1.The problem that I want to talk with you about is really the problem of how does one supply healthcare in a world in which cost is everything.
今天我想和大家一同探讨的问题是 具有现实意义的 即人们如何获得基本的医疗保障 我们都知道，现在是一个成本至上的社会
2.How do you do that?
对于此我们应如何取舍？
3.And the basic paradigm we want to suggest to you, I want to suggest to you is, one in which you say that in order to treat disease you have to first know what you’re treating —
首先，我们来讨论这样一种情况 这个情况是这样的 如果我们想要治疗某种疾病 我们必须先弄清楚这是什么样的一种病
4.that’s diagnostics — and then you have to do something.
只有通过诊断，我们才能进行相应的治疗。
5.So, the program that we’re involved in is something which we call diagnostics for all, or zero-cost diagnostics.
同样，诊断也是我们这个项目的核心问题 这里，称作诊断为先，或零成本诊断。
6.How do you provide medically relevant information at as close as possible to zero cost? How do you do it?
在座的各位或许会问 如何才能提供零成本的医疗信息？
7.Let me just give you two examples.
接下来，我就用两个例子予以说明。
8.The rigors of military medicine are not so dissimilar from the third world, poor resources, a rigorous environment, a series of problems in light weight, and things of this kind.
其实，艰苦的随军医疗 与第三世界的医疗情况甚是相像 两者都面临，匮乏的医疗资源、艰苦的生存环境 及一系列因营养失衡、体重不足，而引起的问题。
9.And also not so different from the home healthcare and diagnostic system world.
同样，两者在普通医疗保健 和诊断方面也没有太大的区别。
10.So, the technology that I want to talk about is for the third world, for the developing world, but it has, I think, much broader application,
其实，今天我们在探讨的这项新技术 是非常适合第三世界与发展中国家的。 当然，就我个人而言，我认为它还有更广泛的应用。
11.because information is so important in the healthcare system.
因为准确的疾病诊断信息对疾病的治疗是至关重要的。
12.So, you see two examples here.
来 我们来看看这两张图片
13.One is a lab that is actually a fairly high end laboratory in Africa.
第一张图片是位于非洲的一家高级实验室
14.The second is basically an entrepreneur who is set up and doing who knows what in a table in a market.
第二张则是一位企业家 他正一个集市里做着一些检验工作。
15.I don’t know what kind of healthcare is delivered there.
或许这并没有传达任何有关医疗的信息。
16.But it’s not really what is probably most efficient.
但同时这也说明他所作的并不是最有效的。
17.What is our approach?
我们这一项目的目标是什么？
18.And the way in which one typically approaches a problem of lowering cost, starting from the perspective of the United States, is to take our solution,
其实我们最为关注的问题是 如何降低使用成本。 从美国市场的角度来看， 如果我们想要成功推广某一方案
19.and then to try to cut cost out of it.
我们就必须要试图去降低它的成本。
20.No matter how you do that you’re not going to start with 100,000 dollar instrument and bring it down to no cost. It isn’t going to work.
因为，无论这一方案是多么有效 市场也不可能把10万美元的仪器费用， 降至零。 这是不可能办到的。
21.So, the approach that we took was the other way around.
所以，我们采用了另外的方法来出奇制胜。
22.To ask, “What is the cheapest possible stuff that you could make a diagnostic system out of, and get useful information, add function?” And what we’ve chosen is paper.
有人问 “世界上什么材料最廉价且适用于制造诊断疾病的仪器， 同时能提供有用的信息， 而且能增添功能？“ 对这一问题，我们的答案是纸张。
23.What you see here is a prototypic device.
现在大家看到的是，用纸做的诊断设备的模型
24.It’s about a centimeter on the side.
它的宽度约为1厘米
25.It’s about the size of a fingernail.
大小与我们的指甲差不多
26.The lines around the edges are a polymer.
纸上的线条来自于 一种聚合物（可与被测物质相互反应，随后产生一系列的物理、化学变化）
27.It’s made of paper, and paper of course wicks fluid.
这是纸质的，而纸是有吸附功能的。
28.As you know, paper, cloth, drop wine on the table cloth, and the wine wicks all over everything.
众所周知，纸啊，布料啊，可以吸收液体。 例如，我们不小心把酒洒在了桌布上，那么桌布会一片狼藉。
29.Put it on your shirt, it ruins the shirt.
如果弄到了衬衣上，那么衬衣也被弄脏了。
30.That’s what a hydrophilic surface does.
这些现象都反应了纸张的亲水特性。
31.So, in this device the idea is that you drip the bottom end of it in a drop of, in this case, urine.
这也是我们仪器的运作原理。 我们在试片的底部，滴入一滴液体 在这个检测中，我们使用的是尿液
32.The fluid wicks its way into those chambers at the top.
