hopefully converting fear into hope.

今日 お話しするのは

When we go to the physician today --

願わくは恐怖を希望に変えることです

when we go to the doctor's office and we walk in,

私達は病院に行くと

there are words that we just don't want to hear.

診察室の中で

There are words that we're truly afraid of.

耳にしたくない言葉があります

Diabetes, cancer, Parkinson's, Alzheimer's,

私達が本当に恐れている言葉です

heart failure, lung failure --

糖尿病 癌 パーキンソン病 アルツハイマー

things that we know are debilitating diseases,

心不全 肺不全

for which there's relatively little that can be done.

私達の認識は 身体をむしばむ

And what I want to lay out for you today is

対処法がほとんどない病気ということです

a different way of thinking about how to treat debilitating disease,

今日お話したいのは

why it's important,

不治の病への従来とは違ったアプローチと

why without it perhaps our health care system will melt down

その重要性です

if you think it already hasn't,

それがなければ 医療制度は崩壊するでしょう

and where we are clinically today, and where we might go tomorrow,

まだ していなければの話ですが…

and what some of the hurdles are.

臨床の現在と 明日の方向性

And we're going to do all of that in 18 minutes, I promise.

問題点を取り上げ

I want to start with this slide,

以上の点を18分で紹介します

because this slide sort of tells the story the way Science Magazine thinks of it.

こちらを見てください

This was an issue from 2002

サイエンスマガジン誌の見方が表れています

that they published with a lot of different articles on the bionic human.

バイオニックヒューマンに関する

It was basically a regenerative medicine issue.

様々な記事を集めた2002年の特集号です

Regenerative medicine is an extraordinarily simple concept

要は 再生医療特集ということです

that everybody can understand.

再生医療とは非常に簡単な概念で

It's simply accelerating the pace at which the body heals itself

誰でも理解できます

to a clinically relevant timescale.

自然治癒のスピードを医療処置のように

So we know how to do this in many of the ways that are up there.

加速するのです

We know that if we have a damaged hip, you can put an artificial hip in.

ここに挙げられている様々な方法を我々は知っています

And this is the idea that Science Magazine used on their front cover.

股関節疾患には人工関節で治します

This is the complete antithesis of regenerative medicine.

サイエンスマガジン誌の表紙で紹介された考え方です

This is not regenerative medicine.

実はこれは再生医療とは正反対で

Regenerative medicine is what Business Week put up

再生医療とは呼びません

when they did a story about regenerative medicine not too long ago.

ビジネスウィーク誌が少し前に

The idea is that instead of figuring out how to ameliorate symptoms

特集したのが本当の再生医療です

with devices and drugs and the like --

その概念とは 器具や薬で症状を

and I'll come back to that theme a few times --

改善させようとする代わりに

instead of doing that, we will regenerate lost function of the body

これは後から触れますが

by regenerating the function of organs and damaged tissue.

臓器や傷ついた組織の機能を再生することで

So that at the end of the treatment,

失われた体の機能を再生するのです

you are the same as you were at the beginning of the treatment.

治療が終了すると

Very few good ideas -- if you agree that this is a good idea --

健康時の体が取り戻せます

very few good ideas are truly novel.

これは良いアイディアだと思いますが

And this is just the same.

良いアイディアは新しくないことが多いものです

If you look back in history,

この案も同じです

Charles Lindbergh, who was better known for flying airplanes,

歴史を振り返れば

was actually one of the first people

有名な飛行家のチャールズ リンドバーグは

along with Alexis Carrel, one of the Nobel Laureates from Rockefeller,

ノーベル賞を受賞した―

to begin to think about, could you culture organs?

アレクシス カレルと共に 臓器の培養を

And they published this book in 1937,

最初に考えた１人です

where they actually began to think about,

彼らは1937年に本を出版し

what could you do in bio-reactors to grow whole organs?

バイオリアクターで

We've come a long way since then.

いかに臓器を生成できるのか考え始め それ以降

I'm going to share with you some of the exciting work that's going on.

躍進を遂げました

But before doing that, what I'd like to do

進行中の素晴らしい事例を幾つか紹介します

is share my depression about the health care system

でも その前に 医療制度に対する

and the need for this with you.

私の不満と 再生医療の必要性を

Many of the talks yesterday talked about

話したいと思います

improving the quality of life, and reducing poverty,

昨日は生活の質の向上や

and essentially increasing life expectancy all around the globe.

貧困を減らすという話をたくさん聞きました

One of the challenges is that the richer we are, the longer we live.

