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Why curiosity is the key to science and medicine | Kevin Jones | TEDxSaltLakeCity

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    Science.
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    The very word for many of you conjures
    unhappy memories of boredom
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    in high school biology or physics class.
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    But let me assure that what you did there
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    had very little to do with science.
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    That was really the "what" of science.
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    It was the history
    of what other people had discovered.
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    What I'm most interested in as a scientist
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    is the "how" of science.
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    Because science is knowledge in process.
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    We make an observation,
    guess an explanation for that observation,
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    and then make a prediction
    that we can test
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    with an experiment or other observation.
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    A couple of examples.
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    First of all, people noticed
    that the Earth was below, the sky above,
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    and both the Sun and the Moon
    seemed to go around them.
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    Their guessed explanation
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    was that the Earth must be
    the center of the universe.
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    The prediction: everything
    should circle around the Earth.
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    This was first really tested
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    when Galileo got his hands
    on one of the first telescopes,
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    and as he gazed into the night sky,
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    what he found there was a planet, Jupiter,
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    with four moons circling around it.
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    He then used those moons
    to follow the path of Jupiter
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    and found that Jupiter
    also was not going around the Earth
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    but around the Sun.
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    So the prediction test failed.
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    And this led to
    the discarding of the theory
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    that the Earth was the center
    of the universe.
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    Another example: Sir Isaac Newton
    noticed that things fall to the Earth.
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    The guessed explanation was gravity,
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    the prediction that everything
    should fall to the Earth.
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    But of course, not everything
    does fall to the Earth.
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    So did we discard gravity?
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    No. We revised the theory and said,
    gravity pulls things to the Earth
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    unless there is an equal
    and opposite force in the other direction.
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    This led us to learn something new.
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    We began to pay more attention
    to the bird and the bird's wings,
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    and just think of all the discoveries
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    that have flown
    from that line of thinking.
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    So the test failures,
    the exceptions, the outliers
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    teach us what we don't know
    and lead us to something new.
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    This is how science moves forward.
    This is how science learns.
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    Sometimes in the media,
    and even more rarely,
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    but sometimes even scientists will say
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    that something or other
    has been scientifically proven.
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    But I hope that you understand
    that science never proves anything
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    definitively forever.
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    Hopefully science remains curious enough
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    to look for
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    and humble enough to recognize
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    when we have found
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    the next outlier,
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    the next exception,
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    which, like Jupiter's moons,
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    teaches us what we don't actually know.
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    We're going to change gears
    here for a second.
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    The caduceus, or the symbol of medicine,
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    means a lot of different things
    to different people,
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    but most of our
    public discourse on medicine
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    really turns it into
    an engineering problem.
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    We have the hallways of Congress,
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    and the boardrooms of insurance companies
    that try to figure out how to pay for it.
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    The ethicists and epidemiologists
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    try to figure out
    how best to distribute medicine,
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    and the hospitals and physicians
    are absolutely obsessed
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    with their protocols and checklists,
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    trying to figure out
    how best to safely apply medicine.
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    These are all good things.
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    However, they also all assume
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    at some level
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    that the textbook of medicine is closed.
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    We start to measure
    the quality of our health care
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    by how quickly we can access it.
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    It doesn't surprise me
    that in this climate,
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    many of our institutions
    for the provision of health care
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    start to look a heck of a lot
    like Jiffy Lube.
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    (Laughter)
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    The only problem is that
    when I graduated from medical school,
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    I didn't get one of those
    little doohickeys
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    that your mechanic
    has to plug into your car
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    and find out exactly what's wrong with it,
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    because the textbook of medicine
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    is not closed.
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    Medicine is science.
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    Medicine is knowledge in process.
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    We make an observation,
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    we guess an explanation
    of that observation,
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    and then we make a prediction
    that we can test.
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    Now, the testing ground
    of most predictions in medicine
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    is populations.
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    And you may remember
    from those boring days in biology class
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    that populations tend to distribute
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    around a mean
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    as a Gaussian or a normal curve.
