[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.70,0:00:05.68,Default,,0000,0000,0000,,The problem I want to talk with you\Nabout is really the problem of:
Dialogue: 0,0:00:05.70,0:00:12.51,Default,,0000,0000,0000,,How does one supply health care\Nin a world in which cost is everything?
Dialogue: 0,0:00:13.01,0:00:14.25,Default,,0000,0000,0000,,How do you do that?
Dialogue: 0,0:00:15.20,0:00:17.53,Default,,0000,0000,0000,,And the basic paradigm\Nwe want to suggest to you,
Dialogue: 0,0:00:17.56,0:00:18.78,Default,,0000,0000,0000,,I want to suggest to you,
Dialogue: 0,0:00:18.81,0:00:22.48,Default,,0000,0000,0000,,is one in which you say\Nthat in order to treat disease,
Dialogue: 0,0:00:22.50,0:00:25.88,Default,,0000,0000,0000,,you have to first know\Nwhat you're treating, that's diagnostics,
Dialogue: 0,0:00:25.90,0:00:27.55,Default,,0000,0000,0000,,and then you have to do something.
Dialogue: 0,0:00:27.57,0:00:31.89,Default,,0000,0000,0000,,The program we're involved in is something\Nwe call "Diagnostics for All,"
Dialogue: 0,0:00:31.91,0:00:34.02,Default,,0000,0000,0000,,or "zero-cost diagnostics."
Dialogue: 0,0:00:34.04,0:00:37.46,Default,,0000,0000,0000,,How do you provide medically\Nrelevant information
Dialogue: 0,0:00:37.48,0:00:40.11,Default,,0000,0000,0000,,at as close as possible to zero cost?
Dialogue: 0,0:00:40.13,0:00:41.36,Default,,0000,0000,0000,,How do you do it?
Dialogue: 0,0:00:41.38,0:00:43.18,Default,,0000,0000,0000,,Let me just give you two examples.
Dialogue: 0,0:00:43.71,0:00:49.57,Default,,0000,0000,0000,,The rigors of military medicine are not\Nso dissimilar from the third world:
Dialogue: 0,0:00:49.60,0:00:53.95,Default,,0000,0000,0000,,poor resources, a rigorous environment --\Na series of problems --
Dialogue: 0,0:00:53.97,0:00:55.95,Default,,0000,0000,0000,,light weight and things of this kind.
Dialogue: 0,0:00:55.98,0:00:59.41,Default,,0000,0000,0000,,And also they're not so different\Nfrom the home health care
Dialogue: 0,0:00:59.44,0:01:01.84,Default,,0000,0000,0000,,and diagnostic system world.
Dialogue: 0,0:01:01.86,0:01:06.71,Default,,0000,0000,0000,,So, the technology I want to talk\Nabout is for the third world,
Dialogue: 0,0:01:06.74,0:01:08.14,Default,,0000,0000,0000,,for the developing world,
Dialogue: 0,0:01:08.16,0:01:10.70,Default,,0000,0000,0000,,but it has, I think,\Nmuch broader application,
Dialogue: 0,0:01:10.72,0:01:14.19,Default,,0000,0000,0000,,because information is so important\Nin the health care system.
Dialogue: 0,0:01:15.04,0:01:16.84,Default,,0000,0000,0000,,So you see two examples here.
Dialogue: 0,0:01:16.86,0:01:22.61,Default,,0000,0000,0000,,One is a lab that is actually\Na fairly high-end laboratory in Africa.
Dialogue: 0,0:01:22.63,0:01:26.94,Default,,0000,0000,0000,,The second is basically an entrepreneur\Nwho is set up and doing who-knows-what
Dialogue: 0,0:01:26.96,0:01:28.41,Default,,0000,0000,0000,,at a table in a market.
Dialogue: 0,0:01:28.43,0:01:31.38,Default,,0000,0000,0000,,I don't know what kind\Nof health care is delivered there.
Dialogue: 0,0:01:31.40,0:01:35.25,Default,,0000,0000,0000,,But it's not really\Nwhat is probably most efficient.
Dialogue: 0,0:01:36.34,0:01:38.97,Default,,0000,0000,0000,,What is our approach?
Dialogue: 0,0:01:39.44,0:01:44.97,Default,,0000,0000,0000,,The way in which one typically\Napproaches a problem of lowering cost,
Dialogue: 0,0:01:44.99,0:01:47.85,Default,,0000,0000,0000,,starting from the perspective\Nof the United States,
Dialogue: 0,0:01:47.88,0:01:50.02,Default,,0000,0000,0000,,is to take our solution,
Dialogue: 0,0:01:50.04,0:01:52.20,Default,,0000,0000,0000,,and then try to cut cost out of it.
Dialogue: 0,0:01:52.76,0:01:54.18,Default,,0000,0000,0000,,No matter how you do that,
Dialogue: 0,0:01:54.20,0:01:56.71,Default,,0000,0000,0000,,you're not going to start\Nwith a $100,000 instrument
Dialogue: 0,0:01:56.73,0:01:58.15,Default,,0000,0000,0000,,and bring it down to no cost.
Dialogue: 0,0:01:58.18,0:01:59.35,Default,,0000,0000,0000,,It isn't going to work.
Dialogue: 0,0:01:59.37,0:02:02.23,Default,,0000,0000,0000,,So the approach we took\Nwas the other way around, to ask:
Dialogue: 0,0:02:02.26,0:02:04.72,Default,,0000,0000,0000,,What is the cheapest possible stuff
Dialogue: 0,0:02:04.74,0:02:07.68,Default,,0000,0000,0000,,that you could make\Na diagnostic system out of,
Dialogue: 0,0:02:07.70,0:02:10.25,Default,,0000,0000,0000,,and get useful information\Nand add function?
Dialogue: 0,0:02:10.28,0:02:12.27,Default,,0000,0000,0000,,And what we've chosen is paper.
