TEDMED 2012
Francis Collins: We need better drugs -- now
法蘭西斯 柯林斯: 我們現在就需要更好的藥
Filmed:
Readability: 3.8
898,302 views
今天，我們知道 4000 種疾病的分子病因，但只有 250 種疾病有治療的藥物。那麼，為何需要這麼長的時間？遺傳學家和醫生法蘭西斯·柯林斯解釋了為什麼系統化的藥物發掘是必要的，甚至為了罕見和複雜的疾病，提供了一些解決方案--例如教老藥玩新花樣。
Francis Collins - Geneticist, physician
A key player in the US' new brain-mapping project, Francis Collins is director of the National Institutes of Health. Full bio
A key player in the US' new brain-mapping project, Francis Collins is director of the National Institutes of Health. Full bio
Double-click the English transcript below to play the video.
00:16
So let me ask for a show of hands.
0
723
2176
請用舉手的方式回答我。
00:18
How many people here are over the age of 48?
1
2899
4192
多少人超過48歲？
00:22
Well, there do seem to be a few.
2
7091
2881
看來並不多。
00:25
Well, congratulations,
3
9972
2175
恭喜大家，
00:28
because if you look at this particular slide of U.S. life expectancy,
4
12147
3870
因為如果當你看到這張幻燈片上
美國人的預期壽命，
美國人的預期壽命，
00:31
you are now in excess of the average life span
5
16017
3098
現在各位的壽命都超過
00:35
of somebody who was born in 1900.
6
19115
2787
1900 年出生的一些人。
00:37
But look what happened in the course of that century.
7
21902
3534
但看看在這個世紀裏發生了什麼事。
00:41
If you follow that curve,
8
25436
1662
如果各位沿著這條曲線，
00:42
you'll see that it starts way down there.
9
27098
2614
可以看到它從這下降了。
00:45
There's that dip there for the 1918 flu.
10
29712
2469
那就是因爲 1918 年大流感。
00:48
And here we are at 2010,
11
32181
2422
這是 2010 年的數據，
00:50
average life expectancy of a child born today, age 79,
12
34603
3056
這一年出生的小孩，預估平均壽命為 79 歲，
00:53
and we are not done yet.
13
37659
1896
而且還會繼續增長。
00:55
Now, that's the good news.
14
39555
1335
目前，這是個好消息。
00:56
But there's still a lot of work to do.
15
40890
1841
但還有很多工作要做。
00:58
So, for instance, if you ask,
16
42731
1634
舉例來說，如果你問，
01:00
how many diseases do we now know
17
44365
2726
我們現在到底知道多少疾病的
01:02
the exact molecular basis?
18
47091
2059
精確的分子基礎？
01:05
Turns out it's about 4,000, which is pretty amazing,
19
49150
3558
說穿了大概就是 4,000 種，這是非常了不起的，
01:08
because most of those molecular discoveries
20
52708
2236
而且發現這些分子大部分都是
01:10
have just happened in the last little while.
21
54944
2665
最近前發生的。
01:13
It's exciting to see that in terms of what we've learned,
22
57609
3296
從已知的觀點，很興奮可以看到這樣的結果，
01:16
but how many of those 4,000 diseases
23
60905
2107
但是 4000 種疾病中，有多少疾病
01:18
now have treatments available?
24
63012
2348
現在有治療方法？
01:21
Only about 250.
25
65360
1888
大概祇有 250 種。
01:23
So we have this huge challenge, this huge gap.
26
67248
2758
所以我們面對著非常巨大的挑戰，巨大的差距。
01:25
You would think this wouldn't be too hard,
27
70006
2580
您可能會想這件事也不會太困難，
01:28
that we would simply have the ability
28
72586
1526
我們很容易就能
01:30
to take this fundamental information that we're learning
29
74112
3026
獲取基本資訊，
01:33
about how it is that basic biology teaches us
30
77138
3145
關於基礎生物學是如何告訴我們的
01:36
about the causes of disease
31
80283
1902
關於疾病的生成原因
01:38
and build a bridge across this yawning gap
32
82185
3026
以及在一條大壕溝的上面蓋一座橋樑，
01:41
between what we've learned about basic science
33
85211
2380
一邊是我們學到的基礎科學，
01:43
and its application,
34
87591
1495
另外一邊是它的應用。
01:44
a bridge that would look maybe something like this,
35
89086
3257
一座橋，看起來也許像這樣，
01:48
where you'd have to put together a nice shiny way
36
92343
3612
我們必須建一條優良的康莊大道
01:51
to get from one side to the other.
