[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:09.84,0:00:11.04,Default,,0000,0000,0000,,Science.
Dialogue: 0,0:00:11.76,0:00:15.18,Default,,0000,0000,0000,,The very word for many of you conjures\Nunhappy memories of boredom
Dialogue: 0,0:00:15.20,0:00:18.10,Default,,0000,0000,0000,,in high school biology or physics class.
Dialogue: 0,0:00:18.12,0:00:21.22,Default,,0000,0000,0000,,But let me assure that what you did there
Dialogue: 0,0:00:21.24,0:00:23.42,Default,,0000,0000,0000,,had very little to do with science.
Dialogue: 0,0:00:23.44,0:00:25.74,Default,,0000,0000,0000,,That was really the "what" of science.
Dialogue: 0,0:00:25.76,0:00:28.48,Default,,0000,0000,0000,,It was the history\Nof what other people had discovered.
Dialogue: 0,0:00:29.72,0:00:32.06,Default,,0000,0000,0000,,What I'm most interested in as a scientist
Dialogue: 0,0:00:32.08,0:00:34.22,Default,,0000,0000,0000,,is the "how" of science.
Dialogue: 0,0:00:34.24,0:00:38.06,Default,,0000,0000,0000,,Because science is knowledge in process.
Dialogue: 0,0:00:38.08,0:00:41.54,Default,,0000,0000,0000,,We make an observation,\Nguess an explanation for that observation,
Dialogue: 0,0:00:41.56,0:00:43.62,Default,,0000,0000,0000,,and then make a prediction\Nthat we can test
Dialogue: 0,0:00:43.64,0:00:45.56,Default,,0000,0000,0000,,with an experiment or other observation.
Dialogue: 0,0:00:46.08,0:00:47.42,Default,,0000,0000,0000,,A couple of examples.
Dialogue: 0,0:00:47.44,0:00:51.02,Default,,0000,0000,0000,,First of all, people noticed\Nthat the Earth was below, the sky above,
Dialogue: 0,0:00:51.04,0:00:54.92,Default,,0000,0000,0000,,and both the Sun and the Moon\Nseemed to go around them.
Dialogue: 0,0:00:55.72,0:00:57.26,Default,,0000,0000,0000,,Their guessed explanation
Dialogue: 0,0:00:57.28,0:01:00.36,Default,,0000,0000,0000,,was that the Earth must be\Nthe center of the universe.
Dialogue: 0,0:01:01.24,0:01:04.44,Default,,0000,0000,0000,,The prediction: everything\Nshould circle around the Earth.
Dialogue: 0,0:01:05.32,0:01:06.98,Default,,0000,0000,0000,,This was first really tested
Dialogue: 0,0:01:07.00,0:01:09.82,Default,,0000,0000,0000,,when Galileo got his hands\Non one of the first telescopes,
Dialogue: 0,0:01:09.84,0:01:12.22,Default,,0000,0000,0000,,and as he gazed into the night sky,
Dialogue: 0,0:01:12.24,0:01:15.94,Default,,0000,0000,0000,,what he found there was a planet, Jupiter,
Dialogue: 0,0:01:15.96,0:01:19.96,Default,,0000,0000,0000,,with four moons circling around it.
Dialogue: 0,0:01:23.16,0:01:27.54,Default,,0000,0000,0000,,He then used those moons\Nto follow the path of Jupiter
Dialogue: 0,0:01:27.56,0:01:31.30,Default,,0000,0000,0000,,and found that Jupiter\Nalso was not going around the Earth
Dialogue: 0,0:01:31.32,0:01:33.28,Default,,0000,0000,0000,,but around the Sun.
Dialogue: 0,0:01:35.66,0:01:37.94,Default,,0000,0000,0000,,So the prediction test failed.
Dialogue: 0,0:01:38.90,0:01:40.100,Default,,0000,0000,0000,,And this led to\Nthe discarding of the theory
Dialogue: 0,0:01:41.02,0:01:43.20,Default,,0000,0000,0000,,that the Earth was the center\Nof the universe.
Dialogue: 0,0:01:43.22,0:01:47.32,Default,,0000,0000,0000,,Another example: Sir Isaac Newton\Nnoticed that things fall to the Earth.
Dialogue: 0,0:01:47.74,0:01:50.66,Default,,0000,0000,0000,,The guessed explanation was gravity,
Dialogue: 0,0:01:51.42,0:01:54.56,Default,,0000,0000,0000,,the prediction that everything\Nshould fall to the Earth.
Dialogue: 0,0:01:54.58,0:01:58.14,Default,,0000,0000,0000,,But of course, not everything\Ndoes fall to the Earth.
Dialogue: 0,0:01:59.80,0:02:01.36,Default,,0000,0000,0000,,So did we discard gravity?
Dialogue: 0,0:02:02.52,0:02:06.94,Default,,0000,0000,0000,,No. We revised the theory and said,\Ngravity pulls things to the Earth
Dialogue: 0,0:02:06.96,0:02:11.16,Default,,0000,0000,0000,,unless there is an equal\Nand opposite force in the other direction.
Dialogue: 0,0:02:11.76,0:02:13.92,Default,,0000,0000,0000,,This led us to learn something new.
Dialogue: 0,0:02:15.22,0:02:18.48,Default,,0000,0000,0000,,We began to pay more attention\Nto the bird and the bird's wings,
Dialogue: 0,0:02:18.50,0:02:20.88,Default,,0000,0000,0000,,and just think of all the discoveries
Dialogue: 0,0:02:20.90,0:02:22.94,Default,,0000,0000,0000,,that have flown\Nfrom that line of thinking.
Dialogue: 0,0:02:23.94,0:02:29.08,Default,,0000,0000,0000,,So the test failures,\Nthe exceptions, the outliers
Dialogue: 0,0:02:29.10,0:02:34.48,Default,,0000,0000,0000,,teach us what we don't know\Nand lead us to something new.
Dialogue: 0,0:02:35.10,0:02:38.30,Default,,0000,0000,0000,,This is how science moves forward.\NThis is how science learns.
