演講MP3+雙語文稿:你健康嗎？呼吸可以告訴你

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聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學(xué)習(xí)使用。本文主要內(nèi)容為演講MP3+雙語文稿:你健康嗎？呼吸可以告訴你，希望你會喜歡！

【演講人及介紹】Julian Burschka

朱利安·布爾什卡(Julian Burschka)多年來一直致力于開發(fā)高效太陽能轉(zhuǎn)換材料。他開創(chuàng)了一種方法來制造所謂的鈣鈦礦太陽能電池，這項(xiàng)開創(chuàng)性研究發(fā)表于《自然》，從那以后引用了幾千次。

【演講主題】從呼吸看出你的身體健康狀況

【演講文稿-中英文】

翻譯 Joseph Geni 校對Camille Martínez

00:00

I have a tendency to assume the worst, andonce in a while, this habit plays tricks on me. For example, if I feelunexpected pain in my body that I have not experienced before and that I cannotattribute, then all of a sudden, my mind might turn a tense back into heartdisease or calf muscle pain into deep vein thrombosis. But so far, I haven'tbeen diagnosed with any deadly or incurable disease. Sometimes things just hurtfor no clear reason.

我傾向于把事情往壞了想，而這種想法偶爾會把我弄糊涂。舉例來說，如果我的身體突然感到疼痛，這種疼痛前所未有，并且我不清楚病因，那么我會突然認(rèn)為背部劇痛是由心臟病所致，或者因?yàn)樾⊥燃∪馓弁炊鴳岩勺约河辛松畈快o脈血栓。但至今為止，我還沒被確診患有任何致命或者難以治愈的疾病。有時這種事實(shí)會毫無緣由地使我傷心。

00:29

But not everyone is as lucky as me. Everyyear, more than 50 million people die worldwide. Especially in high-incomeeconomies like ours, a large fraction of deaths is caused by slowly progressingdiseases: heart disease, chronic lung disease, cancer, Alzheimer's, diabetes,just to name a few.

但并不是所有人都像我這么幸運(yùn)。每年，世界上都有超過五千萬人死去。尤其像我們這種高收入經(jīng)濟(jì)體里，慢性病致死占了很大一部分：心臟病，慢性肺病，癌癥，阿爾茲海默癥，糖尿病，這些只是其中一小部分例子。

00:51

Now, humanity has made tremendous progressin diagnosing and treating many of these. But we are at a stage where furtheradvancement in health cannot be achieved only by developing new treatments. Andthis becomes evident when we look at one aspect that many of these diseaseshave in common: the probability for successful treatment strongly depends onwhen treatment is started. But a disease is typically only detected oncesymptoms occur. The problem here is that, in fact, many diseases can remainasymptomatic, hence undetected, for a long period of time. Because of this,there is a persisting need for new ways of detecting disease at early stage,way before any symptoms occur. In health care, this is called screening.

如今，人類已經(jīng)在慢性病確診和治療上取得了顯著進(jìn)展。但就現(xiàn)階段而言，醫(yī)學(xué)上的進(jìn)一步突破不能只依賴于研發(fā)新的治療方法。而當(dāng)我們觀察所有這些疾病的一個共同點(diǎn)時，這一點(diǎn)就變得尤為明顯：治療的成功率很大程度上取決于何時開展治療。但是一般來說，疾病只有在癥狀顯現(xiàn)后才會被確診。這里的問題在于，實(shí)際上，很多疾病一直沒有臨床癥狀，所以很長一段時間都不會被檢測出來。因此，在遠(yuǎn)早于癥狀顯現(xiàn)出來前，便能檢測出早期疾病的新治療方法變得極為需要。在醫(yī)療保健上，這被稱為篩檢。

01:39

And as defined by the World Health Organization,screening is "the presumptive identification of unrecognized disease in anapparently healthy person, by means of tests ... that can be applied rapidlyand easily ..." That's a long definition, so let me repeat it:identification of unrecognized disease in an apparently healthy person by meansof tests that can be applied both rapidly and easily. And I want to put specialemphasis on the words "rapidly" and "easily" because manyof the existing screening methods are exactly the opposite. And those of youwho have undergone colonoscopy as part of a screening program for colorectalcancer will know what I mean.

