we can now fit one billion.

過去可容納一個電晶體的空間，

That made it so that a computer the size of an entire room

我們現在可以放進 10 億個。

now fits in your pocket.

這使得過去一個房間大小的電腦

You might say the future is small.

現在可以放進你的口袋裡了。

As an engineer,

你可能會說，未來的東西會是小的。

I'm inspired by this miniaturization revolution in computers.

身為一位工程師，

As a physician,

我被這個電腦的 微型化革命所啟發。

I wonder whether we could use it to reduce the number of lives lost

而身為一位醫師，

due to one of the fastest-growing diseases on Earth:

我在想，我們是否可以利用它來降低

cancer.

癌症 ─ 地球上成長最快速的疾病之一 的死亡人數。

Now when I say that,

現在，當我這樣說時，

what most people hear me say is that we're working on curing cancer.

大部份聽到的人會說， 我們是研究癌症治療的。

And we are.

的確是！

But it turns out

但事實上，

that there's an incredible opportunity to save lives

有一個不可思議的機會 可以拯救生命，

through the early detection and prevention of cancer.

就是藉由癌症的早期發現與預防。

Worldwide, over two-thirds of deaths due to cancer are fully preventable

全球因癌症死亡的病例 超過 2/3 是可預防的 ，

using methods that we already have in hand today.

經由使用我們現今已有的方法，

Things like vaccination, timely screening

像是接種疫苗、定期篩檢，

and of course, stopping smoking.

當然，戒菸也是。

But even with the best tools and technologies that we have today,

但即使現在我們已經有 最好的工具與科技，

some tumors can't be detected

某些腫瘤要開始成長十年後 才能被偵測出來，

until 10 years after they've started growing,

那時的癌細胞已多達 5 千萬個了。

when they are 50 million cancer cells strong.

要是我們有更好的科技，

What if we had better technologies

可以更早偵測到更多這些致命的癌症，

to detect some of these more deadly cancers sooner,

也就是在它們可以被移除

when they could be removed,

或剛長出時，那該有多好？

when they were just getting started?

讓我向各位說明 微型化科技將如何讓我們做到。

Let me tell you about how miniaturization might get us there.

這是一般實驗室裡的一台顯微鏡，

This is a microscope in a typical lab

病理學家用它來觀察組織的樣本，

that a pathologist would use for looking at a tissue specimen,

例如活體切片或子宮頸抹片檢查。

like a biopsy or a pap smear.

這台 $7000 美金的顯微鏡 ，

This $7,000 microscope

會被某些受多年專業訓練的人

would be used by somebody with years of specialized training

用來找出癌細胞。

to spot cancer cells.

這一張圖是來自我的 一位萊斯大學的同事

This is an image from a colleague of mine at Rice University,

麗貝卡·理查茲卡頓，

Rebecca Richards-Kortum.

她和她的團隊所做的 就是把顯微鏡縮小成為一個

What she and her team have done is miniaturize that whole microscope

價值十元的零件，

into this $10 part,

並且可以裝在光纖的末端上。

and it fits on the end of an optical fiber.

意思是，不需要從病人身上取出檢體，

Now what that means is instead of taking a sample from a patient

送到顯微鏡下觀察，

and sending it to the microscope,

而是你可以把顯微鏡放到病人體內。

you can bring the microscope to the patient.

並且，不需要專家來檢視影像，

And then, instead of requiring a specialist to look at the images,

你可以訓練電腦區分 正常細胞與癌症細胞。

you can train the computer to score normal versus cancerous cells.

這很重要，

Now this is important,

因為他們發現在郊區工作，

because what they found working in rural communities,

即使有一台行動篩檢箱型車，

is that even when they have a mobile screening van

可以開到社區裡進行檢查，

that can go out into the community and perform exams

及收集檢體

and collect samples

並把它們送回醫院做分析，

and send them to the central hospital for analysis,

過幾天後，

that days later,

受測女士們接到 檢查結果不正常的電話，

women get a call with an abnormal test result

並被要求到醫院來，

and they're asked to come in.