Dialogue: 0,0:02:38.94,0:02:41.20,Default,,0000,0000,0000,,Sometimes in the media,\Nand even more rarely,
Dialogue: 0,0:02:41.22,0:02:43.64,Default,,0000,0000,0000,,but sometimes even scientists will say
Dialogue: 0,0:02:43.66,0:02:46.42,Default,,0000,0000,0000,,that something or other\Nhas been scientifically proven.
Dialogue: 0,0:02:47.08,0:02:51.66,Default,,0000,0000,0000,,But I hope that you understand\Nthat science never proves anything
Dialogue: 0,0:02:51.68,0:02:53.56,Default,,0000,0000,0000,,definitively forever.
Dialogue: 0,0:02:54.72,0:02:58.54,Default,,0000,0000,0000,,Hopefully science remains curious enough
Dialogue: 0,0:02:58.56,0:02:59.98,Default,,0000,0000,0000,,to look for
Dialogue: 0,0:03:00.00,0:03:01.98,Default,,0000,0000,0000,,and humble enough to recognize
Dialogue: 0,0:03:02.00,0:03:03.50,Default,,0000,0000,0000,,when we have found
Dialogue: 0,0:03:03.52,0:03:05.22,Default,,0000,0000,0000,,the next outlier,
Dialogue: 0,0:03:05.24,0:03:06.74,Default,,0000,0000,0000,,the next exception,
Dialogue: 0,0:03:06.76,0:03:09.06,Default,,0000,0000,0000,,which, like Jupiter's moons,
Dialogue: 0,0:03:09.08,0:03:11.68,Default,,0000,0000,0000,,teaches us what we don't actually know.
Dialogue: 0,0:03:12.36,0:03:14.90,Default,,0000,0000,0000,,We're going to change gears\Nhere for a second.
Dialogue: 0,0:03:14.92,0:03:16.86,Default,,0000,0000,0000,,The caduceus, or the symbol of medicine,
Dialogue: 0,0:03:16.88,0:03:19.34,Default,,0000,0000,0000,,means a lot of different things\Nto different people,
Dialogue: 0,0:03:19.36,0:03:21.62,Default,,0000,0000,0000,,but most of our\Npublic discourse on medicine
Dialogue: 0,0:03:21.64,0:03:24.42,Default,,0000,0000,0000,,really turns it into\Nan engineering problem.
Dialogue: 0,0:03:24.44,0:03:26.18,Default,,0000,0000,0000,,We have the hallways of Congress,
Dialogue: 0,0:03:26.20,0:03:30.20,Default,,0000,0000,0000,,and the boardrooms of insurance companies\Nthat try to figure out how to pay for it.
Dialogue: 0,0:03:30.88,0:03:32.50,Default,,0000,0000,0000,,The ethicists and epidemiologists
Dialogue: 0,0:03:32.52,0:03:35.22,Default,,0000,0000,0000,,try to figure out\Nhow best to distribute medicine,
Dialogue: 0,0:03:35.24,0:03:37.90,Default,,0000,0000,0000,,and the hospitals and physicians\Nare absolutely obsessed
Dialogue: 0,0:03:37.92,0:03:39.86,Default,,0000,0000,0000,,with their protocols and checklists,
Dialogue: 0,0:03:39.88,0:03:43.42,Default,,0000,0000,0000,,trying to figure out\Nhow best to safely apply medicine.
Dialogue: 0,0:03:43.44,0:03:45.56,Default,,0000,0000,0000,,These are all good things.
Dialogue: 0,0:03:46.16,0:03:48.90,Default,,0000,0000,0000,,However, they also all assume
Dialogue: 0,0:03:48.92,0:03:50.90,Default,,0000,0000,0000,,at some level
Dialogue: 0,0:03:50.92,0:03:53.44,Default,,0000,0000,0000,,that the textbook of medicine is closed.
Dialogue: 0,0:03:55.16,0:03:57.66,Default,,0000,0000,0000,,We start to measure\Nthe quality of our health care
Dialogue: 0,0:03:57.68,0:04:00.22,Default,,0000,0000,0000,,by how quickly we can access it.
Dialogue: 0,0:04:00.24,0:04:02.34,Default,,0000,0000,0000,,It doesn't surprise me\Nthat in this climate,
Dialogue: 0,0:04:02.36,0:04:05.18,Default,,0000,0000,0000,,many of our institutions\Nfor the provision of health care
Dialogue: 0,0:04:05.20,0:04:07.70,Default,,0000,0000,0000,,start to look a heck of a lot\Nlike Jiffy Lube.
Dialogue: 0,0:04:07.72,0:04:10.30,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:04:10.32,0:04:14.26,Default,,0000,0000,0000,,The only problem is that\Nwhen I graduated from medical school,
Dialogue: 0,0:04:14.28,0:04:16.34,Default,,0000,0000,0000,,I didn't get one of those\Nlittle doohickeys
Dialogue: 0,0:04:16.36,0:04:18.74,Default,,0000,0000,0000,,that your mechanic\Nhas to plug into your car
Dialogue: 0,0:04:18.76,0:04:21.14,Default,,0000,0000,0000,,and find out exactly what's wrong with it,
Dialogue: 0,0:04:21.16,0:04:23.26,Default,,0000,0000,0000,,because the textbook of medicine
Dialogue: 0,0:04:23.28,0:04:24.80,Default,,0000,0000,0000,,is not closed.
Dialogue: 0,0:04:25.32,0:04:27.16,Default,,0000,0000,0000,,Medicine is science.
Dialogue: 0,0:04:27.56,0:04:30.24,Default,,0000,0000,0000,,Medicine is knowledge in process.
Dialogue: 0,0:04:31.28,0:04:32.66,Default,,0000,0000,0000,,We make an observation,
Dialogue: 0,0:04:32.68,0:04:34.82,Default,,0000,0000,0000,,we guess an explanation\Nof that observation,
Dialogue: 0,0:04:34.84,0:04:37.46,Default,,0000,0000,0000,,and then we make a prediction\Nthat we can test.