Dialogue: 0,0:02:12.30,0:02:15.32,Default,,0000,0000,0000,,What you see here is a prototypic device.
Dialogue: 0,0:02:15.34,0:02:17.18,Default,,0000,0000,0000,,It's about a centimeter on the side.
Dialogue: 0,0:02:17.20,0:02:19.18,Default,,0000,0000,0000,,It's about the size of a fingernail.
Dialogue: 0,0:02:19.20,0:02:22.80,Default,,0000,0000,0000,,The lines around the edges are a polymer.
Dialogue: 0,0:02:22.83,0:02:24.67,Default,,0000,0000,0000,,It's made of paper.
Dialogue: 0,0:02:24.69,0:02:29.38,Default,,0000,0000,0000,,And paper, of course, wicks fluid,\Nas you know, paper, cloth --
Dialogue: 0,0:02:29.40,0:02:31.28,Default,,0000,0000,0000,,drop wine on the tablecloth,
Dialogue: 0,0:02:31.30,0:02:34.04,Default,,0000,0000,0000,,and the wine wicks all over everything.
Dialogue: 0,0:02:34.06,0:02:36.10,Default,,0000,0000,0000,,Put it on your shirt, it ruins the shirt.
Dialogue: 0,0:02:36.13,0:02:38.87,Default,,0000,0000,0000,,That's what a hydrophilic surface does.
Dialogue: 0,0:02:38.89,0:02:42.51,Default,,0000,0000,0000,,So in this device, the idea\Nis that you drip the bottom end of it
Dialogue: 0,0:02:42.54,0:02:45.18,Default,,0000,0000,0000,,in a drop of, in this case, urine.
Dialogue: 0,0:02:45.20,0:02:48.95,Default,,0000,0000,0000,,The fluid wicks its way\Ninto those chambers at the top.
Dialogue: 0,0:02:48.97,0:02:53.18,Default,,0000,0000,0000,,The brown color indicates\Nthe amount of glucose in the urine,
Dialogue: 0,0:02:53.20,0:02:56.75,Default,,0000,0000,0000,,the blue color indicates the amount\Nof protein in the urine.
Dialogue: 0,0:02:56.77,0:02:59.81,Default,,0000,0000,0000,,And the combination of those two\Nis a first-order shot
Dialogue: 0,0:02:59.83,0:03:02.95,Default,,0000,0000,0000,,at a number of useful things\Nthat you want.
Dialogue: 0,0:03:02.98,0:03:06.33,Default,,0000,0000,0000,,So, this is an example of a device\Nmade from a simple piece of paper.
Dialogue: 0,0:03:06.36,0:03:08.62,Default,,0000,0000,0000,,Now, how simple can you make\Nthe production?
Dialogue: 0,0:03:09.20,0:03:10.96,Default,,0000,0000,0000,,Why do we choose paper?
Dialogue: 0,0:03:11.46,0:03:14.37,Default,,0000,0000,0000,,There's an example\Nof the same thing on a finger,
Dialogue: 0,0:03:14.39,0:03:16.65,Default,,0000,0000,0000,,showing you basically what it looks like.
Dialogue: 0,0:03:16.67,0:03:19.10,Default,,0000,0000,0000,,One reason for using paper\Nis that it's everywhere.
Dialogue: 0,0:03:19.12,0:03:24.30,Default,,0000,0000,0000,,We have made these kinds of devices\Nusing napkins and toilet paper
Dialogue: 0,0:03:24.32,0:03:26.55,Default,,0000,0000,0000,,and wraps, and all kinds of stuff.
Dialogue: 0,0:03:26.58,0:03:29.01,Default,,0000,0000,0000,,So the production capability is there.
Dialogue: 0,0:03:29.04,0:03:33.34,Default,,0000,0000,0000,,The second is, you can put lots and lots\Nof tests in a very small place.
Dialogue: 0,0:03:33.36,0:03:36.18,Default,,0000,0000,0000,,I'll show you in a moment\Nthat the stack of paper there
Dialogue: 0,0:03:36.20,0:03:38.93,Default,,0000,0000,0000,,would probably hold\Nsomething like 100,000 tests,
Dialogue: 0,0:03:38.96,0:03:40.70,Default,,0000,0000,0000,,something of that kind.
Dialogue: 0,0:03:40.72,0:03:43.57,Default,,0000,0000,0000,,And then finally, a point\Nyou don't think of so much
Dialogue: 0,0:03:43.59,0:03:46.18,Default,,0000,0000,0000,,in developed world medicine:
Dialogue: 0,0:03:46.20,0:03:47.88,Default,,0000,0000,0000,,it eliminates sharps.
Dialogue: 0,0:03:47.90,0:03:51.28,Default,,0000,0000,0000,,And what sharps means\Nis needles, things that stick.
Dialogue: 0,0:03:51.31,0:03:53.60,Default,,0000,0000,0000,,If you've taken a sample\Nof someone's blood
Dialogue: 0,0:03:53.63,0:03:56.12,Default,,0000,0000,0000,,and the someone might have hepatitis C,
Dialogue: 0,0:03:56.15,0:03:58.70,Default,,0000,0000,0000,,you don't want to make a mistake\Nand stick it in you.
Dialogue: 0,0:03:58.72,0:04:00.02,Default,,0000,0000,0000,,You don't want to do that.
Dialogue: 0,0:04:00.04,0:04:01.53,Default,,0000,0000,0000,,So how do you dispose of that?
Dialogue: 0,0:04:01.55,0:04:04.24,Default,,0000,0000,0000,,It's a problem everywhere,\Nand here, you simply burn it.
Dialogue: 0,0:04:04.26,0:04:07.76,Default,,0000,0000,0000,,So it's a sort of a practical approach\Nto starting on things.
