:28
the brain operates by electrical signals.
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腦是藉著電訊號在運作的。
21:31
If the electrical signals create a brain disorder,
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如果電訊號製造了一個腦疾病，
21:34
electro-stimulation can overcome that disorder by acting on the brain's neurons.
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電刺激可以藉著作用在腦神經來克服那個疾病。
21:38
In other words, if you've screwed up electrical signals,
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換句話說如果妳已經搞砸了電訊號，
21:42
maybe, by putting other electrical signals from a computer in the brain,
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也許，藉著從電腦放入其它的電訊號在腦中，
21:46
we can counteract that.
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我們可以抵制它。
21:49
A signal in the brain that triggers brain dysfunction
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一個在腦裡的訊號那是會引起腦功能障礙
21:52
might be sensed as a trigger for electro-stimulation
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可能被偵測到而成為電刺激的刺激點
21:55
like we're doing with epilepsy.
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就像我們正為癲癇所作的。
21:57
But even if there is no signal,
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但是甚至是沒有訊號，
21:59
electro-stimulation of an appropriate part of the brain can turn off a brain disorder.
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一部份好的腦區的電刺激是可以關掉一個腦疾病。
22:04
And consider treating psychotic disorders --
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這也被考慮用來治療精神疾病—
22:08
and I want this involved with the TED group --
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而我要這個能涵蓋TED族群—
22:11
such as obsessive-compulsive disorder
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就像強迫症
22:13
that, presently, is not well treated with drugs, and includes five million Americans.
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那，在目前，還未能以藥物作有效的治療，而且包括五百萬的美國人。
22:19
And Mr. Fischer, and his group at NeuroPace, and myself believe
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而且費爾雪先生，和他在神經節律的團隊，還有我自己相信
22:23
that we can have a dramatic effect in improving OCD in America and in the world.
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那是我們可以有一個驚人的效果來改善在美國及在全世界的強迫症。
22:29
That is the first wish.
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那是第一個願望。
22:32
(Applause)
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（鼓掌）
22:37
The second wish is, at the present time,
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第二個願望是，在目前，
22:40
the clinical trials of transcranial magnetic stimulators --
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臨床的經顱磁刺激器—
22:45
that's what TMS means, device to treat migraine headaches --
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那也是TMS代表的意思，用來治療偏頭痛的儀器—
22:49
appears to be quite successful.
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看起來是還蠻成功的。
22:51
Well, that's the good news.
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這個嘛，那是個好消息。
22:53
The present portable device is far from optimally designed,
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但目前可攜式的儀器離最佳的設計還差得遠，
22:55
both as to human factors as appearance.
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不管是人為的因素還是在它的外型上。
22:58
I think she said it looks like a gun. A lot of people don't like guns.
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我想她說它看起來像把槍。有很多人都不喜歡槍。
23:02
(Laughter)
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（笑聲）
23:04
Engage a company having prior successes
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讓一個公司在有了之前的成功
23:06
for human factors engineering and industrial design
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在為人因工程銲工業設計
23:09
to optimize the design of the first portable TMS device
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以最佳化第一個可攜式的經顱磁刺激器的設計
23:14
that will be sold to the patients who have migraine headaches.
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那是可以賣給那些有偏頭痛的病人。
23:17
And that is the second wish.
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而這也是第二個願望。
23:19
(Applause)
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（鼓掌）
23:24
And, of the 100,000-dollar prize money, that TED was so generous to give me,
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接下來，那十萬美元的奬金，是TED如此慷慨的給我，
23:28
I am donating 50,000 dollars to the NeuroPace people
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我要捐五萬美元給神經節律的人們
23:32
to get on with the treatment of OCD, obsessive-compulsive disorder,
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去推展強迫症(OCD) 的治療，
23:37
and I'm making another 50,000 available for a company
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而且我正用這五萬美元讓一個公司
23:41
to optimize the design of the device for migraines.