Dialogue: 0,0:04:37.48,0:04:41.06,Default,,0000,0000,0000,,Now, the testing ground\Nof most predictions in medicine
Dialogue: 0,0:04:41.08,0:04:42.62,Default,,0000,0000,0000,,is populations.
Dialogue: 0,0:04:42.64,0:04:46.22,Default,,0000,0000,0000,,And you may remember\Nfrom those boring days in biology class
Dialogue: 0,0:04:46.24,0:04:48.42,Default,,0000,0000,0000,,that populations tend to distribute
Dialogue: 0,0:04:48.44,0:04:49.66,Default,,0000,0000,0000,,around a mean
Dialogue: 0,0:04:49.68,0:04:51.54,Default,,0000,0000,0000,,as a Gaussian or a normal curve.
Dialogue: 0,0:04:52.26,0:04:53.92,Default,,0000,0000,0000,,Therefore, in medicine,
Dialogue: 0,0:04:53.94,0:04:58.06,Default,,0000,0000,0000,,after we make a prediction\Nfrom a guessed explanation,
Dialogue: 0,0:04:58.08,0:04:59.96,Default,,0000,0000,0000,,we test it in a population.
Dialogue: 0,0:05:00.92,0:05:03.86,Default,,0000,0000,0000,,That means that what we know in medicine,
Dialogue: 0,0:05:03.88,0:05:06.14,Default,,0000,0000,0000,,our knowledge and our know-how,
Dialogue: 0,0:05:06.16,0:05:08.42,Default,,0000,0000,0000,,comes from populations
Dialogue: 0,0:05:08.44,0:05:11.22,Default,,0000,0000,0000,,but extends only as far
Dialogue: 0,0:05:11.24,0:05:12.98,Default,,0000,0000,0000,,as the next outlier,
Dialogue: 0,0:05:13.00,0:05:14.22,Default,,0000,0000,0000,,the next exception,
Dialogue: 0,0:05:14.24,0:05:15.98,Default,,0000,0000,0000,,which, like Jupiter's moons,
Dialogue: 0,0:05:16.00,0:05:18.40,Default,,0000,0000,0000,,will teach us what we don't actually know.
Dialogue: 0,0:05:19.58,0:05:20.92,Default,,0000,0000,0000,,Now, I am a surgeon
Dialogue: 0,0:05:20.94,0:05:23.36,Default,,0000,0000,0000,,who looks after patients with sarcoma.
Dialogue: 0,0:05:23.38,0:05:25.58,Default,,0000,0000,0000,,Sarcoma is a very rare form of cancer.
Dialogue: 0,0:05:26.22,0:05:28.26,Default,,0000,0000,0000,,It's the cancer of flesh and bones.
Dialogue: 0,0:05:28.74,0:05:33.08,Default,,0000,0000,0000,,And I would tell you that every one\Nof my patients is an outlier,
Dialogue: 0,0:05:33.10,0:05:34.30,Default,,0000,0000,0000,,is an exception.
Dialogue: 0,0:05:35.50,0:05:38.72,Default,,0000,0000,0000,,There is no surgery I have ever performed\Nfor a sarcoma patient
Dialogue: 0,0:05:38.74,0:05:42.100,Default,,0000,0000,0000,,that has ever been guided\Nby a randomized controlled clinical trial,
Dialogue: 0,0:05:43.02,0:05:46.74,Default,,0000,0000,0000,,what we consider the best kind\Nof population-based evidence in medicine.
Dialogue: 0,0:05:47.90,0:05:50.20,Default,,0000,0000,0000,,People talk about thinking\Noutside the box,
Dialogue: 0,0:05:50.22,0:05:52.96,Default,,0000,0000,0000,,but we don't even have a box in sarcoma.
Dialogue: 0,0:05:53.58,0:05:56.92,Default,,0000,0000,0000,,What we do have as we take\Na bath in the uncertainty
Dialogue: 0,0:05:56.94,0:06:01.08,Default,,0000,0000,0000,,and unknowns and exceptions\Nand outliers that surround us in sarcoma
Dialogue: 0,0:06:01.10,0:06:05.64,Default,,0000,0000,0000,,is easy access to what I think\Nare those two most important values
Dialogue: 0,0:06:05.66,0:06:07.20,Default,,0000,0000,0000,,for any science:
Dialogue: 0,0:06:07.22,0:06:09.42,Default,,0000,0000,0000,,humility and curiosity.
Dialogue: 0,0:06:10.60,0:06:12.90,Default,,0000,0000,0000,,Because if I am humble and curious,
Dialogue: 0,0:06:12.92,0:06:15.22,Default,,0000,0000,0000,,when a patient asks me a question,
Dialogue: 0,0:06:15.24,0:06:16.68,Default,,0000,0000,0000,,and I don't know the answer,
Dialogue: 0,0:06:17.52,0:06:18.74,Default,,0000,0000,0000,,I'll ask a colleague
Dialogue: 0,0:06:18.76,0:06:21.78,Default,,0000,0000,0000,,who may have a similar\Nalbeit distinct patient with sarcoma.
Dialogue: 0,0:06:21.80,0:06:24.50,Default,,0000,0000,0000,,We'll even establish\Ninternational collaborations.
Dialogue: 0,0:06:24.52,0:06:27.66,Default,,0000,0000,0000,,Those patients will start\Nto talk to each other through chat rooms
Dialogue: 0,0:06:27.68,0:06:28.88,Default,,0000,0000,0000,,and support groups.
Dialogue: 0,0:06:29.40,0:06:32.98,Default,,0000,0000,0000,,It's through this kind\Nof humbly curious communication
Dialogue: 0,0:06:33.00,0:06:36.56,Default,,0000,0000,0000,,that we begin to try and learn new things.
Dialogue: 0,0:06:37.84,0:06:39.90,Default,,0000,0000,0000,,As an example, this is a patient of mine
Dialogue: 0,0:06:39.92,0:06:41.60,Default,,0000,0000,0000,,who had a cancer near his knee.