Dialogue: 0,0:04:09.42,0:04:13.07,Default,,0000,0000,0000,,Now, you say, "If paper is a good idea,
Dialogue: 0,0:04:13.10,0:04:15.06,Default,,0000,0000,0000,,other people have surely thought of it."
Dialogue: 0,0:04:15.08,0:04:16.97,Default,,0000,0000,0000,,And the answer is, of course, yes.
Dialogue: 0,0:04:16.99,0:04:20.81,Default,,0000,0000,0000,,Those half of you, roughly, who are women,
Dialogue: 0,0:04:20.83,0:04:23.30,Default,,0000,0000,0000,,at some point may have had\Na pregnancy test.
Dialogue: 0,0:04:23.32,0:04:27.30,Default,,0000,0000,0000,,And the most common of these\Nis in a device
Dialogue: 0,0:04:27.33,0:04:29.18,Default,,0000,0000,0000,,that looks like the thing on the left.
Dialogue: 0,0:04:29.20,0:04:31.69,Default,,0000,0000,0000,,It's something called\Na lateral-flow immunoassay.
Dialogue: 0,0:04:31.72,0:04:33.18,Default,,0000,0000,0000,,In that particular test,
Dialogue: 0,0:04:33.20,0:04:36.82,Default,,0000,0000,0000,,urine, either containing\Na hormone called hCG,
Dialogue: 0,0:04:36.84,0:04:40.18,Default,,0000,0000,0000,,does or does not flow\Nacross a piece of paper.
Dialogue: 0,0:04:40.20,0:04:44.10,Default,,0000,0000,0000,,And there are two bars; one bar\Nindicates that the test is working,
Dialogue: 0,0:04:44.12,0:04:47.29,Default,,0000,0000,0000,,and if the second bar shows up,\Nyou're pregnant.
Dialogue: 0,0:04:47.31,0:04:50.48,Default,,0000,0000,0000,,This is a terrific kind of test\Nin a binary world,
Dialogue: 0,0:04:50.51,0:04:53.42,Default,,0000,0000,0000,,and the nice thing about pregnancy\Nis either you are pregnant
Dialogue: 0,0:04:53.45,0:04:54.60,Default,,0000,0000,0000,,or you're not pregnant;
Dialogue: 0,0:04:54.63,0:04:57.61,Default,,0000,0000,0000,,you're not partially pregnant\Nor thinking about being pregnant
Dialogue: 0,0:04:57.63,0:04:58.92,Default,,0000,0000,0000,,or something of that sort.
Dialogue: 0,0:04:58.94,0:05:01.67,Default,,0000,0000,0000,,So it works very well there,\Nbut it doesn't work very well
Dialogue: 0,0:05:01.70,0:05:03.78,Default,,0000,0000,0000,,when you need more\Nquantitative information.
Dialogue: 0,0:05:03.81,0:05:05.03,Default,,0000,0000,0000,,There are also dipsticks,
Dialogue: 0,0:05:05.05,0:05:06.80,Default,,0000,0000,0000,,but if you look at the dipsticks,
Dialogue: 0,0:05:06.82,0:05:09.04,Default,,0000,0000,0000,,they're for another kind\Nof urine analysis.
Dialogue: 0,0:05:09.06,0:05:11.94,Default,,0000,0000,0000,,There are an awful lot of colors\Nand things like that.
Dialogue: 0,0:05:11.96,0:05:15.25,Default,,0000,0000,0000,,What do you actually do about that\Nin a difficult circumstance?
Dialogue: 0,0:05:16.37,0:05:20.68,Default,,0000,0000,0000,,So the approach we started with is to ask:
Dialogue: 0,0:05:20.70,0:05:24.18,Default,,0000,0000,0000,,Is it really practical\Nto make things of this sort?
Dialogue: 0,0:05:24.20,0:05:28.49,Default,,0000,0000,0000,,And that problem is now,\Nin a purely engineering way, solved.
Dialogue: 0,0:05:28.51,0:05:32.06,Default,,0000,0000,0000,,And the procedure that we have\Nis simply to start with paper.
Dialogue: 0,0:05:32.08,0:05:35.63,Default,,0000,0000,0000,,You run it through a new kind\Nof printer called a wax printer.
Dialogue: 0,0:05:35.65,0:05:38.29,Default,,0000,0000,0000,,The wax printer does\Nwhat looks like printing.
Dialogue: 0,0:05:38.31,0:05:39.47,Default,,0000,0000,0000,,It is printing.
Dialogue: 0,0:05:39.49,0:05:41.53,Default,,0000,0000,0000,,You put that on, you warm it a little bit,
Dialogue: 0,0:05:41.56,0:05:44.60,Default,,0000,0000,0000,,the wax prints through,\Nso it absorbs into the paper,
Dialogue: 0,0:05:44.62,0:05:46.77,Default,,0000,0000,0000,,and you end up with the device you want.
Dialogue: 0,0:05:46.79,0:05:49.87,Default,,0000,0000,0000,,The printers cost 800 bucks now.
Dialogue: 0,0:05:49.89,0:05:53.78,Default,,0000,0000,0000,,We estimate that if you were\Nto run them 24 hours a day,
Dialogue: 0,0:05:53.81,0:05:55.91,Default,,0000,0000,0000,,they'd make about 10 million tests a year.
Dialogue: 0,0:05:55.94,0:05:59.16,Default,,0000,0000,0000,,So it's a solved problem.\NThat particular problem is solved.
Dialogue: 0,0:05:59.19,0:06:01.96,Default,,0000,0000,0000,,And there is an example\Nof the kind of thing that you see.
Dialogue: 0,0:06:01.99,0:06:03.82,Default,,0000,0000,0000,,That's on a piece of 8 by 12 paper.
Dialogue: 0,0:06:03.85,0:06:06.12,Default,,0000,0000,0000,,That takes about two seconds to make.
Dialogue: 0,0:06:06.14,0:06:08.78,Default,,0000,0000,0000,,And so I regard that as done.
