医生要知道的几个装置：Eric Topol未来医疗的无线化

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liver411

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http://dotsub.com/view/bc4091fa-2285-46e4-ab56-568efe4d5cbf

演讲中文翻译：

Eric Topol未来医疗的无线化

有人知道听诊器是什么时候发明的吗？ 大家试着猜一猜，有人说是1816年。 而我认为是在2016年。 那个时候医生就不需要拿着听诊器跑来跑去了 更好的医疗技术已经呈现在我们面前 而这也是医疗革命的一部分。

已经改变我们人类社会的 是那些无线设备 但我们的未来是数字化的医用无线设备，OK？

因此，让我来通过一些例子 更具体地描述这个概念。 这是第一个，这是一组心电图 作为一名心脏病专家， 无论在世界的哪一个角落， 都能用智能手机及时诊断病人，观察他们的心电图， 这是不可思议的。 然而今天，这种不可思议已经成为现实

但这仅仅是个开始 今天你可以坐在这里查收邮件 不久的将来你就可以坐在这里查询你的生命体征 你所有的生命体征，像心律、 血压、体内的含氧量以及体温等等 其实这些今天都已经实现了

那就是AirStrip Technologies公司的技术。 现在它是有线的， 如果我将医院、重症监护室的数据信息进行汇总， 输入到我的智能手机里发送给医生， 这个意义上可以说是无线的。 如果你是一位准爸爸或者准妈妈 如果你可以随时持续获知胎儿的心率、你的宫缩确保临产时各项指标都正常 如果你可以随时持续获知胎儿的心率、你的宫缩确保临产时各项指标都正常 如果你可以随时持续获知胎儿的心率、你的宫缩确保临产时各项指标都正常 如果你可以随时持续获知胎儿的心率、你的宫缩确保临产时各项指标都正常 并及时送往医院生产，将会怎样？

进一步讲 今天在我们的皮肤下 可以安装葡萄糖检测器， 但在不久的将来这些将无需植入体内。 当然，我们需要每隔5分钟查一下葡萄糖传感器， 确认我们的葡萄糖是否保持在75-200之间 确认我们的葡萄糖是否保持在75-200之间 大家可以看到这一变革将怎样影响糖尿病人的生活。

那么我们的睡眠是否也可以如上所述呢？ 在这里，我们花一点时间稍作解释 我们的一生大约有三分之一的时间用于睡眠 假如在几个星期后， 你的手机可以显示你每一分钟的睡眠情况， 会怎么样？ 大家请看，当你醒着的时候，这里的显示为橙色， 当你处于快速眼动睡眠（REM=rapid eye movement sleep睡眠中眼睛迅速转动） 状态时，显示为绿色 当你处于轻度睡眠状态时，显示为灰色 当你处于深度睡眠（恢复体力的睡眠）状态时 呈现的是深绿色

那么，如何计算你消耗和吸收的卡路里呢？ 这里可以通过这个类似创可贴的东西 来实时计算出你卡路里的摄入和支出 来实时计算出你卡路里的摄入和支出

好，我刚才给大家讲述的是生理上的度量标准体系 但我接下来想很快地， 为大家介绍的是另一项前沿科技。 为什么说听诊器快落伍了呢？ 因为通过GE引进的手持超声装置， 我们的可听域超出了肠蠕动音、呼吸音的范围 我们的可听域超出了肠蠕动音、呼吸音的范围 为什么这是一项重要的技术？因为它更为灵敏。 这里有三个范例，一个是关于腹部超声的 第二个可以通过无线传输心脏超声 第三个可以用你的智能手机进行胎儿监控

在这里，我们所讨论的不仅仅是生理指标 或者是关键的生命体征值 以及生理学的其他指标， 还包括可以通过智能手机看到的所有成像结果。 现在，我给大家展示另一项即将过时的技术 霍尔行氏心电动态监控仪 它可以24小时监控，大家可以看到有好多线连着 现在改进为一个小贴片 你可以将这个放在身上长达2个星期 并且可以通过邮件传输
那么这是如何实现的呢？ 测试者可以把这些类似创可贴的小贴片和传感器 戴在手腕上或者放在鞋子里面 这个装置就可以发送信号 从而建立通往网关的一个人体局域网 网关可以是你的智能手机或者是专用网关 我们现在使用的网关大多是专用网关 因为他们还没有很好地兼容 信号被传到网络，经过云计算 这样信号就可以被处理并传输到任何地方 比如说给护士、医生 或者病人自己等等 这基本是这一技术工作原理的简单介绍。 这基本是这一技术工作原理的简单介绍。