Dialogue: 0,0:06:42.08,0:06:44.46,Default,,0000,0000,0000,,Because of humbly curious communication
Dialogue: 0,0:06:44.48,0:06:46.58,Default,,0000,0000,0000,,in international collaborations,
Dialogue: 0,0:06:46.60,0:06:51.14,Default,,0000,0000,0000,,we have learned that we can repurpose\Nthe ankle to serve as the knee
Dialogue: 0,0:06:51.16,0:06:53.42,Default,,0000,0000,0000,,when we have to remove the knee\Nwith the cancer.
Dialogue: 0,0:06:53.44,0:06:56.28,Default,,0000,0000,0000,,He can then wear a prosthetic\Nand run and jump and play.
Dialogue: 0,0:06:56.96,0:06:59.98,Default,,0000,0000,0000,,This opportunity was available to him
Dialogue: 0,0:07:00.00,0:07:02.78,Default,,0000,0000,0000,,because of international collaborations.
Dialogue: 0,0:07:02.80,0:07:04.50,Default,,0000,0000,0000,,It was desirable to him
Dialogue: 0,0:07:04.52,0:07:07.48,Default,,0000,0000,0000,,because he had contacted other patients\Nwho had experienced it.
Dialogue: 0,0:07:08.52,0:07:12.58,Default,,0000,0000,0000,,And so exceptions and outliers in medicine
Dialogue: 0,0:07:12.60,0:07:16.56,Default,,0000,0000,0000,,teach us what we don't know,\Nbut also lead us to new thinking.
Dialogue: 0,0:07:17.68,0:07:19.54,Default,,0000,0000,0000,,Now, very importantly,
Dialogue: 0,0:07:19.56,0:07:23.42,Default,,0000,0000,0000,,all the new thinking that outliers\Nand exceptions lead us to in medicine
Dialogue: 0,0:07:23.44,0:07:26.80,Default,,0000,0000,0000,,does not only apply\Nto the outliers and exceptions.
Dialogue: 0,0:07:27.52,0:07:30.70,Default,,0000,0000,0000,,It is not that we only learn\Nfrom sarcoma patients
Dialogue: 0,0:07:30.72,0:07:32.68,Default,,0000,0000,0000,,ways to manage sarcoma patients.
Dialogue: 0,0:07:33.52,0:07:35.58,Default,,0000,0000,0000,,Sometimes, the outliers
Dialogue: 0,0:07:35.60,0:07:37.30,Default,,0000,0000,0000,,and the exceptions
Dialogue: 0,0:07:37.32,0:07:40.56,Default,,0000,0000,0000,,teach us things that matter quite a lot\Nto the general population.
Dialogue: 0,0:07:41.96,0:07:43.82,Default,,0000,0000,0000,,Like a tree standing outside a forest,
Dialogue: 0,0:07:43.84,0:07:47.86,Default,,0000,0000,0000,,the outliers and the exceptions\Ndraw our attention
Dialogue: 0,0:07:48.68,0:07:53.53,Default,,0000,0000,0000,,and lead us into a much greater sense\Nof perhaps what a tree is.
Dialogue: 0,0:07:54.34,0:07:56.84,Default,,0000,0000,0000,,We often talk about\Nlosing the forests for the trees,
Dialogue: 0,0:07:56.86,0:07:58.68,Default,,0000,0000,0000,,but one also loses a tree
Dialogue: 0,0:07:58.70,0:08:00.22,Default,,0000,0000,0000,,within a forest.
Dialogue: 0,0:08:01.70,0:08:03.56,Default,,0000,0000,0000,,But the tree that stands out by itself
Dialogue: 0,0:08:03.58,0:08:06.48,Default,,0000,0000,0000,,makes those relationships\Nthat define a tree,
Dialogue: 0,0:08:06.50,0:08:10.32,Default,,0000,0000,0000,,the relationships between trunk\Nand roots and branches,
Dialogue: 0,0:08:10.34,0:08:11.58,Default,,0000,0000,0000,,much more apparent.
Dialogue: 0,0:08:12.06,0:08:13.76,Default,,0000,0000,0000,,Even if that tree is crooked
Dialogue: 0,0:08:13.78,0:08:16.76,Default,,0000,0000,0000,,or even if that tree\Nhas very unusual relationships
Dialogue: 0,0:08:16.78,0:08:19.08,Default,,0000,0000,0000,,between trunk and roots and branches,
Dialogue: 0,0:08:19.10,0:08:21.80,Default,,0000,0000,0000,,it nonetheless draws our attention
Dialogue: 0,0:08:21.82,0:08:23.72,Default,,0000,0000,0000,,and allows us to make observations
Dialogue: 0,0:08:23.74,0:08:25.98,Default,,0000,0000,0000,,that we can then test\Nin the general population.
Dialogue: 0,0:08:26.70,0:08:28.68,Default,,0000,0000,0000,,I told you that sarcomas are rare.
Dialogue: 0,0:08:28.70,0:08:31.34,Default,,0000,0000,0000,,They make up about one percent\Nof all cancers.
Dialogue: 0,0:08:31.98,0:08:35.94,Default,,0000,0000,0000,,You also probably know that cancer\Nis considered a genetic disease.
Dialogue: 0,0:08:36.54,0:08:39.88,Default,,0000,0000,0000,,By genetic disease we mean\Nthat cancer is caused by oncogenes
Dialogue: 0,0:08:39.90,0:08:41.28,Default,,0000,0000,0000,,that are turned on in cancer
Dialogue: 0,0:08:41.30,0:08:44.34,Default,,0000,0000,0000,,and tumor suppressor genes\Nthat are turned off to cause cancer.
Dialogue: 0,0:08:44.86,0:08:47.28,Default,,0000,0000,0000,,You might think\Nthat we learned about oncogenes
Dialogue: 0,0:08:47.30,0:08:49.52,Default,,0000,0000,0000,,and tumor suppressor genes\Nfrom common cancers
Dialogue: 0,0:08:49.54,0:08:51.52,Default,,0000,0000,0000,,like breast cancer and prostate cancer
Dialogue: 0,0:08:51.54,0:08:53.04,Default,,0000,0000,0000,,and lung cancer,
Dialogue: 0,0:08:53.06,0:08:54.26,Default,,0000,0000,0000,,but you'd be wrong.
