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Host: TED is always about[br]lifting humanity,

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and our next speaker is George Whitesides.

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

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

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

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that he has co-authored [br]950 scientific articles,

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or the fact that he is listed [br]on 50 patents.

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But I think[br]what he is going to talk about today

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is similar to what Hugo talked about,

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

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gives us all hope and optimism.

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I'd like to introduce George Whitesides.

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(Applause)

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George Whitesides: I am a wonk.

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

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

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And I will illustrate this in a way

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that's relevant[br]to what I want to talk about.

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

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and lifted some heavy stuff.

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

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And I thought,[br]well I've probably strained my back,

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but I wanted to be a responsible adult,

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so I went off to the local emergency room,

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and I learned something very interesting,

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which is that as a middle aged male,

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if you walk into the emergency room

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

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

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It's really impressive.

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(Laughter)

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So, very sharp needles [br]were stuck into veins,

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and electrodes were applied

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and very fancy equipment [br]did fantastic stuff

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and - turns out I didn't.

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But I have to say, I loved the experience,

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

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And it was very sophisticated,

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it would have been even more sophisticated

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had I actually had a heart attack,

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but it was also very, very expensive.

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

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and the story is much more complicated.

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

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The problem that I want[br]to talk with you about

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is really the problem of:

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How does one supply healthcare

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in a world in which cost is everything?

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How do you do that?

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And the basic paradigm[br]we want to suggest to you,

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I want to suggest to you,

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is one in which you say that in order to

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

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

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

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Diagnostics for All,[br]or zero-cost diagnostics.

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How do you provide medically[br]relevant information

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

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There are a number of reasons

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for doing this kind of thing, [br]other than this,

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

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Let me just give you two examples.

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The rigors of military medicine

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are not so dissimilar[br]from the third world -

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poor resources, a rigorous environment,

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

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and also not so different[br]from the home healthcare

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and diagnostic system world.

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So, the technology[br]that I want to talk about

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is for the third world,[br]for the developing world,

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but it has, I think,[br]much broader application,

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because information is so important[br]in the healthcare system.

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So what would have been the equivalent

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of the laboratory that did the diagnosis[br]in the Newton hospital?

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And, you see two examples here.

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

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The second is basically an entrepreneur

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

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

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

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What is our approach?

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And the way[br]in which one typically approaches

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a problem of lowering cost,

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starting from the perspective[br]of the United States,

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is to take our solution,

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and then to try to cut cost out of it.

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No matter how you do that,

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

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

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

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To ask, "What is the cheapest[br]possible stuff

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that you could make[br]a diagnostic system out of,

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and get useful information, add function?"

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And what we've chosen is paper.

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What you see here is a prototypic device.

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It's about a centimeter on the side.

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

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The lines around the edges are a polymer.

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It's made of paper

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and paper, of course, wicks fluid,

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

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and the wine wicks all over everything.

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Put it on your shirt, it ruins the shirt.

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That's what a hydrophilic surface does.

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So, in this device[br]the idea is that you drip

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the bottom end of it in a drop of,

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in this case, urine.

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

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The brown color indicates[br]the amount of glucose in the urine,

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the blue color indicates the amount[br]of protein in the urine.

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And the combination of those two

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is a first order shot at a number

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of useful things that you want.

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

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Now, how simple can you[br]make the production?

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Why do we choose paper?

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

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showing you basically what it looks like.

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

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We have made these kinds of devices

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using napkins and toilet paper

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and wraps, and all kinds of stuff.

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So, the production capability is there.

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The second is, you can put lots and lots

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of tests in a very small place.

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

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would probably hold something like

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100,000 tests, something of that kind.

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

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in developed world medicine:

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it eliminates sharps.

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And what sharps means[br]is needles, things that stick.

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If you've taken a sample[br]of someone's blood

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and the someone might have hepatitis C,

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

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You don't want to do that.

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

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And here you simply burn it.

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So, it's a sort of a practical approach

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to starting on things.

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

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other people have surely thought of it."

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And the answer is, of course, yes.

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Those half of you, roughly,

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who are women,

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at some point may have[br]had a pregnancy test.

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Probably had several.

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And the most common of these

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

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It's something called[br]a lateral flow immunoassay.

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In that particular test,

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urine either, containing

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a hormone called HCG, does or does not

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flow across a piece of paper.