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    Therefore, in medicine,
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    after we make a prediction
    from a guessed explanation,
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    we test it in a population.
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    That means that what we know in medicine,
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    our knowledge and our know-how,
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    comes from populations
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    but extends only as far
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    as the next outlier,
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    the next exception,
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    which, like Jupiter's moons,
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    will teach us what we don't actually know.
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    Now, I am a surgeon
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    who looks after patients with sarcoma.
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    Sarcoma is a very rare form of cancer.
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    It's the cancer of flesh and bones.
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    And I would tell you that every one
    of my patients is an outlier,
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    is an exception.
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    There is no surgery I have ever performed
    for a sarcoma patient
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    that has ever been guided
    by a randomized controlled clinical trial,
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    what we consider the best kind
    of population-based evidence in medicine.
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    People talk about thinking
    outside the box,
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    but we don't even have a box in sarcoma.
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    What we do have as we take
    a bath in the uncertainty
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    and unknowns and exceptions
    and outliers that surround us in sarcoma
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    is easy access to what I think
    are those two most important values
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    for any science:
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    humility and curiosity.
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    Because if I am humble and curious,
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    when a patient asks me a question,
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    and I don't know the answer,
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    I'll ask a colleague
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    who may have a similar
    albeit distinct patient with sarcoma.
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    We'll even establish
    international collaborations.
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    Those patients will start
    to talk to each other through chat rooms
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    and support groups.
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    It's through this kind
    of humbly curious communication
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    that we begin to try and learn new things.
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    As an example, this is a patient of mine
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    who had a cancer near his knee.
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    Because of humbly curious communication
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    in international collaborations,
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    we have learned that we can repurpose
    the ankle to serve as the knee
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    when we have to remove the knee
    with the cancer.
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    He can then wear a prosthetic
    and run and jump and play.
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    This opportunity was available to him
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    because of international collaborations.
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    It was desirable to him
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    because he had contacted other patients
    who had experienced it.
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    And so exceptions and outliers in medicine
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    teach us what we don't know,
    but also lead us to new thinking.
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    Now, very importantly,
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    all the new thinking that outliers
    and exceptions lead us to in medicine
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    does not only apply
    to the outliers and exceptions.
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    It is not that we only learn
    from sarcoma patients
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    ways to manage sarcoma patients.
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    Sometimes, the outliers
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    and the exceptions
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    teach us things that matter quite a lot
    to the general population.
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    Like a tree standing outside a forest,
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    the outliers and the exceptions
    draw our attention
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    and lead us into a much greater sense
    of perhaps what a tree is.
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    We often talk about
    losing the forests for the trees,
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    but one also loses a tree
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    within a forest.
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    But the tree that stands out by itself
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    makes those relationships
    that define a tree,
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    the relationships between trunk
    and roots and branches,
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    much more apparent.
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    Even if that tree is crooked
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    or even if that tree
    has very unusual relationships
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    between trunk and roots and branches,
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    it nonetheless draws our attention
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    and allows us to make observations
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    that we can then test
    in the general population.
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    I told you that sarcomas are rare.
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    They make up about one percent
    of all cancers.
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    You also probably know that cancer
    is considered a genetic disease.
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    By genetic disease we mean
    that cancer is caused by oncogenes
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    that are turned on in cancer
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    and tumor suppressor genes
    that are turned off to cause cancer.
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    You might think
    that we learned about oncogenes
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    and tumor suppressor genes
    from common cancers
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    like breast cancer and prostate cancer
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    and lung cancer,
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    but you'd be wrong.
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    We learned about oncogenes
    and tumor suppressor genes
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    for the first time
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    in that itty-bitty little one percent
    of cancers called sarcoma.
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    In 1966, Peyton Rous got the Nobel Prize
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    for realizing that chickens
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    had a transmissible form of sarcoma.
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    Thirty years later, Harold Varmus
    and Mike Bishop discovered
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    what that transmissible element was.
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    It was a virus
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    carrying a gene,
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    the src oncogene.
