when I was attending the TED conference in Long Beach,

幾年前

I met Harriet.

當我參加TED長灘會議的時候

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

我遇見了哈里特。

We were introduced because we both knew Linda Avey,

我們之前在網路上就遇到過

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

不是你們想的那種遇見方式。

And because we shared our genetic information with Linda,

其實我們遇見是因為我們都認識琳達.埃維

she could see that Harriet and I shared

她是最早的線上私人基因組公司的創始人之一。

a very rare type of mitochondrial DNA, haplotype K1a1b1a,

因為琳達知道我們兩人的基因訊息

which meant we were distantly related.

所以她發現我們兩個都有一種罕見的線粒體DNA

We actually share the same genealogy with Ötzi the Iceman.

叫做單倍體基因型 K1a 1b 1a

So -- Ötzi, Harriet and me.

這說明了我們是遠親。

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

其實我們和冰人奧茲也有血緣關係

You're all welcome to join.

所以，奧茲、哈裏特和我算是親戚。

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

因為現在大家都使用臉書，我們當然也設立了自己的臉書群組。

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

我們歡迎你們加入。

(Laughter)

隔年當我在TED會議上遇到哈里特時

Why am I telling you this story?

她早就已經上網訂做了我們自己的快樂單倍體T恤。

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

為什麼我要告訴你們這件事呢?

Well, the way I met Harriet is an example

這和我們未來的健康又有什麼關係呢?

of how leveraging cross-disciplinary, exponentially growing technologies

我和哈裏特相遇的過程其實充分地說明了一件事

is affecting our future of health and wellness --

那就是跨學科的研究、突飛猛進的科技

from low-cost gene analysis

正影響我們將來的身心健康——

to the ability to do powerful bioinformatics

這些研究和科技包含了低成本的基因分析

to the connection of the Internet and social networking.

有能力運用功能強大的生物信息學

What I'd like to talk about today

以及網路和社會網絡之間的關聯。

is understanding these exponential technologies.

今天我想談的就是我們應該了解這些指數科技。

We often think linearly.

我們的思考經常是直線的。

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

但是你想像一下，如果你有一片蓮花葉子

and it just divided every single day --

而且它每天都分裂一次

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

兩片，四片，八片，十六片

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

15天後你就有三萬兩千片葉子。

We're at a billion.

那一個月後你認為會有多少葉子？答案是10億。

If we start to think exponentially,

所以如果我們開始學著「次方性思考」

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

我們就可以讓我們身邊所有的科技有所不同。

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

許多這些科技，就我醫生的角色和想創新的人來說，

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

是我們真的能用來改變我們未來的健康以及保健發展

and of health care,

解決我們現今在保健發展遇到的主要難題

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

例如說保健制度的巨額成本

ranging from the exponential costs to the aging population,

老年人口

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

沒能非常有效地運用資訊、整合保健制度

the fragmentation of care

還有採用創新技術時

and the often very difficult course of adoption of innovation.

過程也經常是困難重重。

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

我們能做的一件重要的事，這我們今天也剛談了一些

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

就是把這條曲線向左移。

What if we could incentivize physicians in the health care system

我們把大多數金錢花費在生命階段的最後百分之二十。

and our own selves

如果我們將錢花在保健制度和我們自身的健康管理中

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

透過科技親自參予這些系統運作和管理

leveraging technology as well?

將曲線向左移、改善我們的健康，那會怎樣呢？

Now my favorite example of exponential technology,

我最喜歡的科技是「次方科技」

we all have in our pocket.

我們大家現在都在使用這種科技了。

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

想想看，這些科技現在正突飛猛進。

I mean, this is the iPhone 4.

打個比方，iPhone4已經是這樣了

Imagine what the iPhone 8 will be able to do.

想像一下iPhone8的功能會有多強大。

Now, I've gained some insight into this.

我對這項技術已經有一些心得。

I've been the track share for the medicine portion

我在矽谷一家辛格蘭若堤大學的醫學部門工作

of a new institution called Singularity University,

我們會在每個夏天從全世界找來一百個傑出的學生

based in Silicon Valley.

