because I'm going to say some radical things,

我承認我有一點點緊張，

about how we should think about cancer differently,

因為我要說一些極端的東西，

to an audience that contains a lot of people

談要如何以不同的角度看癌症，

who know a lot more about cancer than I do.

但在座有很多人

But I will also contest that I'm not as nervous as I should be

卻比我還瞭解癌症。

because I'm pretty sure I'm right about this.

但我也要說我其實沒有我應當的那麼緊張

(Laughter)

因為我很確定我是對的。

And that this, in fact, will be

（笑聲）

the way that we treat cancer in the future.

而且這個，事實上，

In order to talk about cancer,

會是我們未來治療癌症的方法。

I'm going to actually have to --

要談癌症，

let me get the big slide here.

我們必須先談這個--

First, I'm going to try to give you a different perspective of genomics.

讓我用這張大投影片。

I want to put it in perspective of the bigger picture

首先，我要讓你們從另一個角度看基因體。

of all the other things that are going on --

我想要以一個更廣的角度

and then talk about something you haven't heard so much about, which is proteomics.

來看整件事情，

Having explained those,

然後談一下你們沒那麼常聽到的東西，也就是蛋白質體學。

that will set up for what I think will be a different idea

解釋了這些後，

about how to go about treating cancer.

我便可以談我認為和現今不同的

So let me start with genomics.

治療癌症的方式。

It is the hot topic.

所以讓我從基因體講起。

It is the place where we're learning the most.

它是個熱門的話題。

This is the great frontier.

它是我們學到最多的地方。

But it has its limitations.

它是先驅。

And in particular, you've probably all heard the analogy

但它有它的極限。

that the genome is like the blueprint of your body,

尤其是：你們可能聽過

and if that were only true, it would be great,

基因就像是身體的藍圖。

but it's not.

如果這是正確的，那就太好了，

It's like the parts list of your body.

但這不是正確的。

It doesn't say how things are connected,

基因像是你身體組成表。

what causes what and so on.

它沒有解釋這中間如何串聯，

So if I can make an analogy,

什麼引起什麼之類的事。

let's say that you were trying to tell the difference

所以如果我要來比喻，

between a good restaurant, a healthy restaurant

想像你要分辨一個好餐廳、

and a sick restaurant,

一個健康的餐廳

and all you had was the list of ingredients

和一個壞餐廳，

that they had in their larder.

而且你所有的只是一張他們庫存的

So it might be that, if you went to a French restaurant

食材表。

and you looked through it and you found

所以有可能是，你去一家法式餐廳

they only had margarine and they didn't have butter,

你發現他們只有人造黃油

you could say, "Ah, I see what's wrong with them.

沒有奶油，

I can make them healthy."

你會說：「喔！我知道哪裡出錯了。

And there probably are special cases of that.

我可以讓他們變健康。」

You could certainly tell the difference

而且有可能有一些像那樣的特殊例子。

between a Chinese restaurant and a French restaurant

你當然可以從他們食品室有的東西中

by what they had in a larder.

輕易分辨

So the list of ingredients does tell you something,

中式餐廳和法式餐廳。

and sometimes it tells you something that's wrong.

所以食材表是能夠告訴你一些東西的，

If they have tons of salt,

而且有時候會告訴你哪裡出問題了。

you might guess they're using too much salt, or something like that.

如果他們有很多鹽，

But it's limited,

你可能會猜他們放太多鹽之類的。

because really to know if it's a healthy restaurant,

但知道的是有限的，

you need to taste the food, you need to know what goes on in the kitchen,

因為要真正知道一家餐聽好壞，

you need the product of all of those ingredients.

你需要吃吃看他們做的食物，你需要知道廚房中發生了什麼事，

So if I look at a person

你需要食材的最終產物。

and I look at a person's genome, it's the same thing.

所以你如果看一個人，

The part of the genome that we can read

看他的基因，這是相同的道理。

is the list of ingredients.

