TED演讲:医学的未来?也许是手机上的一个应用程序(4)

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it might help to have some extra imagery to remind you how many calories are going to be coming at you. 一些图像也许会有助于提醒你食物里有多少热量。

How about enabling the pathologist to use their cell phone again to see at a microscopic¹ level and to lumber² that data back to the cloud and make better diagnostics? 让病理学家能用他们的手机在显微水平观察把数据放回云端信息来做更好的诊断会怎样？

In fact, the whole era of laboratory medicine is completely changing. 实际上，整个实验医学时代完全变了。

We can now leverage³ microfluidics,  我们能利用微流体，

like this chip made by Steve Quake at Stanford.  像斯坦福的Steve Quake公司制造的芯片。

Microfluidics can replace an entire lab of technicians.  微流体能替代整个实验室的技术员。

Put it on a chip, enable thousands of tests to be done at the point of care, anywhere in the world. 把它放在一个芯片上，能做几千个测试在世界任何地方都可以做。

And this is really going to leverage technology to the rural and the under-served and enable what used to be thousand-dollar tests to be done at pennies and at the point of care. 这将真正地从技术上获益,那些农村和保障不发达地区能让过去上千块的测试减到几分钱在护理方面上讲。

If we go down the small pathway a little bit farther,  如果在这条小路上走得稍微远一点，

we're entering the era of nanomedicine,  我们将来到纳米医学时代，

the ability to make devices super small to the point where we can design red blood cells or microrobots that will monitor our blood system or immune system, 能将装置做得超小小到我们可以设计血红细胞或者微型机器人来监测我们的血液系统或免疫系统，

or even those that might clear out the clots⁴ from our arteries⁵.  或者甚至清除动脉里的血栓。

Now how about exponentially cheaper?  如果指数更加便宜会怎样？

Not something we usually think about in the era of medicine,  在医学领域，这种便宜不是我们通常认为的那样，

but hard disks used to be 3,400 dollars for 10 megabytes-exponentially cheaper.  而是10MB硬盘过去3400美元-指数便宜。

In genomics now,  在基因组学，

the genome cost about a billion dollars about 10 years ago when the first one came out.  基因组价值约10亿美元10年前当第一个基因组出现的时候。

We're now approaching essentially⁶ a thousand-dollar genome-probably next year to two years, probably a hundred-dollar genome.  我们现在基本上可以1000美元买到。也许今后一两年，100美元的基因组会出现。

What are we going to do with hundred-dollar genomes?  我们能用100美元的基因组做什么呢?

And soon we'll have millions of these tests available.  不久以后我们可以进行上百万的测试。

And that's when it gets interesting, when we start to crowdsource that information.  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。

And we enter the era of true personalized medicine, 我们进入了真正的个人化医学时代,

the right drug for the right person at the right time, 在正确的时间为正确的人制造正确的药,

instead of what we're doing today, which is the same drug for everybody, 而不是像现在我们这样，给每个人同样的药物,

sort of blockbuster drug medications,  一种药物治疗的混乱，

medications which don't work for you, the individual.  对你个人不一定有效。

And many, many different companies are working on leveraging⁷ these approaches.  很多不同的公司正在利用这些方法。

And I'll also show you a simple example, from 23andMe again.  我会给你一个简单的例子，还是来自23andMe。

My data indicates that I've got about average risk for developing macular degeneration, a kind of blindness.  我的数据表明我已经达到平均风险系数对于黄斑病变，一种失明病。

But if I take that same data, upload it to deCODEme,  但是如果我把同样的数据上传到deCODEme，

I can look at my risk for sample type 2 diabetes⁸.  比如我能看到我得2型糖尿病的风险指数。

I'm at almost twice the risk for type 2 diabetes.  我现在差不多有2倍的风险得2型糖尿病。

I might want to watch how much dessert I have at the lunch break for example.  例如我也许想看到午饭的时候吃多少甜点。

It might change my behavior.  这也许能改变我的行为。

Leveraging my knowledge of my pharmacogenomics, 利用我基因测试学的知识,

how my genes⁹ modulate¹⁰, what my drugs do and what doses I need are going to become increasingly important,  我的基因怎样调整，我的药物作用是什么和我需要什么将变得越来越重要，

and once in the hands of the individual and the patient,  在个人和患者手中的时候，

will make better drug dosing and selection available.  将使得可用的药物选择和服用更好。

So again, it's not just genes, it's multiple details our habits, our environmental exposure.  所以不仅是基因，有多种因素,我们的习惯，我们的环境。

