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TED奖希望:寻找新的治疗偏头痛、抑郁症、医疗事故

Robert Fischell: TED Prize wish: Finding new cures for migraine, depression, malpractice

我将与你讨论我的三项发明
I’m going to discuss with you three of my inventions
这些发明能够让成千上万的人受益
that can have an effect on 10 to a 100 million people,
这也是我们所希望看到的
which we will hope to see happen.
在上一张的图片中,我们讨论了一些我们以前用过的仪器
We discussed, in the prior film, some of the old things that we did,
像各种血管支架和糖尿病胰岛素泵
like stents and insulin pumps for the diabetic.
现在我想非常简要地谈谈有关这三项新的发明
And I’d like to talk very briefly about three new inventions
将会如何改变我们大多数人的生活
that will change the lives of many people.
目前,心脏病人在意识到病情发作的那一刻起
At the present time, it takes an average of three hours
到被送进急诊室的时间
after the first symptoms of a heart attack are recognized by the patient,
平均要花上3个小时
before that patient arrives at an emergency room.
而对于那些无症状心肌缺血的病人
And people with silent ischemia —
即是英语中所说的在发病之前是看不出任何症状的人
which, translated into English, means they don’t have any symptoms —
他们从发病到被送进医院需要更长的时间
it takes even longer for them to get to the hospital.
急性心肌梗死
The AMI, Acute Myocardial Infarction,
医生通常会以这样严重的词来形容这种心脏突发病,然后收取你更多的钱
which is a doctor’s big word so they can charge you more money —
大笑
(Laughter)
在美国,每年心脏突发病例达到120万人;
— means a heart attack. Annual incidence: 1.2 million Americans.
死亡病例每年达到30万人
Mortality: 300,000 people dying each year.
而约有一半的人,即60万人,总是会被心脏病折磨
About half of them, 600,000, have permanent damage to their heart
这给他们接下来的生活带来了许多麻烦
that will cause them to have very bad problems later on.
因此,剩下的90万患者,要么是后来死亡了
Thus 900,000 people either have died
要么是他们的心肌受到了极其严重的损伤
or have significant damage to their heart muscle.
一些患者往往不能接受自己患心脏病的事实,尤其是我们这些男性
Symptoms are often denied by the patient, particularly us men,
因为我们自认为够勇敢。而且由于这个特性,
because we are very brave. We are very brave,
我们不愿意承认自己的胸部正在承受一种无与伦比的疼痛。
and we don’t want to admit that I’m having a hell of a chest pain.
所以,大约百分之二十五的病人从来没有在医院留下任何病史的记录。
Then, approximately 25 percent of all patients never have any symptoms.
我们该打算如何处理和说服他们呢?甚至挽救他们的生命呢
What are we going to do about them? How can we save their lives?
尤其是对那些糖尿病患者和老年妇女病患者
It’s particularly true of diabetics and elderly women.
那么,如何做才能最早的预测到心脏病突发的可能?
Well, what is needed for the earliest possible warning of a heart attack?
什么仪器才能确诊患者患有冠状动脉梗死呢
A means to determine if there’s a complete blockage of a coronary artery.
女士们先生们,请听好,这种有冠状动脉梗死的症状就是心脏病。
That, ladies and gentlemen, is a heart attack.
这种仪器主要是记录一些比较具有技术性的
The means consist of noting something a little technical,
ST段抬高的心电图
ST segment elevation of the electrogram —
用英语来说就是
translated into English, that means that
如果心脏出现电信号,即心电图中的某个部分—
if there’s an electrical signal in the heart, and one part of the ECG —
ST段这部分升高了
which we call the ST segment — elevates,
这就证明患有心脏病的迹象。
that is a sure sign of a heart attack.
如果我们把一个计算机移植到那些处于病情危险的患者的身体里面
And if we had a computer put into the body of a person who’s at risk,
那么,我们就可以在他们还没有出现心脏病发作的症状之前
we could know, before they even have symptoms,
就判断出他的病情,从而挽救了他们的生命
that they’re having a heart attack, to save their life.
这样的话,医生可以事先设置ST段信号电压的波动范围,
Well, the doctor can program a level of this ST elevation voltage
超过范围的将会触发紧急报警
that will trigger an emergency alarm,
就像你的手机震动那样,但却是在你的锁骨间震动
vibration like your cell phone, but right by your clavicle bone.
当心电图出现嘟嘟嘟响的时候,你最好要开始重视自己的病情
And when it goes beep, beep, beep, you better do something about it,
因为如果你想活下去的话就必须用药物治疗
because if you want to live you have to get to some medical treatment.
因此,我们首先必须对自己发明的这些设备做试验
So we have to try these devices out
因为美国食品和药物管理局规定,设备绝不允许在没有得到认可之前就使用在人身上
because the FDA won’t just let us use them on people
除非按科学方式证明这些设备是有效的
unless we try it out first,
让猪来测试这些设备是最佳的选择
and the best model for this happens to be pigs.
我们首先尝试的是在猪的皮肤上做外部电极测试,
And what we tried with the pig was external electrodes on the skin,
这种测试就像你在急诊室看到的那样
like you see in an emergency room,
然后我会向你解释这种方法效果不太理想的原因。
and I’m going to show you why they don’t work very well.
我们用一根电线连接在猪的右心房
And then we put a lead, which is a wire, in the right ventricle inside the heart,
而右心房直接与心电图机连接,从而能够看到心脏显示出来的电压信号。
which does the electrogram, which is the signal voltage from inside the heart.
