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TEDx Talks
Published: 2014-12-22
Source: https://www.youtube.com/watch?v=isTlzL0fxtw
until you some things about how we would like to change medicine but first I want to say what the idea was and how I tried to explain things to people I've been working for about twenty years try to shrink the hardware that allows us to detect pathogens bacteria viruses and making a small as possible in about two thousand eight my colleagues Elaine who Barry Letts and
I said wait a minute we can switch and make things in paper and throw away the instruments completely and move things to the home but then you've got this idea your university and you got a raise some money and have to tell people a story and my way of telling stories involves pictures and often movies so I ran to my graphics program we made this picture
of something we thought we could do so imagine you've had a swapping you've had in someone's nose so you can see that it's green and then you stick it into a two and you're twirling the tube to get the stuff off the swab you push it to activate it and then liquid start moving around and they go on to paper and they run up the paper
and minutes later you've got dots on a piece of paper you pick up your cellphone over there to take a picture in that picture since your medical data any place on the planet that's the core idea few forget everything else you go to sleep now it's fine but I would say to me little things about me and and how I got to be the way I
am problem is that I didn't grow up in this planet really I grew up in the future specifically I grew up in New York City around the corner from the lower Roy street branch of the New York City public library which had in this beautiful nineteenth century building a whole bunch a science fiction books you know everybody from Jules Verran through Larry Niven last name Brunner
Selene wonderful writers who told stories convincing stories about times in the future where a lot of the problems we had didn't exist and then when I was twelve years old this thing called Star Trek captains and you know for twelve years hormones it's a pretty exciting moment in the kids life and there it was on TV like it was real right so I've been splitting infinitives
pretty much continuously for about the last now forty fifty years one of the problems however having that in your head is this cognitive dissonance problem which is that you've grown up in one place and you live here this weird place that you know a lot of people but the bumper sticker their cars and just you have said drop out this is just not for me I've
been fortunate enough to be able to go through an educational process right now hang out with bio engineers who are wonderful bright people what stuns them is that my bookshelf is mostly my science fiction collection to let them know that I'm actually up there not down on this planet and we're just trying to get from here to there so let me tell you what we're going
to try to do in the near future to help us get there so we all know that you know when I was a kid anyway he went to the computing center was a big centralized place new broad data cards and today we've all got these things on our hips which have farmer compute power that were available the best computer centers back in the seventies it's an
amazing revolution and it's changed the world we haven't quite done is fix the hospital the hospital is still the equivalent of the computing center of the nineteen seventies where we go when we do everything there we'd like to do is use that sort of hardware and bring the medical testing to wherever you are when you are there we think that could help a lot that what
is it you have to do in order to cure sick people the first thing you have to do is find out what's wrong with them and you can do that in a major hospital %HESITATION for you ideally could do when the patient's home and that home could be here or a hundred miles north of Monrovia Newser seemingly different problems we want them to be done the
same way we think the same technology could be used in both places and it could be quite liberating and yes we're gonna use the cellphone technology is part of the tool so if you want to treat someone with an infectious disease the first thing you really got to know is what is wrong with them and today and for a long time you first look at symptoms
coughs spots temperature but those things are shared by lots of different diseases you really can't do that and what we do today is we tried it and look at history in environments and part of the problem is if you live in the tropics and you have a fever the first thing is they say well you've got malaria and very often people treated for malaria when that
is not the half they have something else or multiple things we need to know that so that the state of the art here in Seattle is you look for the presence of chemical fingerprints of the suspected disease and it could be antibody responses things your body produces against these things or it could be looking for bits of the pathogen itself a virus or bacterium this is
a flu virus we could be looking at the proteins we could be looking at the DNA or RNA inside either one works that were actually pursuing both of those what we're addressing is that today if you go down the street here to the UW hospital didn't have huge machines that work incredibly officially very effectively however you and I would not want to have them at home
have big your home is but mine won't fit that %HESITATION and if your home or your laboratory is not like the university but it's like this developing world laboratory little ways out of Delhi you don't have the infrastructure to do this under any let alone the power the way to support at the service come so we're trying to do is for camping the person the lapping
the lab to the person %HESITATION in the U. S. were concerned about the AMA and the FDA we want to keep the doctor in the loop we don't want to say Hey I'm gonna become a doctor even though I don't have a degree and give me the tools to do that were saying how can the doctor real pacing relationship be extended back to the home wherever
the patient is that I think is a really potentially successful approach now if you're home happens to be someplace like this and this is on the road from Wally or to the airport a couple years back you really don't have any infrastructure there's no power there's no running water there's nothing so you really want this technology be very simple very robust and there's a roadmap for
how to do this the World Health Organization has what they call their assured challenge and it's an acronym for affordable sensitive cefic was our medical terms about the task but user friendly we all understand so something you kids could use rapid and robust meaning I could store it in the glove compartment of my car or in one of those homes in Gwalior it should be equipment
free that means no power cord ideally something you could carry around with you the trickiest part of course is D. hits the delivered that's the part where a faculty member has to become an entrepreneur and that's a whole other lecture but will go to that one some other day next year maybe so we have this idea which is let's focus on the user experience and my