根據(jù)世界衛(wèi)生組織（WHO）的定義，篩檢意為“在看似健康的人身上，通過快速簡單的...多種檢測手段... 得出的未確診疾病的假定診斷?！边@段定義非常長，所以我再重復(fù)一遍：在看似健康的人身上，通過多種快速簡單的檢測手段得出的未確診疾病的假定診斷。我想著重強(qiáng)調(diào)“快速”和“簡單”這兩個詞，因?yàn)楝F(xiàn)階段的很多篩檢方法并沒做到這兩點(diǎn)。而在座的觀眾中做過直腸癌篩檢程序之一，即結(jié)腸鏡檢查的人將會明白我的話中之意。

02:25

Obviously, there's a variety of medicaltools available to perform screening tests. This ranges from imaging techniquessuch as radiography or magnetic resonance imaging to the analysis of blood ortissue. We have all had such tests. But there's one medium that for long hasbeen overlooked: a medium that is easily accessible, basically nondepletable,and it holds tremendous promise for medical analysis. And that is our breath.

顯而易見，目前有許許多多可應(yīng)用于篩檢的醫(yī)學(xué)手段。其中包括X射線放射成像、磁共振成像、 還有血液和組織分析。我們一直都擁有這些技術(shù)。但有一個長期被忽視的媒介：一個可輕易接觸到的，基本無損耗的，擁有巨大前景的醫(yī)學(xué)分析媒介。這便是我們的呼氣。

02:58

Human breath is essentially composed offive components: nitrogen, oxygen, carbon dioxide, water and argon. But besidesthese five, there are hundreds of other components that are present in very lowquantity. These are called volatile organic compounds, and we release hundreds,even thousands of them every time we exhale. The analysis of these volatileorganic compounds in our breath is called breath analysis. In fact, I believethat many of you have already experienced breath analysis. Imagine: you'redriving home late at night, when suddenly, there's a friendly police officerwho asks you kindly but firmly to pull over and blow into a device like thisone. This is an alcohol breath tester that is used to measure the ethanolconcentration in your breath and determine whether driving in your condition isa clever idea. Now, I'd say my driving was pretty good, but let me check.

人類呼出的氣體基本由五個部分組成：氮、氧、二氧化碳、水和氬。除此之外，還有其它上百種含量極低的成分。它們是揮發(fā)性有機(jī)物質(zhì)，而我們每次呼氣都會釋放成百甚至上千種有機(jī)物質(zhì)。以這些揮發(fā)性有機(jī)物為對象的分析被稱為呼氣分析。事實(shí)上，我相信在座的許多人都已經(jīng)做過呼氣分析。試想一下：你在深夜開車回家，突然這時，有位親切的警官，和善卻態(tài)度堅(jiān)決地要求你靠邊停車，并朝這個儀器里呼氣。這是酒精呼氣檢測儀，用于測量呼出氣體中的酒精含量以評估你此時的身體條件是否允許開車。我覺得我的駕駛水平很不錯，但讓我現(xiàn)在檢測一下。

04:02

(Beep)

響聲

04:08

0.0, so nothing to worry about, all fine.

0.0，所以沒什么好擔(dān)心的，一切正常。

04:11

(Laughter)

（笑聲）

04:14

Now imagine a device like this one, thatdoes not only measure alcohol levels in your breath, but that detects diseaseslike the ones I've shown you and potentially many more. The concept ofcorrelating the smell of a person's breath with certain medical conditions, infact, dates back to Ancient Greece. But only recently, research efforts onbreath analysis have skyrocketed, and what once was a dream is now becomingreality. And let me pull up this list again that I showed you earlier. For themajority of diseases listed here, there's substantial scientific evidencesuggesting that the disease could be detected by breath analysis.

