Any guesses? 1816.

猜猜看? 答案是1816年。

And what I can say is, in 2016,

我預測到2016年，

doctors aren't going to be walking around with stethoscopes.

醫生就不會再帶聽診器了。

There's a whole lot better technology coming,

未來科技將更加精良，

and that's part of the change in medicine.

醫療科技的變革亦然。

What has changed our society

在過去，無線設備

has been wireless devices.

改變了我們的社會，

But the future are digital medical wireless devices, OK?

而未來，數位醫療無線設備是必然趨勢。

So, let me give you some examples of this

我可以用一些例子

to kind of make this much more concrete.

來具體說明。

This is the first one. This is an electrocardiogram.

首先，這是一張心電圖。

And, as a cardiologist, to think that you could see in real time

身為一位心臟專科醫師，試想不論在世上任何地方，

a patient, an individual, anywhere in the world

你都能在第一時間，用智慧型手機，

on your smartphone,

判讀病患的心電圖，

watching your rhythm -- that's incredible,

這是多麼不可思議，

and it's with us today.

今天我們辦到了，

But that's just the beginning.

但這只是個開始。

You check your email while you're sitting here.

坐在這裡的同時你也在檢查電子郵件，

In the future you're going to be checking all your vital signs,

未來你可以檢查你的生命徵象，

all your vital signs: your heart rhythm,

所有生命徵象，包括心跳、

your blood pressure, your oxygen, your temperature, etc.

血壓、血氧量及體溫等等。

This is already available today.

這些數據現在垂手可得。

This is AirStrip Technologies.

這是遠端醫療監測服務(AirStrip Technologies公司提供)。

It's now wired -- or I should say, wireless --

目前是有線的，如果從彙集醫院，

by taking the aggregate of these signals

加護病房裡的訊號，

in the hospital, in the intensive care unit,

再匯入醫生的智慧型手機這一點來看，

and putting it on a smartphone for physicians.

那我應該說它是無線的。

If you're an expectant parent,

如果你即將為人父母，

what about the ability to monitor, continuously,

要是能夠持續觀察監測

fetal heart rate, or intrauterine contractions,

胎兒的心跳或子宮收縮，

and not having to worry so much that things are

不用太過擔心懷孕的過程，

fine as the pregnancy,

一直到生產的那天，

and moving over into the time of delivery?

那會如何呢?

And then as we go further,

我們再來看看，

today we have continuous glucose sensors.

現有的連續式血糖感應器，

Right now, they are under the skin,

目前是植入在皮膚底下的。

but in the future, they won't have to be implanted.

但是未來不再需要植入體內了。

And of course, the desired range -- trying to keep glucose

理想的狀況是把血糖值控制在

between 75 and less than 200,

75 到 200 之間，

checking it every five minutes in a continuous glucose sensor --

每五分鐘檢查一次血糖感應器。

you'll see how that can impact diabetes.

可以想見這對糖尿病患影響有多大。

And what about sleep?

那麼在睡眠方面呢?

We're going to zoom in on that a little bit.

現在來稍微深入看看睡眠。

We're supposed to spend a third of our life in sleep.

我們一生中有三分之一都在睡覺，

What if, on your phone,

要是接下來的幾個禮拜

which will be available in the next few weeks,

你每分鐘的睡眠狀況

you had every minute of your sleep displayed?

都可以顯示在手機上呢?

And this is, of course, as you can see, the awake is the orange.

如您所見，橘色代表清醒狀態。

The REM sleep, rapid eye movement,

綠色是REM，快速動眼期，

dream state, is in light green;

也就是夢發生的時期。

and light is gray, light sleep;

灰色是淺眠期。

and deep sleep, the best restorative sleep,

還有，最有助於恢復精神的深眠期

is that dark green.

是深綠色。

How about counting every calorie?

那麼，計算卡路里呢?

And this is ability, in real time, to actually take

藉由類似OK蹦的東西就可以

measurements of caloric intake

即時測量所攝取

as well as expenditure, through a Band-Aid.

及消耗的卡路里。

Now, what I've talked about are physiologic metrics.

到目前為止，我所談的都僅只於生理指標。

But what I want to get to, the next frontier,

接下來我要談談新的領域，

very quickly, and why the stethoscope

我也會說明為什麼聽診器

is on its way out,

正快速的被淘汰，

is because we can transcend listening to the valve sounds,

奇異公司研發的手持超音波掃描儀，

and the breath sounds, because now,

讓聽診不再僅侷限於

introduced by G.E. is a handheld ultra-sound.