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    Now, I will not tell you
    that src is the most important oncogene.
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    I will not tell you
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    that src is the most frequently
    turned on oncogene in all of cancer.
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    But it was the first oncogene.
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    The exception, the outlier
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    drew our attention and led us to something
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    that taught us very important things
    about the rest of biology.
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    Now, TP53 is the most important
    tumor suppressor gene.
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    It is the most frequently turned off
    tumor suppressor gene
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    in almost every kind of cancer.
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    But we didn't learn about it
    from common cancers.
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    We learned about it
    when doctors Li and Fraumeni
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    were looking at families,
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    and they realized that these families
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    had way too many sarcomas.
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    I told you that sarcoma is rare.
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    Remember that a one
    in a million diagnosis,
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    if it happens twice in one family,
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    is way too common in that family.
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    The very fact that these are rare
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    draws our attention
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    and leads us to new kinds of thinking.
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    Now, many of you may say,
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    and may rightly say,
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    that yeah, Kevin, that's great,
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    but you're not talking
    about a bird's wing.
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    You're not talking about moons
    floating around some planet Jupiter.
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    This is a person.
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    This outlier, this exception,
    may lead to the advancement of science,
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    but this is a person.
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    And all I can say
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    is that I know that all too well.
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    I have conversations with these patients
    with rare and deadly diseases.
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    I write about these conversations.
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    These conversations are terribly fraught.
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    They're fraught with horrible phrases
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    like "I have bad news"
    or "There's nothing more we can do."
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    Sometimes these conversations
    turn on a single word:
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    "terminal."
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    Silence can also be rather uncomfortable.
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    Where the blanks are in medicine
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    can be just as important
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    as the words that we use
    in these conversations.
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    What are the unknowns?
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    What are the experiments
    that are being done?
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    Do this little exercise with me.
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    Up there on the screen,
    you see this phrase, "no where."
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    Notice where the blank is.
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    If we move that blank one space over
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    "no where"
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    becomes "now here,"
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    the exact opposite meaning,
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    just by shifting the blank one space over.
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    I'll never forget the night
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    that I walked into
    one of my patients' rooms.
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    I had been operating long that day
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    but I still wanted to come and see him.
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    He was a boy I had diagnosed
    with a bone cancer a few days before.
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    He and his mother had been meeting
    with the chemotherapy doctors
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    earlier that day,
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    and he had been admitted
    to the hospital to begin chemotherapy.
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    It was almost midnight
    when I got to his room.
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    He was asleep, but I found his mother
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    reading by flashlight
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    next to his bed.
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    She came out in the hall
    to chat with me for a few minutes.
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    It turned out that
    what she had been reading
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    was the protocol
    that the chemotherapy doctors
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    had given her that day.
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    She had memorized it.
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    She said, "Dr. Jones, you told me
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    that we don't always win
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    with this type of cancer,
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    but I've been studying this protocol,
    and I think I can do it.
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    I think I can comply
    with these very difficult treatments.
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    I'm going to quit my job.
    I'm going to move in with my parents.
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    I'm going to keep my baby safe."
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    I didn't tell her.
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    I didn't stop to correct her thinking.
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    To shift that blank to where it should be.
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    The experiment wasn't whether or not
    she could comply
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    with this very difficult protocol.
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    She was trusting in a protocol
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    that even if complied with,
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    wouldn't necessarily save her son.
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    I didn't tell her.
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    I didn't fill in that blank.
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    But a year and a half later
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    her boy nonetheless died of his cancer.
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    Should I have told her?
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    Now, many of you may say, "So what?
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    I don't have sarcoma.
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    No one in my family has sarcoma.
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    And this is all fine and well,
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    but it probably doesn't
    matter in my life."
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    And you're probably right.
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    Sarcoma may not matter
    a whole lot in your life.
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    But where the blanks are in medicine
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    does matter in your life.
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    I didn't tell you one dirty little secret.