在猪的基准线上
Well, with the pig, at the baseline,
在我们堵塞猪的动脉来刺激它心脏病发作之前,基准线上已经出现了一些信号
before we blocked the pig’s artery to simulate a heart attack, that was the signal.
43秒后,即使是专家,也看不出来有什么变化
After 43 seconds, even an expert couldn’t tell the difference,
直到过了3分钟
and after three minutes — well,
如果你对这个有研究,你便能看到其中的差别
if you really studied it, you’d see a difference.
但是,在我们看到猪体内的心脏跳动时,心电图会有什么不同呢?
But what happened when we looked inside the pig’s heart, to the electrogram?
在心电图上出现了一条基准线。第一,它是一条更粗的线,而且具有更可靠的信号。
There was the baseline — first of all, a much bigger and more reliable signal.
第二的是,我敢说,就算你是未经训练的人,也能看出其中的区别
Second of all, I’ll bet even you people who are untrained can see the difference,
我们看到了紧跟着这条尖锐的线显示出ST段抬高。
and we see here an ST segment elevation right after this sharp line.
差异虽然并不大
Look at the difference there. It doesn’t take much —
但是几乎每个外行人都可以看出差别。
every layperson could see that difference,
而且计算机经过编程后可以更方便地检测到其中的区别。
and computers can be programmed to easily detect it.
然后,再看看那段过3分钟的心电图,
Then, look at that after three minutes.
这些我们看到的信号实际上就是猪当时心脏跳动的真实现状。
We see that the signal that’s actually in the heart,
而这些图示,我们可以用它来向人们说明,在猪发生心脏病之前,
we can use it to tell people that they’re having a heart attack
已经被检测出症状了,从而及早的挽救它们的生命。
even before they have symptoms so we can save their life.
接着,我和我的儿子提姆费舍尔
Then we tried it with my son, Dr. Tim Fischell,
将这个球囊狂涨式支架移入到人类患者体内。
we tried it on some human patients who had to have a stent put in.
接着使球囊扩张,堵塞了他的冠状动脉
Well, he kept the balloon filled to block the artery,
从而引发了心脏病的发作
to simulate a blockage, which is what a heart attack is.
不难看出,这条基线
And it’s not hard to see that — the baseline
从这最左边的这样的图
is the first picture on the upper left.
到过了30秒,它抬高到这里
Next to it, at 30 seconds, you see this rise here,
然后又到这里—这就是我们所说的ST段抬高。
then this rise — that’s the ST elevation.
如果我们有一台计算机可以检测的话,
And if we had a computer that could detect it,
那么我们就能在你心脏病发作之前告诉你这些症状
we could tell you you’re having a heart attack so early
从而挽救你的生命,并防止心脏心力衰竭。
it could save your life and prevent congestive heart failure.
测试又做一次。我们再次让球囊扩张,数分钟后
And then he did it again. We filled the balloon again a few minutes later
这里可以看到,即使在过了10秒钟,在这一块,它大幅度提高
and here you see, even after 10 seconds, a great rise in this piece,
我们可以在病人体内移入电脑,它连接你的心脏
which we can have computers inside, under your chest like a pacemaker,
就像胸部内的心脏起搏器一样
with a wire into your heart like a pacemaker.
计算机是不会停止工作的
And computers don’t go to sleep.
如果我们有一个小的电池,而且把它放在计算机内
We have a little battery and on this little battery
计算机将能在无需更换电池的情况下运行5年。
that computer will run for five years without needing replacement.
这个系统是什么样子?
What does the system look like?
看,左侧的是IMD,这是植入式医疗设备,
Well, on the left is the IMD, which is Implantable Medical Device,
今晚在我们暂时居住的地方就可以看到它-它在那里展示。
and tonight in the tent you can see it — they’ve exhibited it.
它跟一个心脏起搏器的大小差不多
It’s about this big, the size of a pacemaker.
它是以非常传统的技术移入人的体内。
It’s implanted with very conventional techniques.
而EXD,它是从体外设备,你可以把它放在床头。
And the EXD is an External Device that you can have on your night table.
它会发出响声提醒你应该告知看护者立即带你去急诊室,
It’ll wake you up and tell you to get your tail to the emergency room
否则的话,它会响得更厉害,嘟嘟声不断。
when the thing goes off because, if you don’t, you’re in deep doo-doo.
直到最后,程序将会自动设置出刺激位准
And then, finally, a programmer that will set the level of the stimulation,
这个位准意味着你的心脏病发作了
which is the level which says you are having a heart attack.
美国食品药物管理局说过,即然这样,这个设备如果在动物身上测试成功后就可以使用
The FDA says, OK, test this final device after it’s built in some animal,
而我们所指的动物就是猪,所以我们必须让猪心脏病发作。
which we said is a pig, so we had to get this pig to have a heart attack.
当你去农场,但是要让猪得心脏病却不是一起很容易的事
And when you go to the farmyard, you can’t easily get pigs to have heart attacks,
我们只能告诉自己,我们是精通血管支架术的专家。
so we said, well, we’re experts in stents.
而且今夜你会看到我们的一些发明的支架。
Tonight you’ll see some of our invented stents.
接着我们在猪体内移入一个支架
We said, so we’ll put in a stent,
但是这种移植方式跟人类的是不一样的。
but we’re not going to put in a stent that we’d put in people.