我們看得懂的基因部份

And so indeed,

就像是食材表。

there are times when we can find ingredients

所以，

that [are] bad.

是有些時候我們可以看到

Cystic fibrosis is an example of a disease

不好的食材。

where you just have a bad ingredient and you have a disease,

囊胞性纖維症就是一個

and we can actually make a direct correspondence

你可以看組成就知道會有疾病，

between the ingredient and the disease.

且我們可以直接建立

But most things, you really have to know what's going on in the kitchen,

這些組成和疾病的關連。

because, mostly, sick people used to be healthy people --

但大部份時候，你需要知道在廚房發生了什麼事，

they have the same genome.

因為，大部份生病的人之前是健康的，

So the genome really tells you much more

但他們有一樣的基因組。

about predisposition.

所以基因組只是告訴你

So what you can tell

預先的定位。

is you can tell the difference between an Asian person and a European person

所以你可以知道的是

by looking at their ingredients list.

你可以從組成成分表中

But you really for the most part can't tell the difference

看出亞州人和歐洲人的差別。

between a healthy person and a sick person --

但大部份的時候你沒有辦法看出

except in some of these special cases.

一個健康的人和不健康的人的差別--

So why all the big deal

除了在很特殊的例子上。

about genetics?

既然如此，為什麼基因學

Well first of all,

這麼重要？

it's because we can read it, which is fantastic.

首先，

It is very useful in certain circumstances.

我們可以讀它，這很棒。

It's also the great theoretical triumph

在某些情況下非常有用。

of biology.

它也是生物理論上

It's the one theory

非常重要的榮耀。

that the biologists ever really got right.

這是一個生物學家們

It's fundamental to Darwin

一直想搞對的理論。

and Mendel and so on.

基因同時也是是達爾文

And so it's the one thing where they predicted a theoretical construct.

和孟德爾和其他人理論的基礎。

So Mendel had this idea of a gene

所以它是唯一一個他們預測且建構的理論。

as an abstract thing,

孟德爾有點抽象地

and Darwin built a whole theory

說明基因這個概念。

that depended on them existing,

然後達爾文在這個基礎上

and then Watson and Crick

建立了一整個理論。

actually looked and found one.

然後華生和克力克

So this happens in physics all the time.

真的去找且找到了基因。

You predict a black hole,

這在物理學上常常發生。

and you look out the telescope and there it is, just like you said.

你預期會有黑洞，

But it rarely happens in biology.

你去找然後透過望遠鏡去看，真的找到了。

So this great triumph -- it's so good,

但在生物上這很少發生。

there's almost a religious experience

所以這個大榮耀--重要到

in biology.

幾乎成爲生物學上的

And Darwinian evolution

信仰教條。

is really the core theory.

且達爾文演化論

So the other reason it's been very popular

就是核心理論。

is because we can measure it, it's digital.

另外一個讓基因這麼受喜愛的原因是

And in fact,

我們可以測量它。它是數位的。

thanks to Kary Mullis,

事實上，

you can basically measure your genome in your kitchen

感謝Kary Mullis，

with a few extra ingredients.

你基本上只需要比你廚房再多一點用具

So for instance, by measuring the genome,

就可以測量你的基因組。

we've learned a lot about how we're related to other kinds of animals

舉例來說，透過測量基因組，

by the closeness of our genome,

我們從其間的相似性

or how we're related to each other -- the family tree,

學到很多關於我們和其他動物的關係、

or the tree of life.

或是我們跟其他人的關係--像家族表，

There's a huge amount of information about the genetics

或是生命表。

just by comparing the genetic similarity.

僅僅只是比對基因間的相似情況，

Now of course, in medical application,

我們可以得到很多資訊。

that is very useful

當然在醫學上

because it's the same kind of information

這是非常有用的，

that the doctor gets from your family medical history --

因為醫生可以得到

except probably,

與瞭解家庭病史相同的資訊。

your genome knows much more about your medical history than you do.

事實上，

And so by reading the genome,

你的基因比你還瞭解你的家庭病史。

we can find out much more about your family than you probably know.

