hopefully converting fear into hope.

今天我所要談的主題

When we go to the physician today --

期盼能在未來化恐懼為希望

when we go to the doctor's office and we walk in,

我們去看醫生的時候

there are words that we just don't want to hear.

當我們走進診療室

There are words that we're truly afraid of.

有些話是我們不想聽到的

Diabetes, cancer, Parkinson's, Alzheimer's,

有些字讓我們深深恐懼

heart failure, lung failure --

像是糖尿病、癌症、帕金森氏症、阿茲海默症

things that we know are debilitating diseases,

心臟衰竭、肺衰竭

for which there's relatively little that can be done.

這些都是大家熟知的衰退性疾病

And what I want to lay out for you today is

對於這些疾病我們卻束手無策

a different way of thinking about how to treat debilitating disease,

今天我所要分享的是

why it's important,

用新的角度來思考衰退性疾病的療法

why without it perhaps our health care system will melt down

這為什麼重要、

if you think it already hasn't,

又為什麼少了它醫療體系將會瓦解

and where we are clinically today, and where we might go tomorrow,

要是你認為醫療體系現在還沒走到這一步

and what some of the hurdles are.

還有目前的臨床成果和可能的未來走向

And we're going to do all of that in 18 minutes, I promise.

有哪些困難需要克服

I want to start with this slide,

我保證一定會在 18 分鐘內全部講完

because this slide sort of tells the story the way Science Magazine thinks of it.

讓我從這張投影片開始

This was an issue from 2002

因為這張投影片反映出「科學」期刊的看法

that they published with a lot of different articles on the bionic human.

這一期發刊於 2002 年

It was basically a regenerative medicine issue.

裡面發表了各種有關生化人的文章

Regenerative medicine is an extraordinarily simple concept

基本上就是再生醫學專題

that everybody can understand.

再生醫學其實是個非常簡單的概念

It's simply accelerating the pace at which the body heals itself

一般人都能理解

to a clinically relevant timescale.

就是加快人體自我修復的速度

So we know how to do this in many of the ways that are up there.

達到在臨床上合理的時間範圍

We know that if we have a damaged hip, you can put an artificial hip in.

目前我們已知可行的方法很多，都在這裡

And this is the idea that Science Magazine used on their front cover.

我們知道要是髖關節損壞，就裝人工髖關節

This is the complete antithesis of regenerative medicine.

這就是這期 「科學」 期刊的封面所要表達的想法

This is not regenerative medicine.

其實這跟再生醫學完全相反

Regenerative medicine is what Business Week put up

這不是再生醫學

when they did a story about regenerative medicine not too long ago.

這本「商業周刊」討論的才是再生醫學

The idea is that instead of figuring out how to ameliorate symptoms

不久前，他們刊出一篇有關再生醫學的文章

with devices and drugs and the like --

想法是與其想辦法改善症狀

and I'll come back to that theme a few times --

用醫學裝置或藥物等等的

instead of doing that, we will regenerate lost function of the body

這主題我們會不斷回頭討論

by regenerating the function of organs and damaged tissue.

與其這麼做，我們不如重建身體失去的功能

So that at the end of the treatment,

做法是重建損壞的器官和組織

you are the same as you were at the beginning of the treatment.

如此一來，診程結束後

Very few good ideas -- if you agree that this is a good idea --

我們的身體就回到治療前的狀態

very few good ideas are truly novel.

好點子還真的不多，如果你們也覺得這想法不錯

And this is just the same.

真正創新的好點子很少

If you look back in history,

就像我要討論的議題一樣

Charles Lindbergh, who was better known for flying airplanes,

要是我們回想歷史

was actually one of the first people

以飛越大西洋成名的查爾斯．林白

along with Alexis Carrel, one of the Nobel Laureates from Rockefeller,

其實正是先驅者之一

to begin to think about, could you culture organs?

還有洛克斐勒醫學研究機構的諾貝爾醫學獎得主艾利克斯．卡萊爾

And they published this book in 1937,

就是他們開始思考，人工培養器官是否可行?

where they actually began to think about,

而且在1937 年出版了這本書

what could you do in bio-reactors to grow whole organs?

在書中他們甚至開始考慮

We've come a long way since then.

要如何在生物反應器中培養出一整個器官?

I'm going to share with you some of the exciting work that's going on.

