A lab the size of a postage stamp | George Whitesides | TEDxBoston

Traditional lab tests for disease diagnosis can be too expensive and cumbersome for the regions most in need. George Whitesides' ingenious answer is a foolproof tool that can be manufactured at virtually zero cost.

Host: TED is always about
lifting humanity,

and our next speaker is George Whitesides.

He's listed as the professor
of chemistry at Harvard,

but any of you who have read
his biography know, he's so much more.

You can start with the fact
that he founded 12 companies,

that he has co-authored
950 scientific articles,

or the fact that he is listed
on 50 patents.

But I think
what he is going to talk about today

is similar to what Hugo talked about,

another way that the application
of technology to today's problems

gives us all hope and optimism.

I'd like to introduce George Whitesides.

(Applause)

George Whitesides: I am a wonk.

Started my career at MIT,
I was quite at home there.

And we are defined
by a certain view of the world.

And I will illustrate this in a way

that's relevant
to what I want to talk about.

A few years ago I spent my evening
cleanin out my attic,

and lifted some heavy stuff.

In the middle of the night
I woke up in agonized pain.

And I thought,
well I've probably strained my back,

but I wanted to be a responsible adult,

so I went off to the local emergency room,

and I learned something very interesting,

which is that as a middle aged male,

if you walk into the emergency room

and say, "I think
I might be having a heart attack,"

all the people behind the desk
actually stand up and do something.

It's really impressive.

(Laughter)

So, very sharp needles
were stuck into veins,

and electrodes were applied

and very fancy equipment
did fantastic stuff

and - turns out I didn't.

But I have to say, I loved the experience,

because I'm a wonk, that's what I do.

And it was very sophisticated,

it would have been even more sophisticated

had I actually had a heart attack,

but it was also very, very expensive.

And imagine that you do
the same thing in this environment,

and the story is much more complicated.

There, the problem is basically solved
by either you die or you don't.

The problem that I want
to talk with you about

is really the problem of:

How does one supply healthcare

in a world in which cost is everything?

How do you do that?

And the basic paradigm
we want to suggest to you,

I want to suggest to you,

is one in which you say that in order to

treat disease you have to first
know what you're treating -

that's diagnostics - and then
you have to do something.

So, the program that we're involved
in is something which we call

Diagnostics for All,
or zero-cost diagnostics.

How do you provide medically
relevant information

at as close as possible to zero cost?
How do you do it?

There are a number of reasons

for doing this kind of thing,
other than this,

and I want to return to one of these
at the end.

Let me just give you two examples.

The rigors of military medicine

are not so dissimilar
from the third world -

poor resources, a rigorous environment,

a series of problems in lightweight,
and things of this kind -

and also not so different
from the home healthcare

and diagnostic system world.

So, the technology
that I want to talk about

is for the third world,
for the developing world,

but it has, I think,
much broader application,

because information is so important
in the healthcare system.

So what would have been the equivalent

of the laboratory that did the diagnosis
in the Newton hospital?

And, you see two examples here.

One is a lab that is actually a fairly
high-end laboratory in Africa.

The second is basically an entrepreneur

who is set up and doing who-knows-what
in a table in a market.

I don't know what kind
of healthcare is delivered there.

But it's not really
what is probably most efficient.

What is our approach?

And the way
in which one typically approaches

a problem of lowering cost,

starting from the perspective
of the United States,

is to take our solution,

and then to try to cut cost out of it.

No matter how you do that,

you're not going to start
with a 100,000-dollar instrument

and bring it down to no-cost.
It isn't going to work.

So, the approach that we took
was the other way around.

To ask, "What is the cheapest
possible stuff

that you could make
a diagnostic system out of,

and get useful information, add function?"

And what we've chosen is paper.

What you see here is a prototypic device.

It's about a centimeter on the side.

It's about the size of a fingernail,
I'll show you a picture in a moment.

The lines around the edges are a polymer.

It's made of paper

and paper, of course, wicks fluid,

as you know, paper, cloth -
drop wine on the tablecloth,

and the wine wicks all over everything.

Put it on your shirt, it ruins the shirt.

That's what a hydrophilic surface does.

So, in this device
the idea is that you drip

the bottom end of it in a drop of,

in this case, urine.

The fluid wicks its way
into those chambers at the top.

The brown color indicates
the amount of glucose in the urine,

the blue color indicates the amount
of protein in the urine.

And the combination of those two

is a first order shot at a number

of useful things that you want.

So, this is an example of a device
made from a simple piece of paper.

Now, how simple can you
make the production?

Why do we choose paper?

There's an example of the same
thing on a finger,

showing you basically what it looks like.

One reason for using paper
is that it's everywhere.

We have made these kinds of devices

using napkins and toilet paper

and wraps, and all kinds of stuff.

So, the production capability is there.

The second is, you can put lots and lots

of tests in a very small place.

I'll show you in a moment
that the stack of paper there

would probably hold something like

100,000 tests, something of that kind.

And then finally, a point
that you don't think of so much

in developed world medicine:

it eliminates sharps.