现在我的身上有一个类似的设备 我不想把衬衫脱掉给各位看，但是可以告诉大家我的确戴着它 这项设备不仅能够测量你的心律—— 正如你已经看到的， 它能做的事情远比这个要多。 我现在就站在这里，你可以看到我的心电图 它的下面是我的实际心率和心脏跳动的趋势 右边是一个生理参量， 这是动态的 这对于患有心力衰竭的病人非常重要 这对于患有心力衰竭的病人非常重要 再下面是体温 呼吸强度以及体内含氧量 这是我的位置活动 这些的确是振奋人心的，因为这项设备 能够监控心力衰竭患者7大项重要的生命体征 能够监控心力衰竭患者7大项重要的生命体征 能够监控心力衰竭患者7大项重要的生命体征

为什么说很重要呢？大家看 这是世界上最贵的一种床 假如我们能减少人们对医院病床的需求，这将会产生什么影响？ 遗憾的是，我们不能。首先， 在美国，入院的病人中， 心力衰竭患者所占的比例是最大的 心力衰竭患者每年的花费将近370个亿 其中80%属于住院治疗的费用 经过住院治疗30天后 65岁以上患者中会有27%的人30天内再次入院 65岁以上患者中会有27%的人30天内再次入院 否则，6个月后将会有56%的患者再次入院 因此，我们能否改善一下这种情况呢？ 我们的想法是，把我现在戴的这个装置， 戴在600名随机抽取的心力衰竭患者身上， 同时，我们对比另外 600名没有佩戴这种装置的心力衰竭患者 以便查证对比一下，这个装置是否可以降低患者再次入院的比例 结果将会是令人惊叹的。我们即将开始这个试验 大家将会听到更多关于我们如何进行这项试验的消息 这是一项能在未来几年将改变医疗现状的无线设备试验 这是一项能在未来几年将改变医疗现状的无线设备试验

什么是现在？为什么这会突然变成现实， 成为未来医疗界令人振奋的方向？ 从某种程度上说，我们现在所经历的是一场积极变革 它引起了以消费者为导向的医疗革命 而这就是一切的根源 如果你还没有意识到这一点，让我给大家举个例子来解释为什么这是一项重大举动 如果你还没有意识到这一点，让我给大家举个例子来解释为什么这是一项重大举动 120万美国人 都有一双耐克鞋，通过人体局域网链接了他们的Iphone、Ipod以及鞋子 都有一双耐克鞋，通过人体局域网链接了他们的iPhone、iPod以及鞋子 这本《连线》的封面文章集合了很多这样的应用。 它提到了耐克鞋如何迅速监控人们的生理运动和能量消耗 它提到了耐克鞋如何迅速监控人们的生理运动 和能量消耗 这些是需要我们牢记于心的指导原则 这些是需要我们牢记于心的指导原则 以数字技术为导向的医疗卫生革命， 将会让我们生活地更好、更快、更强 将会让我们生活地更好、更快、更强 看一下这个，这的确很有说服力 这是7月的封面文章

个人的监控远不止日常饮食和运动， 它涉及到生活的方方面面， 从睡眠到情绪到疼痛感， 贯穿一天24小时，一周7天，一年365天。 因此，我尝试使用这种设备。 我知道你们中的很多人使用飞利浦的Direct Life 我没有那个东西 不过我有个Fitbit 就是这个 它看起来就像是一个无线加速器或计步器 在这里，我只想给大家展示这个东西监控的结果 因为我想知道消费者的运动情况 我希望Phillips Direct Life会更好用一些 希望如此 但这个还监控饮食，运动和体重 然而，你需要输入大部分信息到这个设备中 它能够独立监控的只有运动 即便是这样，它还不是完整的。 因此，当你运动的时候，这个装置就会记录你运动的情况。 你输入你的身高和体重，它就会计算出你的体质指数。 当然，它还会告诉你在运动过程中你消耗了多少卡路里， 吃东西吸收了多少卡路里， 不过，前提是你必须先输入有关食物的信息。