我们往他体内放入了一个铜支架,
We’re putting in a copper stent,
这个铜材料的支架就慢慢侵蚀猪体内的动脉,直到引起它心脏病的发作
and this copper stent erodes the artery and causes heart attacks.
这种做法其实不是很成功,但是我们必须找出失败的原因。
That’s not very nice, but, after all, we had to find out what the answer is.
因此,我们把两个铜支架移入到了猪的动脉
So we took two copper stents and we put it in the artery of this pig,
结果是让人欢喜的
and let me show you the result that’s very gratifying
而这个结果会让那些患有心脏病的人看到希望。
as far as people who have heart disease are concerned.
结果是这样,星期四早上,我们停止了猪的药物
So there it was, Thursday morning we stopped the pig’s medication
而这就是它的心电图,这些信号反映了猪的心脏跳动状况。
and there is his electrogram, the signal from inside the pig’s heart
而这些信号是无线电勘测出来的
coming out by radio telemetry.
接着,在周五的6点43分,它在我们要求跑了一圈之后
Then, on Friday at 6:43, he began to get certain signs,
开始出现了异样信号
which later we had the pig run around —
其实我并没打算会进入这个早期阶段
I’m not going to go into this early stage.
但在10时06分,在我们让猪停掉了这些治疗心脏病的药物后
But look what happened at 10:06 after we removed this pig’s medication
会发生什么状况呢?
that kept him from having a heart attack.
我想你们现在都已经对ST段抬高很了解了。你们能从中看出什么吗
Any one of you now is an expert on ST elevation. Can you see it there?
你能看到的图片中QRS波ST段抬高的大幅度上涨么?
Can you see it in the picture after the big rise of the QRS — you see ST elevation?
这证明了它在10:06时心脏病发作。
This pig at 10:06 was having a heart attack.
在它心脏病发作时血管堵塞后又会发生什么呢?
What happens after you have the heart attack, this blockage?
他心脏跳动的节奏变得不规律,这就是45分钟后所发生的。
Your rhythm becomes irregular, and that’s what happened 45 minutes later.
然后,它的心室颤动,代替了普通的跳动,
Then, ventricular fibrillation, the heart quivers instead of beats —
这通常是它即将死亡的预兆,接着,这猪真的死了,心电图上呈现一条平线。
this is just before death of the pig — and then the pig died; it went flat-line.
其实,如果我们在1个小时之前发现它的症状就能挽救它的生命。
But we had a little bit over an hour where we could’ve saved this pig’s life.
但是因为要达到FDA的要求,我们并没有救活它。
Well, because of the FDA, we didn’t save the pig’s life,
毕竟为了人类的安全,我们必须做更多这样的动物研究
because we need to do this type of animal research for humans.
但是,当试验者是人的话,我们是绝对会救活他的。
But when it comes to the sake of a human, we can save their life.
我们可以拯救那些具有严重心脏病患者的生命。
We can save the lives of people who are at high risk for a heart attack.
在发生急性心肌梗死,病人会有什么反应呢?
What is the response to acute myocardial infarction, a heart attack, today?
其实,你会感到胸部疼痛或觉得消化不良。
Well, you feel some chest pain or indigestion.
你也许认为这不是最糟的状况,那时你就选择不做任何事情
It’s not all that bad; you decide not to do anything.
但是往往在几个小时后,情况变得更糟糕,就连男性也不可不重视这个病。
Several hours pass and it gets worse, and even the man won’t ignore it.
最后,你还是被送进了急诊室。
Finally, you go to the emergency room.
但是你却只能焦急的等待,因为还有其他重病人正在会诊中
You wait as burns and other critical patients are treated,
而且进去急诊室中75%的病人都是胸部疼痛,
because 75 percent of the patients who go to an emergency room with chest pains
但是你的疼痛不能证明是由急性心肌梗塞引起的,所以也不能受到特殊的待遇。
don’t have AMI, so you’re not taken very seriously.
终于轮到你了,却要花上更多的时间
They finally see you. It takes more time
从皮肤测试开始直到获得你的心电图的所有信息,接着才能进行会诊
to get your electrocardiogram on your skin and diagnose it,
然而,一起都很难进行,因为医生看不到从你体内的计算机得出
and it’s hard to do because they don’t have the baseline data,
得出的基线信号信息
which the computer we put in you gets.
如果你够幸运的话,你会在病发之后的三,四个小时后得到医生顺利的救治
Finally, if you’re lucky, you are treated in three or four hours after the incident,
然而到那时,心肌却已经萎缩了。
but the heart muscle has died.
但这却是典型的治疗情况。在世界先进国家中,不包括非洲国家–
And that is the typical treatment in the advanced world — not Africa —
这是典型的疗法
that’s the typical treatment in the advanced world today.
因此,我们开发了AngelMed监测守卫系统
So we developed the AngelMed Guardian System
它可以植入病人的体内,
and we have a device inside this patient, called the Implanted AngelMed Guardian.
当患者出现心脏病迹象时他就会及时做出警报
And when you have a blockage, the alarm goes off
警告声和心电信号图会被传递到对外部设备
and it sends the alarm and the electrogram to an external device,
这个设备已经预存了病人24小时前基线心电图
which gets your baseline electrogram from 24 hours ago
接着你被送到急诊室
and the one that caused the alarm, so you can take it to the emergency room
并把心电图显示情况给医生看,告诉医生立即治疗。
and show them, and say, take care of me right away.