Dialogue: 0,0:08:54.70,0:08:57.60,Default,,0000,0000,0000,,We learned about oncogenes\Nand tumor suppressor genes
Dialogue: 0,0:08:57.62,0:08:58.84,Default,,0000,0000,0000,,for the first time
Dialogue: 0,0:08:58.86,0:09:02.30,Default,,0000,0000,0000,,in that itty-bitty little one percent\Nof cancers called sarcoma.
Dialogue: 0,0:09:03.46,0:09:06.04,Default,,0000,0000,0000,,In 1966, Peyton Rous got the Nobel Prize
Dialogue: 0,0:09:06.06,0:09:08.08,Default,,0000,0000,0000,,for realizing that chickens
Dialogue: 0,0:09:08.10,0:09:11.22,Default,,0000,0000,0000,,had a transmissible form of sarcoma.
Dialogue: 0,0:09:11.96,0:09:14.80,Default,,0000,0000,0000,,Thirty years later, Harold Varmus\Nand Mike Bishop discovered
Dialogue: 0,0:09:14.82,0:09:17.36,Default,,0000,0000,0000,,what that transmissible element was.
Dialogue: 0,0:09:17.38,0:09:18.96,Default,,0000,0000,0000,,It was a virus
Dialogue: 0,0:09:18.98,0:09:20.40,Default,,0000,0000,0000,,carrying a gene,
Dialogue: 0,0:09:20.42,0:09:21.86,Default,,0000,0000,0000,,the src oncogene.
Dialogue: 0,0:09:22.58,0:09:26.24,Default,,0000,0000,0000,,Now, I will not tell you\Nthat src is the most important oncogene.
Dialogue: 0,0:09:26.26,0:09:27.48,Default,,0000,0000,0000,,I will not tell you
Dialogue: 0,0:09:27.50,0:09:30.100,Default,,0000,0000,0000,,that src is the most frequently\Nturned on oncogene in all of cancer.
Dialogue: 0,0:09:31.02,0:09:33.46,Default,,0000,0000,0000,,But it was the first oncogene.
Dialogue: 0,0:09:34.66,0:09:36.100,Default,,0000,0000,0000,,The exception, the outlier
Dialogue: 0,0:09:37.02,0:09:39.54,Default,,0000,0000,0000,,drew our attention and led us to something
Dialogue: 0,0:09:40.22,0:09:44.26,Default,,0000,0000,0000,,that taught us very important things\Nabout the rest of biology.
Dialogue: 0,0:09:45.58,0:09:49.68,Default,,0000,0000,0000,,Now, TP53 is the most important\Ntumor suppressor gene.
Dialogue: 0,0:09:49.70,0:09:52.44,Default,,0000,0000,0000,,It is the most frequently turned off\Ntumor suppressor gene
Dialogue: 0,0:09:52.46,0:09:54.26,Default,,0000,0000,0000,,in almost every kind of cancer.
Dialogue: 0,0:09:55.06,0:09:57.36,Default,,0000,0000,0000,,But we didn't learn about it\Nfrom common cancers.
Dialogue: 0,0:09:57.38,0:09:59.80,Default,,0000,0000,0000,,We learned about it\Nwhen doctors Li and Fraumeni
Dialogue: 0,0:09:59.82,0:10:01.40,Default,,0000,0000,0000,,were looking at families,
Dialogue: 0,0:10:01.42,0:10:03.44,Default,,0000,0000,0000,,and they realized that these families
Dialogue: 0,0:10:03.46,0:10:05.98,Default,,0000,0000,0000,,had way too many sarcomas.
Dialogue: 0,0:10:06.62,0:10:08.40,Default,,0000,0000,0000,,I told you that sarcoma is rare.
Dialogue: 0,0:10:08.42,0:10:11.60,Default,,0000,0000,0000,,Remember that a one\Nin a million diagnosis,
Dialogue: 0,0:10:11.62,0:10:13.76,Default,,0000,0000,0000,,if it happens twice in one family,
Dialogue: 0,0:10:13.78,0:10:16.18,Default,,0000,0000,0000,,is way too common in that family.
Dialogue: 0,0:10:17.34,0:10:20.04,Default,,0000,0000,0000,,The very fact that these are rare
Dialogue: 0,0:10:20.06,0:10:21.50,Default,,0000,0000,0000,,draws our attention
Dialogue: 0,0:10:22.46,0:10:24.70,Default,,0000,0000,0000,,and leads us to new kinds of thinking.
Dialogue: 0,0:10:26.18,0:10:27.64,Default,,0000,0000,0000,,Now, many of you may say,
Dialogue: 0,0:10:27.66,0:10:29.20,Default,,0000,0000,0000,,and may rightly say,
Dialogue: 0,0:10:29.22,0:10:31.12,Default,,0000,0000,0000,,that yeah, Kevin, that's great,
Dialogue: 0,0:10:31.14,0:10:33.20,Default,,0000,0000,0000,,but you're not talking\Nabout a bird's wing.
Dialogue: 0,0:10:33.22,0:10:36.70,Default,,0000,0000,0000,,You're not talking about moons\Nfloating around some planet Jupiter.
Dialogue: 0,0:10:37.22,0:10:38.76,Default,,0000,0000,0000,,This is a person.
Dialogue: 0,0:10:38.78,0:10:42.04,Default,,0000,0000,0000,,This outlier, this exception,\Nmay lead to the advancement of science,
Dialogue: 0,0:10:42.06,0:10:43.26,Default,,0000,0000,0000,,but this is a person.
Dialogue: 0,0:10:44.98,0:10:46.60,Default,,0000,0000,0000,,And all I can say
Dialogue: 0,0:10:46.62,0:10:48.98,Default,,0000,0000,0000,,is that I know that all too well.
Dialogue: 0,0:10:50.46,0:10:53.86,Default,,0000,0000,0000,,I have conversations with these patients\Nwith rare and deadly diseases.
Dialogue: 0,0:10:54.50,0:10:56.44,Default,,0000,0000,0000,,I write about these conversations.