実質的に平均寿命を延ばすということです

And the longer we live, the more expensive it is

でも より裕福になれば 寿命も延びるわけで

to take care of our diseases as we get older.

寿命が延びれば 加齢と共に

This is simply the wealth of a country

病気の治療費も増加するということです

versus the percent of population over the age of 65.

これは65歳以上の人口の割合と

And you can basically see that the richer a country is,

国の豊かさの関係を示した図です

the older the people are within it.

国が より裕福であればあるほど

Why is this important?

高齢者は多くなります

And why is this a particularly dramatic challenge right now?

なぜ これが重要なのか？

If the average age of your population is 30,

なぜ これが危急の難題なのか？

then the average kind of disease that you have to treat

平均年齢が30歳だと

is maybe a broken ankle every now and again,

処置が必要な平均的な病気は

maybe a little bit of asthma.

時折見られる足首の骨折や

If the average age in your country is 45 to 55,

喘息などでしょう

now the average person is looking at diabetes,

平均年齢が45歳から55歳になると

early-onset diabetes, heart failure, coronary artery disease --

平均的なのは 早期の糖尿病

things that are inherently more difficult to treat,

心不全 冠動脈疾患などです

and much more expensive to treat.

治療がより難しく 医療費がより高い―

Just have a look at the demographics in the U.S. here.

病気が出てきます

This is from "The Untied States of America."

これは米国の人口統計データです

In 1930, there were 41 workers per retiree.

ある本から借用した資料です

41 people who were basically outside of being really sick,

1930年 年金生活者１人に対し労働者は41人

paying for the one retiree who was experiencing debilitating disease.

基本的に健康には さほど問題のない41人が

In 2010, two workers per retiree in the U.S.

医療費のかさむ年金生活者1人を養っています

And this is matched in every industrialized, wealthy country in the world.

2010年の米国は 年金生活者1人に対し労働者2人

How can you actually afford to treat patients

これは世界中の裕福な産業国すべてに当てはまります

when the reality of getting old looks like this?

高齢化の現実がこのような状態で

This is age versus cost of health care.

いかに患者を治療すればいいか？

And you can see that right around age 45, 40 to 45,

これは年齢と医療費のグラフです

there's a sudden spike in the cost of health care.

ちょうど40～45歳のあたりで

It's actually quite interesting. If you do the right studies,

医療費の急激な増加が見られます

you can look at how much you as an individual spend on your own health care,

興味深いのは 研究をすれば

plotted over your lifetime.

個人の医療費が生涯に渡ってどれだけかかるか

And about seven years before you're about to die, there's a spike.

わかるということです

And you can actually --

死の約７年前に費用が急激に上昇します

(Laughter)

ここから分かるのは…

-- we won't get into that.

（笑）

(Laughter)

…よしておきます

There are very few things, very few things that you can really do

（笑）

that will change the way that you can treat these kinds of diseases

このような病気の治療法を変え

and experience what I would call healthy aging.

私が健康的な加齢と呼ぶものを

I'd suggest there are four things,

実現できる方法は あまりありません

and none of these things include an insurance system or a legal system.

提案する方法は4つ

All those things do is change who pays.

保険や法律に関連したことではありません

They don't actually change what the actual cost of the treatment is.

それらは負担者を変えるだけで

One thing you can do is not treat. You can ration health care.

治療費に変化は出せません

We won't talk about that anymore. It's too depressing.

１つの方法は 医療を制限し 治療をやめることです

You can prevent.

こんな暗い話題はやめましょう

Obviously a lot of monies should be put into prevention.

もう１つは予防です

But perhaps most interesting, to me anyway, and most important,

予防に多くの費用をかけるべきなのは明白です

is the idea of diagnosing a disease much earlier on in the progression,

興味深く 最も重要なのは

and then treating the disease to cure the disease

病気の早期発見をして

instead of treating a symptom.

対症療法ではなく

Think of it in terms of diabetes, for instance.

完治するように治療すること

Today, with diabetes, what do we do?

糖尿病を例に考えてみましょう

We diagnose the disease eventually, once it becomes symptomatic,

現在の糖尿病への対応とは？

and then we treat the symptom for 10, 20, 30, 40 years.

症状が現れてから診断がなされ

And we do OK. Insulin's a pretty good therapy.

そして何十年と長期に渡る治療をし

But eventually it stops working,

インスリンが効くので健康を保てますが

and diabetes leads to a predictable onset of debilitating disease.

結局は効かなくなり

Why couldn't we just inject the pancreas with something

糖尿病がどんどん身体を弱らせる素因になります

to regenerate the pancreas early on in the disease,

症状が現れる前の初期の段階で

perhaps even before it was symptomatic?