然后这些信号会传到网络操作中心
Then it goes to a network operations center,
在那里他们可以从你的病历记录的数据库中获得你的有关信息,
where they get your data from your patient database
而这些信息已经收集在某个中心站,比如美国。
that’s been put in at some central location, say, in the United States.
然后相关数据被传到了诊断中心,而且在你心脏病发作后不到一个分钟的时间
Then it goes to a diagnostic center, and within one minute of your heart attack,
计算机的屏幕和电脑就很快显示出你体内的信号,
your signal appears on the screen of a computer
并开始分析问题的所在。
and the computer analyzes what your problem is.
站在电脑旁的医生就会
And the person who’s there, the medical practitioner, calls you —
用手机问你
this is also a cell phone — and says,
“史密斯先生,你的仪器在嘟嘟的响,你的病发作了。
“Mr. Smith, you’re in deep doo-doo; you have a problem.
不过我们为你叫的救护车已经在路上。
We’ve called the ambulance. The ambulance is on the way.
它会接你到医院,并让他们把你送到主治医师这里。
It’ll pick you up, and then we’re going to call your doctor, tell him about it.
到时我们会把你的这些信号传到他那里的电脑了,显示你的病情。
We’re going to send him the signal that we have, that says you have a heart attack,
接着我们也会将此信号发送到医院
and we’re going to send the signal to the hospital
将对它进一步的分析,
and we’re going to have it analyzed there,
然后医生会在你旁边,根据病情
and there you’re going to be with your doctor
好好的治疗你,从而挽救你的生命。”
and you’ll be taken care of so you won’t die of a heart attack.”
这就是我所说的第一个发明
That’s the first invention that I wanted to describe.
鼓掌
(Applause)
现在我想谈谈与上面毫不相关的事情。
And now I want to talk about something entirely different.
刚开始我不认为偏头痛是一个很严重的问题,
At first I didn’t think migraine headaches were a big problem
因为我从未有过偏头痛
because I’d never had a migraine headache,
但后来我曾跟那些只剩下3或4个星期寿命的病人聊过之后
but then I spoke to some people who have three or four every week of their life,
我才发现他们的生命完全是被便头痛病毁掉的。
and their lives are being totally ruined by it.
我们公司治疗偏头痛的宗旨是,
We have a mission statement for our company doing migraine, which is,
为了预防或减轻偏头痛
“Prevent or ameliorate migraine headaches
可以使用一个安全的,具有可操控性的电磁脉冲
by the application of a safe, controlled magnetic pulse
来作用于需要服务的病人身上。”
applied, as needed, by the patient.”
也许,这里在座的你们可能没有物理学家。
Now, you’re probably very few physicists here.
但如果你是一名物理学家,您一定知道法拉第定律,
If you’re a physicist you’d know there’s a certain Faraday’s Law,
这条定律认为,如果我把一个电磁脉冲放到盐水里面–
which says if I apply a magnetic pulse on salt water —
-比如这盐水就是人的大脑-
that’s your brains by the way —
它便会产生电流,而且这些在大脑中产生的电流
it’ll generate electric currents, and the electric current in the brain
刚好可以去除偏头痛
can erase a migraine headache.
这也正是我们所发现的原理
That’s what we have discovered.
这是一张我们所做的图片。
So here’s a picture of what we’re doing.
有些患有偏头痛的病人在发病之前会有预兆
The patients who have a migraine preceded by an aura
出现大量的兴奋神经元–就是显示为红色的这部分-
have a band of excited neurons — that’s shown in red —
它以每分钟3-5毫米的速度扩散到中脑。
that moves at three to five millimeters a minute towards the mid-brain.
当它触发到中脑的神经元,头痛就开始发作了。
And when it hits the mid-brain, that’s when the headache begins.
这就是有预兆的偏头痛
There’s this migraine that is preceded by a visual aura,
对于这可视的预兆,我会给你们看一张图片-
and this visual aura, by the way — and I’ll show you a picture —
开始显示的是一些小小闪烁的光
but it sort of begins with little dancing lights,
然后慢慢的变得越来越大,直到它填充你的整个视野。
gets bigger and bigger until it fills your whole visual field.
而我们这里有一个卡德韦尔模型MES10设备,它就是我们根据这一原理做出来的医疗仪器
And what we tried was this; here is a device called the Cadwell Model MES10.
它重约70磅,直径约有一英寸的直线那么长。
Weighs about 70 pounds, has a wire about an inch in diameter.
这里也有一个病人,他在发生严重头痛之前也有这种预兆
And here’s one of the patients who has an aura
那么,我们能为这做出什么呢?
and always has a headache, bad one, after the aura. What do we do?
这就是预兆–那层光晕的样子
This is what an aura looks like.
它们像是一些小小闪烁的灯光,在图片中的左右边都有存在着
It’s sort of funny dancing lights, shown there on the left and right side.
然后在图片最上方就充分形成了一层可见的光晕。
And that’s a fully developed visual aura, as we see on top.
而中间的那部分,我们的神经科医生说:
In the middle, our experimentalist, the neurologist, who said,
“我将把这一部分稍微往下移,然后再去除掉光晕的半部分。”
“I’m going to move this down a little and I’m going to erase half your aura.”
天哪,神经科医生真的把那半边光晕给去除掉,而这也就是中间图片中所显示的那样
And, by God, the neurologist did erase it, and that’s the middle picture:
那样是做了电磁脉冲短时间后出现的结果示图。
half of the aura erased by a short magnetic pulse.
这意味着什么呢?
What does that mean?