滴入的尿液集中在这个小槽中，
33.The brown color indicates the amount of glucose in the urine.
左边棕色部分显示尿液中葡萄糖的含量
34.The blue color indicates the amount of protein in the urine.
右边蓝色部分则显示尿液中蛋白质的含量
35.And the combination of those two, is a first order shot at a number of useful things that you want.
随后将两部分的信息相结合， 我们便获得 初步所需的检测结果
36.So, this is an example of a device made from a simple piece of paper.
这就是一个用简单的纸张制成的分析仪的例子
37.Now, how simple can you make the production?
现在，我们来看看这类仪器是如何制成的？
38.Why do we choose paper?
第一个问题，为什么选择纸质？
39.There is an example of the same thing, on a finger showing you basically what it looks like.
图片中手指上 呈现的也是类似刚才介绍过的分析仪
40.One reason for using paper is that it’s everywhere.
选择用纸质的首要原因是“纸，无处不在”
41.We have made these kinds of devices using napkins and toilet paper and wraps, and all kinds of stuff.
我们可以用纸做成 餐巾纸，卫生纸等类似的许多其他纸类物品 还有用纸来包装，等等。
42.So, the production capability is there.
所以，产能上基本没有限制。
43.The second is, you can put lots and lots of tests in a very small place.
其次是 “小小一片纸能完成许许多多的测试”
44.I’ll show you in a moment that the stack of paper there would probably hold something like 100,000 tests, something of that kind.
待会，我会给大家讲解一堆纸张如何 可能被用来进行 10万个检验。
45.And then finally, a point that you don’t think of so much in developed world medicine, it eliminates sharps.
最后一个原因，大家往往比较容易忽略 因为在发达国家 我们不太使用针刺的方法来获取检验样本
46.And what sharps means in needles, things that stick.
针刺法就是用针，刺穿皮肤获得检验样本，而残余样本会滞留在针里。
47.If you’ve taken a sample of someone’s blood and the someone might have hepatitis C, you don’t want to make a mistake and stick it in you.
如果我们抽取了某人的血液样本 而那个人可能携带丙肝病毒的血液样本 在检测后，样本是不可以随便遗弃的?
48.It just, you don’t want to do that.
这时，我们就会考虑，
49.So, how do you dispose of that? It’s a problem everywhere.
怎样才能安全有效的清理这些医疗垃圾?
50.And here you simply burn it.
最为简单的方法就是焚烧
51.So, it’s a sort of a practical approach to starting on things.
所以，纸质的检测仪确实是一种实用的方法 来采用
52.Now, you say, if paper is a good idea, other people have surely though of it.
好了 现在 在座的各位都应该认同
53.And the answer is, of course, yes.
纸是非常好用的一种材料，对。
54.Those half of you, roughly, who are women, at some point may have had a pregnancy test.
这里的各位 粗粗看来，一半都是女性 相信大家，可能都经历过验孕测试。
55.And the most common of these is in a device that looks like the thing on the left.
大多数的验孕仪， 就像是左边图片中的那样
56.It’s something called a lateral flow immunoassay.
学术上，我们称之为横向流动免疫测定仪。
57.And in that particular test urine, either containing a hormone called HCG does or does not flow across a piece of paper.
在这一检测中 我们让 可能含有HCG（绒毛膜促性腺激素，荷尔蒙的一种）的尿液 渗透一张试纸来进行检测
58.And there are two bars. One bar indicates that the test is working.
试纸上有两条线
59.And if the second bar shows up, you’re pregnant.
一条是用来显示试纸是否起作用的，另一条是用来检测是否怀孕的。
60.This is a terrific kind of test in a binary world.
这对于新时代而言，这是一项非常赞的发明。
61.And the nice thing about pregnancy is either you are pregnant or you’re not pregnant.
有关怀孕更重要的是 你只能是怀孕了或是没有怀孕
62.You’re not partially pregnant or thinking about being pregnant or something of that sort.
你不可能是不完全的怀孕了，或是正想着而变怀孕了， 或者是其它一些中间状态。
63.So, it works very well there.
对于上述的问题，验孕试纸能给我们很好的回答
64.But it doesn’t work very well when you need more quantitative information.
但却无法给予更多的量化的信息
65.There are also dipsticks.
图片中的这些，同样也是试纸。
66.But if you look at the dipsticks, they’re for another kind of urine analysis.
但，这里的尿样检测 却有了其他的意义
67.There are an awful lot of colors and things like that.
试纸上有许多的颜色， 在不同的情况下，显示不同的结果
68.What do you actually do about that in a difficult circumstance?
在这种复杂的情况下，我们如何办到？
69.So, the approach that we started with, is to ask, is it really practical to make things of this sort?