37
95955
2968
從一側連結到另一側。
01:54
Well, wouldn't it be nice if it was that easy?
38
98923
2600
嗯，是不是如果這麼簡單就太好了?
01:57
Unfortunately, it's not.
39
101523
2145
不幸的是，事與願違。
01:59
In reality, trying to go from fundamental knowledge
40
103668
2591
在現實中，試圖從基礎知識
02:02
to its application is more like this.
41
106259
2664
走向該知識的實際應用，更像是這樣。
02:04
There are no shiny bridges.
42
108923
1915
沒有閃亮的橋樑。
02:06
You sort of place your bets.
43
110838
1652
如同你在下賭注。
02:08
Maybe you've got a swimmer and a rowboat
44
112490
1961
也許你會得到一位泳將和划艇
02:10
and a sailboat and a tugboat
45
114451
1524
一艘拖船和一艘帆船
02:11
and you set them off on their way,
46
115975
1728
然後你開始給他們方向，
02:13
and the rains come and the lightning flashes,
47
117703
2664
開始下雨、雷電交加
02:16
and oh my gosh, there are sharks in the water
48
120367
1514
唉呦喂呀，水中還有鯊魚
02:17
and the swimmer gets into trouble,
49
121881
2021
你的泳將陷入大麻煩，
02:19
and, uh oh, the swimmer drowned
50
123902
1584
喔哦，你的泳將溺水了
02:21
and the sailboat capsized,
51
125486
3212
帆船翻船了，
02:24
and that tugboat, well, it hit the rocks,
52
128698
1701
這艘拖船，撞到大石頭，
02:26
and maybe if you're lucky, somebody gets across.
53
130399
2640
如果你幸運的話，剛好有人要過去。
02:28
Well, what does this really look like?
54
133039
1989
事實上這樣看起來像什麼？
02:30
Well, what is it to make a therapeutic, anyway?
55
135028
2054
到底什麼東西可以有療效?
02:32
What's a drug? A drug is made up
56
137082
3001
藥是什麼? 藥是由
02:35
of a small molecule of hydrogen, carbon,
57
140083
2325
氫分子、碳分子、
02:38
oxygen, nitrogen, and a few other atoms
58
142408
2251
氧分子、 氮分子、 和其它幾個原子
02:40
all cobbled together in a shape,
59
144659
2223
組合而成的特定形狀，
02:42
and it's those shapes that determine whether, in fact,
60
146882
2377
正是靠這些形狀，事實上，
02:45
that particular drug is going to hit its target.
61
149259
3313
決定是否某種特定的藥物可擊中目標。
02:48
Is it going to land where it's supposed to?
62
152572
2223
它會到達它應該去的地方嗎?
02:50
So look at this picture here -- a lot of shapes dancing around for you.
63
154795
3156
看看這張照片 -- 各位的周遭都有很多這種形狀在跳舞。
02:53
Now what you need to do, if you're trying to develop
64
157951
2387
現在你需要做什麼，如果你想要探索
02:56
a new treatment for autism
65
160338
1457
自閉症的新治療法
02:57
or Alzheimer's disease or cancer
66
161795
2219
或阿茲海默症、或癌症
02:59
is to find the right shape in that mix
67
164014
1792
是在混和之中找到正確的形狀，
03:01
that will ultimately provide benefit and will be safe.
68
165806
2917
最終會帶來好處，而且很安全。
03:04
And when you look at what happens to that pipeline,
69
168723
3167
當你觀察這些管線，
03:07
you start out maybe with thousands,
70
171890
1501
你也許從成千上萬，
03:09
tens of thousands of compounds.
71
173391
1642
上億的化合物開始。
03:10
You weed down through various steps
72
175033
2149
你釐清各個的步驟
03:13
that cause many of these to fail.
73
177182
1383
這導致許多失敗。
03:14
Ultimately, maybe you can run a clinical trial with four or five of these,
74
178565
3340
最終，也許您可以對其中的 4~5 項做臨床試驗，
03:17
and if all goes well, 14 years after you started,
75
181905
3042
如果一切順利，在你開始14 年後，
03:20
you will get one approval.
76
184947
2011
你得到一個批准。
03:22
And it will cost you upwards of a billion dollars
77
186958
2030
它將花費超過 10 億美金
03:24
for that one success.
78
188988
2144
就為了一次成功。
03:27
So we have to look at this pipeline the way an engineer would,
79
191132
3304
所以我們必須用一種工程師的思維看看這條管線，
03:30
and say, "How can we do better?"
80
194436
1208
並說，"可以做得更好嗎?"