すい臓を再生させる注射をすることは

And it might be a little bit expensive at the time that we did it,

できないでしょうか？

but if it worked, we would truly be able to do something different.

その時は多少費用が必要ですが

This video, I think, gets across the concept that I'm talking about quite dramatically.

効果が出れば 違いは著しいでしょう

This is a newt re-growing its limb.

私が話している概念は このビデオで劇的に伝えられると思います

If a newt can do this kind of thing, why can't we?

これは再生中のイモリの手です

I'll actually show you some more important features

イモリに可能ならば 我々にも可能なのでは？

about limb regeneration in a moment.

もう少し後で 手足再生に関する―

But what we're talking about in regenerative medicine

もっと重要な事を紹介します

is doing this in every organ system of the body,

再生医療とは

for tissues and for organs themselves.

体中すべての組織や

So today's reality is that if we get sick,

器官全体に適用できます

the message is we will treat your symptoms,

今日の実情では 病気になった場合

and you need to adjust to a new way of life.

治療されるのは症状であり 患者には

I would pose to you that tomorrow --

新しいあり方への適応が求められます

and when tomorrow is we could debate,

いつ起きるのかは

but it's within the foreseeable future --

議論の余地がありますが

we will talk about regenerative rehabilitation.

近い将来に

There's a limb prosthetic up here,

再生医療を伴うリハビリが行われるようになるでしょう

similar actually one on the soldier

この義足は

that's come back from Iraq.

イラク帰還兵が使用しているものに

There are 370 soldiers that have come back from Iraq that have lost limbs.

よく似ています

Imagine if instead of facing that, they could actually

手足を失ったイラク帰還兵が370名もいます

face the regeneration of that limb.

彼らが直面するのが 手足の喪失ではなく

It's a wild concept.

手足の再生であるところを想像してみてください

I'll show you where we are at the moment in working towards that concept.

興味深いですね

But it's applicable, again, to every organ system.

その発想に向けた進行中の事例を紹介します

How can we do that?

どの器官にも有効な方法です

The way to do that is to develop a conversation with the body.

その方法とは

We need to learn to speak the body's language.

肉体と会話をすること

And to switch on processes that we knew how to do when we were a fetus.

肉体の言語を話し

A mammalian fetus, if it loses a limb during the first trimester of pregnancy,

胎児だった時に使っていたプロセスを起動するのです

will re-grow that limb.

哺乳類の胎児は妊娠３ヶ月までに手足を失っても

So our DNA has the capacity to do these kinds of wound-healing mechanisms.

再び形成されます

It's a natural process,

私たちのDNAはそのような怪我を治癒する機能を備えているのです

but it is lost as we age.

これは自然な能力ですが

In a child, before the age of about six months,

成長と共に失われます

if they lose their fingertip in an accident,

生後６ヶ月以内の乳児であれば

they'll re-grow their fingertip.

指先を事故で失っても

By the time they're five, they won't be able to do that anymore.

元通りになりますが

So to engage in that conversation with the body,

5歳児だと 元通りにはなりません

we need to speak the body's language.

そこで 肉体と対話する為には

And there are certain tools in our toolbox that allow us to do this today.

肉体の言葉を話す必要があります

I'm going to give you an example of three of these tools

現在 そのための道具立てを我々は持っています

through which to converse with the body.

肉体と対話する能力３つの例を

The first is cellular therapies.

お見せします

Clearly, we heal ourselves in a natural process,

１つめは細胞セラピー

using cells to do most of the work.

私たちは主に細胞の働きによって

Therefore, if we can find the right cells

自然なプロセスとして自ら治癒します

and implant them in the body, they may do the healing.

適切な細胞を見つけ

Secondly, we can use materials.

体に移植すれば 細胞が治してくれるかもしれません

We heard yesterday about the importance of new materials.

２つめは物質を使うこと

If we can invent materials, design materials,

昨日 新物質の重要性について聞きました

or extract materials from a natural environment,

もし物質を発明したり 設計したり

then we might be able to have those materials induce the body to heal itself.

自然界から抽出することが出来れば

And finally, we may be able to use smart devices

その物質で体自身が治癒するように誘導できるかもしれません

that will offload the work of the body and allow it to heal.

最後に 体の機能を肩代わりして

I'm going to show you an example of each of these,

体が治癒できるようにする知的な装置を作れるかもしれません

and I'm going to start with materials.

それぞれの例を紹介します

Steve Badylak -- who's at the University of Pittsburgh --

物質から始めます

about a decade ago had a remarkable idea.