辨識心臟瓣膜音及呼吸音。

Why is this important? Because this is so much more sensitive.

這項技術為什麼如此重要? 因為它非常的敏感。

Here is an example of an abdominal ultrasound,

來看看幾個例子，腹部超音波，

and also a cardiac echo, which can be sent wireless,

可以無線傳送的心臟超音波，

and then there's an example of fetal monitoring on your smartphone.

及使用智慧型手機進行胎兒監測。

So, we're not just talking about physiologic metrics --

現在談的不只是測量重要生命徵象、

the key measurements of vital signs,

生理指標數據、

and all those things in physiology -- but also all the imaging

生理機能，而是同時能

that one could look at in your smartphone.

在智慧型手機上看到影像。

Now, this is an example of another obsolete technology,

這是另一個會被淘汰的科技，

soon to be buried: the Holter Monitor.

很快將被遺忘的24小時心電圖。

Twenty-four hour recording, lots of wires.

可以全天候監測紀錄，有很多電線。

This is now a little tiny patch.

現在這小小的貼片將取代它。

You can put it on for two weeks

這貼片可以貼在身上兩周。

and send it in the mail.

記錄的數據可以透過email傳送。

Now, how does this work? Well,

這是如何辦到的?

there is these smart Band-Aids or these sensors

病人在鞋子裡或手腕上穿戴

that one would put on, on a shoe or on the wrist.

這些智慧型OK蹦或感應器

And this sends a signal

它們會發出訊號。

and it creates a body area network to a gateway.

這讓病人的身體成為一個連接到網路通信閘道器的訊息網路

Gateway could be a smartphone or it could be a dedicated gateway,

閘道器可以是智慧型手機，或專用的閘道器，

as today many of these things are dedicated gateways,

現在專用閘道器仍普遍使用，

because they are not so well integrated.

因為兩者尚未整合好。

That signal goes to the web, the cloud,

訊號傳到網路，也就是雲端，

and then it can be processed and sent anywhere:

這些數據會被處理

to a caregiver, to a physician,

並傳送給護士、醫生

back to the patient, etc.

或是病人自己…，等等。

So, that's basically very simplistic technology

基本上這一項技術的運作方式

of how this works.

其實很簡單。

Now, I have this device on.

現在我身上就貼了這個感應器。

I didn't want to take my shirt off to show you, but I can tell you it's on.

我不會把襯衫脫下來給各位看，但是我身上真有一個。

This is a device that not only measures cardiac rhythm,

這個裝置不只能夠測量心律，

as you saw already,

如同您已經看到的，

but it also goes well beyond that.

它可以做的事情遠超過這些。

This is me now. And you can see the ECG.

您現在看到的是我的心電圖。

Below that's the actual heart rate and the trend;

下方是我的心跳速率及模式，

to the right of that is a bioconductant.

右邊的是生理參數，

That's the fluid status,

它反映的是體液的狀態，

fluid status, that's really important

對於監測心臟衰竭的病患

if you're monitoring somebody with heart failure.

體液狀態尤其重要。

And below that's temperature,

下方是體溫、

and respiration, and oxygen,

呼吸、及血氧量，

and then the position activity.

還有我的身體活動姿勢。

So, this is really striking, because this device

這真是非常了不起!

measures seven things

因為這個裝置可以同時

that are very much vital signs

監測心臟衰竭病患的

for monitoring someone with heart failure. OK?

七個重要生命徵象。

And why is this important? Well,

為什麼這很重要？

this is the most expensive bed.

這是一張費用最昂貴的病床，

What if we could reduce the need for hospital beds?

要是可以減少對病床的需求會如何呢？

Well, we can. First of all, heart failure

事實上辦不到。因為心臟衰竭

is the number one reason

是美國病患住院及

for hospital admissions and readmissions in this country.

再度住院的首要原因。

The cost of heart failure is 37 billion dollars a year,

每年花在治療心臟衰竭的費用高達370億美元，

which is 80 percent related to hospitalization.

其中80%與住院有關。

And in the course of 30 days after a hospital stay

醫療保險Medicare支付30天的住院療程，

for a Medicare greater than 65 years or older,

其65歲以上的病患出院後

is -- 27 percent are readmitted in 30 days,

30天內再住院率是27%。

and by six months, over 56 percent are readmitted.