03:31
And that's the main theme of what I want to say to you this morning.
81
195644
2677
這就是今天早上要對各位說的主題。
03:34
How can we make this go faster?
82
198321
1813
如何讓整件事進行得更快?
03:36
How can we make it more successful?
83
200134
3065
我們如何讓它更成功？
03:39
Well, let me tell you about a few examples
84
203199
1341
讓我告訴你幾個例子
03:40
where this has actually worked.
85
204540
2256
實際有效的例子。
03:42
One that has just happened in the last few months
86
206796
2951
一個案例是幾個月前才發生的事情
03:45
is the successful approval of a drug for cystic fibrosis.
87
209747
3710
一項針對 "囊狀纖維化" 的藥物成功取得審批。
03:49
But it's taken a long time to get there.
88
213457
1654
但是已經花了很長一段時間才得到。
03:51
Cystic fibrosis had its molecular cause discovered in 1989
89
215111
4602
"囊狀纖維化" 已於1989 年發現其分子層的成因。
03:55
by my group working with another group in Toronto,
90
219713
2328
經由我的團隊與位於多倫多的團隊一起合作
03:57
discovering what the mutation was in a particular gene
91
222041
2135
發現一個特定的基因突變
04:00
on chromosome 7.
92
224176
1628
在7 號染色體。
04:01
That picture you see there?
93
225804
2038
看到的那幅畫了嗎？
04:03
Here it is. That's the same kid.
94
227842
2103
是的。這就是同一的孩子。
04:05
That's Danny Bessette, 23 years later,
95
229945
3344
他叫丹尼班賽特，23 年之後，
04:09
because this is the year,
96
233289
1279
就是這一年
04:10
and it's also the year where Danny got married,
97
234568
2438
也是在丹尼結婚的一年
04:12
where we have, for the first time, the approval by the FDA
98
237006
3057
我們第一次通過 FDA 批准
04:15
of a drug that precisely targets the defect in cystic fibrosis
99
240063
3737
一種藥物可精確地修復"囊狀纖維化"的缺陷
04:19
based upon all this molecular understanding.
100
243800
1938
基於所有對分子的認識的基礎上。
04:21
That's the good news.
101
245738
1424
這是個好消息。
04:23
The bad news is, this drug doesn't actually treat all cases of cystic fibrosis,
102
247162
3629
壞消息是，這種藥物並不真的
可以治療所有的 "囊狀纖維化"
可以治療所有的 "囊狀纖維化"
04:26
and it won't work for Danny, and we're still waiting
103
250791
2209
對丹尼就無效，然而我們仍然在等待
04:28
for that next generation to help him.
104
253000
2335
希望下一代可以幫助到他。
04:31
But it took 23 years to get this far. That's too long.
105
255335
3195
但歷經了 23 年才到這邊。實在太長太久。
04:34
How do we go faster?
106
258530
1693
我們如何加速?
04:36
Well, one way to go faster is to take advantage of technology,
107
260223
2698
嗯，一種加速方式是利用科技，
04:38
and a very important technology that we depend on
108
262921
2664
一種我們非常看重的技術
04:41
for all of this is the human genome,
109
265585
2296
適用於全人類的基因組，
04:43
the ability to be able to look at a chromosome,
110
267881
2588
能够看到一對染色體，
04:46
to unzip it, to pull out all the DNA,
111
270469
2670
解開它，並拔出所有的 DNA，
04:49
and to be able to then read out the letters in that DNA code,
112
273139
2950
然後能夠解讀該 DNA 代碼中的密码子
04:51
the A's, C's, G's and T's
113
276089
2081
A、 C、 G 的和 T 的
04:54
that are our instruction book and the instruction book for all living things,
114
278170
3271
這是我們人類的指令書
和一切生物的建構組成指導書，
和一切生物的建構組成指導書，
04:57
and the cost of doing this,
115
281441
1514
做到這一點的成本
04:58
which used to be in the hundreds of millions of dollars,
116
282955
2655
曾經需要好幾億美元
05:01
has in the course of the last 10 years
117
285610
1913
在過去 10 年中
05:03
fallen faster than Moore's Law, down to the point
118
287523
2399
下降的速度已超越摩爾定律，
05:05
where it is less than 10,000 dollars today to have your genome sequenced, or mine,
119
289922
4007
今天做一份你我的基因體定序已經低於一萬美元
05:09
and we're headed for the $1,000 genome fairly soon.
120
293929
3799
我們正快速朝向1,000 美元基因體定序前進。
05:13
Well, that's exciting.
121
297728
1326
嗯，真令人興奮。
05:14
How does that play out in terms of application to a disease?