这表明了通过电磁脉冲产生电流
That means that the magnetic pulse is generating an electric current
然后这些电流干扰了产生疼痛的电信号
that’s interfering with the erroneous electrical activity in the brain.
最后他说,“接着我要—- ”
And finally he says, “OK, now I’m going to — “
通过一定时间的电磁脉冲,所有的光晕全都消失了
all of the aura get erased with an appropriately placed magnetic pulse.
结果怎么样呢?我们设计了一个磁消偏剂
What is the result? We designed a magnetic depolarizer
它看起来是这样,可以放进女性衣服的口袋里面,
that looks like this, that you could have — a lady, in her pocket book —
当你出现视觉预兆偏头痛时,立即取出它,看它是如何工作的
and when you get an aura you can try it and see how it works.
接下来我们要看的是纽约市美国广播公司
Well, the next thing they have to show is what was on ABC News,
第七频道上周11点钟播报的新闻。
Channel 7, last week in New York City, in the 11 o’clock news.
对于那些患有偏头痛的人—
Anchor: For anyone who suffers from migraine headaches —
即3000万美国人都患有这种病-今晚可能会知道解决办法
and there are 30 million Americans who do — tonight: a possible answer.
今晚的新闻记者斯泰西塞杰是一位最好的目击者,它看到了
Eyewitness news reporter Stacy Sager tonight, with a small and portable machine
一个又小又方便携带的机器居然能慢慢消除头痛
that literally zaps your migraines away.
哦,我当时的第一反应是,
Christina Sidebottom: Well, my first reaction was that it was —
这仪器看上去像一把可怕的枪,样子特别奇怪。
looked awfully gun-like, and it was very strange.
但是对于克里斯蒂娜来说,如果它能制止偏头痛,
Stacy Sager: But for Christina Sidebottom, almost anything was worth trying
任何东西都值得试一下。
if it could stop a migraine.
它可能看起来很怪,甚至你认为当你把这个机器放在你的钱包里然后转几圈会很傻,
It may look silly or even frightening as you walk around with it in your purse,
但这里的研究人员在俄亥俄州举办过一个偏遥控器的临床试验,
but researchers here in Ohio organizing clinical trials for this migraine zapper,
都认为它是符合科学要求,而且对去除头痛非常有效
say it is scientifically sound —
事实上,一般人的偏头痛
that, in fact, when the average person gets a migraine,
都是由一种类似于电脉冲引起的。
it’s caused by something similar to an electrical impulse.
而该遥控器刚好产生了磁场去抵消了此类脉冲。
The zapper creates a magnetic field to counteract that.
换句话说,我们是利用电磁来抵消电磁
Yousef Mohammed: In other words, we’re treating electricity with electricity,
而不是我们医学上使用的用化学药物来抵消电磁。
rather than treating electricity with the chemicals that we’re using nowadays.
但是如果我们每天都使用它会不会不太安全?
SS: But is it safe to use everyday?
专家解释,实际研究已超过10年了,
Experts say the research has actually been around for more than a decade,
但是还需要更长的时间研究才能证明这一点。但克里斯蒂娜说她准备买它了。
and more long-term studies need to be done. Christina now swears by it.
看来这东西能够治疗我的头痛病,这实在是太好了。
CS: It’s been the most wonderful thing for my migraine.
研究人员希望能在今年夏天向美国食品药物管理局阐述他们的这一研究并取得认可。
SS: Researchers are hoping to present their studies to the FDA this summer.
这就是我们发明的偏头痛治疗仪
Robert Fischell: And that is the invention to treat migraines.
(掌声)
(Applause)
问题是,有3000万美国人患有偏头痛,
You see, the problem is, 30 million Americans have migraine headaches,
我们需要一种医疗手段来治疗它,而且我认为我们现在做到了
and we need a means to treat it, and I think that we now have it.
这是我们研究出来的第一个偏头痛治疗仪,接着我将会谈谈
And this is the first device that we did, and I’m going to talk about my second wish,
与这个设备有关的第二个愿望。
which has something to do with this.
从我们的研究可以得出一个结论,迄今三个研究中心
Our conclusions from our studies so far, at three research centers,
在使用过这个设备一次之后,在治疗疼痛方面技术已经创造出显著的进步。
is there is a marked improvement in pain levels after using it just once.
就算是那种最严重的头痛,在用了这个设备几次后就明显得到了好转。
The most severe headaches responded better after we did it several times,
这一让人叹为观止的发明,神奇的让患者的偏头痛减轻或治愈,
and the unexpected finding indicates that even established headaches,
而其不仅包括视觉预兆偏头痛。
not only those with aura, get treated and get diminished.
偏头痛的预兆没有了,甚至症状也不再发生了。
And auras can be erased and the migraine, then, does not occur.
这就是我们所说的发明,而且我们还在不断努力的改善它。
And that is the migraine invention that we are talking about and that we are working on.
(掌声)
(Applause)
第三个,也是我们最后的一项发明是从一个想法开始的。
The third and last invention began with an idea.
癫痫的最佳治疗方法是通过神经反应电刺激术
Epilepsy can best be treated by responsive electrical stimulation.
现在,我们为什么要增加癫痫作为重点来讲呢?
Now, why do we use — add on, nearly, an epileptic focus?
不幸的是,我们的技术人员,不像博诺先生那样,
Now, unfortunately, us technical people, unlike Mr. Bono,
也要与这些技术术语打交道。♫
have to get into all these technical words.