使用这个装置，你必须要输入所有有关你运动的信息。 我一直使用这个， 我很高兴Fitbit监控了我42分钟的运动 我所做的42分钟椭圆机运动 但是它还需要更多的信息 因此，它显示：“请录入性爱活动” 你和你的爱人做爱多长时间 （笑声） 它又显示：“做爱的力度是怎样的？” （笑声） 然后它又显示：“开始的时间是？” 但现在它什么也不显示了...它停止工作了 我的意思是说，这样是不行的

好的，让我们转向下一个，睡眠 顺便问一下，有谁想过在自己家里的闹钟上 就可以看到自己的心电图？ 这是和闹钟配套的头带 当你睡觉的时候，它能够监控你的脑电波 为了准备TEDMed的演讲，我拿自己做试验， 检测了我7天以来的睡眠状况。 睡眠是我们生命非常重要的一部分，我们三分之一的时间都用于睡觉。

请问在座的各位 有哪些睡眠存在问题？ 一般的比例高达90%，你们的情况比我想象得要好。 好的，请看，这是我一个星期的睡眠情况 好的，请看，这是我一个星期的睡眠情况 在这里我们用Z.Q.分数衡量睡眠质量，而不是I.Q. 当你起床的时候，就会有一个Z.Q.得分。 Z.Q.的标准会随着年龄不断调整。 Z.Q.的标准会随着年龄不断调整。 你希望能够得到你的年龄范围内最高的分数。 它会记录你分分秒秒的睡眠情况。 它会记录你分分秒秒的睡眠情况。 看一下，我的Z.Q.得分是80多 醒着的时候显示为橙色 我发现了一个问题 因为这不仅帮助你评估自己的睡眠质量 也同时告诉其他人你是醒着的 也同时告诉其他人你是醒着的 所以，我的妻子一进房门 就可以看出其实我是醒着的 “艾瑞克，我想聊天，我想聊天” 而我还在装睡 这件事情让我印象非常非常深刻

好的，这是第一个晚上 这天晚上我得了67分 这不是很好的分数 这个还告诉你，你分别处于快速眼动睡眠、 深度睡眠或其他睡眠状态的时间 这的确很有趣 因为它为你睡眠的各个阶段进行定量分析 因为它为你睡眠的各个阶段进行定量分析 而且，Z.Q.也可以帮助你与你同龄组的人进行比较 这好像是一个睡眠竞争比赛 非常有趣 我看到这个结果，然后想：“虽然我的睡眠质量不算好， 但与50~60岁年龄组的平均水平相比还是很不错的。” 重要的是，我竟然不知道 我睡觉的时候经常做梦

好的，让我们再从睡眠转向疾病 80%的美国人都患有慢性疾病 高于65岁的美国人中 80%以上患有两种或多种慢性疾病 1.4亿美国人 有一种或多种慢性疾病 我们的1.5万亿医疗开销中 80%与慢性疾病有关 糖尿病就是其中人数最多的一种 在美国，几乎有2400万人患有糖尿病 这是纽约时报上星期发表的最新疾病地图 这是纽约时报一周多前发表的最新疾病地图 看起来情况不是很好 在美国，60岁以上的男性中 29%患有II型糖尿病 女性较男性人数虽少一些，但数目还是相当巨大

当然现在我们已经有方法可以连续监控它了 当然现在我们已经有方法可以连续监控它了 方法是用一个传感器来连续检测血糖浓度 这很重要，因为通过检测 可以确定我们自己不知道的高血糖症或低血糖症 可以确定我们自己不知道的高血糖症或低血糖症 你可以看到，这个病例中的红点 是不连续数据，它遗漏了很多居于两端的数据

但是由于持续的监控 我们可以获得所有的重要信息 这一技术的未来 是要能把监控设备做得像创可贴一样简易 而且这也即将得以实现 下面，让我来简略地介绍 无线医疗的十大目标 所有这些都是能够实现的 有些已经非常接近了 或者如你所知 已经以某种形式或方式存在了