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

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

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This is a terrific kind of test[br]in a binary world,

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and the nice thing about pregnancy

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is either you are pregnant[br]or you're not pregnant.

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You're not partially pregnant[br]or thinking about being pregnant

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or something of that sort.

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So, it works very well there,

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

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There are also dipsticks,

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but if you look at the dipsticks,

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they're for another kind[br]of urine analysis.

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

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What do you actually do[br]about that in a difficult circumstance?

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

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Is it really practical[br]to make things of this sort?

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

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

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

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The wax printer does[br]what looks like printing.

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

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the wax prints through[br]so it absorbs into the paper,

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and you end up with the device[br]that you want.

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The printers cost 800 bucks now.

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

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they'd make about 10 million tests a year.

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

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

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

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That takes about two seconds to make.

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And so I regard that as done.

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There is a very important issue here,

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which is that because it's a printer,

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a color printer, it prints colors.

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That's what color printers do.

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

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Now, the next question[br]that you would like to ask

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is, what would you like to measure?

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What would you like to analyze?

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

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we're a fair distance from.

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It's what's called[br]"fever of undiagnosed origin."

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Someone comes into the clinic,

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they have a fever, they feel bad.

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What do they have?

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Do they have T.B.?[br]Do they have AIDS?

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Do they have a common cold?

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The triage problem.

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

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

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But then there are a series of things:

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AIDS, hepatitis, malaria, TB, others

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and simpler ones,[br]such as guidance of treatment.

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Now even that's[br]more complicated than you think.

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A friend of mine works[br]in transcultural psychiatry,

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and he is interested in the question

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

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So, Dapsone, or something like that,

0:10:04.200,0:10:05.813
you have to take it for a while.

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He has a wonderful story[br]of talking to a villager in India

0:10:09.200,0:10:12.194
and saying, "Have you taken[br]your Dapsone?" "Yes."

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

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

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What the guy actually meant

0:10:18.026,0:10:20.600
was that he'd fed a 30-day dose of Dapsone

0:10:20.621,0:10:22.600
to his dog, that morning.

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(Laughter)

0:10:23.641,0:10:24.922
He was telling the truth.

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Because in a different culture,

0:10:27.044,0:10:29.291
the dog is a surrogate for you,

0:10:29.329,0:10:32.537
you know, "today," "this month,"[br]"since the rainy season" -

0:10:32.558,0:10:35.557
there are lots of opportunities[br]for misunderstanding,

0:10:35.578,0:10:37.577
and so an issue here is to,

0:10:37.598,0:10:39.499
in some cases, to figure out

0:10:39.520,0:10:42.519
how to deal with matters[br]that seem uninteresting,

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like compliance.

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

0:10:49.354,0:10:51.728
Prick a finger, you get some blood,

0:10:51.749,0:10:53.085
about 50 microliters.

0:10:53.106,0:10:55.067
That's about all you're going to get,

0:10:55.088,0:10:58.743
because you can't use[br]the usual sort of systems.

0:10:59.520,0:11:01.519
You can't manipulate it very well,

0:11:01.540,0:11:04.062
although I'll show something[br]about that in a moment.

0:11:04.062,0:11:06.791
So, you take the drop of blood,[br]no further manipulations,

0:11:06.791,0:11:08.462
you put it on a little device,

0:11:08.462,0:11:12.388
the device filters out the blood cells,[br]lets the serum go through,

0:11:12.473,0:11:14.316
and you get a series of colors

0:11:14.337,0:11:16.141
down in the bottom there.

0:11:16.266,0:11:20.175
And the colors indicate[br]"disease" or "normal."

0:11:20.647,0:11:22.466
But even that's complicated,

0:11:22.487,0:11:25.902
because to you, to me, [br]colors might indicate "normal,"

0:11:25.923,0:11:28.783
but, after all, we're all suffering from

0:11:28.804,0:11:30.863
probably an excess of education.

0:11:30.885,0:11:33.339
What you do about something which requires

0:11:33.360,0:11:35.156
quantitative analysis?

0:11:35.583,0:11:38.273
And so the solution[br]that we and many other people

0:11:38.294,0:11:39.853
are thinking about there,

0:11:39.874,0:11:42.392
and at this point[br]there is a dramatic flourish,

0:11:42.413,0:11:45.662
and out comes the universal solution[br]to everything these days,

0:11:45.683,0:11:46.797
which is a cell phone.