那么,我们所理解的神经反应电刺激术就是
Well, “responsive electrical stimulation” means
就是在人的大脑里面某个位置,这个位置被称为癫痫病灶,
that we sense, at a place in your brain which is called an “epileptic focus,”
而且它也正是癫痫发作开始的地方
which is where the epileptic seizure begins —
我们能够感觉到那个地方的疼痛,
we sense there, that it’s going to happen,
接着我们只能利用电能量对这个具体的地方做电刺激
and then we respond by applying an electrical energy at that spot,
从而抵消产生疼痛的信号
which erases the errant signal
这样你就不会有偏头痛的临床表现。
so that you don’t get the clinical manifestations of the migraine headache.
目前我们使用心脏起搏器除颤器技术。
We use current pacemaker defibrillator technology that’s used for the heart.
我们认为,它也能够利用它来治疗大脑疾病。
We thought we could adapt it for the brain.
该设备可以植入头皮下,
The device could be implanted under the scalp
完全隐藏,和避免断线
to be totally hidden and avoid wire breakage,
因为如果不这样,当你把它放在胸部,或者是扭一下脖子他可能就会断线。
which occurs if you put it in the chest and you try to move your neck around.
我们要专门建立一个公司来研究治疗癫痫或其他脑部疾病的神经起搏器,
Form a company to develop a neuro-pacemaker for epilepsy,
因为所有大脑疾病
as well as other diseases of the brain, because all diseases of the brain
都是由于脑电波失调引起的,
are a result of some electrical malfunction in it,
至少也有包括大脑神经混乱的疾病
that causes many, if not all, of brain disorders.
我们成立了一家名为NeuroPace的公司
We formed a company called NeuroPace
我们开始研究造成癫痫病的响应性刺激疗法
and we started work on responsive neurostimulation,
看,这就是医疗仪的图片
and this is a picture of what the device looked like,
而这个设备是被植入在人的颅骨里。
that’s placed into the cranial bone.
这也许是一张更好的图片
This is probably a better picture.
设备里面有我们设计好支架
Here we have our device in which we put in a frame.
即是说,神经外科医生先在模板的头皮上开一个口
There’s a cut made in the scalp; it’s opened; the neurosurgeon has a template;
并且在口的周围作了标志,然后用牙钻去掉一片颅骨,
he marks it around, and uses a dental burr
而这片颅骨的大小刚好跟我们设备一样。
to remove a piece of the cranial bone exactly the size of our device.
今晚,你可以在我们暂时居住的地方看到这个设备
And tonight, you’ll be able to see the device in the tent.
然后我们把四个螺丝放进这个支架€€
And then with four screws, we put in a frame,
并且用电线把支架与治疗仪连接在一起–
then we snap in the device and we run with wires —
绿色的线连接大脑表面的电极
the one shown in green will go to the surface of the brain with electrodes,
称为病灶,即是致痫的地区,
to the epileptic focus, the origin of the epilepsy,
在这个地方,我们可以感受到电信号
where we can sense the electrical signal
并通过电脑分析并可以选择适当时间启动电流刺激,
and have computer analysis that tells us when to hit it with some electrical current
从而防止癫痫病的临床表现。
to prevent the clinical manifestation of the seizure.
而在那根蓝线上,我们看到了所谓的脑深部电极
In the blue wire, we see what’s called a deep brain electrode.
如果它是造成癫痫的来源,我们也可以采用响应性刺激疗法。
If that’s the source of the epilepsy, we can attack that as well.
综上所术,这个医疗仪,
The comprehensive solution: this is the device;
大小是2*1英寸,奇怪的是,
it’s about one inches by two inches and, oddly enough,
跟颅骨的厚度一样
just the thickness of most cranial bones.
神经响应性刺激的优点是:
The advantages of responsive neurostimulation:
它可以在临床症状发作之前就做出检测并终止病症的发生
It can detect and terminate seizures before the clinical symptoms occur,
而且当需要的时候还可以提供刺激能量
provide stimulation only when needed,
症状消失时刺激也就会自动停止,而且副作用也小–
can be turned off if seizures disappear; it has minimal side effects —
事实上,目前为止在我们所有的临床试验中
as a matter of fact, in all our clinical trials to date,
我们已经看到40多个病人在移植了这个设备后还没有产生过副作用
we’ve seen no side effects in the 40 or so patients in whom it’s been implanted —
而且这设备被移植到体内后是看不见的,
and it’s invisible, cosmetically hidden,
因此如果你有癫痫病,用了这个设备后
so, if you have epilepsy and you have the device,
没有人看得出它的存在,而你也不能向他们指出它的具体形状
no one will know it because you can’t tell that it’s there.
下面是病人癫痫发作时的脑电图
And this shows what an electroencephalogram is,
脑电图左边信号是一个病人自发病的信号。
and on the left is the signal of a spontaneous seizure of one of the patients.
然后,我们采用电刺激治疗,接着你会看到脑电图轨迹在变化
Then we stimulated, and you see how that heavy black line
最后脑电图信号就变成正常的
and then you see the electroencephalogram signal going to normal,
这意味着病人恢复了正常。
which means they did not get the epileptic seizure.
接着要结束关于癫痫治疗仪的讨论
That concludes my discussion of epilepsy,
而这也是我今天下午所说的第三个发明。
which is the third invention that I want to discuss here this afternoon.
(鼓掌)
(Applause)
我有三个愿望。嗯,但不会给非洲带去影响。
I have three wishes. Well, I can’t do much about Africa.