老年痴呆症 我们有500万人患有老年痴呆症，大家可以检查 生命体征、活动以及身体各项均衡来进行监测 哮喘，患者众多，你也可以通过检测 花粉、空气质量、呼吸率来有效控制。乳腺癌—— 稍后我将给诸位展示一个例子 慢性阻塞性肺病 忧郁症——我们现在有了监控情绪是否异常的好方法 糖尿病、心力衰竭我刚才已提到；然后就是高血压 7400万的人可以通过持续监控来来很好的控制和预防高血压 7400万的人可以通过持续监控来来很好的控制和预防高血压 肥胖症和睡眠异常 也可以通过这样的方法来控制
这在全球范围内都是非常有效的 智能手机和移动手机现在已经遍地都是 这篇经济学人的文章很好地总结了 发展中国家健康卫生的机遇 “手机比其他先前的技术更大、更快地影响了更多人的生活” “手机比其他先前的技术更大、更快地影响了更多人的生活” 而这正是在我们步入移动医疗卫生世界的基础 老龄化：问题非常严重 每年都有300000老人髋部骨折 然而解决问题的办法是非常多的 并且每一个办法又包含了很多不同的内容

我想提到的一点就是： iShoe就是一个很好的传感器的例子 它通过一个传感器来提高老年人的本体感受 从而降低摔倒的机率 现在很多技术都是通过无线传感器实现的 因此我们可以在持续护理的过程中、 在不同的年龄组成中、 在变化的医药舞台上、 以及全疾病谱上，来改变医疗方法。我希望大家能意识到一件事—— 这个信念就是医疗改革的国际化

能推动这个进程的有两件事 其中一件——我们很幸运——就是建立一个专门的机构 高通公司和Scripps医疗公司已经开始了这个项目 我非常幸运的遇见了Gary和Mary West 他们正在着手建立一个无线化的健康机构 圣地亚哥是一个非常适合做研究地方 那里有650个无线公司 其中100多个主攻无线医疗 这是该商业领域最大的资源，比较有趣的是 他们还和500多个生命科学研究公司完美地结合在一起

该无线研究所 西方无线医疗研究所 是两位杰出的人所创立的 他们今晚也来到了会议现场 Gary和MaryWest。让我们将掌声送给台下这两位 掌声 他们的慈善投资让这个项目成为可能 这个研究所完全是非盈利性教育中心 而这个研究院也即将开放。它看起来是这个样子的 这栋建筑都是专用于研究所的研究的。 我们努力要做的就是推动这个时代向前发展 以实现未满足的医疗需求，进行不断创新 我们不久前刚刚任命了首席工程师，并在本周一宣布了结果 他就是Mehran Mehregany 我们需要不断与时俱进 发展临床试验，改善医疗实践 最具挑战性的一件事情是 这需要同时关注医疗赔偿、医疗卫生政策以及医疗经济学

除了有这个先进的研究院来推动这个领域的发展 另一件重要的事情 就是指引这个领域的发展方向 当然，这是建立在药物数字化基础之上的 如果我们通过生理表现型，基因组学、生命组学以及 无线来理解生物学，这将是很震撼的事情 因为这将是我们从未达到过的知识的集合 80%的主要疾病已经在基因组层次上被破解了 这已经很了不起了 在过去的两年半里，在疾病的理论基础方面，人们的认识急剧增加 比人类历史中任何时候都多 当你把这些新旧知识放在一起，比如说 用iPhone上的一个关于你基因类型的应用程序 作为你的药物治疗指南 因此，不久的将来，我们就可以从所有的常见类型中 判断出谁将会得II型糖尿病 而且将来我们会发现更多的 低频类型 我们可以通过多种遗传基因知道谁会患上乳腺癌 我们可以通过多种遗传基因知道谁会患上乳腺癌 我们也能够知道谁会患心房纤维性颤动

此外，另一个实例就是心源性猝死 在这些的背后就是传感器 我们可以给每个人一个葡萄糖传感器来预防糖尿病 给病人使用超声设备 我们可以第一时间发现并预防乳腺癌 我们可以第一时间发现并预防乳腺癌 心房纤维性颤动则可以用iRhythm来监测 也可以通过监控生命体征来预防心脏性猝死 美国每年都会有700000人丧命于心脏性猝死
今天，我希望自己所说的内容，能让大家达成共识—— 无线医疗设备对医院临床资源有着深远影响 同时，对各种疾病的诊断的影响也是极其深远的 同时，对各种疾病的诊断的影响也是极其深远的 我们将把个性化医疗推向一个新高度 这将是一项创新性极强的事情 我想这将成为医学界的一朵奇葩 谢谢大家

掌声

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Eric Topol: The wireless future of medicine

Does anybody know when the stethoscope was invented? Any guesses? 1816. And what I can say is in 2016, doctors aren't going to be walking around with stethoscopes. There is a whole lot better technology coming. And that is part of the change in medicine.