Dialogue: 0,0:10:56.46,0:10:58.76,Default,,0000,0000,0000,,These conversations are terribly fraught.
Dialogue: 0,0:10:58.78,0:11:00.60,Default,,0000,0000,0000,,They're fraught with horrible phrases
Dialogue: 0,0:11:00.62,0:11:03.86,Default,,0000,0000,0000,,like "I have bad news"\Nor "There's nothing more we can do."
Dialogue: 0,0:11:04.46,0:11:07.66,Default,,0000,0000,0000,,Sometimes these conversations\Nturn on a single word:
Dialogue: 0,0:11:08.46,0:11:09.66,Default,,0000,0000,0000,,"terminal."
Dialogue: 0,0:11:17.62,0:11:20.54,Default,,0000,0000,0000,,Silence can also be rather uncomfortable.
Dialogue: 0,0:11:22.06,0:11:24.64,Default,,0000,0000,0000,,Where the blanks are in medicine
Dialogue: 0,0:11:24.66,0:11:26.52,Default,,0000,0000,0000,,can be just as important
Dialogue: 0,0:11:26.54,0:11:28.78,Default,,0000,0000,0000,,as the words that we use\Nin these conversations.
Dialogue: 0,0:11:29.78,0:11:31.32,Default,,0000,0000,0000,,What are the unknowns?
Dialogue: 0,0:11:31.34,0:11:33.54,Default,,0000,0000,0000,,What are the experiments\Nthat are being done?
Dialogue: 0,0:11:34.38,0:11:36.08,Default,,0000,0000,0000,,Do this little exercise with me.
Dialogue: 0,0:11:36.10,0:11:39.32,Default,,0000,0000,0000,,Up there on the screen,\Nyou see this phrase, "no where."
Dialogue: 0,0:11:39.34,0:11:40.62,Default,,0000,0000,0000,,Notice where the blank is.
Dialogue: 0,0:11:41.38,0:11:44.58,Default,,0000,0000,0000,,If we move that blank one space over
Dialogue: 0,0:11:45.34,0:11:46.92,Default,,0000,0000,0000,,"no where"
Dialogue: 0,0:11:46.94,0:11:49.64,Default,,0000,0000,0000,,becomes "now here,"
Dialogue: 0,0:11:49.66,0:11:51.56,Default,,0000,0000,0000,,the exact opposite meaning,
Dialogue: 0,0:11:51.58,0:11:53.78,Default,,0000,0000,0000,,just by shifting the blank one space over.
Dialogue: 0,0:11:56.38,0:11:57.96,Default,,0000,0000,0000,,I'll never forget the night
Dialogue: 0,0:11:57.98,0:12:00.22,Default,,0000,0000,0000,,that I walked into\None of my patients' rooms.
Dialogue: 0,0:12:00.98,0:12:02.64,Default,,0000,0000,0000,,I had been operating long that day
Dialogue: 0,0:12:02.66,0:12:04.68,Default,,0000,0000,0000,,but I still wanted to come and see him.
Dialogue: 0,0:12:04.70,0:12:07.90,Default,,0000,0000,0000,,He was a boy I had diagnosed\Nwith a bone cancer a few days before.
Dialogue: 0,0:12:08.54,0:12:11.60,Default,,0000,0000,0000,,He and his mother had been meeting\Nwith the chemotherapy doctors
Dialogue: 0,0:12:11.62,0:12:12.84,Default,,0000,0000,0000,,earlier that day,
Dialogue: 0,0:12:12.86,0:12:15.84,Default,,0000,0000,0000,,and he had been admitted\Nto the hospital to begin chemotherapy.
Dialogue: 0,0:12:15.86,0:12:18.04,Default,,0000,0000,0000,,It was almost midnight\Nwhen I got to his room.
Dialogue: 0,0:12:18.06,0:12:20.24,Default,,0000,0000,0000,,He was asleep, but I found his mother
Dialogue: 0,0:12:20.26,0:12:21.84,Default,,0000,0000,0000,,reading by flashlight
Dialogue: 0,0:12:21.86,0:12:23.32,Default,,0000,0000,0000,,next to his bed.
Dialogue: 0,0:12:23.34,0:12:26.14,Default,,0000,0000,0000,,She came out in the hall\Nto chat with me for a few minutes.
Dialogue: 0,0:12:26.98,0:12:29.08,Default,,0000,0000,0000,,It turned out that\Nwhat she had been reading
Dialogue: 0,0:12:29.10,0:12:31.28,Default,,0000,0000,0000,,was the protocol\Nthat the chemotherapy doctors
Dialogue: 0,0:12:31.30,0:12:32.54,Default,,0000,0000,0000,,had given her that day.
Dialogue: 0,0:12:32.90,0:12:34.14,Default,,0000,0000,0000,,She had memorized it.
Dialogue: 0,0:12:35.90,0:12:39.44,Default,,0000,0000,0000,,She said, "Dr. Jones, you told me
Dialogue: 0,0:12:39.46,0:12:41.64,Default,,0000,0000,0000,,that we don't always win
Dialogue: 0,0:12:41.66,0:12:42.94,Default,,0000,0000,0000,,with this type of cancer,
Dialogue: 0,0:12:44.38,0:12:47.86,Default,,0000,0000,0000,,but I've been studying this protocol,\Nand I think I can do it.
Dialogue: 0,0:12:48.66,0:12:52.24,Default,,0000,0000,0000,,I think I can comply\Nwith these very difficult treatments.
Dialogue: 0,0:12:52.26,0:12:55.24,Default,,0000,0000,0000,,I'm going to quit my job.\NI'm going to move in with my parents.
Dialogue: 0,0:12:55.26,0:12:57.22,Default,,0000,0000,0000,,I'm going to keep my baby safe."
Dialogue: 0,0:13:00.02,0:13:01.22,Default,,0000,0000,0000,,I didn't tell her.
Dialogue: 0,0:13:02.54,0:13:05.46,Default,,0000,0000,0000,,I didn't stop to correct her thinking.