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去最佳化為偏頭痛所作的儀器設計。
23:44
And that's how I'll use my 100,000-dollar prize money.
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而那也是我要如何去應用我的十萬元奬金。
23:48
(Applause)
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（鼓掌）
23:54
Well, the third and final wish is somewhat --
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這個嘛，第三個和最後一個願望是有一點—
23:56
unfortunately, it's much more complicated because it involves lawyers.
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不幸的，它是比較複雜因為它牽扯到律師。
24:01
(Laughter)
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（笑聲）
24:03
Well, medical malpractice litigation in the US
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這個，在美國的醫療誤診訴訟
24:05
has escalated the cost of malpractice insurance,
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已經逐漸累積誤診的保險金額，
24:07
so that competent physicians are leaving their practice.
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所以讓有能力的醫師正離開他們的執業。
24:10
Lawyers take cases on contingency with the hope of a big share
383
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律師接手不確定的案子總希望能分到最大的利益
24:14
of a big settlement by a sympathetic jury, because this patient really ended up badly.
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特別是從一個有同情心的陪審團下的定案，因為這個病人真的下場很慘。
24:19
The high cost of health care in the US is partly due to litigation and insurance costs.
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美國健康照護之所以昂貴有部份的原因是訴訟及保險的花費。
24:24
I've seen pictures, graphs in today's USA Today
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我已經在今天的今日美國 (USA Today) 看過圖片，圖表
24:29
showing it skyrocketing out of control, and this is one factor.
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顯示它狂飆到失控，而這是一個原因。
24:32
Well, how can the TED community help with this situation?
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置於，TED社群要如何幫助這個情形？
24:36
I have a couple of ideas to begin with.
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我有幾個初步的想法。
24:39
As a starting point for discussion with the TED group,
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可以作為為了和TED社群討論的起點，
24:43
a major part of the problem is the nature of the written extent
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一個主要的問題是同意書文字內容的本質
24:46
of informed consent that the patient or spouse must read and sign.
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那是病人或其配偶必須閱讀並簽名的。
24:50
For example, I asked the epilepsy people
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打個比方，我問了癲癇的人
24:53
what are they using for informed consent.
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他們用的是甚麼樣的同意書。
24:55
Would you believe, 12 pages, single space,
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你能相信，十二頁，單行間距，
24:59
the patient has to read before they're in our trial to cure their epilepsy?
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是病人必須在加入我們治癒他們癲癇的試驗前先讀的？
25:04
What do you think someone has at the end of reading 12 single-spaced pages?
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你覺得一個人在讀了十二頁單行間距後會怎樣？
25:08
They don't understand what the hell it's about.
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他們其實根本就不懂它到底是跟甚麼有關。
25:10
(Laughter)
399
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（笑聲）
25:12
That's the present system. How about making a video?
400
1488000
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那也是目前的系統。那是不是可以製作一個影片？
25:15
We have entertainment people here;
401
1491000
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我們這是有娛樂界的人士，
25:17
we have people who know how to do videos,
402
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2000
我們有人是知道怎麼製作影片，
25:19
with visual presentation of the anatomy and procedure done with animation.
403
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4000
藉著視覺來呈現解剖以及動畫來呈現完成的手術過程
25:23
Everybody knows that we can do better with a visual thing
404
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每個人都知道我們在有視覺東西的輔助下總做得比較好
25:28
that can be interactive with the patient, where they see the video
405
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4000
那是可以和病人互動的，那樣他們可以看著影片
25:32
and they're being videoed and they press, do you understand this? No, I don't.
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而他們被攝影且他們可以按按鍵，你了解這個了嗎？不，我不懂。
25:37
Well, then let's go to a simpler explanation.
407
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2000
這個嘛，那我們試試一個簡單點的解釋。
25:39
Then there's a simpler one and, oh yes, I understand that.