6個月內再度住院率超過56%。

So, can we improve that? Well the idea is

這個狀況可以改善嗎？有個臨床實驗是

we take this device that I'm wearing,

把我身上的裝置隨機

and we put it on 600 patients with heart failure,

裝在600位心臟衰竭患者身上，

randomly assigned, versus 600 patients

與600位沒有裝感應器的

who don't have active monitoring,

心臟衰竭患者作比較，

and see whether we can reduce heart failure readmissions,

觀察是否可以降低病患的再住院率。

and that's exciting. And we'll start that trial,

這很令人興奮，這個實驗即將開始，

and you'll hear more about how we're going to do that,

您會聽到實驗進展的消息。

but that's a type of wireless device trial

這只是未來幾年改變醫療的

that could change medicine in the years ahead.

無線裝置實驗的其中一種。

Why now? Why has this all of a sudden become

為何是現在？為何這令人振奮

a reality, an exciting direction in the future of medicine?

的醫療發展新走向突然瞬間成真？

What we have is, in a way, a perfect positive storm.

這是因為一場積極正面的醫療變革，促成了

This sets up consumer-driven healthcare.

消費者導向醫療照護的形成，

That's where this is all starting.

一切就是由此開始的。

Let me just give you specifics about why this is

假如您尚未知悉，容我向各位報告

a big movement if you're not aware of it:

為什麼這是一場巨大變革的細節。

1.2 million Americans

有120萬美國人擁有

have gotten a Nike shoe, which is a body-area network

具身體訊息網路功能的Nike運動鞋，

that connects the shoe, the sole of the shoe to the iPhone, or an iPod.

鞋底的感應器可以連結到iPhone或iPod。

And this Wired Magazine cover article

這篇《連線》雜誌的封面文章

really captured a lot of this; it talked a lot about the Nike shoe

對此詳盡報導，文中對Nike運動鞋著墨甚多，

and how quickly that's been adopted to monitor exercise physiology

談到它快速的被用於監測運動生理狀態

and energy expenditure.

及能量消耗。

Here are some things, the principles

有些該銘記於心的

that are guiding principles to keep in mind:

指導原則：

"A data-driven health revolution

「一場由數據主導的健康革命

promises to make us all

承諾藉著密切掌控數據，

better, faster, and stronger. Living by numbers."

將使我們活的更好、更快、更強壯。」

And this one, which is really telling,

《連線》雜誌的七月號刊的

this was from July, this cover article:

封面文章說：

"The personal metrics movement goes way beyond

「這場生理指標數值個人化的變革

diet and exercise. It's about tracking every facet

將遠超越飲食、運動的用途，它可以365天，

of life, from sleep to mood to pain,

24小時，全年無休追蹤睡眠、

24/7/365."

情緒、疼痛等身體的各個面向。」

Well, I tried this device.

我試用過這個裝置。

A lot of you have gotten that Phillips Direct Life.

大部分的人用的是飛利浦的 Direct Life，

I didn't have one of those,

我用的不是Direct Life，

but I got the Fitbit.

而是Fitbit（隨身生活記錄器）

That looks like this.

就是這個，

It's like a wireless accelerometer, pedometer.

它像是無線的加速度計或計步器。

And I want to just give you the results of that testing,

我要測試一下讓大家看看結果，

because I wanted to understand about the consumer movement.

我想要了解消費者運動。

I hope the, by the way, the Phillips Direct Life works better --

喔，我希望飛利浦的Direct Life比較好用，

I hope so.

我說真的。

But this monitors food, it monitors activity and tracks weight.

Fitbit可以監測食物、活動、體重。

However you have to put in most of this stuff.

但大部分你得自己輸入；

The only thing it really tracks by itself is activity,

它唯一自動追蹤監測的是活動，

and even then, it's not complete.

即便如此，它仍然不夠完善。

So, you exercise and it picks up the exercise.

你運動，它會記錄下來，

You put in your height and weight, it calculates BMI,

你輸入身高、體重，它會計算BMI，

and of course it tells you how many calories you're expending

運動時它會告訴你耗盡了多少熱量，

from the exercise, and how many you took in,

如果輸入你吃的所有食物，

if you go in and enter all the foods.

它會告訴你攝取了多少熱量。

But it really wants you to enter all your activity.