現(xiàn)在試想這樣一臺儀器，它不僅可以檢測呼氣中的酒精含量，還可以檢測出像我剛剛介紹過的那樣的疾病，甚至可能檢測出更多種。這種將人類呼氣中的氣味和他的某種健康狀況所聯(lián)系起來的概念，實(shí)際上起源于古希臘。但直到最近，關(guān)于呼氣分析的研究成果才有了飛躍性的進(jìn)展，曾經(jīng)只存在于想象中的事物如今變成了事實(shí)。我現(xiàn)在再展示一下剛才的那張單子。有大量證據(jù)表明，這張單子中的大部分疾病，可以通過呼氣分析檢測到。

04:59

But how does it work, exactly? Theessential part is a sensor device that detects the volatile organic compoundsin our breath. Simply put: when exposed to a breath sample, the sensor outputsa complex signature that results from the mixture of volatile organic compoundsthat we exhale. Now, this signature represents a fingerprint of yourmetabolism, your microbiome and the biochemical processes that occur in yourbody. If you have a disease, your organism will change, and so will thecomposition of your exhaled breath. And then the only thing that is left to dois to correlate a certain signature with the presence or absence of certainmedical conditions.

但呼氣分析到底是如何檢測的？分析儀器里必不可缺的部分是可以檢測呼氣中揮發(fā)性有機(jī)物的感應(yīng)器。簡單地說，當(dāng)把此裝置置于呼氣樣本中，它便會輸出復(fù)雜的信號，這些信號便是來源于我們呼氣中的揮發(fā)性有機(jī)物。而這些信號就好比你體內(nèi)的新陳代謝，微生物菌群，以及生化過程的“指紋”。如果你患有某種疾病，你的機(jī)體會產(chǎn)生變化，這也包括了呼出氣體的成分。接下來該做的，便是把某個信號與某項(xiàng)身體狀況的存在與否給聯(lián)系起來。

05:47

The technology promises several undeniablebenefits. Firstly, the sensor can be miniaturized and integrated into small,handheld devices like this alcohol breath tester. This would allow the test tobe used in many different settings and even at home, so that a visit at thedoctor's office is not needed each time a test shall be performed.

這項(xiàng)技術(shù)具備一些不可忽視的優(yōu)點(diǎn)。首先，感應(yīng)器可以微型化，并被整合進(jìn)小型便攜設(shè)備，比如酒精呼氣檢測儀。這使得測試可在很多不同情境下，甚至在家里完成，如此一來，每次檢測便沒必要去醫(yī)生辦公室才能完成了。

06:10

Secondly, breath analysis is noninvasiveand can be as simple as blowing into an alcohol breath tester. Such simplicityand ease of use would reduce patient burden and provide an incentive for broadadoption of the technology.

其次，呼氣分析是無創(chuàng)的，就像朝酒精檢測儀里吹氣那樣簡單。此種簡單且易操作的特點(diǎn)可以減輕病人的負(fù)擔(dān)，還可以促進(jìn)這項(xiàng)技術(shù)的推廣。

06:27

And thirdly, the technology is so flexiblethat the same device could be used to detect a broad range of medicalconditions. Breath analysis could be used to screen for multiple diseases atthe same time. Nowadays, each disease typically requires a different medicaltool to perform a screening test. But this means you can only find what you'relooking for.

另外，這項(xiàng)技術(shù)的靈活性使得儀器能被應(yīng)用于檢測很多方面的身體狀況。呼氣檢測可以同時篩檢多種疾病。如今，每種疾病的篩檢需要用到不同醫(yī)療儀器。但這意味這你只能有目的的進(jìn)行疾病監(jiān)測。

06:54

With all of these features, breath analysisis predestined to deliver what many traditional screening tests are lacking.And most importantly, all of these features should eventually provide us with aplatform for medical analysis that can operate at attractively low cost pertest. On the contrary, existing medical tools often lead to rather high costper test. Then, in order to keep costs down, the number of tests needs to berestricted, and this means (a) that the tests can only be performed on a narrowpart of the population, for example, the high-risk population; and (b) that thenumber of tests per person needs to be kept at a minimum. But wouldn't itactually be beneficial if the test was performed on a larger group of people,and more often and over a longer period of time for each individual? Especiallythe latter would give access to something very valuable that is calledlongitudinal data.