Dialogue: 0,0:13:05.86,0:13:08.45,Default,,0000,0000,0000,,To shift that blank to where it should be.
Dialogue: 0,0:13:09.13,0:13:11.86,Default,,0000,0000,0000,,The experiment wasn't whether or not\Nshe could comply
Dialogue: 0,0:13:11.89,0:13:13.65,Default,,0000,0000,0000,,with this very difficult protocol.
Dialogue: 0,0:13:15.38,0:13:17.64,Default,,0000,0000,0000,,She was trusting in a protocol
Dialogue: 0,0:13:17.66,0:13:20.88,Default,,0000,0000,0000,,that even if complied with,
Dialogue: 0,0:13:20.90,0:13:23.30,Default,,0000,0000,0000,,wouldn't necessarily save her son.
Dialogue: 0,0:13:25.66,0:13:26.86,Default,,0000,0000,0000,,I didn't tell her.
Dialogue: 0,0:13:28.06,0:13:29.46,Default,,0000,0000,0000,,I didn't fill in that blank.
Dialogue: 0,0:13:30.78,0:13:32.76,Default,,0000,0000,0000,,But a year and a half later
Dialogue: 0,0:13:32.78,0:13:35.50,Default,,0000,0000,0000,,her boy nonetheless died of his cancer.
Dialogue: 0,0:13:37.10,0:13:38.42,Default,,0000,0000,0000,,Should I have told her?
Dialogue: 0,0:13:41.16,0:13:43.42,Default,,0000,0000,0000,,Now, many of you may say, "So what?
Dialogue: 0,0:13:43.44,0:13:44.70,Default,,0000,0000,0000,,I don't have sarcoma.
Dialogue: 0,0:13:44.72,0:13:46.62,Default,,0000,0000,0000,,No one in my family has sarcoma.
Dialogue: 0,0:13:46.64,0:13:48.10,Default,,0000,0000,0000,,And this is all fine and well,
Dialogue: 0,0:13:48.12,0:13:50.82,Default,,0000,0000,0000,,but it probably doesn't\Nmatter in my life."
Dialogue: 0,0:13:50.84,0:13:52.10,Default,,0000,0000,0000,,And you're probably right.
Dialogue: 0,0:13:52.12,0:13:54.80,Default,,0000,0000,0000,,Sarcoma may not matter\Na whole lot in your life.
Dialogue: 0,0:13:56.84,0:13:59.18,Default,,0000,0000,0000,,But where the blanks are in medicine
Dialogue: 0,0:13:59.20,0:14:00.52,Default,,0000,0000,0000,,does matter in your life.
Dialogue: 0,0:14:02.32,0:14:04.62,Default,,0000,0000,0000,,I didn't tell you one dirty little secret.
Dialogue: 0,0:14:04.64,0:14:09.02,Default,,0000,0000,0000,,I told you that in medicine,\Nwe test predictions in populations,
Dialogue: 0,0:14:09.04,0:14:10.30,Default,,0000,0000,0000,,but I didn't tell you,
Dialogue: 0,0:14:10.32,0:14:12.54,Default,,0000,0000,0000,,and so often medicine never tells you
Dialogue: 0,0:14:12.56,0:14:15.42,Default,,0000,0000,0000,,that every time an individual
Dialogue: 0,0:14:15.44,0:14:17.54,Default,,0000,0000,0000,,encounters medicine,
Dialogue: 0,0:14:17.56,0:14:21.60,Default,,0000,0000,0000,,even if that individual is firmly\Nembedded in the general population,
Dialogue: 0,0:14:24.16,0:14:26.54,Default,,0000,0000,0000,,neither the individual\Nnor the physician knows
Dialogue: 0,0:14:26.56,0:14:29.24,Default,,0000,0000,0000,,where in that population\Nthe individual will land.
Dialogue: 0,0:14:29.84,0:14:32.54,Default,,0000,0000,0000,,Therefore, every encounter with medicine
Dialogue: 0,0:14:32.56,0:14:34.00,Default,,0000,0000,0000,,is an experiment.
Dialogue: 0,0:14:34.72,0:14:36.74,Default,,0000,0000,0000,,You will be a subject
Dialogue: 0,0:14:36.76,0:14:38.44,Default,,0000,0000,0000,,in an experiment.
Dialogue: 0,0:14:39.47,0:14:44.31,Default,,0000,0000,0000,,And the outcome will be either\Na better or a worse result for you.
Dialogue: 0,0:14:45.72,0:14:47.74,Default,,0000,0000,0000,,As long as medicine works well,
Dialogue: 0,0:14:47.76,0:14:50.78,Default,,0000,0000,0000,,we're fine with fast service,
Dialogue: 0,0:14:50.80,0:14:54.24,Default,,0000,0000,0000,,bravado, brimmingly\Nconfident conversations.
Dialogue: 0,0:14:55.12,0:14:56.78,Default,,0000,0000,0000,,But when things don't work well,
Dialogue: 0,0:14:56.80,0:14:58.64,Default,,0000,0000,0000,,sometimes we want something different.
Dialogue: 0,0:14:59.92,0:15:03.20,Default,,0000,0000,0000,,A colleague of mine\Nremoved a tumor from a patient's limb.
Dialogue: 0,0:15:04.32,0:15:06.14,Default,,0000,0000,0000,,He was concerned about this tumor.
Dialogue: 0,0:15:06.16,0:15:09.18,Default,,0000,0000,0000,,In our physician conferences,\Nhe talked about his concern
Dialogue: 0,0:15:09.20,0:15:10.62,Default,,0000,0000,0000,,that this was a type of tumor
Dialogue: 0,0:15:10.64,0:15:13.20,Default,,0000,0000,0000,,that had a high risk\Nfor coming back in the same limb.
Dialogue: 0,0:15:14.08,0:15:16.06,Default,,0000,0000,0000,,But his conversations with the patient
Dialogue: 0,0:15:16.08,0:15:18.18,Default,,0000,0000,0000,,were exactly what a patient might want:
Dialogue: 0,0:15:18.20,0:15:19.46,Default,,0000,0000,0000,,brimming with confidence.