研究這些關於醫學，生物科技

We bring together each summer about 100 very talented students

人工智能，機器人技術，納米技術，空間技術的整合科技，

from around the world.

解決跨學科訓練的問題

And we look at these exponential technologies from medicine,

並利用這些技術來影響還沒有實現的重大目標。

biotech, artificial intelligence, robotics, nanotechnology, space,

我們也有七天的執行計畫。

and address how we can cross-train and leverage these

接下來的幾個月是「未來醫學」

to impact major unmet goals.

這個計畫能協助跨學科訓練並將技術運用到醫學上。

We also have seven-day executive programs.

我剛提到了手機。

And coming up next month is FutureMed,

這些手機擁有超過兩萬個不同的應用程序

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

甚至英國還設計了一種應用程式

Now, I mentioned the phone.

你可以把一片小晶片連上你的 iPhone，然後在晶片上小便

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

看看你是不是得了性病。

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

我不知道我會不會試，不過是有這樣的程式可以用。

connect it to your iPhone,

還有其他的應用程式能讓手機有診斷功能。

and check for an STD.

例如說如果你有糖尿病

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

你可以用iPhone來測量血脂

There are other sorts of applications.

然後把數據發給你的醫師

Merging your phone and diagnostics, for example,

所以你和醫生都能更了解你的血糖狀況。

measuring your blood glucose on your iPhone

讓我們看看整合科技是如何應用在保健用途上。

and sending that to your physician,

讓我們從速度開始。

so they can better understand and you can better understand

我們都知道，就如摩爾定律所說的

your blood sugars as a diabetic.

電腦運作的速度越來越快了。

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

所以我們能夠運用它們來做更多事。

Let's start with faster.

電腦的能力越來越接近人腦的能力

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

很多情況下甚至超越了人腦。

are speeding up faster and faster.

但我認為電腦的速度對成像技術的好處最大。

We can do more powerful things with them.

這種用非常高畫素即時地呈現身體內部的技術

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

進步真的是越來越驚人。

the ability of the human mind.

我們正在綜合多種技術, PET掃描、CT掃描和分子診斷

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

來發現和尋找所在位置不同的東西。

The ability now to look inside the body in real time

你現在看到的是今天MRI掃描技術以極高畫素重建的馬克.霍頓希的頭像

with very high resolution

他是TED醫學會議的管理者。

is really becoming incredible.

現在我們可以以前所未有的的像素和能力來看大腦內部

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

從根本上學會如何重建、甚至重新設計、或是逆向設計大腦

and molecular diagnostics --

因此我們能更了解病變，疾病和治療方法。

to find and seek things at different levels.

我們能用fMRI即時來觀察大腦內部。

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

通過理解這些過程和聯繫

of Marc Hodosh, the curator of TEDMED.

我們能夠瞭解藥物和冥想所帶來的影響

And now we can see inside of the brain

改善個人化治療、提高功效

at a resolution and ability never before available,

例如說，更符合個人需求、更有效的精神藥物。

and essentially learn how to reconstruct and maybe even reengineer

fMR用的掃描器現在變得更小更輕便，也不像過去那樣昂貴。

or backwards engineer the brain,

從這些掃描器得到的數據實在太多

so we can better understand pathology, disease and therapy.

很快地會造成很大的問題。

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

現在的掃描佔用了800本書的空間或者20G。

And by understanding these sorts of processes and these connections,

幾年後的掃描將會佔用1T或者800000本書的空間。

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

我們該如何去利用這些信息呢？

and better personalize and make effective, for example,

讓我們從自己的例子說起吧。我不會問這裡誰做過結腸檢查，

psychoactive drugs.

但是如果你大於50歲，那麼該是你檢查結腸的時候了。

The scanners for these are getting smaller, less expensive

你怎麼避開結腸鏡的尖端呢？

and more portable.

現在有一種虛擬的結腸鏡檢查。

And this sort of data explosion available from these

比較這兩張圖，作為放射科醫生

is really almost becoming a challenge.

你可以檢查你病人結腸的內部

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

藉由人工智慧的協助

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

找出可能受傷的部位，就像你在這裡所看到的損傷。

How do you leverage that information?