408
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3000
接著這裡有一個簡單點的，喔對了，我了解那了。
25:42
Well, press the button and you're on record, you understand.
409
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3000
這個嘛，按這按鍵而你正在紀錄，這你了解。
25:45
And that is one of the ideas.
410
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3000
而這正是其中一個概念。
25:48
Now, also a video is done of the patient or spouse and medical presenter,
411
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3000
現在，影片也是由病人或配偶及醫療呈現者來作的。
25:51
with the patient agreeing that he understands the procedure to be done,
412
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5000
讓病人同意他了解所要執行的步驟，
25:56
including all the possible failure modes.
413
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包括所有可能的失敗模式。
25:59
The patient or spouse agrees not to file a lawsuit
414
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病人或配偶能不要提出訴訟
26:01
if one of the known procedure failures occurs.
415
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如果其中一個預知的失敗程序發生了。
26:04
Now, in America, in fact, you cannot give up your right to trial by jury.
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現在，在美國，事實上，你不能放棄你被陪審團審判的權力。
26:10
However, if a video is there that everything was explained to you,
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但是，如果影片在那裡而且每一樣東西都解釋給你了，
26:14
and you have it all in the video file,
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而你在影片資料裡有所有的檔案，
26:16
it'll be much less likely that some hotshot lawyer
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它就會變得比較不讓自命不凡的律師
26:19
will take this case on contingency, because it won't be nearly as good a case.
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還會拿這個案子當作是意外，因為它不會還是個那麼好的案子。
26:24
If a medical error occurs, the patient or spouse agrees to a settlement
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如果醫療錯誤發生，病人或配偶同意一個定案
26:29
for fair compensation by arbitration instead of going to court.
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那是來自於人為定義公平的賠償而不是訴諸於法庭。
26:34
That would save hundreds of millions of dollars in legal costs in the United States
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那就能為美國省下數以萬計美元那是與法律有關的花費
26:39
and would decrease the cost of medicine for everyone.
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而能減少每個人醫療的花費。
26:42
These are just some starting points.
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這些只是一些開端。
26:45
And, so there, that's the end of all my wishes.
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而且，到這，這是我所有願望的總結。
26:49
I wish I had more wishes but three is what I've got and there they are.
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我希望我能有更多願望但三個已經是我所擁有的而且這些就是了。
26:53
(Applause)
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(掌聲)
ABOUT THE SPEAKER
Robert Fischell - Biomedical inventorRobert Fischell invented the rechargeable pacemaker, the implantable insulin pump, and devices that warn of epileptic seizures and heart attacks. Yet it's not just his inventive genius that makes him fascinating, but his determination to make the world a better place.
Why you should listen
Robert Fischell began his work in space development, and created a 16-satellite system called Transit that was a key precursor to GPS. When he turned his attention to medical devices, he had the key insight that a pacemaker is like a tiny satellite within the body. The medical devices he has pioneered -- starting with a pacemaker that didn't require a new battery every two years -- have saved thousands of lives and improved countless more.
Fischell's true genius is his ability to see across technologies and sciences. His uncanny intuition allowed him to invent special features of the implantable cardiac defibrillator that has saved more than 60,000 lives -- followed by the implantable insulin pump, coronary stents used to open clogged arteries, and two extraordinary feedback systems that provide early warning of epileptic seizures and heart attacks. Though he is officially retired, he continues to create new devices to treat a wide range of ailments, from heart attacks to chronic migraines.
Accepting his 2005 TED Prize, Fischell made three wishes. First, he wished for help in developing an implantable device to treat brain disorders such as obsessive-compulsive disorder; second, he asked for help in designing his portable Transcranial Magnetic Stimulator (TMS), a drug-less migraine treatment -- for the latest news on this device, see the website for his company Neuralieve. For his third wish, Fischell took on the medical malpractice system, which, he believes, puts doctors at the mercy of lawyers and insurers.
Robert Fischell | Speaker | TED.com