And what sharps means
is needles, things that stick.

If you've taken a sample
of someone's blood

and the someone might have hepatitis C,

you don't want to make
a mistake and stick it in you.

You don't want to do that.

So, how do you dispose of that?
It's a problem everywhere.

And here you simply burn it.

So, it's a sort of a practical approach

to starting on things.

Now, you say, "If paper is a good idea,

other people have surely thought of it."

And the answer is, of course, yes.

Those half of you, roughly,

who are women,

at some point may have
had a pregnancy test.

Probably had several.

And the most common of these

is in a device that looks
like the thing on the left.

It's something called
a lateral flow immunoassay.

In that particular test,

urine either, containing

a hormone called HCG, does or does not

flow across a piece of paper.

And there are two bars.
One indicates that the test is working,

and if the second bar shows up,
you're pregnant.

This is a terrific kind of test
in a binary world,

and the nice thing about pregnancy

is either you are pregnant
or you're not pregnant.

You're not partially pregnant
or thinking about being pregnant

or something of that sort.

So, it works very well there,

but it doesn't work very well when you
need more quantitative information.

There are also dipsticks,

but if you look at the dipsticks,

they're for another kind
of urine analysis.

There are an awful lot of colors
and things like that.

What do you actually do
about that in a difficult circumstance?

So, the approach that we started
with is to ask:

Is it really practical
to make things of this sort?

And that problem is now,
in a purely engineering way, solved.

And the procedure that we have
is simply to start with paper.

You run it through a new kind
of printer called a wax printer.

The wax printer does
what looks like printing.

It is printing. You put that on,
you warm it a little bit,

the wax prints through
so it absorbs into the paper,

and you end up with the device
that you want.

The printers cost 800 bucks now.

We estimate that if you
were to run them 24 hours a day

they'd make about 10 million tests a year.

So, it's a solved problem,
that particular problem is solved.

And there is an example of the kind
of thing that you see.

That's on a piece of 8 by 12 paper.

That takes about two seconds to make.

And so I regard that as done.

There is a very important issue here,

which is that because it's a printer,

a color printer, it prints colors.

That's what color printers do.

I'll show you in a moment,
that's actually quite useful.

Now, the next question
that you would like to ask

is, what would you like to measure?

What would you like to analyze?

And the thing
which you'd most like to analyze,

we're a fair distance from.

It's what's called
"fever of undiagnosed origin."

Someone comes into the clinic,

they have a fever, they feel bad.

What do they have?

Do they have T.B.?
Do they have AIDS?

Do they have a common cold?

The triage problem.

That's a hard problem
for reasons that I won't go through.

There are an awful lot of things
that you'd like to distinguish among.

But then there are a series of things:

AIDS, hepatitis, malaria, TB, others

and simpler ones,
such as guidance of treatment.

Now even that's
more complicated than you think.

A friend of mine works
in transcultural psychiatry,

and he is interested in the question

of why people do
and don't take their meds.

So, Dapsone, or something like that,

you have to take it for a while.

He has a wonderful story
of talking to a villager in India

and saying, "Have you taken
your Dapsone?" "Yes."

"Have you taken it every day?" "Yes."

"Have you taken if for a month?" "Yes."

What the guy actually meant

was that he'd fed a 30-day dose of Dapsone

to his dog, that morning.

(Laughter)

He was telling the truth.

Because in a different culture,

the dog is a surrogate for you,

you know, "today," "this month,"
"since the rainy season" -

there are lots of opportunities
for misunderstanding,

and so an issue here is to,

in some cases, to figure out

how to deal with matters
that seem uninteresting,

like compliance.

Now, take a look at what a typical
test looks like.

Prick a finger, you get some blood,

about 50 microliters.

That's about all you're going to get,

because you can't use
the usual sort of systems.

You can't manipulate it very well,

although I'll show something
about that in a moment.

So, you take the drop of blood,
no further manipulations,

you put it on a little device,

the device filters out the blood cells,
lets the serum go through,

and you get a series of colors

down in the bottom there.

And the colors indicate
"disease" or "normal."

But even that's complicated,

because to you, to me,
colors might indicate "normal,"

but, after all, we're all suffering from

probably an excess of education.

What you do about something which requires

quantitative analysis?

And so the solution
that we and many other people

are thinking about there,

and at this point
there is a dramatic flourish,

and out comes the universal solution
to everything these days,

which is a cell phone.

In this particular case, a camera phone.

They're everywhere,
six billion a month in India.

And the idea is that what one does,

is to take the device,

you dip it, you develop the color,

you take a picture, the picture
goes to a central laboratory.

You don't have to send out a doctor,

you send out somebody who can
just take the sample,

and in the clinic either a doctor,
or ideally a computer

in this case, does the analysis.

Turns out to work actually quite well,

particularly when your color printer
has printed the color bars

that indicate how things work.

So, my view of the health care worker
of the future

is not a doctor,

but is an 18-year-old,
otherwise unemployed, who has two things:

He has a backpack full of these tests,

and a lancet to occasionally
take a blood sample,

and an AK-47.