Dialogue: 0,0:15:19.48,0:15:22.50,Default,,0000,0000,0000,,He said, "I got it all\Nand you're good to go."
Dialogue: 0,0:15:22.52,0:15:24.26,Default,,0000,0000,0000,,She and her husband were thrilled.
Dialogue: 0,0:15:24.28,0:15:28.36,Default,,0000,0000,0000,,They went out, celebrated, fancy dinner,\Nopened a bottle of champagne.
Dialogue: 0,0:15:29.44,0:15:31.74,Default,,0000,0000,0000,,The only problem was a few weeks later,
Dialogue: 0,0:15:31.76,0:15:34.86,Default,,0000,0000,0000,,she started to notice\Nanother nodule in the same area.
Dialogue: 0,0:15:34.88,0:15:39.02,Default,,0000,0000,0000,,It turned out he hadn't gotten it all,\Nand she wasn't good to go.
Dialogue: 0,0:15:40.34,0:15:43.18,Default,,0000,0000,0000,,But what happened at this juncture\Nabsolutely fascinates me.
Dialogue: 0,0:15:43.90,0:15:45.52,Default,,0000,0000,0000,,My colleague came to me and said,
Dialogue: 0,0:15:45.54,0:15:48.26,Default,,0000,0000,0000,,"Kevin, would you mind\Nlooking after this patient for me?"
Dialogue: 0,0:15:48.94,0:15:52.16,Default,,0000,0000,0000,,I said, "Why, you know the right thing\Nto do as well as I do.
Dialogue: 0,0:15:52.18,0:15:53.80,Default,,0000,0000,0000,,You haven't done anything wrong."
Dialogue: 0,0:15:53.82,0:15:58.30,Default,,0000,0000,0000,,He said, "Please, just look\Nafter this patient for me."
Dialogue: 0,0:15:59.90,0:16:01.44,Default,,0000,0000,0000,,He was embarrassed...
Dialogue: 0,0:16:01.46,0:16:02.86,Default,,0000,0000,0000,,Not by what he had done,
Dialogue: 0,0:16:03.85,0:16:05.78,Default,,0000,0000,0000,,but by the conversation that he had had,
Dialogue: 0,0:16:06.46,0:16:07.90,Default,,0000,0000,0000,,by the overconfidence.
Dialogue: 0,0:16:09.30,0:16:11.92,Default,,0000,0000,0000,,So I performed\Na much more invasive surgery
Dialogue: 0,0:16:11.94,0:16:15.08,Default,,0000,0000,0000,,and had a very different conversation\Nwith the patient afterwards.
Dialogue: 0,0:16:15.10,0:16:17.44,Default,,0000,0000,0000,,I said, "Most likely I've gotten it all
Dialogue: 0,0:16:17.46,0:16:19.88,Default,,0000,0000,0000,,and you're most likely good to go,
Dialogue: 0,0:16:19.90,0:16:23.06,Default,,0000,0000,0000,,but this is the experiment\Nthat we're doing.
Dialogue: 0,0:16:23.74,0:16:25.76,Default,,0000,0000,0000,,This is what you're going to watch for.
Dialogue: 0,0:16:25.78,0:16:27.68,Default,,0000,0000,0000,,This is what I'm going to watch for.
Dialogue: 0,0:16:27.70,0:16:31.64,Default,,0000,0000,0000,,And we're going to work together\Nto find out if this surgery will work
Dialogue: 0,0:16:31.66,0:16:32.98,Default,,0000,0000,0000,,to get rid of your cancer."
Dialogue: 0,0:16:33.62,0:16:35.56,Default,,0000,0000,0000,,I can guarantee you, she and her husband
Dialogue: 0,0:16:35.58,0:16:38.50,Default,,0000,0000,0000,,did not crack another bottle of champagne\Nafter talking to me.
Dialogue: 0,0:16:40.30,0:16:43.16,Default,,0000,0000,0000,,But she was now a scientist,
Dialogue: 0,0:16:43.18,0:16:46.54,Default,,0000,0000,0000,,not only a subject in her experiment.
Dialogue: 0,0:16:48.66,0:16:50.28,Default,,0000,0000,0000,,And so I encourage you
Dialogue: 0,0:16:50.30,0:16:53.76,Default,,0000,0000,0000,,to seek humility and curiosity
Dialogue: 0,0:16:53.78,0:16:54.98,Default,,0000,0000,0000,,in your physicians.
Dialogue: 0,0:16:56.86,0:16:59.84,Default,,0000,0000,0000,,Almost 20 billion times each year,
Dialogue: 0,0:16:59.86,0:17:03.80,Default,,0000,0000,0000,,a person walks into a doctor's office,
Dialogue: 0,0:17:03.82,0:17:06.10,Default,,0000,0000,0000,,and that person becomes a patient.
Dialogue: 0,0:17:07.42,0:17:10.94,Default,,0000,0000,0000,,You or someone you love\Nwill be that patient sometime very soon.
Dialogue: 0,0:17:11.94,0:17:13.58,Default,,0000,0000,0000,,How will you talk to your doctors?
Dialogue: 0,0:17:14.74,0:17:15.94,Default,,0000,0000,0000,,What will you tell them?
Dialogue: 0,0:17:16.86,0:17:18.38,Default,,0000,0000,0000,,What will they tell you?
Dialogue: 0,0:17:20.70,0:17:22.92,Default,,0000,0000,0000,,They cannot tell you
Dialogue: 0,0:17:22.94,0:17:24.46,Default,,0000,0000,0000,,what they do not know,
Dialogue: 0,0:17:25.66,0:17:29.22,Default,,0000,0000,0000,,but they can tell you when they don't know
Dialogue: 0,0:17:30.38,0:17:31.74,Default,,0000,0000,0000,,if only you'll ask.
Dialogue: 0,0:17:32.26,0:17:35.10,Default,,0000,0000,0000,,So please, join the conversation.
Dialogue: 0,0:17:36.30,0:17:37.52,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:17:37.54,0:17:40.41,Default,,0000,0000,0000,,(Applause)