Dialogue: 0,0:06:08.81,0:06:10.60,Default,,0000,0000,0000,,There's a very important issue here,
Dialogue: 0,0:06:10.63,0:06:15.04,Default,,0000,0000,0000,,which is that because it's a printer,\Na color printer, it prints colors.
Dialogue: 0,0:06:15.07,0:06:16.59,Default,,0000,0000,0000,,That's what color printers do.
Dialogue: 0,0:06:16.62,0:06:19.38,Default,,0000,0000,0000,,I'll show you in a moment,\Nthat's actually quite useful.
Dialogue: 0,0:06:20.65,0:06:23.18,Default,,0000,0000,0000,,Now, the next question\Nthat you would like to ask is:
Dialogue: 0,0:06:23.20,0:06:26.39,Default,,0000,0000,0000,,What would you like to measure?\NWhat would you like to analyze?
Dialogue: 0,0:06:26.42,0:06:31.18,Default,,0000,0000,0000,,And the thing you'd most like to analyze,\Nwe're a fair distance from.
Dialogue: 0,0:06:31.20,0:06:35.18,Default,,0000,0000,0000,,It's what's called\N"fever of undiagnosed origin."
Dialogue: 0,0:06:35.20,0:06:38.76,Default,,0000,0000,0000,,Someone comes into the clinic,\Nthey have a fever, they feel bad.
Dialogue: 0,0:06:38.78,0:06:39.95,Default,,0000,0000,0000,,What do they have?
Dialogue: 0,0:06:39.98,0:06:43.38,Default,,0000,0000,0000,,Do they have TB? Do they have AIDS?\NDo they have a common cold?
Dialogue: 0,0:06:43.40,0:06:44.62,Default,,0000,0000,0000,,The triage problem.
Dialogue: 0,0:06:44.64,0:06:47.30,Default,,0000,0000,0000,,That's a hard problem for reasons\NI won't go through.
Dialogue: 0,0:06:47.32,0:06:50.86,Default,,0000,0000,0000,,There are an awful lot of things\Nthat you'd like to distinguish among.
Dialogue: 0,0:06:50.88,0:06:53.09,Default,,0000,0000,0000,,But then there are a series of things --
Dialogue: 0,0:06:53.11,0:06:56.70,Default,,0000,0000,0000,,AIDS, hepatitis, malaria, TB, others --
Dialogue: 0,0:06:56.72,0:07:00.21,Default,,0000,0000,0000,,and simpler ones,\Nsuch as guidance of treatment.
Dialogue: 0,0:07:00.24,0:07:03.18,Default,,0000,0000,0000,,Now, even that's more\Ncomplicated than you think.
Dialogue: 0,0:07:03.20,0:07:07.42,Default,,0000,0000,0000,,A friend of mine works\Nin transcultural psychiatry,
Dialogue: 0,0:07:07.44,0:07:09.54,Default,,0000,0000,0000,,and he is interested in the question
Dialogue: 0,0:07:09.57,0:07:12.30,Default,,0000,0000,0000,,of why people do\Nand don't take their meds.
Dialogue: 0,0:07:12.32,0:07:15.90,Default,,0000,0000,0000,,So Dapsone, or something like that,\Nyou have to take for a while.
Dialogue: 0,0:07:15.92,0:07:19.54,Default,,0000,0000,0000,,He has a wonderful story\Nof talking to a villager in India
Dialogue: 0,0:07:19.56,0:07:20.71,Default,,0000,0000,0000,,and saying,
Dialogue: 0,0:07:20.74,0:07:22.54,Default,,0000,0000,0000,,"Have you taken your Dapsone?" "Yes."
Dialogue: 0,0:07:22.57,0:07:24.43,Default,,0000,0000,0000,,"Have you taken it every day?" "Yes."
Dialogue: 0,0:07:24.46,0:07:26.41,Default,,0000,0000,0000,,"Have you taken if for a month?" "Yes."
Dialogue: 0,0:07:26.44,0:07:27.94,Default,,0000,0000,0000,,What the guy actually meant
Dialogue: 0,0:07:27.96,0:07:31.86,Default,,0000,0000,0000,,was that he'd fed a 30-day dose of Dapsone\Nto his dog that morning.
Dialogue: 0,0:07:31.89,0:07:33.01,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:07:33.04,0:07:36.79,Default,,0000,0000,0000,,And he was telling the truth,\Nbecause in a different culture,
Dialogue: 0,0:07:36.82,0:07:39.39,Default,,0000,0000,0000,,the dog is a surrogate for you;
Dialogue: 0,0:07:39.41,0:07:42.56,Default,,0000,0000,0000,,"today," "this month,"\N"since the rainy season" --
Dialogue: 0,0:07:42.58,0:07:45.06,Default,,0000,0000,0000,,there are lots of opportunities\Nfor misunderstanding.
Dialogue: 0,0:07:45.09,0:07:46.10,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:07:46.12,0:07:49.68,Default,,0000,0000,0000,,And so an issue here is to,\Nin some cases, figure out
Dialogue: 0,0:07:49.71,0:07:53.82,Default,,0000,0000,0000,,how to deal with matters\Nthat seem uninteresting, like compliance.
Dialogue: 0,0:07:55.16,0:07:58.70,Default,,0000,0000,0000,,Now, take a look\Nat what a typical test looks like.
Dialogue: 0,0:07:59.42,0:08:03.18,Default,,0000,0000,0000,,Prick a finger, you get some blood --\Nabout 50 microliters.
Dialogue: 0,0:08:03.20,0:08:05.03,Default,,0000,0000,0000,,That's about all you're going to get,
Dialogue: 0,0:08:05.06,0:08:09.03,Default,,0000,0000,0000,,because you can't use\Nthe usual sort of systems.