重點是要輸入你所有的活動，

And so I went to this,

我用了Fitbit，

and of course I was gratified that it picked up

也很滿意它記錄了

the 42 minutes of exercise, elliptical exercise I did,

我做的42分鐘的簡單的運動。

but then it wants more information.

但是它要求的更多，

So, it says, "You want to log sexual activity.

它說：「輸入你的性行為；

How long did you do it for?"

活動持續多久？」

(Laughter)

（觀眾笑聲）

And it says, "How hard was it?"

「有多困難？」（雙關語:有多硬？）

(Laughter)

（觀眾笑聲）

Furthermore it says, "Start time."

「開始時間。」

Now, this doesn't appear -- this just doesn't work,

我沒有輸入...這樣不行啊，

I mean, this just doesn't work.

這樣根本行不通啊。

So, now I want to move to sleep.

好，現在來談睡眠，

Who would ever have thought you could have your own EEG

誰想到過在自己家裡，

at your home, tagged to a very nice alarm clock, by the way?

可以有個附腦波監測器的鬧鐘。

This is the headband that goes with this alarm clock.

這是這個鬧鐘的頭帶，

It monitors your brainwaves continuously, when you're sleeping.

你睡覺的時候，它會持續監測你的腦波。

So, I did this thing for seven days

為了準備TEDMed的演講

getting ready for TEDMed.

我試了這個裝置七天。

This is an important part of our life, one-third you're supposed to be sleeping.

睡眠是人生的重要部分，一生中有1/3在睡覺。

Of course how many here

在座各位有多少

have any problems with sleeping?

有睡眠方面的問題？

It's usually 90 percent. So, you tell me you sleep better than expected.

通常是90%，所以在座各位都睡的不錯喔!

Okay, well this was a week of

好，這是我一個禮拜的

my life in sleeping,

睡眠狀況。

and you get a Z.Q. score. Instead of an I.Q. score,

這是睡眠商數，不是智力商數，

you get a Z.Q. score when you wake up.

一早醒來你會知道你的睡眠商數。

You say, "Oh, OK." And a Z.Q. score

你可能會想：「嗯，好。」

is adjusted to age,

睡眠商數隨年齡而易，

and you want to get as high as you possibly can.

得分越高越好。

So this is the moment-by-moment,

這個圖片顯示的是

or minute-by-minute sleep.

每分鐘的睡眠狀況。

And you see that Z.Q. there was 80-odd.

你可以看到我得了80幾分，

And the wake time is in orange.

橘色代表我醒著的時間。

And this can be a problem, as I learned.

我發現這樣有問題，

Because it not only helps you with quantifying

因為這樣一來它不僅幫助你

your sleep,

把睡眠狀況數據化，

but also tells others you're awake.

同時也告訴別人你醒著。

So, when my wife came in and she

當我太太走進房間

could tell you're awake.

她知道我是醒著的。

"Eric, I want to talk. I want to talk."

「艾瑞克，我有話要說，我有話要說。」

And I'm trying to play possum.

我還在裝睡。

This thing is very, very impressive.

這真的是非常的了不起！

OK. So, that's the first night.

好，這是第一個晚上，

And this one is now 67,

我的分數是67分，

and that's not a good score.

這個分數不是很好。

And this tells you, of course, how much you had in REM sleep,

這個裝置還告訴你在快速動眼期、

in deep sleep, and all this sort of thing.

深眠期和各個狀態的睡眠時間。

This was really fascinating because

這真的非常吸引人，

this gave that quantitation

因為它對睡眠的

about all the different phases of sleep.

各個階段作定量分析。

So, it also then tells you how you do compared to your age group.

同時也把你和同年齡的人比較一番，

It's like a managed competition of sleep.

好像睡眠大賽似的。

And really interesting stuff.

這個裝置真的很有趣。

Look at this thing and say, "Well, I didn't think I was a very good sleeper,

我看著它心裡想：「嗯，我睡覺睡得不怎麼樣嘛！

but actually I did better than average in 50 to 60 year olds." OK?

但是比起一般五、六十歲的人，我表現的還不賴喔！」

And the key thing was, what I didn't know,

我以前所不知道的是，

was that I was a really good dreamer.

我睡覺時作很多夢。

OK. Now let's move from sleep to diseases.

好，談完了睡眠，來看看疾病。

Eighty percent of Americans have chronic disease,

80%的美國人有慢性病，