What has changed our society has been wireless devices. But the future are digital medical wireless devices. Okay?

So, let me give you some examples of this to kind of make this much more concrete. This is the first one. This is an electrocardiogram. And, as a cardiologist, to think that you could see in real time a patient, an individual, anywhere in the world on your smartphone, watching your rhythm, that's incredible. And it's with us today.

But that's just the beginning. You check your email while you're sitting here. In the future you're going to be checking all your vital signs, all your vital signs, your heart rhythm, your blood pressure, your oxygen, your temperature, etc. This is already available today.

This is AirStrip Technologies. It's now wired, or I should say wireless by taking the aggregate of these signals in the hospital, in the intensive care unit, and putting it on a smartphone for physicians. If you're an expectant parent, what about the ability to monitor, continuously, fetal heart rate, or intrauterine contractions, and not having to worry so much that things are fine as the pregnancy, and moving over into the time of delivery.

And then as we go further, today we have continuous glucose sensors. Right now they are under the skin. But in the future they won't have to be implanted. And of course, the desired range, trying to keep glucose between 75 and less than 200, checking it every five minutes in a continuous glucose sensor. You'll see how that can impact diabetes.

And what about sleep? We're going to zoom in on that a little bit. We're supposed to spend a third of our life in sleep. What if, on your phone, which will be available in the next few weeks, you had every minute of your sleep displayed. And this is, of course, as you can see, the awake is the orange. The REM sleep, rapid eye movement, dream state is in light green. And light is gray, light sleep. and deep sleep, the best restorative sleep is that dark green.

How about counting every calorie? And this is ability, in real time, to actually take measurements of caloric intake as well as expenditure, through a band-aid.

Now, what I've talked about are physiologic metrics. But what I want to get to, the next frontier, very quickly, and why the stethoscope is on its way out, is because we can transcend listening to the valve sounds, and the breath sounds, because now, introduced by G.E. is a handheld ultra-sound. Why is this important? Because this is so much more sensitive. Here is an example of an abdominal ultrasound. And also a cardiac echo, which can be sent wireless. And then there is an example of fetal monitoring on your smartphone.

So, we're not just talking about physiologic metrics, the key measurements of vital signs, and all those things in physiology, but also all the imaging that one could look at in your smartphone. Now, this is an example of another obsolete technology, soon to be buried, the Holter Monitor. 24 hour recording, lots of wires. This is now a little tiny patch. You can put it on for two weeks and send it in the mail.

Now, how does this work? Well, there is these smart band-aids or these sensors that one would put on, on a shoe or on the wrist. And this sends a signal. It creates a body area network to a gateway. Gateway could be a smartphone or it could be a dedicated gateway, as today many of these things are dedicated gateways, because they are not so well-integrated. That signal goes to the web, the cloud, and then it can be processed and sent anywhere, to a caregiver, to a physician, back to the patient, etc. So, that's basically very simplistic technology of how this works.

Now, I have this device on. I didn't want to take my shirt off to show you, but I can tell you it's on. This is a device that not only measures cardiac rhythm, as you saw already, but it also goes well beyond that. This is me now. And you can see the ECG. Below that is the actual heart rate and the trend. to the right of that is a bioconductant. That's the fluid status, fluid status, that's really important if you're monitoring somebody with heart failure. And below that is temperature, and respiration, and oxygen. And then the position activity. So, this is really striking, because this device measures seven things that are very much vital signs for monitoring someone with heart failure. Okay?

And why is this important? Well, this is the most expensive bed. What if we could reduce the need for hospital beds? Well, we can't. First of all, heart failure is the number one reason for hospital admissions and readmissions in this country. The cost of heart failure is 37 billion dollars a year, which is 80 percent related to hospitalization. And in the course of 30 days after a hospital stay for a Medicare, greater than 65 years or older, is 27 percent are readmitted in 30 days. Otherwise, over six months, over 56 percent are readmitted. So, can we improve that? Well the idea is we take this device that I'm wearing, and we put it on 600 patients with heart failure, randomly assigned, versus 600 patients who don't have active monitoring, and see whether we can reduce heart failure readmissions. And that's exciting. And we'll start that trial, and you'll hear more about how we're going to do that. But that's a type of wireless device trial that could change medicine in the years ahead.