122
299054
3810
應用於疾病的觀點，這件事是如何演變的?
05:18
I want to tell you about another disorder.
123
302864
2280
我要告訴你另一個障礙。
05:21
This one is a disorder which is quite rare.
124
305144
2312
這是非常罕見的一種紊亂。
05:23
It's called Hutchinson-Gilford progeria,
125
307456
2768
它被稱為哈欽森-吉爾福德（早衰症），
05:26
and it is the most dramatic form of premature aging.
126
310224
3305
它是最具戲劇性的過早老化現象。
05:29
Only about one in every four million kids has this disease,
127
313529
3783
大約每個 400 萬孩子中只有 1位有這種疾病，
05:33
and in a simple way, what happens is,
128
317312
3360
一種簡單的方式發生，發生的情況是，
05:36
because of a mutation in a particular gene,
129
320672
2701
因為在一個特定的基因突變
05:39
a protein is made that's toxic to the cell
130
323373
2667
產生一種對細胞有毒的蛋白質
05:41
and it causes these individuals to age
131
326040
2297
造成這些人老化
05:44
at about seven times the normal rate.
132
328337
2584
老化的速度比一般人快 7 倍。
05:46
Let me show you a video of what that does to the cell.
133
330921
3143
透過一段影片說明這個突變對細胞做了什麼事。
05:49
The normal cell, if you looked at it under the microscope,
134
334064
3135
正常的細胞，如果你在顯微鏡下看它是這樣
05:53
would have a nucleus sitting in the middle of the cell,
135
337199
2889
會有一個核心在細胞中央，
05:55
which is nice and round and smooth in its boundaries
136
340088
3879
邊緣是是漂亮、圓潤、平滑
05:59
and it looks kind of like that.
137
343967
1755
和它看上去有點像。
06:01
A progeria cell, on the other hand,
138
345722
1864
另一方面，早衰症細胞
06:03
because of this toxic protein called progerin,
139
347586
3102
因為這種有毒蛋白質，稱為 "早衰蛋白" (progerin)，
06:06
has these lumps and bumps in it.
140
350688
2284
有這些腫塊與凹凸不平整。
06:08
So what we would like to do after discovering this
141
352972
3015
發見這件事後，最想做的事
06:11
back in 2003
142
355987
1852
早在 2003 年
06:13
is to come up with a way to try to correct that.
143
357839
3218
就是找出修正它的方法。
06:16
Well again, by knowing something about the molecular pathways,
144
361057
3088
同樣，透過瞭解分子途徑，
06:20
it was possible to pick
145
364145
1999
是有可能
06:22
one of those many, many compounds that might have been useful
146
366144
2617
從許多化合物中找出有用的一個
06:24
and try it out.
147
368761
1461
然後試試看。
06:26
In an experiment done in cell culture
148
370222
2575
培養細胞時做的一個實驗
06:28
and shown here in a cartoon,
149
372797
2042
在此以動畫方式秀出來，
06:30
if you take that particular compound
150
374839
2694
如果把特定化合物
06:33
and you add it to that cell that has progeria,
151
377533
3256
將其加到具有早衰症的細胞，
06:36
and you watch to see what happened,
152
380789
2221
你看發生什麼事，
06:38
in just 72 hours, that cell becomes,
153
383010
2962
在短短 72 小時內，那個細胞變成
06:41
for all purposes that we can determine,
154
385972
2268
可由我們控制的所有目標。
06:44
almost like a normal cell.
155
388240
1842
幾乎就是一個正常細胞。
06:45
Well that was exciting, but would it actually work in a real human being?
156
390082
4341
真令人興奮，但在實際人體中是否也有效?
06:50
This has led, in the space of only four years
157
394423
3385
僅四年的空間裡
06:53
from the time the gene was discovered to the start of a clinical trial,
158
397808
3501
從發現基因到臨床實驗測試
06:57
to a test of that very compound.
159
401309
2197
到測試那個非常複合物。
06:59
And the kids that you see here
160
403506
1963
然後看到這些孩子
07:01
all volunteered to be part of this,
161
405469
2562
全部都是自願參加的，
07:03
28 of them,
162
408031
1461
一共有28位，
07:05
and you can see as soon as the picture comes up
163
409492
3095
从照片上可以看出
07:08
that they are in fact a remarkable group of young people
164
412587
3382
他們事實上是一群非常突出的年輕人。
07:11
all afflicted by this disease,
165
415969
1419
他们都患有這種疾病，
07:13
all looking quite similar to each other.