Dialogue: 0,0:08:09.58,0:08:11.26,Default,,0000,0000,0000,,You can't manipulate it very well;
Dialogue: 0,0:08:11.28,0:08:13.40,Default,,0000,0000,0000,,I'll show something\Nabout that in a moment.
Dialogue: 0,0:08:13.42,0:08:16.18,Default,,0000,0000,0000,,So you take the drop of blood,\Nno further manipulations,
Dialogue: 0,0:08:16.20,0:08:17.98,Default,,0000,0000,0000,,you put it on a little device,
Dialogue: 0,0:08:18.01,0:08:22.68,Default,,0000,0000,0000,,the device filters out the blood cells,\Nlets the serum go through,
Dialogue: 0,0:08:22.70,0:08:26.46,Default,,0000,0000,0000,,and you get a series of colors\Ndown in the bottom there.
Dialogue: 0,0:08:26.49,0:08:30.65,Default,,0000,0000,0000,,And the colors indicate\N"disease" or "normal."
Dialogue: 0,0:08:30.67,0:08:32.35,Default,,0000,0000,0000,,But even that's complicated,
Dialogue: 0,0:08:32.38,0:08:35.98,Default,,0000,0000,0000,,because to me, colors\Nmight indicate "normal,"
Dialogue: 0,0:08:36.00,0:08:40.96,Default,,0000,0000,0000,,but after all, we're all suffering\Nfrom probably an excess of education.
Dialogue: 0,0:08:40.99,0:08:45.57,Default,,0000,0000,0000,,What do you do about something\Nwhich requires quantitative analysis?
Dialogue: 0,0:08:45.60,0:08:48.28,Default,,0000,0000,0000,,And so the solution\Nthat we and many other people
Dialogue: 0,0:08:48.30,0:08:49.92,Default,,0000,0000,0000,,are thinking about there,
Dialogue: 0,0:08:49.94,0:08:52.53,Default,,0000,0000,0000,,and at this point,\Nthere is a dramatic flourish,
Dialogue: 0,0:08:52.55,0:08:55.72,Default,,0000,0000,0000,,and out comes the universal solution\Nto everything these days,
Dialogue: 0,0:08:55.75,0:08:56.90,Default,,0000,0000,0000,,which is a cell phone --
Dialogue: 0,0:08:56.93,0:08:58.93,Default,,0000,0000,0000,,in this particular case, a camera phone.
Dialogue: 0,0:08:58.95,0:09:03.18,Default,,0000,0000,0000,,They're everywhere --\Nsix billion a month in India.
Dialogue: 0,0:09:03.20,0:09:08.72,Default,,0000,0000,0000,,And the idea is that what one does\Nis to take the device,
Dialogue: 0,0:09:08.75,0:09:11.18,Default,,0000,0000,0000,,you dip it, you develop the color,
Dialogue: 0,0:09:11.20,0:09:14.42,Default,,0000,0000,0000,,you take a picture,\Nthe picture goes to a central laboratory.
Dialogue: 0,0:09:14.45,0:09:16.18,Default,,0000,0000,0000,,You don't have to send out a doctor,
Dialogue: 0,0:09:16.20,0:09:18.94,Default,,0000,0000,0000,,you send out somebody\Nwho can just take the sample,
Dialogue: 0,0:09:18.96,0:09:22.69,Default,,0000,0000,0000,,and in the clinic either a doctor,\Nor ideally, a computer in this case,
Dialogue: 0,0:09:22.71,0:09:23.88,Default,,0000,0000,0000,,does the analysis.
Dialogue: 0,0:09:23.90,0:09:25.75,Default,,0000,0000,0000,,Turns out to work actually quite well,
Dialogue: 0,0:09:25.78,0:09:28.87,Default,,0000,0000,0000,,particularly when your color printer\Nhas printed the color bars
Dialogue: 0,0:09:28.89,0:09:30.71,Default,,0000,0000,0000,,that indicate how things work.
Dialogue: 0,0:09:30.74,0:09:33.76,Default,,0000,0000,0000,,So my view of the health care\Nworker of the future
Dialogue: 0,0:09:33.79,0:09:36.35,Default,,0000,0000,0000,,is not a doctor, but an 18-year-old,
Dialogue: 0,0:09:36.38,0:09:39.13,Default,,0000,0000,0000,,otherwise unemployed, who has two things:
Dialogue: 0,0:09:39.15,0:09:41.24,Default,,0000,0000,0000,,a backpack full\Nof these tests and a lancet
Dialogue: 0,0:09:41.26,0:09:43.18,Default,,0000,0000,0000,,to occasionally take a blood sample,
Dialogue: 0,0:09:43.20,0:09:44.76,Default,,0000,0000,0000,,and an AK-47.
Dialogue: 0,0:09:44.78,0:09:47.38,Default,,0000,0000,0000,,And these are the things\Nthat get him through his day.
Dialogue: 0,0:09:47.40,0:09:48.95,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:09:50.11,0:09:52.45,Default,,0000,0000,0000,,There's another very\Ninteresting connection here,
Dialogue: 0,0:09:52.47,0:09:58.01,Default,,0000,0000,0000,,and that is, that what one wants to do\Nis pass through useful information
Dialogue: 0,0:09:58.04,0:10:01.57,Default,,0000,0000,0000,,over what is generally\Na pretty awful telephone system.
Dialogue: 0,0:10:01.59,0:10:04.18,Default,,0000,0000,0000,,It turns out there's an enormous\Namount of information
Dialogue: 0,0:10:04.20,0:10:07.58,Default,,0000,0000,0000,,already available on that subject,\Nwhich is the Mars Rover problem.
Dialogue: 0,0:10:07.60,0:10:11.47,Default,,0000,0000,0000,,How do you get back an accurate view\Nof the color on Mars
Dialogue: 0,0:10:11.49,0:10:15.28,Default,,0000,0000,0000,,if you have a really terrible\Nbandwidth to do it with?