所以利用解讀基因組，

And so we can discover things

我們可以瞭解更多你不知道的關於你的家庭的資訊。

that probably you could have found

我們可以發現一些

by looking at enough of your relatives,

你如果看夠多你的親戚

but they may be surprising.

將可能會找到的資訊，

I did the 23andMe thing

但這些可能是驚人的。

and was very surprised to discover that I am fat and bald.

我做了「二十三和我」（基因檢測）的測驗，

(Laughter)

且驚人地發現我是又胖又禿頭的。

But sometimes you can learn much more useful things about that.

（笑聲）

But mostly

但有時候你會學到一些更有用的東西。

what you need to know, to find out if you're sick,

但大部份時候

is not your predispositions,

當你生病時你需要知道的

but it's actually what's going on in your body right now.

不是你的體質，

So to do that, what you really need to do,

而是現在在你身上發生了什麼事。

you need to look at the things

要瞭解這個，你需要做的是

that the genes are producing

你需要看這些基因

and what's happening after the genetics,

製造的東西

and that's what proteomics is about.

和基因背後發生的事情。

Just like genome mixes the study of all the genes,

而那正是蛋白質體學。

proteomics is the study of all the proteins.

就像基因體學是研究所有的基因

And the proteins are all of the little things in your body

蛋白質體學就是研究所有的蛋白質。

that are signaling between the cells --

蛋白質是所有在你身上

actually, the machines that are operating --

在不同細胞間傳遞訊息的小東西。

that's where the action is.

而細胞則是體內工作的機器。

Basically, a human body

那是事情的發生地。

is a conversation going on,

基本上，

both within the cells and between the cells,

人體是一場正在進行的對話，

and they're telling each other to grow and to die,

是正在細胞內和細胞間進行的對話，

and when you're sick,

細胞互相告訴對方該生長還是死亡。

something's gone wrong with that conversation.

當你生病時，

And so the trick is --

這樣的對話出現問題。

unfortunately, we don't have an easy way to measure these

所以訣竅是--

like we can measure the genome.

不幸的，我們沒有像測量基因一樣

So the problem is that measuring --

有個簡單的方式可以測量蛋白質。

if you try to measure all the proteins, it's a very elaborate process.

所以測量是個大問題--

It requires hundreds of steps,

如果你試著測量所有的蛋白質，這是非常複雜的過程。

and it takes a long, long time.

需要好幾百個步驟，

And it matters how much of the protein it is.

而且需要花很久很久的時間。

It could be very significant that a protein changed by 10 percent,

而且蛋白質含量也有關係的

so it's not a nice digital thing like DNA.

十分之一的含量差異可以有嚴重的影響，

And basically our problem is somebody's in the middle

所以不是像DNA那樣有數位性的。

of this very long stage,

而且基本上我們的問題是

they pause for just a moment,

如果有人在一個很長的過程的中間，

and they leave something in an enzyme for a second,

他們停下來一下下，

and all of a sudden all the measurements from then on

且他們把東西留在生物酶中一秒鐘，

don't work.

突然所有從那時後開始的測量值

And so then people get very inconsistent results

就都不對了。

when they do it this way.

當他們這麼做時，

People have tried very hard to do this.

人們會得到非常不一致的結果。

I tried this a couple of times

有人很努力做這個。

and looked at this problem and gave up on it.

我試了幾次，

I kept getting this call from this oncologist

看了這個問題然後放棄。

named David Agus.

我一直接到一個癌症學家的電話

And Applied Minds gets a lot of calls

他叫大維艾格斯。

from people who want help with their problems,

在Applied Minds的人常常接到很多電話，

and I didn't think this was a very likely one to call back,

來自於需要幫忙解決他們的問題的人，

so I kept on giving him to the delay list.

而我不覺得這個是我會想要回電的人，

And then one day,

所以我一直把他放到晚點再回的名單。

I get a call from John Doerr, Bill Berkman

直到有一天，

and Al Gore on the same day

我接到約翰杜爾、比爾貝客門、

saying return David Agus's phone call.