166
417388
2249
每個人都很相似。
07:15
And instead of telling you more about it,
167
419637
1674
與其告訴你更多資訊，
07:17
I'm going to invite one of them, Sam Berns from Boston,
168
421311
3986
不如邀請其中之一，
從波士頓來的 山姆· 伯恩斯
從波士頓來的 山姆· 伯恩斯
07:21
who's here this morning, to come up on the stage
169
425297
2433
他早上來到這裡，站上這舞台
07:23
and tell us about his experience
170
427730
2220
告訴我們他的經歷。
07:25
as a child affected with progeria.
171
429950
1910
身為早衰症的患童。
07:27
Sam is 15 years old. His parents, Scott Berns and Leslie Gordon,
172
431860
4058
山姆現在15 歲。他的父母，
斯科特 · 伯恩斯和萊斯利 · 戈登
斯科特 · 伯恩斯和萊斯利 · 戈登
07:31
both physicians, are here with us this morning as well.
173
435918
2121
和兩位醫生早上也都和我們在一起。
07:33
Sam, please have a seat.
174
438039
2538
山姆，請坐。
07:36
(Applause)
175
440577
7320
（掌聲）
07:43
So Sam, why don't you tell these folks
176
447897
2178
山姆，你何不告訴大家
07:45
what it's like being affected with this condition called progeria?
177
450075
3375
身受早衰症所苦的的感覺是什麼?
07:49
Sam Burns: Well, progeria limits me in some ways.
178
453450
3808
山姆伯恩斯： 嗯，早衰症限制我某些發展。
07:53
I cannot play sports or do physical activities,
179
457258
3964
我不能運動或肢體活動
07:57
but I have been able to take interest in things
180
461222
3204
但是我一直可以對事物感到興趣
08:00
that progeria, luckily, does not limit.
181
464426
2979
幸運的是，早衰症並不侷限我的興趣。
08:03
But when there is something that I really do want to do
182
467405
2557
但當我真正想做某件事
08:05
that progeria gets in the way of, like marching band
183
469962
3017
早衰症有點像鼓號樂隊般介入
08:08
or umpiring, we always find a way to do it,
184
472979
3426
或像主審，我們總是找方法去做，
08:12
and that just shows that progeria isn't in control of my life.
185
476405
3517
只是要說明早衰症並沒有控制我的人生。
08:15
(Applause)
186
479922
1710
（掌聲）
08:17
Francis Collins: So what would you like to say to researchers
187
481632
2036
法蘭西斯 · 柯林斯： 所以，您想要對研究人員說什麼
08:19
here in the auditorium and others listening to this?
188
483668
3097
在這個禮堂及所有聆聽的人？
08:22
What would you say to them both about research on progeria
189
486765
2597
你會針對早衰症的研究說什麼
08:25
and maybe about other conditions as well?
190
489362
1886
也許其他有關的狀況說時麼?
08:27
SB: Well, research on progeria has come so far
191
491248
3146
SB： 嗯，研究早衰症至今
08:30
in less than 15 years,
192
494394
2242
不少於15年，
08:32
and that just shows the drive that researchers can have
193
496636
4369
只要研究者有一條路
08:36
to get this far, and it really means a lot
194
501005
3418
撐到目前為止，有非常的意義
08:40
to myself and other kids with progeria,
195
504423
3251
對我自己和所有早衰症的孩子們，
08:43
and it shows that if that drive exists,
196
507674
2824
只要還有一條路，
08:46
anybody can cure any disease,
197
510498
2601
任何人都可以治癒任何疾病，
08:48
and hopefully progeria can be cured in the near future,
198
513099
3947
期望早衰症在不久的將來是可以被治癒的，
08:52
and so we can eliminate those 4,000 diseases
199
517046
3757
因此，我們可以消除這 4,000 種疾病
08:56
that Francis was talking about.
200
520803
3007
這就是法蘭西斯所言。
08:59
FC: Excellent. So Sam took the day off from school today
201
523810
3129
FC: 很棒。山姆今天向學校請假一天。
09:02
to be here, and he is — (Applause) --
202
526939
5135
來到這裡，他是 -- (掌聲) --
09:07
He is, by the way, a straight-A+ student in the ninth grade
203
532074
4816
順便說明，他是成绩一直優等的九年級學生
09:12
in his school in Boston.
204
536890
1333
在他的學校在波士頓。
09:14
Please join me in thanking and welcoming Sam.
205
538223
2201
請和我一起感謝並歡迎山姆。
09:16
SB: Thank you very much. FC: Well done. Well done, buddy.