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    I told you that in medicine,
    we test predictions in populations,
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    but I didn't tell you,
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    and so often medicine never tells you
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    that every time an individual
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    encounters medicine,
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    even if that individual is firmly
    embedded in the general population,
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    neither the individual
    nor the physician knows
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    where in that population
    the individual will land.
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    Therefore, every encounter with medicine
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    is an experiment.
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    You will be a subject
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    in an experiment.
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    And the outcome will be either
    a better or a worse result for you.
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    As long as medicine works well,
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    we're fine with fast service,
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    bravado, brimmingly
    confident conversations.
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    But when things don't work well,
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    sometimes we want something different.
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    A colleague of mine
    removed a tumor from a patient's limb.
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    He was concerned about this tumor.
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    In our physician conferences,
    he talked about his concern
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    that this was a type of tumor
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    that had a high risk
    for coming back in the same limb.
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    But his conversations with the patient
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    were exactly what a patient might want:
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    brimming with confidence.
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    He said, "I got it all
    and you're good to go."
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    She and her husband were thrilled.
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    They went out, celebrated, fancy dinner,
    opened a bottle of champagne.
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    The only problem was a few weeks later,
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    she started to notice
    another nodule in the same area.
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    It turned out he hadn't gotten it all,
    and she wasn't good to go.
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    But what happened at this juncture
    absolutely fascinates me.
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    My colleague came to me and said,
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    "Kevin, would you mind
    looking after this patient for me?"
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    I said, "Why, you know the right thing
    to do as well as I do.
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    You haven't done anything wrong."
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    He said, "Please, just look
    after this patient for me."
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    He was embarrassed...
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    Not by what he had done,
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    but by the conversation that he had had,
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    by the overconfidence.
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    So I performed
    a much more invasive surgery
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    and had a very different conversation
    with the patient afterwards.
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    I said, "Most likely I've gotten it all
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    and you're most likely good to go,
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    but this is the experiment
    that we're doing.
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    This is what you're going to watch for.
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    This is what I'm going to watch for.
  • 16:28 - 16:32
    And we're going to work together
    to find out if this surgery will work
  • 16:32 - 16:33
    to get rid of your cancer."
  • 16:34 - 16:36
    I can guarantee you, she and her husband
  • 16:36 - 16:38
    did not crack another bottle of champagne
    after talking to me.
  • 16:40 - 16:43
    But she was now a scientist,
  • 16:43 - 16:47
    not only a subject in her experiment.
  • 16:49 - 16:50
    And so I encourage you
  • 16:50 - 16:54
    to seek humility and curiosity
  • 16:54 - 16:55
    in your physicians.
  • 16:57 - 17:00
    Almost 20 billion times each year,
  • 17:00 - 17:04
    a person walks into a doctor's office,
  • 17:04 - 17:06
    and that person becomes a patient.
  • 17:07 - 17:11
    You or someone you love
    will be that patient sometime very soon.
  • 17:12 - 17:14
    How will you talk to your doctors?
  • 17:15 - 17:16
    What will you tell them?
  • 17:17 - 17:18
    What will they tell you?
  • 17:21 - 17:23
    They cannot tell you
  • 17:23 - 17:24
    what they do not know,
  • 17:26 - 17:29
    but they can tell you when they don't know
  • 17:30 - 17:32
    if only you'll ask.
  • 17:32 - 17:35
    So please, join the conversation.
  • 17:36 - 17:38
    Thank you.
  • 17:38 - 17:40
    (Applause)
Title:
Why curiosity is the key to science and medicine | Kevin Jones | TEDxSaltLakeCity
Description:

Science is a learning process that involves experimentation, failure and revision -- and the science of medicine is no exception. Cancer researcher Kevin B. Jones faces the deep unknowns about surgery and medical care with a simple answer: honesty. In a thoughtful talk about the nature of knowledge, Jones shows how science is at its best when scientists humbly admit what they do not yet understand.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

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Video Language:
English
Team:
TED
Project:
TEDxTalks
Duration:
17:45

English subtitles

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