Dialogue: 0,0:10:15.30,0:10:17.18,Default,,0000,0000,0000,,And the answer is not complicated,
Dialogue: 0,0:10:17.20,0:10:19.74,Default,,0000,0000,0000,,but it's one which I don't want\Nto go through here,
Dialogue: 0,0:10:19.76,0:10:22.81,Default,,0000,0000,0000,,other than to say that the communication\Nsystems for doing this
Dialogue: 0,0:10:22.83,0:10:24.53,Default,,0000,0000,0000,,are really pretty well understood.
Dialogue: 0,0:10:24.56,0:10:27.30,Default,,0000,0000,0000,,Also, a fact which you may not know
Dialogue: 0,0:10:27.32,0:10:31.05,Default,,0000,0000,0000,,is that the compute capability\Nof this thing is not so different
Dialogue: 0,0:10:31.08,0:10:33.92,Default,,0000,0000,0000,,from the compute capability\Nof your desktop computer.
Dialogue: 0,0:10:33.94,0:10:37.60,Default,,0000,0000,0000,,This is a fantastic device\Nwhich is only beginning to be tapped.
Dialogue: 0,0:10:37.62,0:10:41.07,Default,,0000,0000,0000,,I don't know whether the idea\Nof one computer, one child
Dialogue: 0,0:10:41.10,0:10:42.25,Default,,0000,0000,0000,,makes any sense.
Dialogue: 0,0:10:42.27,0:10:44.18,Default,,0000,0000,0000,,Here's the computer of the future,
Dialogue: 0,0:10:44.20,0:10:47.40,Default,,0000,0000,0000,,because this screen is already there\Nand they're ubiquitous.
Dialogue: 0,0:10:48.85,0:10:52.09,Default,,0000,0000,0000,,All right, let me show you just\Na little bit about advanced devices.
Dialogue: 0,0:10:52.11,0:10:54.27,Default,,0000,0000,0000,,And we'll start by posing\Na little problem.
Dialogue: 0,0:10:54.29,0:10:57.69,Default,,0000,0000,0000,,What you see here\Nis another centimeter-sized device,
Dialogue: 0,0:10:57.71,0:11:01.69,Default,,0000,0000,0000,,and the different colors\Nare different colors of dye.
Dialogue: 0,0:11:01.72,0:11:02.90,Default,,0000,0000,0000,,And you notice something
Dialogue: 0,0:11:02.92,0:11:05.62,Default,,0000,0000,0000,,which might strike you\Nas a little bit interesting,
Dialogue: 0,0:11:05.64,0:11:08.50,Default,,0000,0000,0000,,which is, the yellow seems to disappear,
Dialogue: 0,0:11:08.52,0:11:11.01,Default,,0000,0000,0000,,get through the blue,\Nand then get through the red.
Dialogue: 0,0:11:11.04,0:11:12.19,Default,,0000,0000,0000,,How does that happen?
Dialogue: 0,0:11:12.21,0:11:14.79,Default,,0000,0000,0000,,How do you make something\Nflow through something?
Dialogue: 0,0:11:14.81,0:11:17.01,Default,,0000,0000,0000,,And, of course the answer is, "You don't."
Dialogue: 0,0:11:17.03,0:11:18.78,Default,,0000,0000,0000,,You make it flow under and over.
Dialogue: 0,0:11:18.80,0:11:19.96,Default,,0000,0000,0000,,But now the question is:
Dialogue: 0,0:11:19.98,0:11:23.53,Default,,0000,0000,0000,,How do you make it flow\Nunder and over in a piece of paper?
Dialogue: 0,0:11:23.55,0:11:26.50,Default,,0000,0000,0000,,The answer is that what you do --
Dialogue: 0,0:11:26.52,0:11:29.18,Default,,0000,0000,0000,,and the details are not\Nterribly important here --
Dialogue: 0,0:11:29.20,0:11:31.09,Default,,0000,0000,0000,,is to make something more elaborate:
Dialogue: 0,0:11:31.12,0:11:33.19,Default,,0000,0000,0000,,You take several different\Nlayers of paper,
Dialogue: 0,0:11:33.22,0:11:36.29,Default,,0000,0000,0000,,each one containing\Nits own little fluid system,
Dialogue: 0,0:11:36.31,0:11:40.90,Default,,0000,0000,0000,,and you separate them by pieces of,\Nliterally, double-sided carpet tape,
Dialogue: 0,0:11:40.92,0:11:43.81,Default,,0000,0000,0000,,the stuff you use to stick\Nthe carpets onto the floor.
Dialogue: 0,0:11:43.83,0:11:47.06,Default,,0000,0000,0000,,And the fluid will flow\Nfrom one layer into the next.
Dialogue: 0,0:11:47.08,0:11:50.18,Default,,0000,0000,0000,,It distributes itself,\Nflows through further holes,
Dialogue: 0,0:11:50.20,0:11:51.79,Default,,0000,0000,0000,,distributes itself.
Dialogue: 0,0:11:51.81,0:11:55.05,Default,,0000,0000,0000,,And what you see,\Nat the lower right-hand side there,
Dialogue: 0,0:11:55.08,0:12:00.38,Default,,0000,0000,0000,,is a sample in which a single sample\Nof blood has been put on the top,
Dialogue: 0,0:12:00.40,0:12:02.91,Default,,0000,0000,0000,,and it has gone through\Nand distributed itself
Dialogue: 0,0:12:02.94,0:12:06.28,Default,,0000,0000,0000,,into these 16 holes on the bottom,
Dialogue: 0,0:12:06.30,0:12:09.01,Default,,0000,0000,0000,,in a piece of paper --\Nbasically, it looks like a chip,
Dialogue: 0,0:12:09.03,0:12:10.77,Default,,0000,0000,0000,,two pieces of paper thick.
Dialogue: 0,0:12:10.80,0:12:12.28,Default,,0000,0000,0000,,And in this particular case,
Dialogue: 0,0:12:12.30,0:12:15.07,Default,,0000,0000,0000,,we were just interested\Nin the replicability of that.
