WEBVTT

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I have a tendency to assume the worst,

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and once in a while,
this habit plays tricks on me.

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For example, if I feel
unexpected pain in my body

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that I have not experienced before
and that I cannot attribute,

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then all of a sudden, my mind
my turn a tense back into heart disease

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or calf muscle pain into ??.

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But so far I haven't been diagnosed
with any deadly or incurable disease.

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Sometimes things just hurt
for no clear reason.

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But not everyone is as lucky as me.

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Every year, more than
50 million people die worldwide.

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Especially in high-income
economies like ours,

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a large fraction of deaths
is caused by slowly progressing diseases:

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heart disease, chronic lung disease,
cancer, Alzheimer's, diabetes,

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just to name a few.

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Now, humanity has made tremendous progress
in diagnosing and treating many of these,

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but we are at stage
where further advancement in health

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cannot be achieved only
by developing new treatments,

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and this becomes evident
when we look at one aspect

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that many of these
diseases have in common.

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The probability for successful treatment

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strongly depends on
when treatment is started,

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but a disease is typically only detected
once symptoms occur,

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and the problem here is that in fact
many disease can remain asymptomatic,

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hence undetected,
for a long period of time.

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Because of this, there is
a persisting need for new ways

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of detecting disease at early stage,
way before any symptoms occur.

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In health care, this is called screening,

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and as defined by
the World Health Organization,

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screening is the
presumptive identification

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of unrecognized disease

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in an apparently healthy person

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by means of tests that can be applied
rapidly and easily.

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That's a long definition,
so let me repeat it:

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identification of unrecognized disease

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in an apparently healthy person

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by means of tests that can be applied
both rapidly and easily.

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And I want to put special emphasis
on the words "rapidly" and "easily,"

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because many of
the existing screening methods

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are exactly the opposite.

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And those of you who have gone colonoscopy

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as part of a screening program
for colorectal cancer

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will know what I mean.

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Obviously, there's a variety
of medical tools available

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to perform screening tests.

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This ranges from imaging techniques

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such as radiography
or magnetic resonance imaging

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to the analysis of blood or tissue.

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We have all had such tests.

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But there's one medium
that for long has been overlooked,

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a medium that is easily accessible,

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basically non-depletable,

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and it holds tremendous promise
for medical analysis,

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and that is our breath.

NOTE Paragraph

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Human breath is essentially
composed of five components:

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nitrogen, oxygen,
carbon dioxide, water and argon,

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but besides these five, there are
hundreds of other components

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that are present in very low quantity.

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These are called volatile
organic compounds,

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and we release hundreds,
even thousands of them,

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every time we exhale.

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The analysis of these volatile
organic compounds in our breath

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is called breath analysis.

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In fact, I believe that many of you
have already experienced breath analysis.

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Imagine, you're driving home late at night

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when suddenly there's
a friendly police officer

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who asks you kindly but firmly

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to pull over and blow
into a device like this one.

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This is an alcohol breath tester

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that is used to measure
the ethanol concentration in your breath

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and determine whether driving
in your condition is a clever idea.

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Now I'd say my driving was pretty good,

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but let me check.

NOTE Paragraph

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(Beep)

NOTE Paragraph

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0.0, so nothing to worry about, all fine.

NOTE Paragraph

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Now, imagine a device like this one

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that does not only measure
alcohol levels in your breath,

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but that detects diseases

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like the ones I've shown you
and potentially many more.

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The concept of correlating
the smell of a person's breath

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with certain medical conditions

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in fact dates back to Ancient Greece,

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but only recently, research efforts
on breath analysis have skyrocketed,

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and what once was a dream
is now becoming reality.

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And let me pull up this list again
that I showed you earlier.

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For the majority of diseases listed here,

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there's substantial scientific evidence
suggesting that the disease

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could be detected by breath analysis.

NOTE Paragraph

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But how does it work exactly?

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The essential part is a sensor device

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that detects the volatile
organic compounds in our breath.

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Simply put, when exposed
to a breath sample,

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the sensor outputs a complex signature

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that results from the mixture of volatile
organic compounds that we exhale.

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Now, this signature represents
a fingerprint of your metabolism,

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your microbiome,

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and the biochemical processes
that occur in your body.

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If you have a disease,

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your organisms will change,

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and so will the composition
of your exhaled breath,

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and then the only thing that is left to do

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is to correlate a certain signature

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with the presence or absence
of certain medical conditions.

NOTE Paragraph

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The technology promises
several undeniable benefits.

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Firstly, the sensor can be miniaturized

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and integrated into small,
handheld devices

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like this alcohol breath tester.

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This would allow the test to be used
in many different settings

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and even at home,

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so that a visit at a doctor's office

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is not needed each time
a test shall be performed.

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Secondly, breath analysis is non-invasive

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and can be as simple as blowing
into an alcohol breath tester.