所以我们采用的办法就是，问我们自己 如何实现纸质检测的构想？
70.And that problem is now, in a purely engineering way, solved.
其实，这个问题只要用简单的工程方法即可解决
71.And the procedure that we have is simply to start with paper.
原材料我们只用到了纸张
72.You run it through a new kind of printer called a wax printer.
然后使用一种叫做“蜡膜打印机”的新型打印机
73.The wax printer does what looks like printing.
这种打印机和普通的打印机，在外表几乎没有区别。
74.It is printing. You put that on, you warm it a little bit.
启动机器，加温蜡盒
75.The wax prints through so it absorbs into the paper.
蜡油便会渗透到纸张内
76.And you end up with the device that you want.
然后，你想要的测试纸就被打印出来了
77.The printers cost 800 bucks now.
这类打印机，现在的售价大概是每台800美元。
78.They’ll make, we estimate that if you were to run them 24 hours a day they’d make about 10 million tests a year.
我估算了一下，如果开足马力，连续工作24小时。 那么，打印后的蜡纸可供一千万的试验用量
79.So, it’s a solved problem. That particular problem is solved.
所以，这个测试纸的构想很好的实现了
80.And there is an example of the kind of thing that you see.
这里我有一个具体的实例
81.That’s on a piece of 8 by 12 paper.
这是由12张纸组成的，可供8次试验的试纸
82.That takes about two seconds to make.
仅用2秒钟制成
83.And so I regard that as done.
十分的迅速
84.There is a very important issue here, which is that because it’s a printer, a color printer, it prints colors. That’s what color printers do.
这里还有一个非常重要的问题， 因为我们用的是彩色打印机 众所周知，彩色打印机可以打印出不同的颜色。
85.I’ll show you in a moment, that’s actually quite useful.
待会，我再说明这个的具体用处。
86.Now, the next question that you would like to ask is what would you like to measure? What would you like to analyze?
大家可能联想到的第二个问题是， 怎样分析、测算试验结果？
87.And the thing which you’d most like to analyze, we’re a fair distance from.
解答前，我还要先澄清一个观点 一直以来，大家想要分析的东西。其实，与我们想要获得的信息是有出入的。
88.It’s what’s called “fever of undiagnosed origin.”
这类似于“发热确诊原因”的情形
89.Someone comes into the clinic, they have a fever, they feel bad, what do they have?
当病人来到诊所时,他们感到发烧，感到不适 他们得了什么病呢？
90.Do they have T.B.? Do they have AIDS?
是肺结核？艾滋？
91.Do they have a common cold?
还是普通感冒？
92.The triage problem. That’s a hard problem for reasons that I won’t go through.
这是个很复杂的问题 其他的可能性，在此不做深究
93.There are an awful lot of things that you’d like to distinguish among.
因为实在是有太多的可能性了
94.But then there are a series of things, AIDS, hepatitis, malaria, TB, others.
但这些病因 如艾滋、肝炎、疟疾 肺结核，等等
95.And simpler ones such as guidance of treatment.
还有包括一些简单的因素，譬如疗程指导。
96.Now even that is more complicated than you think.
还个因素比我们想象的要更复杂。
97.A friend of mine works in trans-cultural psychiatry.
我有一位朋友负责跨文化精神病学的研究。
98.And he is interested in the question of why people do and don’t take their meds.
他对于病人不按时吃药的问题 十分关注
99.So, Dapsone, or something like that, you have to take it for a while.
特别是，例如氨苯砜（抗麻风病的一种药物） 及其他需要长期服用的药物
100.There is a wonderful story of talking to a villager in India.
他告诉我，在印度某个村庄流传着一个非常有意思的故事。
101.And saying, “Have you taken your Dapsone?” “Yes.”
某日，医生问：“你是否服用氨苯砜？”病人答：“是”
102.”Have you taken it every day?” “Yes.”
医生问：“你是每天服用么？”病人答：“是”
103.”Have you taken if for a month?” “Yes.”
医生问：“你是否服用治疗了一个月？”病人答：“是”
104.What the guy actually meant was that he’d fed a 30 day dose of Dapsone to his dog, that morning.
大家知道么，其实，那个病人真正的意思是 他在早晨给自家的狗 喂了30天剂量的氨苯砜
105.(Laughter) He was telling the truth. Because in a different culture, the dog is a surrogate for you, you know, “today,” “this month,” “since the rainy season,”
病人说了实话。 因为在不同的文化背景下， 狗是人类的替代物 对话中使用的，“今天”，“这个月”，“雨季前”
106.there are lots of opportunities for misunderstanding.
也会引发很多的歧义
107.And so an issue here is to in some cases to figure out how to deal with matters that seem uninteresting, like compliance.