Why now? Why is this all of a sudden become a reality, an exciting direction in the future of medicine? What we have is, in a way, a perfect positive storm. This sets up consumer driven healthcare. That's where this is all starting. Let me just give you specifics about why this is a big movement if you're not aware of it. 1.2 million Americans have gotten a Nike shoe, which is a body area network that connects the shoe, the sole of the shoe to the iPhone, or an iPod. And this Wired Magazine cover article really captured a lot of this. It talked a lot about the Nike shoe and how quickly that's been adopted to monitor exercise physiology and energy expenditure. Here is some things, the principles that are guiding principles to keep in mind: "A data-driven health revolution promises to make us all better, faster, and stronger. Living by numbers." And this one, which was really telling, This was from July, this cover article.

"The personal metrics movement goes way beyond diet and exercise. It's about tracking every facet of life, from sleep to mood to pain, 24/7/365." Well, I tried this device. A lot of you have gotten that Phillips Direct Life. I didn't have one of those, but I got the Fitbit. That looks like this. It's like a wireless accelerometer, pedometer. And I want to just give you the results of that testing, because I wanted to understand about the consumer movement. I hope the, by the way, the Phillips Direct Life works better. I hope so. But this monitors food. It monitors activity and tracks weight. However you have to put in most of this stuff. The only thing it really tracks by itself is activity. And even then, it's not complete. So, you exercise and it picks up the exercise. You put in your height and weight, it calculates BMI. And of course it tells you how many calories you're expending from the exercise, and how many you took in, if you go in and enter all the foods.

But it really wants you to enter all your activity. And so I went to this, and of course I was gratified that it picked up the 42 minutes of exercise, elliptical exercise I did. But then it wants more information. So, it says, "You want to log sexual activity. How long did you do it for?" (Laughter) And it says, "How hard was it?" (Laughter) Furthermore it says, "Start time." Now, this doesn't appear ... now this just doesn't work. I mean this just doesn't work.

So, now I want to move to sleep. Who would ever have thought you could have your own EEG at your home, tagged to a very nice alarm clock, by the way. This is the headband that goes with this alarm clock. It monitors your brainwaves continuously, when you're sleeping. So, I did this thing for seven days getting ready for TEDMed. This is an important part of our life, one third supposed to be sleeping.

Of course how many here have any problems with sleeping? It's usually 90 percent. So, you tell me you sleep better than expected. Okay, well this was a week of my life in sleeping. And you get a Z.Q. score. Instead of an I.Q. score, you get a Z.Q. score when you wake up. You say, "Oh, okay." And a Z.Q. score is adjusted to age. And you want to get as high as you possibly can. And so this is the moment by moment, or minute by minute sleep. And you see that Z.Q. there was 80-odd. And the wake time is in orange. And this can be a problem, as I learned. Because it not only helps you with quantifying your sleep, but also tells others you're awake. So, when my wife came in and she could tell you're awake. "Eric, I want to talk. I want to talk." And I'm trying to play possum. This thing is very, very impressive.

Okay. So, that's the first night. And this one is now 67. And that's not a good score. And this tells you, of course, how much you had in REM sleep, in deep sleep, and all this sort of thing. This was really fascinating because this gave that quantitation about all the different phases of sleep. So, it also then tells you how you do compared to your age group. It's like a managed competition of sleep. And really interesting stuff. Look at this thing and say, "Well, I didn't think I was a very good sleeper, but actually I did better than average in 50 to 60 year olds." Okay? And the key thing was, what I didn't know, was that I was a really good dreamer.

Okay. Now let's move from sleep to diseases. 80 percent of Americans have chronic disease, or 80 percent of age greater than 65 have two or more chronic disease. 140 million Americans have one or more chronic disease. And 80 percent of our 1.5 whatever trillion expenditures are related to chronic disease. Now, diabetes is one of the big ones. Almost 24 million people have diabetes. And here is the latest map. It was published just a little more than a week ago in the New York Times. And it isn't looking good. That is, for men, 29 percent in the country, over 60, have type II diabetes. And women, although it's less, it's terribly high.