我們以前可能會錯過這種損傷，但是藉由在放射科中用人工智能

Let's get personal.

我們能找到我們以前沒發現的損傷。

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

這可能會讓以前不願做結腸檢查的人願意檢查。

it's time for your screening colonoscopy.

這是一個診療方式轉變的例子。

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

我們正朝向一個生物醫學、信息技術和無線網路的整合時代

Now there's essentially virtual colonoscopy.

而且我會說是「整合機動式」時代，也就是數位醫學的時代。

Compare those two pictures.

所以甚至我的聽診器都是數位的。

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

當然，它有個應用程序。

and augmenting that with artificial intelligence,

我們正走向《星際奇航記》裡出現的那個「影音分析儀」的時代。

potentially identify a lesion that we might have missed,

這種手持超音波儀器正超越而且取代聽診器。

but using AI on top of radiology,

這種儀器過去的價位是十萬英鎊或幾十萬美元

we can find lesions that were missed before.

現在只要大約五千美元

Maybe this will encourage people to get colonoscopies

我就能買得起這樣一個功能強大的診斷儀器。

that wouldn't have otherwise.

我們正把這個裝置和電子醫療記錄結合起來

This is an example of this paradigm shift.

在美國，電子化醫療紀錄仍然少於百分之二十。

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

我想在荷蘭應該高於百分之八十。

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

但是我們現在轉到結合醫療數據，

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

把數據電子化，

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

如此我們就能整合資訊。

So the handheld ultrasound is basically surpassing

現在作為一名醫生，不論在哪裡

and supplanting the stethoscope.

透過這些移動設備，我就能得到病人的數據。

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

當然，我們正處在iPad,甚至iPad2的時代。

or a couple hundred-thousand dollars.

就在上個月美國食品藥品管理局首度通過的應用程序

For about 5,000 dollars,

證實可以讓放射科醫生直接在這些設備上讀數據。

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

所以肯定的是，現今的醫生，包括我自己

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

已經完全離不開這些設備了。

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

正如你們大約一個月前所看到的

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

來自IBM的華生在益智節目「危險邊緣」中擊敗了兩位冠軍。

Now that we're switching to merging medical data,

因此我要你們想像當我們在幾年內開始採用雲端資訊

making it available electronically,

並真正有了人工智慧醫生連接到我們的大腦

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

我們做的決定和診斷會和過去全然不同。

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

你們現在在很多情況下已經不需要去看醫生了。

just through my mobile device.

只有大約百分之二十的狀況下醫生才會用到手來做診療。

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

我們正處在虛擬診療的時代

Just last month,

從使用Skype到American Well來做線上看病

the first FDA-approved application was approved

到思科研製的非常精密的健康診斷系統。

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

這種和你的醫師的互動能力是有別於以往的。

So certainly, the physicians of today, including myself,

現在因為有這些設備我們的能力更是提高了。

are completely reliable on these devices.

這是我的朋友傑西卡傳給我的她頭部裂傷的圖片

And as you saw just about a month ago,

所以她不用來急診室，我能通過看照片來診斷。

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

或許我們能利用現今的遊戲技術

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

比如微軟Kinect來進行診斷。

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

例如在診斷中風時，

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

用簡單的移動偵測儀器和幾百元的設備就可以進行檢測。

to make decisions and diagnostics at a level never done.

我們現在實際上能用機器人來看病。

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

如果我是一名血液病專家

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

可以用這台RP7到另一家診所或醫院看診。

We're now in the era of virtual visits.

這種能提升診療效率的整套工具其實現在在家就找的到。

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

所以想像一下，我們已經擁有無線網路體重計。

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

你可以站在體重計上

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

你可以把你的體重用Tweet告訴你的朋友，他們能幫你保持身材。

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

我們有無線網絡血壓器。

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

我們正在整合這所有的技術。

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

所以我們不用戴這些雜七雜八的裝置，而是可以把他們變成一個貼片。

and do diagnostics that way.