但她們至少有一半不會來， 因為付不起旅費。

Fully half of them don't turn up because they can't afford the trip.

藉由整合顯微鏡與電腦分析，

With the integrated microscope and computer analysis,

麗貝卡和她的同事 已經可以做出一台

Rebecca and her colleagues have been able to create a van

同時具有診斷與治療設施的廂型車。

that has both a diagnostic setup and a treatment setup.

意思就是，他們可以直接在現場

And what that means is that they can do a diagnosis

做診斷與治療，

and perform therapy on the spot,

這樣就沒人會錯過追蹤了。

so no one is lost to follow up.

這僅是一個微型化科技 如何拯救人命的案例之一。

That's just one example of how miniaturization can save lives.

身為工程師，

Now as engineers,

我們認為這就是微型化，

we think of this as straight-up miniaturization.

你把一個大的東西變小了。

You took a big thing and you made it little.

但我稍早跟各位提到 有關於電腦

But what I told you before about computers

改變了我們的生活，

was that they transformed our lives

當它們變得 小到可以讓我們帶到任何地方時。

when they became small enough for us to take them everywhere.

在醫學上， 有什麼東西是相對等的改變呢？

So what is the transformational equivalent like that in medicine?

如果你有一個偵測器，

Well, what if you had a detector

它小到可以在你的體內循環，

that was so small that it could circulate in your body,

並靠它自己找到腫瘤，

find the tumor all by itself

而且還能把訊號傳到體外呢？

and send a signal to the outside world?

這聽起來有點像科幻小說，

It sounds a little bit like science fiction.

但實際上，奈米科技 已經可以讓我們做到了。

But actually, nanotechnology allows us to do just that.

奈米科技已經讓我們能夠 把製造偵測器的零件

Nanotechnology allows us to shrink the parts that make up the detector

從原本是頭髮寬度即100微米

from the width of a human hair,

縮更小到其 1/1000，

which is 100 microns,

也就是100奈米。

to a thousand times smaller,

這樣就有很大的影響了，

which is 100 nanometers.

也就是說，材質實際上 以奈米規格改變其特性。

And that has profound implications.

就拿黃金這個普遍的材質來說，

It turns out that materials actually change their properties

當你把黃金磨到奈米粒子的大小，

at the nanoscale.

它會從金色變成紅色。

You take a common material like gold,

如果你再拿一個更奇特的材質， 像是硒化鎘 ──

and you grind it into dust, into gold nanoparticles,

一個大而黑的晶體，

and it changes from looking gold to looking red.

若把它製成奈米大小，

If you take a more exotic material like cadmium selenide --

然後放進一種液體裡，

forms a big, black crystal --

並以光線照射它

if you make nanocrystals out of this material

它們會發光。

and you put it in a liquid,

它們會發出藍色、綠色、 黃色、橘色、紅色的光，

and you shine light on it,

僅依據它們的大小不同。

they glow.

這太神奇了！你可想像 這樣一個在宏觀世界裡的物體嗎？

And they glow blue, green, yellow, orange, red,

就好比你衣櫃裡那些 全都是棉製的牛仔褲，

depending only on their size.

會依它們的尺寸大小 而有不同的顏色。

It's wild! Can you imagine an object like that in the macro world?

（笑聲）

It would be like all the denim jeans in your closet are all made of cotton,

所以，身為一位醫師，

but they are different colors depending only on their size.

讓我感興趣的

(Laughter)

不只是材質 會依奈米規格的大小而改變顏色；

So as a physician,

它們在你身體裡面的 運行方式也會改變。

what's just as interesting to me

而我們將運用這種觀察方式

is that it's not just the color of materials

來製作更好的癌症偵測器。

that changes at the nanoscale;

讓我向各位解釋一下，

the way they travel in your body also changes.