But of course we have a way to measure that now on a continuous basis, with a sensor that detects blood glucose. I mean it's important because we could detect hyperglycemia that otherwise wouldn't be known, and also hypoglycemia. And you can see the red dots in this particular patient's case were finger sticks, which would have missed both ends.

But by continuous monitoring, it captures all that vital information. The future of this though, is being able to move this to a band-aid type phenomenon. And that's not so far away. So, let me just give you, very quickly, 10 top targets for wireless medicine. All these things are possible. Some of them are very close, or already, as you heard, are available today. in some way or form.

Alzheimer's disease, there is five million people affected. And you can check vital signs, activity, balance. Asthma, large number, you could detect things like pollen count, air quality, respiratory rate. Breast cancer -- I'll show you an example of that real quickly. Chronic obstructive pulmonary disease. Depression -- there's a great approach to that in mood disorders. Diabetes I've just mentioned. Heart failure we already talked about. Hypertension -- 74 million people could have continuous blood-pressure monitoring to come up with much better management and prevention. And obesity we already talked about, the ways to get to that. And sleep disorders.

This is effective around the world. The access to smartphones and cell phones today is extraordinary. And this article from The Economist summed it up beautifully about the opportunities in health across the developing world. "Mobile phones made a bigger difference to the lives of more people, more quickly, than any previous technology." And that's before we got going on the m-health world. Aging: the problem is enormous. 300,000 broken hips per year. But the solutions are extraordinary, and they include so many different things.

One of the ones I just wanted to mention: The iShoe is another example of a sensor that improves proprioception among the elderly to prevent falling. One of many different techniques using wireless sensors. So, we can change medicine across the continuum of care, across the ages from premies or unborn children to seniors; the pharmaceutical arena changes; the full spectrum of disease -- I hope I've given you a sense of that -- across the globe.

There are two things that can really accelerate this whole process. One of them -- we're very fortunate -- is to develop a dedicated institute and that's work that started with the work that Scripps with Qualcomm ... and then the great fortune of meeting up with Gary and Mary West, to get behind this wireless health institute. San Diego is an extraordinary place for this. There's over 650 wireless companies, 100 of which or more are working in wireless health. It's the number one source of commerce, and interestingly it dovetails beautifully with over 500 life science companies.

The wireless institute, the West Wireless Health Institute, is really the outgrowth of two extraordinary people who are here this evening: Gary and Mary West. And I'd like to give it up to them for getting behind this. (Applause) Their fantastic philanthropic investment made this possible, and this is really a nonprofit education center which is just about to open. It looks like this. This whole building dedicated. And what it's trying to do is accelerate this era: to take unmet medical needs, to work and innovate ... And we just appointed the chief engineer, Mehran Mehregany. It was announced on Monday. Then to move up with development, clinical trial validation, and then changing medical practice -- the most challenging thing of all, requiring attention to reimbursement, healthcare policy, healthcare economics.

The other big thing, besides having this fantastic institute to catalyze this process is guidance, and that's of course relying on the fact that medicine goes digital. If we understand biology from genomics and omics and wireless through physiologic phenotyping, that's big. Because what it does is allow a convergence like we've never had before. Over 80 major diseases have been cracked at the genomic level, but this is quite extraordinary: more has been learned about the underpinnings of disease in the last two and a half years than in the history of man. And when you put that together with, for example, now an app for the iPhone with your genotype to guide drug therapy ... but, the future -- we can now tell who's going to get Type II Diabetes from all the common variants, and that's going to get filled in more with low-frequency variants in the future. We can tell who's going to get breast cancer from the various genes. We can also know who's likely to get atrial fibrillation.

And finally, another example: sudden cardiac death. Each of these has a sensor. We can give a glucose sensor for diabetes to prevent it. We can prevent or have the earliest detection possible for breast cancer with an ultrasound device given to the patient. An iRhythm for atrial fibrillation. And vital-signs monitoring to prevent sudden cardiac death. We lose 700,000 people a year in the U.S. from sudden cardiac death.

So, I hope I've convinced you of this -- of the impact on hospital clinic resources is profound and then the impact on diseases is equally impressive across all these different diseases and more. It's really taking individualized medicine to a new height and it's hyper-innovative. And I think it represents the Black Swan of medicine. Thanks for your attention.

(Applause)