這是我在史丹福的一個同事發明的iRhythm。

Or maybe we can leverage today's gaming technology,

它完全取代了先前的技術，而且價格低很多，效率更好。

like the Microsoft Kinect,

現在我們正處於自我量化的時代。

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

人們可以買幾百元的裝置

using simple motion detection, using $100 devices.

像這個小FitBit。

We can actually now visit our patients robotically.

我可以量化我的步數和我的卡路里消耗。

This is the RP7;

我可以每天都從這些數據了解一些事情。

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

我可以把數據和朋友，醫生分享。

These are being augmented by a whole suite of tools

現在有一種手錶可以測量你的心律，叫Zeo睡眠偵測器。

actually in the home now.

它能讓你使用這些資訊對自身的健康更了解。

We already have wireless scales.

當我們開始整合這些資訊

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

我們就會更知道用它做什麼，更了解我們的病狀和身心健康。

they can keep you in line.

現在甚至有一種鏡子可以測量你的脈搏率。

We have wireless blood pressure cuffs.

我認為，在未來，我們衣服裡會有可以穿戴的裝置

A whole gamut of technologies are being put together.

全天候檢測我們的身體。

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

就像我們現在車裏的OnStar系統，

This was developed at Stanford.

紅燈會亮起，雖然它不會說「去檢查引擎」

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

但它會說去「檢查你的身體」

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

回家好好照顧自己。

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

也許幾年後

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

你照鏡子時鏡子會幫你看病。

I can measure my steps, my caloric outtake.

家裡有小孩的

I can get insight into that on a daily basis

你會想要這種會幫你的無線尿布吧...

and share it with my friends or physician.

我想你不需要這麼多資訊。

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

但是這一天會來的。

a suite of tools that enable you to leverage

今天我們已經聽了很多新技術和技術整合。

and have insight into your own health.

我認為有些技術會使我們和病人更接近

As we start to integrate this information,

有更多時間表達我們對病人的關懷。

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

這些技術能夠提供這樣的幫助。

into our own pathologies, health and wellness.

我們談到了一些能幫助患者的科技

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

那麼科技如何幫助醫生呢？

And I would argue, in the future,

我們正處在「超強化外科醫生」的時代。

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

他們能進入身體內部

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

用機器人做手術，這現在已經可以做到了。

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

這種水平即使是短短五年前都不太可能達到的。

and you'll go get it taken care of.

現在這種技術還因為多重影像技術，例如「增像技術」得到提升。

Probably in a few years,

所以醫生能通過他們的鏡頭看到患者的內部

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

看腫瘤在哪裡，血管在哪裡。

(Laughter)

除此之外，「決策支持」這個技術也可以和「機器手術」做整合。

For those of you with kiddos at home,

例如說，在紐約的醫生可以幫阿姆茲特丹的醫生。

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

我們正在步入一個叫做NOTES的真正無疤手術的時代。

(Laughter)

機器內窺鏡能穿過胃部切除膽囊

More information, I think, than you might need,

不會留下疤痕，過程也是機器化的。

but it's going to be here.

這是即將被採用的技術。

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

基本上是一種無疤手術

And I think some of these technologies

拜機器化手術之賜。

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

除了控制機器手，我們還能控制其他東西嗎？

and do the important human-touch elements of medicine,

對於身障人士，那些半身不遂的人

as augmented by these technologies.

有一種能讓人腦和電腦互動的技術叫做BCI。

Now, we've talked about augmenting the patient.

在四肢癱瘓者的大腦皮層運動區植入晶片

How about augmenting the physician?

他們就能控制滑鼠指標、輪椅或者機器手臂。

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

這些晶片現在做得越來越小

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

越來越多患者體內都能夠放入這種晶片。

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

這種技術仍在臨床階段，但想像一下

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

當我們將這些技術結合令人驚歎的仿生學假肢

like augmented reality.

像卡門院長和他的同事設計的DEKA手臂

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

有17種不同的移動方式和靈活度

where the tumor is, where the blood vessels are.

能使失去肢體的人比以前更靈巧。

This can be integrated with decision support.

我們實際上真正進入到了可穿的機器人時代。

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

如果你手腳完好，但是你得了中風

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

你可以穿這些假肢。

where the robotic endoscope can come out the stomach