到了今天，我們已經有了長足進步

But before doing that, what I'd like to do

我現在要跟大家分享的是一些進行中的研究

is share my depression about the health care system

但是在這之前，我想先與大家分享

and the need for this with you.

我對現今醫療體系的悲觀想法

Many of the talks yesterday talked about

以及再生醫學的必要性

improving the quality of life, and reducing poverty,

昨天的講題很多都談論到

and essentially increasing life expectancy all around the globe.

提升生活品質和減少貧窮發生

One of the challenges is that the richer we are, the longer we live.

以及真正延長全球人口的壽命

And the longer we live, the more expensive it is

難題之一就是我們越富裕，壽命就越長

to take care of our diseases as we get older.

但壽命越長，開銷就越大

This is simply the wealth of a country

醫療照護的開銷跟壽命延長成正比

versus the percent of population over the age of 65.

這是一張探討國家的富裕程度

And you can basically see that the richer a country is,

與 65 歲以上人口比例相關性的圖

the older the people are within it.

很明顯可以看出，國家越富有

Why is this important?

國民壽命就越長

And why is this a particularly dramatic challenge right now?

這為什麼重要？

If the average age of your population is 30,

又為什麼是當下最嚴峻的考驗?

then the average kind of disease that you have to treat

如果人口平均年齡是 30 歲

is maybe a broken ankle every now and again,

那麼一般需要醫療的疾病可能是

maybe a little bit of asthma.

三不五時扭傷腳踝

If the average age in your country is 45 to 55,

也許加上點氣喘

now the average person is looking at diabetes,

要是國家的平均年齡是 45 到 55 歲

early-onset diabetes, heart failure, coronary artery disease --

那麼普遍的疾病可能是糖尿病

things that are inherently more difficult to treat,

早發性糖尿病、心臟衰竭、心血管疾病

and much more expensive to treat.

這些疾病的治癒難度本來就較高

Just have a look at the demographics in the U.S. here.

且醫療成本也高出許多

This is from "The Untied States of America."

來看一下這份美國人口統計資料

In 1930, there were 41 workers per retiree.

擷取自「The Untied States of America」這本書

41 people who were basically outside of being really sick,

在 1930 年間，每 41 個勞力人口中就有 1 個退休

paying for the one retiree who was experiencing debilitating disease.

這 41 個身體沒有嚴重疾病的人

In 2010, two workers per retiree in the U.S.

僅需負擔這 1 個退休人口治療衰退性疾病的費用

And this is matched in every industrialized, wealthy country in the world.

到了 2010 年，每兩個勞力人口中就有 1 人退休

How can you actually afford to treat patients

而且全球各工業化的富裕國家都是如此

when the reality of getting old looks like this?

我們要如何才能負擔醫療成本？

This is age versus cost of health care.

要是老化所要面對的現實就是如此？

And you can see that right around age 45, 40 to 45,

這張圖顯示年齡與醫療照護成本之間的關係

there's a sudden spike in the cost of health care.

可以看出大約在 45 歲，40 到 45 歲的區間

It's actually quite interesting. If you do the right studies,

醫療照護成本急遽上升

you can look at how much you as an individual spend on your own health care,

這其實相當有趣，在適當的統計研究下

plotted over your lifetime.

我們可以看出自己在人生各個階段

And about seven years before you're about to die, there's a spike.

所需的醫療成本

And you can actually --

而且在死亡前 7 年會出現一個高峰

(Laughter)

我們還可以...

-- we won't get into that.

(笑聲)

(Laughter)

...我們還是不要討論這些

There are very few things, very few things that you can really do

(笑聲)

that will change the way that you can treat these kinds of diseases

其實我們真正能做的很有限

and experience what I would call healthy aging.

要改變這些疾病的治療方式

I'd suggest there are four things,

同時享受我所謂的「健康老化」

and none of these things include an insurance system or a legal system.

我想提出 4 個想法

All those things do is change who pays.

而且都跟壽險和立法無關

They don't actually change what the actual cost of the treatment is.

僅僅是改變只是負擔費用的對象

One thing you can do is not treat. You can ration health care.

實際需要的醫療成本不變

We won't talk about that anymore. It's too depressing.

我們的選擇之一就是不治療，也可以配給醫療資源

You can prevent.

我們不要再討論這方面，實在太令人沮喪了。

Obviously a lot of monies should be put into prevention.