When was the last time your physician asked you where you've lived?  上次医生问你住在哪里是什么时间？

Geomedicine: where you've lived, what you've been exposed to,  风土医学：你住在哪里，你接触过什么

can dramatically affect your health.  能极大影响你的健康。

We can capture that information.  我们能抓住这些信息。

So genomics, proteomics, the environment,  因此基因组学，蛋白组学，环境，

all this data streaming at us individually and us, as poor physicians,  所有数据涌向我们作为个体人和医生们。

how do we manage it?  我们怎样管理它们呢？

Well we're now entering the era of systems medicine, or systems biology,  我们正在进入系统医学或者系统生物学时代，

where we can start to integrate all of this information.  我们能开始集成这些信息。

And by looking at the patterns, for example, in our blood of 10,000 biomarkers in a single test, 通过这些式样，例如，在我们的血液中一个测试中有10000个生物标记，

we can start to look at these little patterns and detect disease at a much earlier stage.  我们能看这些小的式样在非常早期发现疾病。

This has been called by Lee Hood¹¹, the father of the field,P4 medicine.  这个领域的创始人，李?胡德叫这种方法为P4医学。

We're going to be predictive; we're going to know what you're likely to have.  我们将能预测；我们能知道我们可能会怎样。

We can be preventative; that prevention can be personalized;  我们能预防；这种预防性可以个人化；

and more importantly, it's going to become increasingly participatory.  更重要的是，它将变得共享。

Through websites like Patients Like Me or managing your data on Microsoft HealthVault or Google Health,  虽然一些网站像Patients Like Me，微软HealthVault或者谷歌Health可以管理数据，

leveraging this together in participatory ways is going to become increasingly important.  用共享的方式利用数据将变得越来越重要。

So I'll finish up with exponentially better.  我将以指数地更好前景来做结束。

We'd like to get therapies better and more effective.  我们会得到更好更有效的治疗。

Now today we treat high blood pressure mostly with pills.  如今我们通常通过吃药治疗高血压。

What if we take a new device and knock out the nerve vessels¹² that help mediate¹³ blood pressure and in a single therapy to cure hypertension?  如果我们用一种新装置敲打神经血管帮助调节血压一次治疗就能治愈高血压。

This is a new device that is essentially doing that.  这是做这种治疗的一种新装置。

It should be on the market within a year or two.  它应该能在一两年内投放市场。

How about more targeted therapies for cancer?  更具目标性的癌症治疗会怎样呢？

Right, I'm an oncologist and I have to say most of what we give is actually poison. 对，我是肿瘤学家,我不得不说大多数我们开的药实际上是毒药。

We've learned at Stanford and other places that we can discover cancer stem cells,  我们在斯坦福和其他地方学到,我们可以发现癌症干细胞，

the ones that seem to be really responsible for disease relapse.  可能是癌症复发的真正原因。

So if you think of cancer as a weed,  如果你把癌症看作一个种子，

we often can whack¹⁴ the weed away.  我们通常能够去除这个种子。

It seems to shrink, but it often comes back.  它好像萎缩了，但它经常又重新复发。

So we're attacking the wrong target.  所以我们正在去除错误的目标体。

The cancer stem cells remain,  癌症干细胞仍存在，

and the tumor¹⁵ can return months or years later.  肿瘤能在几个月或几年后重新长出来。

We're now learning to identify the cancer stem cells and identify those as targets and go for the long-term cure.  我们现在学会了鉴定癌症干细胞作为鉴定目标体来进行长期治疗。

And we're entering the era of personalized oncology,  我们正在进入个人化肿瘤学时代，

the ability to leverage all of this data together,  利用汇集所有数据的能力，

analyze¹⁶ the tumor and come up with a real, specific cocktail¹⁷ for the individual patient.  分析肿瘤并提出来针对每一个患者而采用的一个真正的，明确的鸡尾酒疗法。

Now I'll close with regenerative medicine.  最后我会讲讲再生医学。

So I've studied a lot about stem cells embryonic¹⁸ stem cells are particularly powerful.  我对干细胞研究很多,胚胎干细胞尤其强大。

We also have adult stem cells throughout our body.  我们有遍布我们身体的成体干细胞。

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