我是一个技术员,也要进入
I’m a tech; I’m into medical gadgetry,
诺先生所说高科技医学仪器的研究领域
which is mostly high-tech stuff like Mr. Bono talked about.
我的第一个愿望是,把癫痫症神经反应刺激器
The first wish is to use the epilepsy responsive neurostimulator,
简称为RNS,即是神经反应刺激器的首字母缩写词
called RNS, for Responsive NeuroStimulator — that’s a brilliant acronym —
把它应用到其他的脑科疾病上
for the treatment of other brain disorders.
因为既然这种仪器对治疗癫痫症有效?为什么我们不试着把它应用在其他疾病上呢?
Well, if we’re going to do it for epilepsy, why the hell not try it for something else?
看看,这就是神经反应刺激器的样子,
Then you saw what that device looked like,
一些女性甚至用它来治愈她们的偏头痛。
that the woman was using to fix her migraines?
我想说的是:这个治疗仪是由一些像我这样的研究工程师设计出来的,
I tell you this: that’s something which some research engineer like me would concoct,
它的设计并没有让人感到最满意。
not a real designer of good equipment.
(大笑)
(Laughter)
我希望有一些人,能够真正让这个仪器设计完美
We want to have some people, who really know how to do this,
即是应用人体工程学研究,从而设计出更加
perform human engineering studies to develop the optimum design
便携且人性化的偏头痛治疗仪。
for the portable device for treating migraine headaches.
对于所有参加TED会议的赞助商
And some of the sponsors of this TED meeting are such organizations.
我想给他们一个挑战
Then we’re going to challenge the TED attendees
希望他们去寻找一种能够改善美国医保体系的方案
to come up with a way to improve health care in the USA,
因为美国医保体系出现了非洲国家医保体系没有出现过的问题
where we have problems that Africa doesn’t have.
从而减少医疗事故产生的诉讼-
And by reducing malpractice litigation —
这种诉讼不是非洲国家所要解决的问题,而个美国急需解决的问题。
malpractice litigation is not an African problem; it’s an American problem.
(鼓掌)
(Applause)
因此,为了更快的达到我的第一个愿望–
So, to get quickly to my first wish —
即是通过电脑信号来控制大脑的运作
the brain operates by electrical signals.
如果这些电子信号导致大脑运作混乱
If the electrical signals create a brain disorder,
而且电刺激可以通过控制大脑神经来克服大脑功能紊乱。
electro-stimulation can overcome that disorder by acting on the brain’s neurons.
换句话说,如果你的大脑产生了这种信号
In other words, if you’ve screwed up electrical signals,
我们可以通过向电脑输入另一种信号
maybe, by putting other electrical signals from a computer in the brain,
来抵消这些信号
we can counteract that.
大脑中触发功能障碍的信号
A signal in the brain that triggers brain dysfunction
跟作用于病人在发生癫痫时的
might be sensed as a trigger for electro-stimulation
电刺激信号被看作是一样的。
like we’re doing with epilepsy.
但即使没有信号,
But even if there is no signal,
对大脑的某个适当部分做电刺激是可以结束大脑功能紊乱。
electro-stimulation of an appropriate part of the brain can turn off a brain disorder.
对于治疗这种精神病
And consider treating psychotic disorders —
我希望TED 能够介入并给予帮助
and I want this involved with the TED group —
比如强迫症
such as obsessive-compulsive disorder
目前还没有药物可以完全治愈这种病,但是却有5万美国人受到这种病的困扰
that, presently, is not well treated with drugs, and includes five million Americans.
菲舍儿先生以及他NeuroPace的所有成员,还有我自己都相信
And Mr. Fischer, and his group at NeuroPace, and myself believe
我们能够在强迫症治疗研究的领域中做出突出的成就,从而造福美国乃至世界所有的人
that we can have a dramatic effect in improving OCD in America and in the world.
而这就是我的第一个愿望。
That is the first wish.
(掌声)
(Applause)
我目前的第二个愿望是,
The second wish is, at the present time,
关于经颅磁刺激器,
the clinical trials of transcranial magnetic stimulators —
它是一种治疗偏头痛的仪器
that’s what TMS means, device to treat migraine headaches —
目前它在临床试验中已经取得很大的成功
appears to be quite successful.
嗯,这对于我们来说是个好消息。
Well, that’s the good news.
但是,目前便携式设备还远远没有达到优化设计的效果,
The present portable device is far from optimally designed,
因为它们的外形不够美观,没有得到人类的认可,
both as to human factors as appearance.
它大概被形容得像把枪。而大部分的人都是不喜欢枪的
I think she said it looks like a gun. A lot of people don’t like guns.
(大笑)
(Laughter)
因此,让公司致力于
Engage a company having prior successes
研究工程学和工业设计,优先考虑设计出让客户满意的产品
for human factors engineering and industrial design
并成功的对这便携式的经颅磁刺激器设计得更人性化
to optimize the design of the first portable TMS device
从而才能成功把它们出售给那些患有偏头痛的病人
that will be sold to the patients who have migraine headaches.
这就是我的第二个愿望。
And that is the second wish.
(掌声)
(Applause)
在TED 慷慨地给我的10万美金奖金中,
And, of the 100,000-dollar prize money, that TED was so generous to give me,
我将会把其中的5万元捐给了NeuroPace公司
I am donating 50,000 dollars to the NeuroPace people
作为他们更好的研究的强迫症治疗方案的资金,
to get on with the treatment of OCD, obsessive-compulsive disorder,
而剩下的一半奖金我就用在另一个公司
and I’m making another 50,000 available for a company
优化设计偏头痛治疗仪的设计中
to optimize the design of the device for migraines.