有了這些特點(diǎn)，呼氣分析就、就可以彌補(bǔ)傳統(tǒng)篩檢里的不足。而最重要的是，所有這些特點(diǎn)最終可提供一個平均花費(fèi)相當(dāng)?shù)偷尼t(yī)療分析平臺。相較之下，現(xiàn)在的醫(yī)療儀器常常意味著高昂的成本。為了降低成本，檢測的數(shù)量便被限制，這說明：(a) 檢測只能提供給一小部分人，比如高危人群； (b) 每人的檢測數(shù)要被控制在最少。但如果這些檢測被提供給更多的人，甚至長此以往提供給每一個人，這樣豈不是更有益？尤其是后一種情況，將會在最后提供一種名為“縱向數(shù)據(jù)”的寶貴數(shù)據(jù)。

07:58

Longitudinal data is a data set that tracksthe same patient over the course of many months or years. Nowadays, medicaldecisions are often based on a limited data set, where only a glimpse of apatient's medical history is available for decision-making. In such a case,abnormalities are typically detected by comparing a patient's health profile tothe average health profile of a reference population. Longitudinal data wouldopen up a new dimension and allow abnormalities to be detected based on apatient's own medical history. This will pave the way for personalizedtreatment.

縱向數(shù)據(jù)是一種跟蹤記錄同一個病人在數(shù)月或數(shù)年內(nèi)情況的數(shù)據(jù)組。如今，醫(yī)療上的決策常受有限數(shù)據(jù)組限制，僅僅只有病人的一部分病史對決策有幫助。在這種情況下，病人身體的異常一般是通過將病人的健康概貌和參考組的平均健康概貌作比較?？v向數(shù)據(jù)將會開拓出新的維度，并以病人自己的病史為依據(jù)檢測出身體異常。這將會為個性化治療開辟道路。

08:44

Sounds pretty great, right? Now you willcertainly have a question that is something like, "If the technology is asgreat as he says, then why aren't we using it today?" And the only answerI can give you is: not everything is as easy as it sounds. There are technicalchallenges, for example. There's the need for extremely reliable sensors thatcan detect mixtures of volatile organic compounds with sufficientreproducibility. And another technical challenge is this: How do you sample a person'sbreath in a very defined manner so that the sampling process itself does notalter the result of the analysis? And there's the need for data. Breathanalysis needs to be validated in clinical trials, and enough data needs to becollected so that individual conditions can be measured against baselines.Breath analysis can only succeed if a large enough data set can be generatedand made available for broad use.

這聽起來很棒，對吧？現(xiàn)在，你肯定會冒出一個問題：“如果這項(xiàng)技術(shù)真的有他說得那么好，為什么現(xiàn)在還沒被應(yīng)用呢？”我能給出的唯一答復(fù)是：并不是所有事情都像聽起來那么簡單。比如，現(xiàn)階段還存在著技術(shù)上的難關(guān)。我們需要非常可靠的感應(yīng)器，可靠到以足夠的再現(xiàn)性檢測到揮發(fā)性有機(jī)混合氣體。另一個技術(shù)難關(guān)是這個：要如何明確清楚地抽樣調(diào)查一個人呼出的氣體，以保證抽樣過程本身不會改變分析結(jié)果呢？另外，我們還需要數(shù)據(jù)。呼氣分析需在醫(yī)療測試中進(jìn)行驗(yàn)證，同時需要收集足夠的數(shù)據(jù)，以保證個體的身體狀況可通過對比基準(zhǔn)線來檢測。呼氣分析只有在能生成大量的數(shù)據(jù)組并廣泛應(yīng)用的情況下才能成功。

09:51

If breath analysis holds up to its promises,this is a technology that could truly aid us to transform our health caresystem -- transform it from a reactive system where treatment is triggered bysymptoms of disease to a proactive system, where disease detection, diagnosisand treatment can happen at early stage, way before any symptoms occur.

如果呼氣分析有望成功，這將會成為能真正幫助我們改革醫(yī)療系統(tǒng)的技術(shù)——從一個只有在病癥顯現(xiàn)時才能給出治療的應(yīng)激系統(tǒng)，轉(zhuǎn)變成主動出擊的系統(tǒng)，而在這個系統(tǒng)里，疾病的檢測、診斷和治療可在疾病早期就被應(yīng)用，遠(yuǎn)早于病癥顯現(xiàn)之時。

10:17

Now this brings me to my last point, andit's a fundamental one. What exactly is a disease? Imagine that breath analysiscan be commercialized as I describe it, and early detection becomes routine. Aproblem that remains is, in fact, a problem that any screening activity has toface because, for many diseases, it is often impossible to predict withsufficient certainty whether the disease would ever cause any symptoms or put aperson's life at risk. This is called overdiagnosis, and it leads to a dilemma.If a disease is identified, you could decide not to treat it because there's acertain probability that you would never suffer from it. But how much would yousuffer just from knowing that you have a potentially deadly disease? Andwouldn't you actually regret that the disease was detected in the first place?