Dialogue: 0,0:12:15.09,0:12:17.39,Default,,0000,0000,0000,,But that is, in principle,\Nthe way you solve
Dialogue: 0,0:12:17.42,0:12:19.57,Default,,0000,0000,0000,,the "fever of unexplained origin" problem,
Dialogue: 0,0:12:19.60,0:12:22.35,Default,,0000,0000,0000,,because each one of those spots\Nthen becomes a test
Dialogue: 0,0:12:22.38,0:12:25.98,Default,,0000,0000,0000,,for a particular set\Nof markers of disease,
Dialogue: 0,0:12:26.00,0:12:28.27,Default,,0000,0000,0000,,and this will work in due course.
Dialogue: 0,0:12:28.29,0:12:31.61,Default,,0000,0000,0000,,Here is an example of a slightly\Nmore complicated device.
Dialogue: 0,0:12:31.63,0:12:32.81,Default,,0000,0000,0000,,There's the chip.
Dialogue: 0,0:12:32.84,0:12:34.05,Default,,0000,0000,0000,,You dip in a corner.
Dialogue: 0,0:12:34.08,0:12:35.62,Default,,0000,0000,0000,,The fluid goes into the center.
Dialogue: 0,0:12:35.65,0:12:39.43,Default,,0000,0000,0000,,It distributes itself out\Ninto these various wells or holes
Dialogue: 0,0:12:39.46,0:12:40.69,Default,,0000,0000,0000,,and turns color,
Dialogue: 0,0:12:40.72,0:12:43.41,Default,,0000,0000,0000,,all done with paper and carpet tape.
Dialogue: 0,0:12:43.43,0:12:45.59,Default,,0000,0000,0000,,So it's, I think, as low-cost
Dialogue: 0,0:12:45.61,0:12:48.44,Default,,0000,0000,0000,,as we're likely to be able\Nto come up and make things.
Dialogue: 0,0:12:49.43,0:12:52.73,Default,,0000,0000,0000,,Now, I have two last\Nlittle stories to tell you
Dialogue: 0,0:12:52.75,0:12:55.36,Default,,0000,0000,0000,,in finishing off this business.
Dialogue: 0,0:12:55.39,0:12:56.55,Default,,0000,0000,0000,,This is one:
Dialogue: 0,0:12:56.58,0:12:59.02,Default,,0000,0000,0000,,One of the things\Nyou occasionally need to do
Dialogue: 0,0:12:59.04,0:13:01.69,Default,,0000,0000,0000,,is separate blood cells from serum.
Dialogue: 0,0:13:02.87,0:13:04.56,Default,,0000,0000,0000,,And the question was,
Dialogue: 0,0:13:04.58,0:13:06.68,Default,,0000,0000,0000,,here we do it by taking a sample,
Dialogue: 0,0:13:06.71,0:13:10.57,Default,,0000,0000,0000,,we put it in a centrifuge, we spin it,
Dialogue: 0,0:13:10.59,0:13:13.06,Default,,0000,0000,0000,,and you get blood cells out.
Dialogue: 0,0:13:13.08,0:13:14.24,Default,,0000,0000,0000,,Terrific.
Dialogue: 0,0:13:14.27,0:13:17.72,Default,,0000,0000,0000,,What happens if you don't have\Nelectricity, a centrifuge, and whatever?
Dialogue: 0,0:13:17.74,0:13:20.26,Default,,0000,0000,0000,,And we thought for a while\Nof how you might do this,
Dialogue: 0,0:13:20.28,0:13:22.92,Default,,0000,0000,0000,,and the way, in fact, you do it,\Nis what's shown here.
Dialogue: 0,0:13:22.94,0:13:27.55,Default,,0000,0000,0000,,You get an eggbeater, which is everywhere,\Nand you saw off a blade,
Dialogue: 0,0:13:27.57,0:13:30.05,Default,,0000,0000,0000,,and then you take tubing,\Nand you stick it on that.
Dialogue: 0,0:13:30.08,0:13:32.82,Default,,0000,0000,0000,,You put the blood in,\Nsomebody sits there and spins it.
Dialogue: 0,0:13:32.84,0:13:34.96,Default,,0000,0000,0000,,It works really, really well.
Dialogue: 0,0:13:34.98,0:13:37.40,Default,,0000,0000,0000,,And we sat down,\Nwe did the physics of eggbeaters
Dialogue: 0,0:13:37.42,0:13:40.50,Default,,0000,0000,0000,,and self-aligning tubes\Nand all the rest of that kind of thing,
Dialogue: 0,0:13:40.52,0:13:41.99,Default,,0000,0000,0000,,and sent it off to a journal.
Dialogue: 0,0:13:42.01,0:13:43.33,Default,,0000,0000,0000,,We were very proud of this,
Dialogue: 0,0:13:43.36,0:13:46.22,Default,,0000,0000,0000,,particularly the title,\Nwhich was "Eggbeater as Centrifuge."
Dialogue: 0,0:13:46.24,0:13:47.32,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:13:47.34,0:13:48.49,Default,,0000,0000,0000,,And we sent it off,
Dialogue: 0,0:13:48.52,0:13:50.42,Default,,0000,0000,0000,,and by return mail, it came back.
Dialogue: 0,0:13:50.45,0:13:52.18,Default,,0000,0000,0000,,I called up the editor and I said,
Dialogue: 0,0:13:52.20,0:13:54.32,Default,,0000,0000,0000,,"What's going on? How is this possible?"
Dialogue: 0,0:13:54.35,0:13:57.48,Default,,0000,0000,0000,,The editor said, with enormous disdain,
Dialogue: 0,0:13:57.50,0:13:58.95,Default,,0000,0000,0000,,"I read this.