research about possibly beating people back at saying no so fortunately I am so the fleur and Samantha Byrnes did this movie which is what we thought the user experience should be so you take something out of a pouch where it's been stored for up to a year at room temperature and in that perhaps they'll be a small box and maybe in this case a nasal swab
she's gonna take out a nasal swab she's going to pretend to stick it knows no noses were harmed in the making of this movie %HESITATION and then twirled around few times and then after she twirled it a few times he's done okay and she can then at this point get up walk away do stuff for a bit no user activity no pipe having no big robots
none of that stuff that you'd use in a regular tree has to happen we've shrunk all that and put in the box then when the timer goes off your cell phone things you go take a picture with your cell phone of the output of the vice in our case for using up sure of an image that comes at the end of the thing at which point
the data is present on your phone I can go anywhere on the planet you can analyze it on your phone you could say that your doctor's office you could senator healthcare provider anywhere that's the model what we've put inside the box is paper based technology and you've probably seen certain types of paper based technology we've ever had a pregnancy to in your hand that's what we're
talking about it's very simple it doesn't use any pumps it uses wicking water through the paper to drive the fluids around the call data flow tester good and inexpensive there just however a little bit dom they don't have complicated things and they don't do all the complicated hentai petting steps so we said what if we can actually do some of that complexity stuff and we call
it programming in paper not really computer program it's setting up the paper so it's going to do interesting things in this case we put food dye in pads we reading them by rising the rising water what's them the water level drops as the water gets sucked into those things there's a week on the left side that just sucks up for water and increases the humidity and
if you watch over here imagine that's where we're going to do some chemical testing we're gonna have some capture molecules and grab proteins and nucleic acids there so this is just what happens this is approximately real time notice the liquids are dropping as they get sucked into the paper first you have yellow liquid going across that spot than blue liquid now the red liquid is gonna
come up the other ones have been shut off because the phone out of the water and then eventually the red stuff will run out you'll actually get white stuff we've now run for different liquids across the spot with no human hands whatsoever that movie was enough to get us a relatively large amount of federal funding from an eye for an eye should DARPA of a good
story and a good picture and something that is simple enough that you could imagine a commercial product is really what it takes these days so that's what we're pursuing in our lab now one of the things we're doing is we're looking at proteins and this is the flu virus again we're looking at the proteins on the outside of them refreshing to be working with David Baker
who is a fabulous protein designer and he's been working on proteins that stick to the flu virus that are smaller and much cheaper to make than antibodies and they were coupling those to paper and using them to grab hold of the whole virus or pieces of the virus in order to detect it and that's great there lots of copies of this protein so it's relatively easy
to do and relatively fast we've also and once that the switching here made a lot of toys with paper that allow us to do valving in the sorts of things a robot would do in this case the liquid is turning on other liquids and here actuators any actuators actually bits of sponge and all the stuff has no middle parts no electronics things of that sort the
ideas that in one version of this the entire thing could be burned and they'll be no waste whatsoever would attach now the bigger challenge of the two was to go after nucleic acids because today if you want to find a clay caskets you have to have a big instrument and they're really similar in many ways the protein based approach in terms of what the box would
look like but %HESITATION nucleic acids can be detected down to single copy and there's no way we can do that with proteins at this point in our system so this gives you an enormous sensitivity so you can work with people that just have a very small amount of bacteria or virus in their sample %HESITATION you get a higher part count because the more complicated that's why
we get a lot of money to work on the problem so we have this device recalled the Mad Max %HESITATION I envision a small angry that when I think of this but if you got have an acronym for gonna go for DARPA money swab transfer is which start with the new likes things that means breaking open the cells busting them and getting out the nucleic acids
it could be as few as a single copy would be happy with that of the fourth we have to make lots of copies so you amplify we have a method that we use for amplifying these things and making lots of lots of copies it takes twenty to thirty minutes to do it when you're done you can have ten of the twelve copies so many copies that
you can use the same letter flow technology used the pregnancy test and see them easily on a piece of paper and hands take a picture with your camera so this is a demo we did back in July to prove that we were crazy this is Lisa the fleur the director of the previous movie actually inserting the swab chief designer for these things and she's putting a
swab running it and then the timer will start going a little faster as this thing goes through see swap pretend seconds start the device in the lids closed this thing is sitting on a table there are no other moving parts outside this thing all the parts are inside the box and the valve open valves move things in applications sounds and a variety of things happen application
for thirty minutes in this case to make sure we get lots of copies %HESITATION finally more valves open up and %HESITATION at the end of it when you're done second valve and you actually run flow and you can probably just barely see through a little bit of liquid going up that white window next Q. R. code %HESITATION which is actually the detection event at which point
outcomes the cellphones Rackley putting the cellphone on top of the device we've got a piece of code running it'll take a picture and the picture shows up over there and afterwards you can run this through a piece of software that we loaded into phones the phone can actually analyze that you had a sample there and how much what if you would you do with this yourselves
how why is this relevant with the so what question well you could imagine if you wonder how long it takes to get the point with your primary care physician you could rather waiting for that %HESITATION you may have been on a trip and the question is what did you bring back from that trip whether it was West Africa or someplace else I'm employers don't really want
you at work when you're sick because you're gonna bring it to everybody else and shut down the production line so that's another issue that can be a big deal sometimes you don't know whether what you've got is a serious thing or something trivial and you contested at home %HESITATION you might be able to pick stuff up in the pharmacy to do that %HESITATION but if you