0:11:46.822,0:11:48.866
In this particular case, a camera phone.

0:11:48.866,0:11:52.680
They're everywhere,[br]six billion a month in India.

0:11:53.117,0:11:56.116
And the idea is that what one does,

0:11:56.137,0:11:58.561
is to take the device,

0:11:58.582,0:12:01.196
you dip it, you develop the color,

0:12:01.217,0:12:04.418
you take a picture, the picture[br]goes to a central laboratory.

0:12:04.439,0:12:06.438
You don't have to send out a doctor,

0:12:06.459,0:12:08.942
you send out somebody who can[br]just take the sample,

0:12:08.963,0:12:11.962
and in the clinic either a doctor,[br]or ideally a computer

0:12:11.983,0:12:13.775
in this case, does the analysis.

0:12:13.796,0:12:15.625
Turns out to work actually quite well,

0:12:15.625,0:12:18.609
particularly when your color printer[br]has printed the color bars

0:12:18.630,0:12:20.629
that indicate how things work.

0:12:20.650,0:12:23.807
So, my view of the health care worker[br]of the future

0:12:23.828,0:12:25.307
is not a doctor,

0:12:25.328,0:12:29.061
but is an 18-year-old,[br]otherwise unemployed, who has two things:

0:12:29.082,0:12:30.934
He has a backpack full of these tests,

0:12:30.955,0:12:33.347
and a lancet to occasionally[br]take a blood sample,

0:12:33.368,0:12:34.870
and an AK-47.

0:12:34.891,0:12:37.891
And these are the things[br]that get him through his day.

0:12:40.133,0:12:42.467
There's another[br]very interesting connection here,

0:12:42.488,0:12:44.855
and that is that what one wants to do

0:12:44.876,0:12:47.886
is to pass through useful information

0:12:47.907,0:12:50.907
over what is generally[br]a pretty awful telephone system.

0:12:51.554,0:12:54.172
It turns out there's an enormous[br]amount of information

0:12:54.193,0:12:57.609
already available on that subject,[br]which is the Mars Rover problem.

0:12:57.630,0:13:01.386
How do you get back an accurate view[br]of the color on Mars

0:13:01.407,0:13:05.093
if you have a really terrible[br]bandwidth to do it with?

0:13:05.114,0:13:07.386
And the answer is not complicated

0:13:07.407,0:13:09.836
but it's one which I don't want[br]to go through here,

0:13:09.857,0:13:12.172
other than to say[br]that the communication systems

0:13:12.193,0:13:14.508
for doing this are really[br]pretty well understood.

0:13:14.508,0:13:17.044
Also, a fact which you may not know

0:13:17.065,0:13:19.902
is that the compute[br]capability of this thing

0:13:19.923,0:13:22.442
is not so different[br]from the compute capability

0:13:22.463,0:13:23.950
of your desktop computer.

0:13:23.971,0:13:27.505
This is a fantastic device[br]which is only beginning to be tapped.

0:13:27.526,0:13:32.207
I don't know whether the idea of[br]one computer, one child makes any sense.

0:13:32.228,0:13:34.437
Here's the computer of the future,

0:13:34.458,0:13:37.458
because this screen is already[br]there and they're ubiquitous.

0:13:38.895,0:13:42.298
All right now let me show you just[br]a little bit about advanced devices.

0:13:42.298,0:13:44.485
And we'll start by posing[br]a little problem.

0:13:44.485,0:13:47.295
What you see here[br]is another centimeter-sized device,

0:13:47.735,0:13:51.167
and the different colors[br]are different colors of dye.

0:13:51.760,0:13:53.948
And you notice something[br]which might strike you

0:13:53.948,0:13:55.760
as a little bit interesting,

0:13:55.781,0:13:58.321
which is the yellow seems to disappear,

0:13:58.466,0:14:01.185
get through the blue,[br]and then get through the red.

0:14:01.185,0:14:02.535
How does that happen?

0:14:02.535,0:14:04.889
How do you make something[br]flow through something?

0:14:04.889,0:14:07.069
And, of course the answer is, "You don't."

0:14:07.069,0:14:08.834
You make it flow under and over.