高爾打來的電話，

(Laughter)

都叫我要回大衛艾格斯的電話。

So I was like, "Okay. This guy's at least resourceful."

（笑聲）

(Laughter)

所以我想「好吧，至少這個人人脈豐富。」

So we started talking,

（笑聲）

and he said, "I really need a better way to measure proteins."

所以我們開始談，

I'm like, "Looked at that. Been there.

然後他說：「我們很需要一個更好的測量蛋白質的方式。」

Not going to be easy."

我說：「我都看過了、做過了。

He's like, "No, no. I really need it.

一點都不容易。」

I mean, I see patients dying every day

他說：「不不，我真的很需要。

because we don't know what's going on inside of them.

我的意思是，我每天看到病人死亡

We have to have a window into this."

因為我們不知道病人體內發生什麼事。

And he took me through

我們必須想個辦法。」

specific examples of when he really needed it.

然後他給我看一些例子

And I realized, wow, this would really make a big difference,

和為什麼他很需要這個技術。

if we could do it,

然後我瞭解到，哇，如果我們做得到的話

and so I said, "Well, let's look at it."

這會是很大的改變。

Applied Minds has enough play money

所以我說：「好，讓我們來看看。」

that we can go and just work on something

Applied Minds有一些閒錢

without getting anybody's funding or permission or anything.

可以讓我們不需要跟任何人要錢獲取得許可

So we started playing around with this.

就可以做些事情。

And as we did it, we realized this was the basic problem --

所以我們開始試試這件事情。

that taking the sip of coffee --

當我們在做的時候，我們瞭解到這是很基本的問題--

that there were humans doing this complicated process

就像喝一口咖啡--

and that what really needed to be done

就是有很多人在做這個複雜的事

was to automate this process like an assembly line

但事實上我們需要的

and build robots

是自動化的流程

that would measure proteomics.

然後建造機器人

And so we did that,

來測量蛋白質體。

and working with David,

所以我們這麼做了。

we made a little company called Applied Proteomics eventually,

與大衛合作，

which makes this robotic assembly line,

我們創立了一個叫做「Applied Proteomics」的公司，

which, in a very consistent way, measures the protein.

專門建造這樣的機器流程線，

And I'll show you what that protein measurement looks like.

這樣可以很穩定的測量蛋白質。

Basically, what we do

且我會給你們看蛋白質測量是怎麼做的。

is we take a drop of blood

基本上，我們做的是

out of a patient,

我們從病人身上

and we sort out the proteins

取一滴血，

in the drop of blood

然後我們將這滴血中的蛋白質

according to how much they weigh,

依照它們的

how slippery they are,

重量、

and we arrange them in an image.

它們的光滑程度來分類，

And so we can look at literally

然後將它們放在一張圖上。

hundreds of thousands of features at once

然後我們可以同時

out of that drop of blood.

看到這滴血當中

And we can take a different one tomorrow,

千百種的特色。

and you will see your proteins tomorrow will be different --

隔天我們可以取另一滴血，

they'll be different after you eat or after you sleep.

然後你會發現你隔天的蛋白質是不一樣的--

They really tell us what's going on there.

蛋白質在你吃過食物或睡過覺後都會不一樣。

And so this picture,

他們真的告訴我們發生了什麼事。

which looks like a big smudge to you,

所以這張圖，

is actually the thing that got me really thrilled about this

對你們來說看起來像是一團大污點，

and made me feel like we were on the right track.

但卻是讓我對這件事感到興奮的原因

So if I zoom into that picture,

而且讓我們覺得我們是往對的方向前進。

I can just show you what it means.

所以如果我們把這張圖放大，

We sort out the proteins -- from left to right

我可以給你們看這是什麼意思。

is the weight of the fragments that we're getting,

我們整理了這些蛋白質--從左至右

and from top to bottom is how slippery they are.

是這些片段的重量。

So we're zooming in here just to show you a little bit of it.