And these are the things
that get him through his day.

There's another
very interesting connection here,

and that is that what one wants to do

is to pass through useful information

over what is generally
a pretty awful telephone system.

It turns out there's an enormous
amount of information

already available on that subject,
which is the Mars Rover problem.

How do you get back an accurate view
of the color on Mars

if you have a really terrible
bandwidth to do it with?

And the answer is not complicated

but it's one which I don't want
to go through here,

other than to say
that the communication systems

for doing this are really
pretty well understood.

Also, a fact which you may not know

is that the compute
capability of this thing

is not so different
from the compute capability

of your desktop computer.

This is a fantastic device
which is only beginning to be tapped.

I don't know whether the idea of
one computer, one child makes any sense.

Here's the computer of the future,

because this screen is already
there and they're ubiquitous.

All right now let me show you just
a little bit about advanced devices.

And we'll start by posing
a little problem.

What you see here
is another centimeter-sized device,

and the different colors
are different colors of dye.

And you notice something
which might strike you

as a little bit interesting,

which is the yellow seems to disappear,

get through the blue,
and then get through the red.

How does that happen?

How do you make something
flow through something?

And, of course the answer is, "You don't."

You make it flow under and over.

But now the question is:
How do you make it flow

under and over in a piece of paper?

The answer is that what you do -

and the details are not
terribly important here -

is to make something more elaborate:

You take several different
layers of paper,

each one containing
its own little fluid system,

and you separate them by pieces of,

literally, double-sided carpet tape,

the stuff you use to stick
the carpets onto the floor.

And the fluid will flow
from one layer into the next.

It distributes itself,
flows through further holes,

distributes itself.

And what you see, at the lower
right-hand side there,

is a sample in which a single sample

of blood has been put on the top,

and it has gone
through and distributed itself

into these 16 holes on the bottom,

in a piece of paper -
basically it looks like a chip,

two pieces of paper thick.

And in this particular case
we were just interested

in the replicability of that.

But that is, in principle,
the way you solve

the "fever of unexplained origin" problem,

because each one of those spots
then becomes

a test for a particular set
of markers of disease,

and this will work in due course.

Here is an example of a slightly
more complicated device.

There's the chip.

You dip in a corner.
The fluid goes into the center.

It distributes itself
out into these various

wells or holes, and turns color,

and all done with paper and carpet tape.

So, I think it's as low-cost

as we're likely to be able
to come up and make things.

Now, I have one last,
two last little stories to tell you,

in finishing off this business.

This is one: One of the things
that one does occasionally

need to do is to separate
blood cells from serum.

And the question was,

here we do it by taking a sample,

we put it in a centrifuge,

we spin it, and you get blood cells out.
Terrific.

What happens if you don't
have an electricity,

and a centrifuge, and whatever?

And we thought
for a while of how you might do this

and the way, in fact,
you do it is what's shown here.

You get an eggbeater,

which is everywhere,
and you saw off a blade,

and then you take tubing,
and you stick it on that.

You put the blood in, you spin it -

somebody sits there and spins it.

It works really, really well.

And we sat down,
we did the physics of eggbeaters

and self-aligning tubes
and all the rest of that kind of thing,

sent it off to a journal.

We were very proud of this,
particularly the title,

which was "Eggbeater as Centrifuge."

(Laughter)

And we sent it off, and by return mail
it came back.

I called up the editor and I said,

"What's going on? How is this possible?"

The editor said, with enormous disdain,

"I read this.

And we're not going to publish it,

because we only publish science."

And it's an important issue

because it means that we have to,

as a society,

think about what we value.

And if it's just papers
and phys. rev. letters,

we've got a problem.

Here is another example
of something which is -

details are not important,

but this is a little spectrophotometer.

It measures the absorption
of light in a sample

The neat thing about this is,
you have light source that flickers

on and off at about 1,000 hertz,

another light source that detects
that light at 1,000 hertz,

and so you can run this system
in broad daylight.

It performs about equivalently to a system

that's in the order of 100,000 dollars.

It costs 50 dollars.

We can probably make it for 50 cents,

if we put our mind to it.

Why doesn't somebody do it?

And the answer is,

"How do you make a profit
in a capitalist system, doing that?"

Interesting problem.

So, let me finish by saying

that we've thought about this
as a kind of engineering problem.

And we've asked: What
is the scientific unifying idea here?

And we've decided
that we should think about this

not so much in terms of cost,

but in terms of simplicity.

Simplicity is a neat word.

And you've got to think about
what simplicity means.

I know what it is but I don't
actually know what it means.

So, I actually was interested
enough in this to put together

several groups of people.

And the most recent involved
a couple of people at MIT,

one of them being
an exceptionally bright kid

who is one of the very
few people I would think of

who's an authentic genius.

We all struggled for an entire
day to think about simplicity.

And I want to give you the answer of this

deep scientific thought.

[Our strategy: Simplicity.
What is simplicity?]

["It's impossible to f..k it up"]
(Laughter)

So, in a sense, you get what you pay for.

Thank you very much.

(Laughter) (Applause)