Dialogue: 0,0:13:58.97,0:14:02.73,Default,,0000,0000,0000,,And we're not going to publish it,\Nbecause we only publish science."
Dialogue: 0,0:14:02.75,0:14:04.16,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:14:04.19,0:14:05.66,Default,,0000,0000,0000,,And it's an important issue,
Dialogue: 0,0:14:05.68,0:14:09.08,Default,,0000,0000,0000,,because it means\Nthat we have to, as a society,
Dialogue: 0,0:14:09.10,0:14:11.08,Default,,0000,0000,0000,,think about what we value.
Dialogue: 0,0:14:11.10,0:14:13.89,Default,,0000,0000,0000,,And if it's just papers\Nand Phys. Rev. letters,
Dialogue: 0,0:14:13.91,0:14:15.16,Default,,0000,0000,0000,,we've got a problem.
Dialogue: 0,0:14:15.82,0:14:19.05,Default,,0000,0000,0000,,Here is another example\Nof something which is --
Dialogue: 0,0:14:19.07,0:14:21.11,Default,,0000,0000,0000,,this is a little spectrophotometer.
Dialogue: 0,0:14:21.14,0:14:24.43,Default,,0000,0000,0000,,It measures the absorption\Nof light in a sample.
Dialogue: 0,0:14:24.45,0:14:25.93,Default,,0000,0000,0000,,The neat thing about this is,
Dialogue: 0,0:14:25.95,0:14:29.64,Default,,0000,0000,0000,,you have a light source that flickers\Non and off at about 1,000 hertz,
Dialogue: 0,0:14:29.67,0:14:33.34,Default,,0000,0000,0000,,another light source\Nthat detects that light at 1,000 hertz,
Dialogue: 0,0:14:33.36,0:14:36.18,Default,,0000,0000,0000,,and so you can run this system\Nin broad daylight.
Dialogue: 0,0:14:36.20,0:14:38.27,Default,,0000,0000,0000,,It performs about equivalently
Dialogue: 0,0:14:38.29,0:14:42.86,Default,,0000,0000,0000,,to a system that's on the order\Nof 100,000 dollars.
Dialogue: 0,0:14:42.89,0:14:44.05,Default,,0000,0000,0000,,It costs 50 dollars.
Dialogue: 0,0:14:44.07,0:14:48.18,Default,,0000,0000,0000,,We can probably make it for 50 cents\Nif we put our mind to it.
Dialogue: 0,0:14:48.20,0:14:50.07,Default,,0000,0000,0000,,Why doesn't somebody do it?
Dialogue: 0,0:14:50.10,0:14:51.25,Default,,0000,0000,0000,,The answer is:
Dialogue: 0,0:14:51.27,0:14:54.54,Default,,0000,0000,0000,,How do you make a profit\Nin a capitalist system, doing that?
Dialogue: 0,0:14:54.57,0:14:55.86,Default,,0000,0000,0000,,Interesting problem.
Dialogue: 0,0:14:57.32,0:15:02.27,Default,,0000,0000,0000,,So, let me finish by saying\Nthat we've thought about this
Dialogue: 0,0:15:02.29,0:15:04.49,Default,,0000,0000,0000,,as a kind of engineering problem.
Dialogue: 0,0:15:04.52,0:15:08.90,Default,,0000,0000,0000,,And we've asked: What\Nis the scientific unifying idea here?
Dialogue: 0,0:15:08.92,0:15:11.05,Default,,0000,0000,0000,,And we've decided\Nwe should think about this
Dialogue: 0,0:15:11.07,0:15:14.18,Default,,0000,0000,0000,,not so much in terms of cost,\Nbut in terms of simplicity.
Dialogue: 0,0:15:14.20,0:15:15.78,Default,,0000,0000,0000,,Simplicity is a neat word.
Dialogue: 0,0:15:15.80,0:15:18.18,Default,,0000,0000,0000,,You've got to think\Nabout what simplicity means.
Dialogue: 0,0:15:18.76,0:15:19.91,Default,,0000,0000,0000,,I know what it is,
Dialogue: 0,0:15:19.94,0:15:22.11,Default,,0000,0000,0000,,but I don't actually know what it means.
Dialogue: 0,0:15:22.14,0:15:24.23,Default,,0000,0000,0000,,So I actually was interested\Nenough in this
Dialogue: 0,0:15:24.26,0:15:28.01,Default,,0000,0000,0000,,to put together several groups of people.
Dialogue: 0,0:15:28.64,0:15:31.18,Default,,0000,0000,0000,,The most recent involved\Na couple of people at MIT,
Dialogue: 0,0:15:31.20,0:15:33.32,Default,,0000,0000,0000,,one of them being\Nan exceptionally bright kid
Dialogue: 0,0:15:33.34,0:15:36.05,Default,,0000,0000,0000,,who is one of the very\Nfew people I would think of
Dialogue: 0,0:15:36.08,0:15:37.47,Default,,0000,0000,0000,,who's an authentic genius.
Dialogue: 0,0:15:37.49,0:15:41.54,Default,,0000,0000,0000,,We all struggled for an entire day\Nto think about simplicity.
Dialogue: 0,0:15:41.56,0:15:45.75,Default,,0000,0000,0000,,And I want to give you the answer\Nof this deep scientific thought.
Dialogue: 0,0:15:45.77,0:15:47.10,Default,,0000,0000,0000,,[What is simplicity?
Dialogue: 0,0:15:47.13,0:15:48.72,Default,,0000,0000,0000,,"It's impossible to f..k it up"]
Dialogue: 0,0:15:48.74,0:15:49.79,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:15:49.81,0:15:52.26,Default,,0000,0000,0000,,So, in a sense, you get what you pay for.
Dialogue: 0,0:15:52.29,0:15:53.80,Default,,0000,0000,0000,,Thank you very much.
Dialogue: 0,0:15:53.82,0:15:55.90,Default,,0000,0000,0000,,(Applause)