0:14:08.834,0:14:11.069
But now the question is:[br]How do you make it flow

0:14:11.090,0:14:12.982
under and over in a piece of paper?

0:14:13.553,0:14:16.386
The answer is that what you do -

0:14:16.407,0:14:18.918
and the details are not[br]terribly important here -

0:14:19.102,0:14:21.101
is to make something more elaborate:

0:14:21.122,0:14:23.170
You take several different[br]layers of paper,

0:14:23.191,0:14:26.122
each one containing[br]its own little fluid system,

0:14:26.156,0:14:28.442
and you separate them by pieces of,

0:14:28.463,0:14:30.966
literally, double-sided carpet tape,

0:14:30.987,0:14:33.513
the stuff you use to stick[br]the carpets onto the floor.

0:14:33.744,0:14:37.164
And the fluid will flow[br]from one layer into the next.

0:14:37.185,0:14:40.184
It distributes itself,[br]flows through further holes,

0:14:40.205,0:14:41.740
distributes itself.

0:14:41.761,0:14:44.986
And what you see, at the lower[br]right-hand side there,

0:14:45.007,0:14:47.954
is a sample in which a single sample

0:14:47.975,0:14:49.974
of blood has been put on the top,

0:14:50.379,0:14:53.243
and it has gone[br]through and distributed itself

0:14:53.264,0:14:56.263
into these 16 holes on the bottom,

0:14:56.284,0:14:58.856
in a piece of paper -[br]basically it looks like a chip,

0:14:58.877,0:15:00.497
two pieces of paper thick.

0:15:00.708,0:15:03.482
And in this particular case[br]we were just interested

0:15:03.503,0:15:04.910
in the replicability of that.

0:15:04.931,0:15:07.347
But that is, in principle,[br]the way you solve

0:15:07.368,0:15:09.544
the "fever of unexplained origin" problem,

0:15:09.586,0:15:11.752
because each one of those spots[br]then becomes

0:15:11.773,0:15:15.726
a test for a particular set [br]of markers of disease,

0:15:15.747,0:15:18.107
and this will work in due course.

0:15:18.244,0:15:21.561
Here is an example of a slightly[br]more complicated device.

0:15:21.582,0:15:22.767
There's the chip.

0:15:22.788,0:15:25.537
You dip in a corner.[br]The fluid goes into the center.

0:15:25.558,0:15:28.060
It distributes itself[br]out into these various

0:15:28.081,0:15:30.585
wells or holes, and turns color,

0:15:30.606,0:15:33.605
and all done with paper and carpet tape.

0:15:33.626,0:15:35.625
So, I think it's as low-cost

0:15:35.646,0:15:38.499
as we're likely to be able[br]to come up and make things.

0:15:39.370,0:15:42.535
Now, I have one last,[br]two last little stories to tell you,

0:15:42.561,0:15:45.185
in finishing off this business.

0:15:45.331,0:15:48.199
This is one: One of the things[br]that one does occasionally

0:15:48.220,0:15:51.595
need to do is to separate[br]blood cells from serum.

0:15:52.855,0:15:54.508
And the question was,

0:15:54.529,0:15:56.696
here we do it by taking a sample,

0:15:56.717,0:15:59.394
we put it in a centrifuge,

0:15:59.415,0:16:03.561
we spin it, and you get blood cells out.[br]Terrific.

0:16:03.582,0:16:05.773
What happens if you don't[br]have an electricity,

0:16:05.794,0:16:07.582
and a centrifuge, and whatever?

0:16:07.736,0:16:10.236
And we thought[br]for a while of how you might do this

0:16:10.257,0:16:12.966
and the way, in fact,[br]you do it is what's shown here.

0:16:12.987,0:16:14.615
You get an eggbeater,

0:16:14.615,0:16:17.742
which is everywhere,[br]and you saw off a blade,

0:16:17.763,0:16:20.271
and then you take tubing,[br]and you stick it on that.

0:16:20.271,0:16:22.048
You put the blood in, you spin it -

0:16:22.048,0:16:23.692
somebody sits there and spins it.

0:16:23.692,0:16:25.121
It works really, really well.

0:16:25.121,0:16:27.581
And we sat down,[br]we did the physics of eggbeaters

0:16:27.602,0:16:30.602
and self-aligning tubes[br]and all the rest of that kind of thing,

0:16:30.623,0:16:32.077
sent it off to a journal.