ピッツバーグ大学のバディラック氏は

And that idea was that the small intestine of a pig,

10年程前に素晴らしい事を思いつきました

if you threw away all the cells,

生物学的に活性な状態のまま 豚の小腸からすべての細胞を

and if you did that in a way that allowed it to remain biologically active,

取り除いたなら

may contain all of the necessary factors and signals

体に治癒を促すのに必要なすべての要素と信号が

that would signal the body to heal itself.

そこには含まれているかもしれない―

And he asked a very important question.

というアイディアです

He asked the question,

彼はとても重要な

if I take that material, which is a natural material

質問をしました

that usually induces healing in the small intestine,

通常は小腸で治癒を誘発する―

and I place it somewhere else on a person's body,

天然の物質を取り 人の耳の部分に

would it give a tissue-specific response,

移植したら 組織固有の反応を見せて

or would it make small intestine if I tried to make a new ear?

耳を作り出すのか それとも小腸を

I wouldn't be telling you this story if it weren't compelling.

作り出すのか という質問です

The picture I'm about to show you

興味深い話でなければ この話はしていません

is a compelling picture.

これからお見せする写真は…

(Laughter)

（スライド： 目をそらすなら今のうち）　（笑）

However, for those of you that are even the slightest bit squeamish --

注目に値する写真です

even though you may not like to admit it in front of your friends --

でも 友人には認めたくなくても

the lights are down. This is a good time to look at your feet,

怖ければ 明かりを落とすので

check your Blackberry, do anything other than look at the screen.

足下を気にしたり 携帯を確認したり

(Laughter)

スクリーンを見る以外のことをして下さい

What I'm about to show you is a diabetic ulcer.

（笑）

And although -- it's good to laugh before we look at this.

お見せするのは糖尿病性潰瘍です

This is the reality of diabetes.

笑うのは今のうちです

I think a lot of times we hear about diabetics, diabetic ulcers,

これが糖尿病の現実です

we just don't connect the ulcer with the eventual treatment,

糖尿病や糖尿病性潰瘍はよく耳にしますが

which is amputation, if you can't heal it.

治癒しなければ切断 という最終段階と

So I'm going to put the slide up now. It won't be up for long.

潰瘍をあまり関連づけすることはありません

This is a diabetic ulcer. It's tragic.

では始めます　長くはありません

The treatment for this is amputation.

これが糖尿病性潰瘍　悲惨なものです

This is an older lady. She has cancer of the liver as well as diabetes,

治療法は切断です

and has decided to die with what' s left of her body intact.

この66歳の女性は糖尿病の他に肝臓ガンも患っており

And this lady decided, after a year of attempted treatment of that ulcer,

死ぬのであれば 体は傷つけずにいようと決めたのですが

that she would try this new therapy that Steve invented.

1年間の潰瘍治療の末 バディラック氏の

That's what the wound looked like 11 weeks later.

新しい治療法を試すことにしました

That material contained only natural signals.

11週後の傷口の様子です

And that material induced the body to switch back on a healing response

その物質には自然の信号だけが含まれていました

that it didn't have before.

この物質が以前には無かった治癒反応を

There's going to be a couple more distressing slides for those of you --

引き起こしました

I'll let you know when you can look again.

ショッキングな写真があと数枚出てきます

This is a horse. The horse is not in pain.

終わったら 言いますね

If the horse was in pain, I wouldn't show you this slide.

これは馬です　痛みは感じていません

The horse just has another nostril that's developed

そうでなければ お見せしません

because of a riding accident.

乗馬事故に巻き込まれて

Just a few weeks after treatment --

このようになってしまいました

in this case, taking that material, turning it into a gel,

治療数週間後です

and packing that area, and then repeating the treatment a few times --

このケースでは 物質をジェル状にして

and the horse heals up.

傷口を覆い それを何度か繰り返して

And if you took an ultrasound of that area, it would look great.

完治しました

Here's a dolphin where the fin's been re-attached.

超音波でもはっきりわかります

There are now 400,000 patients around the world

これは新しい背びれを得たイルカです

who have used that material to heal their wounds.

世界中には現在40万人もの患者が

Could you regenerate a limb?

この物質を用いた怪我の治療を受けています

DARPA just gave Steve 15 million dollars to lead an eight-institution project

手足は再生できるのでしょうか？

to begin the process of asking that question.

この疑問の解明のため ８組織に渡るプロジェクトの資金として

And I'll show you the 15 million dollar picture.

国防省の研究機関が1500万ドルを提供しました

This is a 78 year-old man who's lost