這便讓我將演講引向最后一點(diǎn)，也是最基礎(chǔ)的一點(diǎn)。疾病到底是什么？想象一下，呼吸分析就像我描述的那樣被商業(yè)化，早期檢測成為常規(guī)流程。還留有的一個問題，實(shí)際上，是任何篩檢手段都需要面對的問題，因?yàn)?，對于大多?shù)疾病而言，想要以足夠的肯定性來檢測此種疾病是否會顯現(xiàn)癥狀，或使病人命懸一線，通常是不可能的。這被稱為“過度診斷”，而它會將我們置于困境。如果某種疾病被檢測出來，你可以決定不去治療它，因?yàn)橛锌赡懿∪藦牟粫蜻@疾病而受煎熬。但如果你只知道可能得了絕癥，這又會讓你受到何種程度的煎熬呢？你會不會因?yàn)榧膊囊婚_始就被檢測出來而感到后悔呢？

11:13

Your second option is to undergo earlytreatment with the hope for curing it. But often, this would not come withoutside effects.

你的第二種選擇是抱著能夠被治好的希望去接受早期治療。但是，這經(jīng)常會帶來副作用。

11:25

To be precise: the bigger problem is notoverdiagnosis, it's overtreatment, because not every disease has to be treatedimmediately just because a treatment is available. The increasing adoption ofroutine screening will raise the question: What do we call a disease that canrationalize treatment, and what is just an abnormality that should not be asource of concern? My hopes are that routine screening using breath analysiscan provide enough data and insight so that at some point, we'll be able tobreak this dilemma and predict with sufficient certainty whether and when totreat at early stage.

準(zhǔn)確地來說：更大的問題并不是過度診斷，而是過度治療，因?yàn)椴⒉皇莾H因?yàn)檫@種疾病有治療方法就要去馬上接受治療。頻繁進(jìn)行常規(guī)篩檢會引發(fā)一個問題：我們該如何判斷 某種疾病是需要治療，還是視它為不需要擔(dān)心的身體異常？ 我希望應(yīng)用呼氣分析的常規(guī)篩檢 可以提供充足的數(shù)據(jù)和見解，能讓我們以后打破僵局，有充分的把握來預(yù)測此疾病是否需要在早期進(jìn)行治療。

12:14

Our breath and the mixture of volatileorganic compounds that we exhale hold tremendous amounts of information on ourphysiological condition. With what we know today, we have only scratched thesurface. As we collect more and more data and breath profiles across thepopulation, including all varieties of gender, age, origin and lifestyle, thepower of breath analysis should increase. And eventually, breath analysisshould provide us with a powerful tool not only to proactively detect specificdiseases but to predict and ultimately prevent them. And this should be enoughmotivation to embrace the opportunities and challenges that breath analysis canprovide, even for people that are not part-time hypochondriacs like me.

我們的呼氣和其中包含的揮發(fā)性有機(jī)物蘊(yùn)含著透露我們身體狀況的豐富信息。我們目前的認(rèn)識只是九牛一毛。隨著我們在人群中收集到越來越多的數(shù)據(jù)和呼吸信息，包括各種性別、年齡、種族和生活方式，呼氣分析的權(quán)威性將會增強(qiáng)。最終，呼氣分析將成為強(qiáng)有力的工具，它不僅能盡早檢測出某種疾病，還可以預(yù)測和最終預(yù)防疾病。這應(yīng)該能敦促我們接受呼氣分析所帶來的機(jī)遇和挑戰(zhàn)，甚至包括不同于我種偶發(fā)疑病癥患者的人。

13:10

Thank you.

謝謝

13:11

(Applause)

（掌聲）