A lab the size of a postage stamp George Whitesides

the problem that I want to talk with you

about is really the problem of how does

one supply health care 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 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 of a series of problems in

light weight and things of this kind and

also not so different from the home

healthcare and diagnostic system world

so the technologies 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 you see two examples here one is a

lab that’s 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 health

care 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 hundred

thousand 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 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 this

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

the lines around the edges are a polymer

it’s made of paper and paper of course

wicks fluid as you know paper cloths

drop wine on the tablecloth and the wine

wicks all over everything I’ve 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 dip 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 just

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

a hundred thousand 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 she was takin a sample of

someone’s blood and the someone might

have hepatitis C you don’t want to make

a mistake and stick it and you just 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

and at some point may have had a

pregnancy test 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 and in that

particular test you’re in either

containing a hormone called HCG does or

does not flow across a piece of paper

and there are two bars one bar 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 therefore

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 we’ve

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

sodus orbs into the paper and you end up

with the device that you want the

printers cost 800 bucks now

they’ll make 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’s an example

of the kind of thing that you see that’s

on a piece of eight by twelve paper that

takes about two seconds to make and so I

regard that as done there’s 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 were a fair distance

from its what’s called fever of on

origin someone comes into the clinic

they have a fever they feel bad what do

they have do they have TB 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 they’re

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 it for a

month yes what the guy actually meant

was that he’d fed 30-day dose of dapsone

to his dog that morning he was telling

the truth because in a different culture

you know 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 you know 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 let’s the serum go through and you

get a series of colors down in the

bottom there and the colors indicate

disease are normal but even that’s

complicated

because to you to me colors might

indicate normal but after all we’re all

suffering from and probably in excess of

Education what do you do about something

which requires quantitative analysis and

so the solution that we and many of

people are thinking about their and at

this point there’s 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 there 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 healthcare worker of the future is

not a doctor but it’s an

eighteen-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 a you know one computer one

child makes any sense that here’s here’s

the computer of the future because the

screen is already there and you they’re

ubiquitous 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 is a little bit interesting

which is the yellow seems to disappear

and get through the blue and then get

through the red how does that happen how

do you make something flow through

something and it hurts 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 and 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 in 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 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 and here’s 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 it’s I think is

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

and finishing off this business this is

one one of the things that one does

occasionally need to do is to separate

blood from 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 the centrifuge in whatever and we

thought for a while of how you might do

this of the way in fact you do it is

what’s shown here you get a 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 set that we did the physics of egg

beaters and self-aligning tubes and all

the rest of that kind of thing send it

off to a journal we were very proud of

this particularly the title which was

eggbeater a centrifuge and we set it off

and by return mail it came back I call

up the editor 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 in phys Rev

letters we’ve got a problem here’s

another example of something which is

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 a thousand Hertz another

light source that detects that’s light

at a thousand 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 thousand

dollars it costs $50 we can probably

make it for 50 Cent’s 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 thought about this as a kind of

engineering problem and we’ve asked what

is you know 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 the simplicity is a neat word

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 wasn’t interested enough

in this to put together a several groups

of people the most recent in

involved a couple of people at MIT one

of them being an exceptionally bright

kid who’s one of the very few people I

would think of who’s innocent ik 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 so in a sense you get

what you pay for

thank you very much