這是身體裡面的一條血管，

And this is the kind of observation that we're going to use

圍繞著血管的是一個腫瘤。

to make a better cancer detector.

我們把奈米粒子注射到血管裡面，

So let me show you what I mean.

然後觀察它們如何從 血流中進到腫瘤裡面。

This is a blood vessel in the body.

結果我們看到 許多腫瘤的血管有漏洞，

Surrounding the blood vessel is a tumor.

所以奈米粒子會從血流漏向腫瘤，

We're going to inject nanoparticles into the blood vessel

它們是否會漏出去 取決於它們的大小。

and watch how they travel from the bloodstream into the tumor.

在這影像

Now it turns out that the blood vessels of many tumors are leaky,

較小、100奈米的 藍色奈米粒子正在漏出去，

and so nanoparticles can leak out from the bloodstream into the tumor.

較大、500奈米的紅色奈米粒子

Whether they leak out depends on their size.

則留在血流當中。

So in this image,

所以身為一位工程師，

the smaller, hundred-nanometer, blue nanoparticles are leaking out,

依據我所製作的物質大小，

and the larger, 500-nanometer, red nanoparticles

可改變它在你身體裡的去處。

are stuck in the bloodstream.

在我的實驗室，我們最近 作出一種癌症奈米偵測器，

So that means as an engineer,

它小到可以進入身體並找尋腫瘤，

depending on how big or small I make a material,

我們設計它用來監聽腫瘤的侵犯：

I can change where it goes in your body.

腫瘤需要製造這些 化學訊號的樂音來擴散。

In my lab, we recently made a cancer nanodetector

腫瘤為了要從它長出來的 組織突破出去，

that is so small that it could travel into the body and look for tumors.

它必須製造一種 稱為「酵素」的化學物質，

We designed it to listen for tumor invasion:

來穿破組織架構而出。

the orchestra of chemical signals that tumors need to make to spread.

我們設計這些奈米粒子 可被腫瘤酵素活化，

For a tumor to break out of the tissue that it's born in,

一個酵素一小時內 可活化一千個這種化學反應。

it has to make chemicals called enzymes

用工程術語來說，我們稱這種 1:1000 比率為一種放大率，

to chew through the scaffolding of tissues.

它會變得超靈敏。

We designed these nanoparticles to be activated by these enzymes.

所以我們製造出一種 超靈敏的癌症偵測器，

One enzyme can activate a thousand of these chemical reactions in an hour.

但我要如何把這個活化訊號傳到體外，

Now in engineering, we call that one-to-a-thousand ratio

我要從那裡著手呢？

a form of amplification,

為此，我們要再利用另一個 奈米規格生物學，

and it makes something ultrasensitive.

而這與腎臟有關。

So we've made an ultrasensitive cancer detector.

腎臟是一種過濾器，

OK, but how do I get this activated signal to the outside world,

它的功能就是將廢物 從血液濾出並排入尿液，

where I can act on it?

其實腎臟所過濾的物質

For this, we're going to use one more piece of nanoscale biology,

也是根據大小而定。

and that has to do with the kidney.

所以在這影片，各位可以看到

The kidney is a filter.

任何小於 5 奈米的物質，

Its job is to filter out the blood and put waste into the urine.

會從血液通過腎臟而排入尿液，

It turns out that what the kidney filters

其他比較大的物質會被留下來。

is also dependent on size.

好，如果我做了一個 100 奈米的癌症偵測器，

So in this image, what you can see

然後把它注射到血流裡面，

is that everything smaller than five nanometers

它會漏入腫瘤裡面， 被腫瘤酵素活化，

is going from the blood, through the kidney, into the urine,

並釋放一種微小訊號，

and everything else that's bigger is retained.