206
540424
3653
SB： 非常感謝你。FC: 非常好。非常好，朋友。
09:19
(Applause)
207
544077
11818
（掌聲）
09:32
So I just want to say a couple more things
208
556886
1716
我想要再講一、兩件事，
09:34
about that particular story, and then try to generalize
209
558602
3132
關於特別的故事，進而希望推廣
09:37
how could we have stories of success
210
561734
2496
我們如何能有成功的故事呢
09:40
all over the place for these diseases, as Sam says,
211
564230
3513
如同山姆所說，這些疾病片佈各地，
09:43
these 4,000 that are waiting for answers.
212
567743
2519
這4,000種疾病在等待解答。
09:46
You might have noticed that the drug
213
570262
1872
您可能已經注意到這個藥物
09:48
that is now in clinical trial for progeria
214
572134
2769
正在做早衰症的臨床試驗
09:50
is not a drug that was designed for that.
215
574903
1764
並不是為了這個目的而製成的藥。
09:52
It's such a rare disease, it would be hard for a company
216
576667
2862
這麼罕見的疾病，很難找到公司
09:55
to justify spending hundreds of millions of dollars to generate a drug.
217
579529
3730
願意花上億美元研發藥物。
09:59
This is a drug that was developed for cancer.
218
583259
2160
這是一種治療癌症的藥物。
10:01
Turned out, it didn't work very well for cancer,
219
585419
2165
事實證明，這藥對癌症沒有很有效，
10:03
but it has exactly the right properties, the right shape,
220
587584
2323
但是這藥有完全相同的屬性與形狀
10:05
to work for progeria, and that's what's happened.
221
589907
2892
對早衰症有效，就是這麼回事。
10:08
Wouldn't it be great if we could do that more systematically?
222
592799
3228
如果我們能更有系統地這樣做，不是很棒嗎？
10:11
Could we, in fact, encourage all the companies that are out there
223
596027
3796
事實上，我們可以鼓勵所有市場上的公司
10:15
that have drugs in their freezers
224
599823
1838
公司冷凍櫃中的藥物
10:17
that are known to be safe in humans
225
601661
2202
只要是對人類是安全的
10:19
but have never actually succeeded in terms
226
603863
2292
但從來沒有真正成功地
10:22
of being effective for the treatments they were tried for?
227
606155
2856
有效治療他們原來被試驗的目的？
10:24
Now we're learning about all these new molecular pathways --
228
609011
2384
現在我們正在學習這些新的分子途徑 --
10:27
some of those could be repositioned or repurposed,
229
611395
3079
其中一些這種藥物可以被重新定位或改變用途，
10:30
or whatever word you want to use, for new applications,
230
614474
2399
若用你想要用的字眼用在新的應用上，
10:32
basically teaching old drugs new tricks.
231
616873
2969
就是讓老藥玩新把戲。
10:35
That could be a phenomenal, valuable activity.
232
619842
2687
有可能變成非常驚人的、有價值的活動。
10:38
We have many discussions now between NIH and companies
233
622529
3046
我們目前對美國國家衛生研究院和藥廠之間有很多討論，
10:41
about doing this that are looking very promising.
234
625575
2124
認為往此方向前進非常有前途。
10:43
And you could expect quite a lot to come from this.
235
627699
2614
你可以對此滿懷期望。
10:46
There are quite a number of success stories one can point to
236
630313
3039
任何人都可以說出一堆成功的故事
10:49
about how this has led to major advances.
237
633352
2353
有關這種方法已經引起的重大進展。
10:51
The first drug for HIV/AIDS
238
635705
2207
愛滋病毒/愛滋病的第一款藥物
10:53
was not developed for HIV/AIDS.
239
637912
1729
並不是為愛滋病毒/愛滋病所發展。
10:55
It was developed for cancer. It was AZT.
240
639641
2518
是為了癌症而研發的藥物。它就是AZT。
10:58
It didn't work very well for cancer, but became
241
642159
2001
當時對癌症並不有效，但成為
11:00
the first successful antiretroviral,
242
644160
2116
但卻首次成功對 "抗反轉病毒" 有效，
11:02
and you can see from the table there are others as well.
243
646276
2572
您可以從表格中看到還有很多其他案例。
11:04
So how do we actually make that a more generalizable effort?
244
648848
3644
所以我們實際上如何讓這種方法更普及而努力？
11:08
Well, we have to come up with a partnership
245
652492
2224
嗯，我們必須拿出一種夥伴關係
11:10
between academia, government, the private sector,
246
654716
2860
學術界、 政府、 私營部門之間
11:13
and patient organizations to make that so.