这个故事 主要告诉我们 对于枯燥、乏味的沟通 我们更需要明确交流双方的信息详情
108.Now, take a look at what a typical test looks like.
言归正传，我们来看一例典型的测试
109.Prick a finger, you get some blood, about 50 microliters.
首先，扎破无名指， 获得50微毫升的血液样本
110.That’s about all you’re going to get.
这么多的血液就已经足够
111.Because you can’t use the usual sort of systems.
因为，我们无需再使用常规的检测仪器。
112.You can’t manipulate it very well, although I’ll show something about that in a moment.
你一般不能很方便的操纵这么少量的样本 但是，等一下我将具体演示我们是怎样办到的。
113.So, you take the drop of blood, no further manipulations.
好了，你只要提供一滴血液样本
114.You put it on a little device.
然后将血液擦拭在试纸仪器上
115.The device filters out the blood cells, lets the serum go through, and you get a series of colors down in the bottom there.
仪器过滤了血液中的细胞，唯独让血清得以通过 然后，你在试纸层上 观察到了许多的颜色
116.And the colors indicate disease or normal.
这些不用的颜色，显示了相应的疾病信息
117.But even that is complicated.
但是，这些颜色分析起来有些复杂。
118.Because to you, to me, colors might indicate normal.
似乎，对你我而言，这些颜色看上去都挺正常的。
119.But after all we’re all suffering from probably an excess of education.
同样，（在仪器推广使用前）我们都没有过多的精力 进行一定的使用培训
120.What you do about something which requires quantitative analysis?
那么 我们应如何处理需要定量分析的测试呢？
121.And so the solution that we and many other people are thinking about there, and at this point there is a dramatic flourish, and out comes the universal solution to everything these days,
我们和其他很多同行 都想到 当今有一种已非常的流行， 而且已变成能几乎解决所有问题的办法，
122.which is a cell phone. In this particular case, a camera phone.
那就是手机。在我们的这个例子里，是有拍照功能的手机。
123.They are everywhere, six billion a month, in India.
在印度，每月大概有600万的拍照手机用户。
124.And the idea is that what one does, is to take the device.
所以，这个设想就很容易实现。 一张纸质分析仪
125.You dip it. You develop the color.
你涂抹上血样，等到出现检测的颜色。
126.You take a picture. The picture goes to a central laboratory.
然后，拍照上传到中央实验室。
127.You don’t have to send out a doctor.
你不必麻烦医生
128.You send out somebody who can just take the sample.
你只要找个能采取这些信息的人
129.And in the clinic either a doctor, or ideally a computer in this case, does the analysis.
然后，在诊所里，一个医生，或一台智能的电脑 来分析采集到的信息。
130.Turns out to work actually quite well, particularly when your color printer has printed the color bars that indicate how things work.
这个办法的效果非常好， 特别是当彩色打印机已打印出彩色线条，这些有颜色的线条 能让测试过程一目了然。
131.So, my view of the health care worker of the future is not a doctor, but an 18 year old, otherwise unemployed who has two things. He has a backpack full of these tests,
因此，我认为未来的医护人员 并不一定是科班出生的医生 只要他年满18周岁，无其他全职工作。 在背包中有充足的试纸仪器；
132.and a lancet to occasionally take a blood sample, and an AK47.
一把柳叶刀，可用于突发的采血需要； 还有一把AK47
133.And these are the things that get him through his day.
就能解决所有的工作需要和人生安全的问题。
134.There is another very interesting connection here.
这里还有个非常有趣的现象
135.And that is that what one wants to do is to pass through useful information over what is generally a pretty awful telephone system.
那就是 人们如何通过错综复杂的电话系统 传递有用的信息并得到回馈？
136.It turns out there is an enormous amount of information already available on that subject, which is the Mars rover problem.
图片中的火星漫步者 已经成功的处理这一系列的问题
137.How do you get back an accurate view of the color on Mars, if you have a really terrible bandwidth to do it with?
如果你没有足够的带宽来进行测量， 如何才能精确的分析在火星上的颜色呢？
138.And the answer is not complicated but it’s one which I don’t want to go through here, other than to say that the communication systems
这个问题的答案并不难， 但我不想在这里再说一遍了， 我想用这个例子说明的是，用来解决这一问题的信息系统，
139.for doing this are really pretty well understood.
早已存在了。
140.Also, a fact which you may not know, is that the compute capability of this thing is not so different from the compute capability of your desktop computer.
还有一点，我需要指明的就是 手机的计算功能 不比你平时使用的台式机 差多少。
141.This is a fantastic device which is only beginning to be tapped.
因为这是一个神奇的装置，它的巨大潜力才刚刚开启。
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