小到可以被腎臟過濾出來，

OK, so if I make a 100-nanometer cancer detector,

然後排到尿液裡面，

I inject it in the bloodstream,

這樣在體外 就有我可以偵測到的訊號了。

it can leak into the tumor where it's activated by tumor enzymes

好，但還有一個問題。

to release a small signal

這是一個很微小的訊號，

that is small enough to be filtered out of the kidney

我要如何偵測呢？

and put into the urine,

訊號其實只是一種分子，

I have a signal in the outside world that I can detect.

是我們工程師設計出來的分子。

OK, but there's one more problem.

它們完全是合成的， 我們可以設計它們，

This is a tiny little signal,

讓它與我們選擇的工具完全相容。

so how do I detect it?

如果我們要用一種 相當靈敏的昂貴設備 ──

Well, the signal is just a molecule.

叫做質譜儀，

They're molecules that we designed as engineers.

那麼我們會製造 一種特定質量的分子。

They're completely synthetic, and we can design them

或許我們想讓它 不那麼昂貴且方便攜帶，

so they are compatible with our tool of choice.

那麼我們會製造 能被試紙抓住的分子，

If we want to use a really sensitive, fancy instrument

就像驗孕一樣。

called a mass spectrometer,

事實上，現在有很多的試紙測試方法，

then we make a molecule with a unique mass.

已廣泛應用在「試紙診斷」領域了。

Or maybe we want make something that's more inexpensive and portable.

好的，我們做這個有什麼用處呢？

Then we make molecules that we can trap on paper,

接下來我要告訴各位的是

like a pregnancy test.

身為一位終身研究員，

In fact, there's a whole world of paper tests

我想對各位訴說我的夢想。

that are becoming available in a field called paper diagnostics.

我不能說這是個承諾；

Alright, where are we going with this?

但它至少是個夢想。

What I'm going to tell you next,

我認為我們都必須有夢想 來讓我們向前邁進，

as a lifelong researcher,

甚至，特別是癌症研究人員。

represents a dream of mine.

我要告訴各位我期望 我的技術將來會有何進展，

I can't say that's it's a promise;

我的團隊和我都會盡心盡力地

it's a dream.

讓這期望成真。

But I think we all have to have dreams to keep us pushing forward,

好的，我要開始了。

even -- and maybe especially -- cancer researchers.

我夢想有一天，

I'm going to tell you what I hope will happen with my technology,

大家不用再使用昂貴的篩檢設備

that my team and I will put our hearts and souls

來做大腸鏡檢查

into making a reality.

或乳房攝影檢查

OK, here goes.

或子宮頸抹片檢查，

I dream that one day,

而是你可能扎一針，

instead of going into an expensive screening facility

等一個小時，

to get a colonoscopy,

然後在試紙上做尿液檢測即可。

or a mammogram,

我想像這甚至

or a pap smear,

不需要穩定的電流 或專業醫療人士在檢驗室裡就可能做到。

that you could get a shot,

或許他們可以遠隔千里

wait an hour,

僅用智能手機連結影像即可。

and do a urine test on a paper strip.

我知道這聽起來像是個夢想，

I imagine that this could even happen

但在實驗室， 我們已經用在老鼠身上了，

without the need for steady electricity,

對於偵測肺癌、大腸癌及卵巢癌， 這比現行方法更有用。

or a medical professional in the room.

而這也意味著我期望

Maybe they could be far away

有一天，在病人腫瘤開始成長的10年內， 我們就可以偵測到。

and connected only by the image on a smartphone.

在各行各業、世界各地的人都能受惠，

Now I know this sounds like a dream,

這會促成早期治療，

but in the lab we already have this working in mice,

藉由早期發現， 我們能比今日拯救更多人的性命。

where it works better than existing methods

謝謝！

for the detection of lung, colon and ovarian cancer.

（掌聲）

And I hope that what this means

is that one day we can detect tumors in patients

sooner than 10 years after they've started growing,

in all walks of life,

all around the globe,

and that this would lead to earlier treatments,

and that we could save more lives than we can today,

with early detection.

Thank you.

(Applause)