我們可以預防

But perhaps most interesting, to me anyway, and most important,

當然我們應該要在預防上投入許多經費

is the idea of diagnosing a disease much earlier on in the progression,

不過最有趣也最重要的想法可能是

and then treating the disease to cure the disease

儘早在症狀惡化的過程中診斷

instead of treating a symptom.

進而根治疾病

Think of it in terms of diabetes, for instance.

而不是只對症下藥

Today, with diabetes, what do we do?

以糖尿病為例

We diagnose the disease eventually, once it becomes symptomatic,

現在我們如何治療糖尿病?

and then we treat the symptom for 10, 20, 30, 40 years.

我們要到出現症狀才能診斷出疾病

And we do OK. Insulin's a pretty good therapy.

然後再花 10、20、30、40 年來對症下藥

But eventually it stops working,

結果還算可以，胰島素注射是個不錯的療法

and diabetes leads to a predictable onset of debilitating disease.

不過它終究會就失去藥效

Why couldn't we just inject the pancreas with something

而且糖尿病一定會併發衰退性疾病

to regenerate the pancreas early on in the disease,

為什麼我們不在發病初期就注射物質到胰臟

perhaps even before it was symptomatic?

促進胰臟再生，

And it might be a little bit expensive at the time that we did it,

或甚至在症狀出現前就這麼做呢?

but if it worked, we would truly be able to do something different.

這種治療一開始可能貴一點

This video, I think, gets across the concept that I'm talking about quite dramatically.

不過一旦成功，我們就真正能開始嘗試變通

This is a newt re-growing its limb.

我覺得這段影片清楚的表達我想傳達的概念

If a newt can do this kind of thing, why can't we?

這是一隻在進行肢體再生的蠑螈

I'll actually show you some more important features

蠑螈做得到，為什麼我們不能?

about limb regeneration in a moment.

待會我會讓大家看一些更重要的

But what we're talking about in regenerative medicine

有關肢體再生的報導

is doing this in every organ system of the body,

但是在再生醫學中討論的

for tissues and for organs themselves.

是重建體內所有的器官系統

So today's reality is that if we get sick,

無論是針對組織和器官

the message is we will treat your symptoms,

在現實中，要是生病了

and you need to adjust to a new way of life.

醫生會治療我們的症狀

I would pose to you that tomorrow --

而且我們必須適應新的生活方式

and when tomorrow is we could debate,

我想要讓大家看看未來

but it's within the foreseeable future --

雖然還沒辦法確定「未來」何時會來

we will talk about regenerative rehabilitation.

不過，應該不用等太久

There's a limb prosthetic up here,

我想談談再生復健

similar actually one on the soldier

這是個義肢

that's come back from Iraq.

跟從戰地回來的士兵

There are 370 soldiers that have come back from Iraq that have lost limbs.

所用的類似

Imagine if instead of facing that, they could actually

有 370 位剛從伊拉克返國的士兵手腳截肢

face the regeneration of that limb.

試想與其截肢, 他們其實可以

It's a wild concept.

重建完整的四肢

I'll show you where we are at the moment in working towards that concept.

這是個很瘋狂的想法

But it's applicable, again, to every organ system.

我將展示這個想法目前的進展

How can we do that?

再次強調，這可以適用於任何器官

The way to do that is to develop a conversation with the body.

要怎麼做到呢？

We need to learn to speak the body's language.

作法是與身體建立良好的溝通

And to switch on processes that we knew how to do when we were a fetus.

我們必須學習了解人體的各種訊息

A mammalian fetus, if it loses a limb during the first trimester of pregnancy,

且要開啟胎兒時期曾經擁有的再生能力

will re-grow that limb.

哺乳類動物的胎兒在懷孕期的頭三個月

So our DNA has the capacity to do these kinds of wound-healing mechanisms.

失去的手腳可以重新長出來

It's a natural process,

因此我們的 DNA 中就有這種癒合機制

but it is lost as we age.

這是個自然的過程

In a child, before the age of about six months,

卻隨著年齡增長而流失

if they lose their fingertip in an accident,

一個未滿 6 個月的嬰兒

they'll re-grow their fingertip.

要是意外割斷了指尖

By the time they're five, they won't be able to do that anymore.

可以重新長回來

So to engage in that conversation with the body,

不過到了 5 歲，他們就失去這種能力

we need to speak the body's language.

為了能夠找回這樣的能力

And there are certain tools in our toolbox that allow us to do this today.

我們必須學會解讀身體的訊息

I'm going to give you an example of three of these tools

以下是一些目前正在使用的技術

through which to converse with the body.