247
657576
2453
及病人組織，成為夥伴。
11:15
At NIH, we have started this new
248
660029
1650
在美國國家衛生研究院，我們已經開始
11:17
National Center for Advancing Translational Sciences.
249
661679
3200
新的國家推進轉化科學研究中心。
11:20
It just started last December, and this is one of its goals.
250
664879
3615
去年 12 月剛開始，其目標之一就是今日討論的概念。
11:24
Let me tell you another thing we could do.
251
668494
1441
讓我告訴你另一件我們能做的事。
11:25
Wouldn't it be nice to be able to a test a drug
252
669935
2919
能做藥物測試不是很好嗎?
11:28
to see if it's effective and safe
253
672854
2371
看看它是否有效和安全
11:31
without having to put patients at risk,
254
675225
2101
而無需置病人於風險之中，
11:33
because that first time you're never quite sure?
255
677326
2553
因為你對第一次永遠不敢確保無事？
11:35
How do we know, for instance, whether drugs are safe
256
679879
2151
例如，我們怎麼知道藥物在我們
11:37
before we give them to people? We test them on animals.
257
682030
3245
給人們使用之前是否安全？我們在動物上測試它們。
11:41
And it's not all that reliable, and it's costly,
258
685275
2642
並不完全可靠，而且代價很高，
11:43
and it's time-consuming.
259
687917
1690
而且很耗時。
11:45
Suppose we could do this instead on human cells.
260
689607
2863
假設我們可以在人體細胞上做試驗。
11:48
You probably know, if you've been paying attention
261
692470
2232
如果你很關注，您可能已經知道，
11:50
to some of the science literature
262
694702
1300
對一些科學文獻
11:51
that you can now take a skin cell
263
696002
1656
您現在可以採一個皮膚細胞
11:53
and encourage it to become a liver cell
264
697658
2881
並培養成為肝細胞
11:56
or a heart cell or a kidney cell or a brain cell for any of us.
265
700539
3075
或一個心臟細胞、腎細胞、或腦細胞給我們任何一個人。
11:59
So what if you used those cells as your test
266
703614
3152
所以如果您使用這些細胞作為您的測試，對
12:02
for whether a drug is going to work and whether it's going to be safe?
267
706766
2945
一種藥物是否會有效?和安全?
12:05
Here you see a picture of a lung on a chip.
268
709711
4231
這裡您看到一張照片，肺在一個晶片上。
12:09
This is something created by the Wyss Institute in Boston,
269
713942
3521
這是由 Wyss 研究所(在波士頓)所創造的
12:13
and what they have done here, if we can run the little video,
270
717463
3175
他們在這裡完成了什麼，如果我們播放這短片，
12:16
is to take cells from an individual,
271
720638
2136
從一個人身上取得細胞，
12:18
turn them into the kinds of cells that are present in the lung,
272
722774
3109
把他們變成類似肺裡面出現的細胞
12:21
and determine what would happen
273
725883
1805
並控制可能的結果
12:23
if you added to this various drug compounds
274
727688
3077
如果您添加到這各種藥物化合物
12:26
to see if they are toxic or safe.
275
730765
2465
以查看它們是否有毒或安全。
12:29
You can see this chip even breathes.
276
733230
2271
您可以看到這晶片甚至會呼吸。
12:31
It has an air channel. It has a blood channel.
277
735501
2617
它具有空氣通道。它有一個血通道。
12:34
And it has cells in between
278
738118
1703
細胞在中間
12:35
that allow you to see what happens when you add a compound.
279
739821
2438
這使您可以看到當您添加一種化合物時會發生什麼反應。
12:38
Are those cells happy or not?
280
742259
1772
這些細胞開心嗎?
12:39
You can do this same kind of chip technology
281
744031
3031
你可以做這種晶片技術
12:42
for kidneys, for hearts, for muscles,
282
747062
2209
給腎臟、 心臟、 肌肉、
12:45
all the places where you want to see whether a drug
283
749271
2464
和所有你想要知道的地方，是否某種藥物
12:47
is going to be a problem, for the liver.
284
751735
2281
對肝臟而言會是一個問題。
12:49
And ultimately, because you can do this for the individual,
285
754016
3048
最終，您可以為個人這麼做
12:52
we could even see this moving to the point
286
757064
2214
我們甚至可以看見一個重點
12:55
where the ability to develop and test medicines
287
759278
3441
在開發和測試藥物的能力上
12:58
will be you on a chip, what we're trying to say here is
288
762719
3186
你就在晶片上，我們要說的是
13:01
the individualizing of the process of developing drugs
289
765905
3501
"個人化"的藥品開發過程
13:05
and testing their safety.