0:16:32.098,0:16:34.524
We were very proud of this,[br]particularly the title,

0:16:34.524,0:16:36.344
which was "Eggbeater as Centrifuge."

0:16:36.344,0:16:37.244
(Laughter)

0:16:37.265,0:16:40.474
And we sent it off, and by return mail[br]it came back.

0:16:40.495,0:16:42.291
I called up the editor and I said,

0:16:42.312,0:16:44.311
"What's going on? How is this possible?"

0:16:44.332,0:16:47.331
The editor said, with enormous disdain,

0:16:47.352,0:16:48.902
"I read this.

0:16:48.923,0:16:50.589
And we're not going to publish it,

0:16:50.589,0:16:52.529
because we only publish science."

0:16:54.259,0:16:55.847
And it's an important issue

0:16:55.868,0:16:57.775
because it means that we have to,

0:16:57.796,0:16:59.180
as a society,

0:16:59.201,0:17:00.759
think about what we value.

0:17:01.053,0:17:03.870
And if it's just papers[br]and phys. rev. letters,

0:17:03.891,0:17:05.347
we've got a problem.

0:17:05.752,0:17:08.551
Here is another example[br]of something which is -

0:17:09.092,0:17:11.250
details are not important,

0:17:11.280,0:17:13.457
but this is a little spectrophotometer.

0:17:13.885,0:17:17.368
It measures the absorption[br]of light in a sample

0:17:18.795,0:17:21.935
The neat thing about this is,[br]you have light source that flickers

0:17:21.935,0:17:24.005
on and off at about 1,000 hertz,

0:17:24.300,0:17:28.002
another light source that detects[br]that light at 1,000 hertz,

0:17:28.300,0:17:31.299
and so you can run this system[br]in broad daylight.

0:17:31.300,0:17:35.082
It performs about equivalently to a system

0:17:36.128,0:17:39.127
that's in the order of 100,000 dollars.

0:17:39.545,0:17:41.105
It costs 50 dollars.

0:17:41.105,0:17:43.493
We can probably make it for 50 cents,

0:17:43.493,0:17:44.918
if we put our mind to it.

0:17:44.939,0:17:46.609
Why doesn't somebody do it?

0:17:46.609,0:17:47.893
And the answer is,

0:17:47.893,0:17:51.173
"How do you make a profit[br]in a capitalist system, doing that?"

0:17:51.183,0:17:52.890
Interesting problem.

0:17:54.041,0:17:56.565
So, let me finish by saying

0:17:57.374,0:18:00.604
that we've thought about this[br]as a kind of engineering problem.

0:18:00.700,0:18:05.270
And we've asked: What[br]is the scientific unifying idea here?

0:18:05.596,0:18:07.892
And we've decided[br]that we should think about this

0:18:07.892,0:18:09.425
not so much in terms of cost,

0:18:09.425,0:18:11.075
but in terms of simplicity.

0:18:11.096,0:18:12.548
Simplicity is a neat word.

0:18:12.548,0:18:15.096
And you've got to think about[br]what simplicity means.

0:18:15.493,0:18:19.060
I know what it is but I don't[br]actually know what it means.

0:18:19.700,0:18:23.093
So, I actually was interested[br]enough in this to put together

0:18:24.037,0:18:25.672
several groups of people.

0:18:26.132,0:18:28.699
And the most recent involved[br]a couple of people at MIT,

0:18:28.700,0:18:30.843
one of them being[br]an exceptionally bright kid

0:18:30.844,0:18:33.225
who is one of the very[br]few people I would think of

0:18:33.245,0:18:34.994
who's an authentic genius.

0:18:35.015,0:18:38.636
We all struggled for an entire[br]day to think about simplicity.

0:18:38.700,0:18:40.699
And I want to give you the answer of this

0:18:40.700,0:18:42.711
deep scientific thought.

0:18:43.134,0:18:45.406
[Our strategy: Simplicity. [br]What is simplicity?]

0:18:45.427,0:18:48.768
["It's impossible to f..k it up"][br](Laughter)

0:18:49.700,0:18:52.460
So, in a sense, you get what you pay for.

0:18:52.481,0:18:54.480
Thank you very much.

0:18:54.501,0:18:56.425
(Laughter) (Applause)