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Such simplicity and ease of use
would reduce patient burden

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and provide an incentive
for broad adoption of the technology.

NOTE Paragraph

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And thirdly, the technology is so flexible

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that the same device could be used

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to detect a broad range
of medical conditions.

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Breath analysis could be used to screen
for multiple diseases at the same time.

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Nowadays, each disease typically requires

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a different medical tool
to perform a screening test,

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but this means you can only find
what you're looking for.

NOTE Paragraph

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With all of these features,
breath analysis is predestined

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to deliver what many traditional
screening tests are lacking,

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and most importantly,
all of these features

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should eventually provide us
with a platform for medical analysis

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that can operate at attractively
low cost per test.

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On the contrary, existing medical tools

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often lead to rather high cost per test.

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Then, in order to keep costs down,

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the number of tests
needs to be restricted,

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and this means a) that the tests
can only be performed

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on a narrow part of the population,
for example the high-risk population,

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and b) that the number of tests per person
needs to be kept at a minimum.

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But wouldn't it actually be beneficial

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if the test was performed
on a larger group of people

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and more often and over a longer period
of time for each individual?

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Especially the latter would give access
to something very valuable

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that is called longitudinal data.

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Longitudinal data is a dataset
that tracks the same patient

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over the course of many months or years.

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Nowadays, medical decisions

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are often based on a limited dataset

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where over a glimpse
of a patient's medical history

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is available for decision-making.

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In such a case,

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abnormalities are typically detected

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by comparing a patient's health profile

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to the average health profile
of a reference population.

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Longitudinal data would
open up a new dimension

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and allow abnormalities to be detected

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based on a patient's own medical history.

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This will pave the way
for personalized treatment.

NOTE Paragraph

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Sounds pretty great, right?

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Now you will certainly have a question

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that is something like,

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"If the technology is as great as he says,
then why aren't they using it today?"

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And the only answer I can give you is,

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not everything is as easy as it sounds.

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There are technical challenges.

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For example, there's the need
for extremely reliable sensors

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that can detect mixtures
of volatile organic compounds

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with sufficient reproducibility.

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And another technical challenge is,

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how do you sample a person's breath
in a very defined manner

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so that the sampling process itself

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does not alter the result of the analysis?

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And there's the need for data.

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Breath analysis needs
to be validated in clinical trials,

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and enough data needs to be collected

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so that individual conditions

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can be measured against baselines.

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Breath analysis can only succeed

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if a large enough dataset can be generated

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and made available for broad use.

NOTE Paragraph

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If breath analysis
holds up to its promises,

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this is a technology
that could truly aid us

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to transform our health care system,

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transform it from a reactive system

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that treatment is triggered
by symptoms of disease

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to a proactive system

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where disease detection,
diagnosis and treatment

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can happen at early stage,

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way before any symptoms occur.

NOTE Paragraph

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Now this brings me to my last point,
and it's a fundamental one.

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What exactly is a disease?

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Imagine that breath analysis
can be commercialized as I describe it

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and early detection becomes routine.

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A problem that remains

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is in fact a problem that
any screening activity has to face,

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because for many diseases,

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it is often impossible to predict
with sufficient certainty

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whether the disease
would ever cause any symptoms

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or put a person's life at risk.

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This is called overdiagnosis,

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and it leads to a dilemma.

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If a disease is identified,

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you could decide not to treat it

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because there's a certain probability
that you would never suffer from it.

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But how much would you suffer

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just from knowing that you have
a potentially deadly disease?

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And wouldn't you actually regret that the
disease was detected in the first place?

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Your second option
is to undergo early treatment

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with the hope for curing it,

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but often this would not
come without side effects.

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To be precise,

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the bigger problem is not overdiagnosis,

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it's overtreatment,

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because not every disease
has to be treated immediately

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just because a treatment is available.

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The increasing adoption
of routine screening

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will raise the question:

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what do we call a disease
that can rationalize treatment,

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and what is just an abnormality
that should not be a source of concern?

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My hopes are that routine screening
using breath analysis

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can provide enough data and insight

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so that at some point,
we'll be able to break this dilemma

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and predict with sufficient certainty

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whether and when to treat at early stage.

NOTE Paragraph

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Our breath, and the mixture
of volatile organic compounds

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that we exhale,

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hold tremendous amounts of information
on our physiological condition.

NOTE Paragraph

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With what we know today,
we have only scratched the surface.

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As we collect more and more data
and breath profiles across the population,

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including all varieties of gender,
age, origin and lifestyle,

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the power of breath analysis
should increase,

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and eventually breath analysis
should provide us with a powerful tool

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not only to proactively detect
specific diseases

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but to predict and
ultimately prevent them,

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and this should be enough
motivation to embrace

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the opportunities and challenges

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that breath analysis can provide,

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even for people that are not
part-time hypochondriacs like me.

NOTE Paragraph

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Thank you.

NOTE Paragraph

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(Applause)