我會介紹其中的 3 種

The first is cellular therapies.

透過這些技術我們可以與身體溝通

Clearly, we heal ourselves in a natural process,

第一個是細胞療法

using cells to do most of the work.

這顯然是利用癒合的自然程序

Therefore, if we can find the right cells

用細胞進行大部分的癒合工作

and implant them in the body, they may do the healing.

因此，只要找到適合的細胞

Secondly, we can use materials.

然後植入人體，或許就能成功

We heard yesterday about the importance of new materials.

第二種我們可以使用材料

If we can invent materials, design materials,

昨天的講題告訴我們新材料的重要性

or extract materials from a natural environment,

如果我們能從自然界合成、設計

then we might be able to have those materials induce the body to heal itself.

或提煉出新的材料

And finally, we may be able to use smart devices

或許就可以利用這些材料來誘發身體的癒合功能

that will offload the work of the body and allow it to heal.

最後, 我們也許可以利用一些精巧的裝置

I'm going to show you an example of each of these,

分擔身體的負擔同時讓它自行癒合

and I'm going to start with materials.

我會針對各種技術舉例

Steve Badylak -- who's at the University of Pittsburgh --

先從材料開始

about a decade ago had a remarkable idea.

匹茲堡大學的學者史提夫.巴迪萊

And that idea was that the small intestine of a pig,

大約在 10 年前提出一個很高明的想法

if you threw away all the cells,

他想利用豬的小腸

and if you did that in a way that allowed it to remain biologically active,

要是能夠剝除小腸上所有的細胞

may contain all of the necessary factors and signals

同時維持其生物活性

that would signal the body to heal itself.

可能可以保存必要的因子和訊號

And he asked a very important question.

啟動身體的自我癒合能力

He asked the question,

他同時提出一個非常重要的問題

if I take that material, which is a natural material

他的問題是

that usually induces healing in the small intestine,

這種天然的材料

and I place it somewhere else on a person's body,

放在小腸通常可以誘發小腸的癒合

would it give a tissue-specific response,

要是放在人體的其他地方

or would it make small intestine if I tried to make a new ear?

是否可以針對不同組織引發正確的修復反應

I wouldn't be telling you this story if it weren't compelling.

還是只對小腸有用，換成耳朵就沒用了？

The picture I'm about to show you

我舉的例子一定夠嚇人

is a compelling picture.

接下來我要展示的圖片 -- 膽小者不宜 --

(Laughter)

(笑聲)

However, for those of you that are even the slightest bit squeamish --

是很嚇人的照片

even though you may not like to admit it in front of your friends --

不過對於那些膽子很小的人

the lights are down. This is a good time to look at your feet,

即使你們可能不想在朋友面前承認

check your Blackberry, do anything other than look at the screen.

燈光變暗了，剛好可以低頭不看

(Laughter)

看看手機，做什麼都好，就是不要看螢幕

What I'm about to show you is a diabetic ulcer.

（笑聲）

And although -- it's good to laugh before we look at this.

我要展示的是糖尿病足部潰瘍的照片

This is the reality of diabetes.

不過看到照片以後可能就笑不出來了

I think a lot of times we hear about diabetics, diabetic ulcers,

這就是糖尿病的真實狀況

we just don't connect the ulcer with the eventual treatment,

我想大家常聽到糖尿病、糖尿病潰瘍

which is amputation, if you can't heal it.

卻不會把潰瘍和醫療上的終極手段聯想在一起

So I'm going to put the slide up now. It won't be up for long.

要是治療無效，終極手段就是截肢

This is a diabetic ulcer. It's tragic.

我現在要放上投影片，不過不會放太久

The treatment for this is amputation.

這就是糖尿病足部潰瘍，真可怕

This is an older lady. She has cancer of the liver as well as diabetes,

唯一的療法就是截肢

and has decided to die with what' s left of her body intact.

這是一位患有肝癌和糖尿病的老婦人

And this lady decided, after a year of attempted treatment of that ulcer,

她希望在死的時候盡量維持身體完整

that she would try this new therapy that Steve invented.

所以治療潰瘍一年後她決定

That's what the wound looked like 11 weeks later.

嘗試史提夫發明的新療法

That material contained only natural signals.

傷口經過 11 個星期治療之後變成這個樣子

And that material induced the body to switch back on a healing response

這個材料只含有天然的訊息因子