290
769406
2248
以及"個人化"的測試安全性。
13:07
So let me sum up.
291
771654
1652
所以讓我總結一下。
13:09
We are in a remarkable moment here.
292
773306
2260
我們正處於一個重要的時刻。
13:11
For me, at NIH now for almost 20 years,
293
775566
2103
對我來說，在美國國家衛生研究院將近20年
13:13
there has never been a time where there was more excitement
294
777669
2601
對於位於前面我們的潛力
13:16
about the potential that lies in front of us.
295
780270
2585
從來沒有更興奮過。
13:18
We have made all these discoveries
296
782855
1792
我們讓這些發現
13:20
pouring out of laboratories across the world.
297
784647
2365
走出實驗室到世界各地。
13:22
What do we need to capitalize on this? First of all, we need resources.
298
787012
3362
我們需要利用什麼？首先，我們需要的資源。
13:26
This is research that's high-risk, sometimes high-cost.
299
790374
3555
這是高風險、 有時高成本的研究。
13:29
The payoff is enormous, both in terms of health
300
793929
1971
為了巨大的回報，可以從健康的角度和
13:31
and in terms of economic growth. We need to support that.
301
795900
2880
經濟增長的角度。我們都需要支持。
13:34
Second, we need new kinds of partnerships
302
798780
2301
第二，我們需要各種新的夥伴關係
13:36
between academia and government and the private sector
303
801081
2221
學術界、政府、私營部門之間
13:39
and patient organizations, just like the one I've been describing here,
304
803302
3347
、病人組織，就像我剛剛說明的一
13:42
in terms of the way in which we could go after repurposing new compounds.
305
806649
3580
用一種我們能去重新提出新化合物的方法。
13:46
And third, and maybe most important, we need talent.
306
810229
3236
第三，可能是最重要的，我們需要人才。
13:49
We need the best and the brightest
307
813465
2141
我們需要最好和最聰明的人
13:51
from many different disciplines to come and join this effort --
308
815606
2857
從許多不同的學科來參加這項工作 --
13:54
all ages, all different groups --
309
818463
2446
來自所有年齡、 所有不同群體 --
13:56
because this is the time, folks.
310
820909
2087
因為現在正是時候，夥伴。
13:58
This is the 21st-century biology that you've been waiting for,
311
822996
3625
這是 21 世紀您一直在等待的生物學，
14:02
and we have the chance to take that
312
826621
2462
我們有機會得到
14:04
and turn it into something which will, in fact,
313
829083
2490
並把它變成某東西，事實上
14:07
knock out disease. That's my goal.
314
831573
2330
殲滅疾病。這就是我的目標。
14:09
I hope that's your goal.
315
833903
1884
我希望這也是你的目標。
14:11
I think it'll be the goal of the poets and the muppets
316
835787
2680
我想它也會是詩人和木偶的目標
14:14
and the surfers and the bankers
317
838467
2009
衝浪者者和銀行家們
14:16
and all the other people who join this stage
318
840476
2278
和所有其他的人加入這舞台
14:18
and think about what we're trying to do here
319
842754
1750
想想我們可以試著做些什麼
14:20
and why it matters.
320
844504
1165
和為什麼它很重要。
14:21
It matters for now. It matters as soon as possible.
321
845669
2770
它現在很重要。它馬上就很重要
14:24
If you don't believe me, just ask Sam.
322
848439
3118
如果你不相信我，問問山姆吧。
14:27
Thank you all very much.
323
851557
1443
感謝大家。
14:28
(Applause)
324
853000
4831
（掌聲）
ABOUT THE SPEAKER
Francis Collins - Geneticist, physicianA key player in the US' new brain-mapping project, Francis Collins is director of the National Institutes of Health.
Why you should listen
In 2000 the world saw the first working draft of the human genome, and that's in no small part thanks to Francis Collins. Under his directorship at the National Human Genome Research Institute, the Human Genome Project was finished, a complete mapping of all 20,500 genes in the human genome, with a high-quality, reference sequence published in April 2003.
In 2009 President Obama nominated Collins as the director of the National Institutes of Health, and later that year he was confirmed by the U.S. Senate. In March 2013, Collins helped Obama introduce the BRAIN Initiative, an ambitious, well-funded program to map the human brain. Read more about the BRAIN Initiative >>
Collins is also a self-described serious Christian and the author of several books on science and faith, including The Language of God: A Scientist Presents Evidence for Belief.
Francis Collins | Speaker | TED.com