这就是我利用这10万元奖金的方法
And that’s how I’ll use my 100,000-dollar prize money.
(掌声)
(Applause)
我的第三个也是最后的愿望是–
Well, the third and final wish is somewhat —
它说起来有点麻烦和复杂,因为它牵涉到律师
unfortunately, it’s much more complicated because it involves lawyers.
(大笑)
(Laughter)
在美国,医疗纠纷诉讼案
Well, medical malpractice litigation in the US
导致了医疗事故保险费用的升高,
has escalated the cost of malpractice insurance,
因此业务精通的医生们都不愿意从医了
so that competent physicians are leaving their practice.
律师们在接下了医疗意外产生的事故案件后,希望得到
Lawyers take cases on contingency with the hope of a big share
陪审团的同情并得到更好的解决方法,,因为这些病人没有得到很好的赔偿
of a big settlement by a sympathetic jury, because this patient really ended up badly.
美国卫生保健费用很高,部分原因是由这些事故诉讼和保险费造成的。
The high cost of health care in the US is partly due to litigation and insurance costs.
我曾经看到,今日美国用图片或图片
I’ve seen pictures, graphs in today’s USA Today
显示这些价格的暴涨趋势,这也是另一个因素
showing it skyrocketing out of control, and this is one factor.
对于这样的社会现象,TED能否给与集体的帮助?
Well, how can the TED community help with this situation?
我有2个想法
I have a couple of ideas to begin with.
我与TED集体讨论第一个问题
As a starting point for discussion with the TED group,
是比较重要的,即是关于同意书的内容书写形式
a major part of the problem is the nature of the written extent
因为在患者或其配偶接受治疗前,他们必须阅读并签署一份协议书
of informed consent that the patient or spouse must read and sign.
例如,我曾经问过癫痫的患者
For example, I asked the epilepsy people
同意书是做什么用,里面是写什么呢?
what are they using for informed consent.
你能相信么,这同意书居然有12页,而且是单倍行距的
Would you believe, 12 pages, single space,
而且他们要在接受实验治疗癫痫之前就必须读完。
the patient has to read before they’re in our trial to cure their epilepsy?
你知道么,有些人甚至在看完了这12页内容之后
What do you think someone has at the end of reading 12 single-spaced pages?
都不明白里面讲的是什么意思。
They don’t understand what the hell it’s about.
(大笑)
(Laughter)
这就是现行制度。为何不把它整理成一个视频
That’s the present system. How about making a video?
我们这里有精通娱乐方面的人,
We have entertainment people here;
也有一些了解制作视频的人
we have people who know how to do videos,
他们能够把详细的内容通过可视化的视频显示出来
with visual presentation of the anatomy and procedure done with animation.
其实大家都知道,可视化的视频效果更好
Everybody knows that we can do better with a visual thing
能够让病人更好的了解其中的含义,并记得在哪里看过视频
that can be interactive with the patient, where they see the video
他们知道自己在录入从而按下按键。你们能明白我在说什么么?也许你会说:“不,我不明白。”
and they’re being videoed and they press, do you understand this? No, I don’t.
那么就让我来做一个更简单的解释,
Well, then let’s go to a simpler explanation.
然后在听完这个简单的介绍后,你就会说:“我终于明白了。”
Then there’s a simpler one and, oh yes, I understand that.
那么,按下按钮,你刚刚所说的已经被记录下来了
Well, press the button and you’re on record, you understand.
而这就是我其中的一个想法。
And that is one of the ideas.
现在,同样是一个关于病人或其配偶和医生的一个视频
Now, also a video is done of the patient or spouse and medical presenter,
这个视频是在病人同意的情况下自己按照程序做的
with the patient agreeing that he understands the procedure to be done,
它记录了所有尽可能产生的医疗事故
including all the possible failure modes.
病人及其配偶同意不能随便起诉
The patient or spouse agrees not to file a lawsuit
但是如果出现了违反视频其中规定的条约
if one of the known procedure failures occurs.
目前在美国,你是不能放弃自己的权利去向法院起诉
Now, in America, in fact, you cannot give up your right to trial by jury.
但是,如果视频的每条规定你都很清楚,
However, if a video is there that everything was explained to you,
而且你也已经愿意按下了按键,自己录了视频
and you have it all in the video file,
那么你就不可能去请律师
it’ll be much less likely that some hotshot lawyer
来处理这个意外事故产生的案件,因为它的理由不充分,不容易胜诉
will take this case on contingency, because it won’t be nearly as good a case.
如果是因为医学错误造成的,而病人及其配偶同意以
If a medical error occurs, the patient or spouse agrees to a settlement
一种公平的赔偿方式来解决,并不是上诉到法庭
for fair compensation by arbitration instead of going to court.
那么在美国,案件处理费用就可以省下上百万美元
That would save hundreds of millions of dollars in legal costs in the United States
而且也能减少每个美国人的医药费
and would decrease the cost of medicine for everyone.
这也是一些想法而已。
These are just some starting points.
至此,我所有的愿望已经分享完毕。
And, so there, that’s the end of all my wishes.
虽然目前我有这三个愿望,但我希望我能实现更多的愿望
I wish I had more wishes but three is what I’ve got and there they are.
(掌声)
(Applause)

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