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Science.

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The very word for many of you conjures[br]unhappy memories of boredom

9:59:59.000,9:59:59.000
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[br]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,[br]guess an explanation for that observation,

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and then make a prediction[br]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[br]that the Earth was below, the sky above,

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and both the Sun and the Moon[br]seemed to go around them.

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Their guessed explanation was that[br]the Earth must be the center

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of the Universe.

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The prediction: everything[br]should circle around the Earth.

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This was first really tested[br]when Galileo got his hands

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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[br]to follow the path of Jupiter

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and found that Jupiter also[br]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[br]of the theory

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that the Earth was the center[br]of the Universe.

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Another example: Sir Isaac Newton[br]noticed that things fall to the Earth.

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The guessed explanation was gravity,

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the prediction that everything[br]should fall to the Earth.

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But of course, not everything[br]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,[br]gravity pulls things to the Earth

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unless there is an equal[br]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[br]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[br]that line of thinking.

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So the test failures, the exceptions,

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the outliers, teach us what we don't know

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and lead us to something new.

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This is how science moves forward.[br]This is how science learns.

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Sometimes in the media,[br]and even more rarely,

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but sometimes even scientists will say

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that something or has been[br]scientifically proven.

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But I hope that you understand[br]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[br]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[br]to different people,

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but most of our public[br]discourse on medicine

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really turns it into[br]an engineering problem.

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We have the hallways of Congress,

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and the boardrooms of insurance companies

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that try to figure out how to pay for it.

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The ethicists and epidemiologists[br]try to figure out how best

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to distribute medicine,

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and the hospitals and physicians[br]are absolutely obsessed

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with their protocols and checklists,

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trying to figure out how best[br]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[br]of our healthcare

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by how quickly we can access it.

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It doesn't surprise me that[br]in this climate,

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many of our institutions for[br]for the provision of healthcare

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start to look a heck of a lot[br]like Jiffy Lube.

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(Laughter)

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The only problem is that when[br]I graduated from medical school,

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I didn't get one of those[br]little doohickeys

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that your mechanic has[br]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[br]of that observation,

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and then we make a prediction[br]that we can test.

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Now the testing ground

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of most predictions in medicine

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is populations,

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and you may remember from those[br]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[br]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 knowhow,

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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[br]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[br]for a sarcoma patient

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that has ever been guided

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by a randomized controlled clinical trial,

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what we consider the best kind[br]of population-based evidence in medicine.

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People talk about thinking[br]outside the box,

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but we don't even have a box

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in sarcoma.

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What we do have as we take[br]a bath in the uncertainty

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and unknowns and exceptions[br]and outliers that surround us in sarcoma

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is easy access to what I think are[br]those two more 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 who may have[br]a similar albeit distinct patient

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with sarcoma.

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We'll even establish international[br]collaborations.

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Those patients will start to talk[br]to each other through chatrooms

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and support groups.

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It's through this kind of[br]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[br]the ankle to serve as the knee

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when we have to remove the knee[br]with the cancer.

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He can then wear a prosthetic[br]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

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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,[br]but also lead us to new thinking.

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Now very importantly,

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all the new thinking that outliers

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and exceptions lead us to in medicine

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does not only apply[br]to the outliers and exceptions.

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It is not that we only learn[br]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[br]quite a lot to the general population.

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Like a tree standing outside a forests,[br]the outliers and the exceptions

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draw our attention

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and lead us into a much greater sense

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of perhaps what a tree is.

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We often talk about losing the forests[br]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

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that define a tree,

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the relationships between trunk[br]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

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has very unusual relationships[br]between trunk and roots and branches,

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it nonetheless draws our attention

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and allows us to make observation

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that we can then test[br]in the general population.

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I told you that sarcomas are rare.

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They make up about 1 percent[br]of all cancers.

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You also probably know that cancer[br]is considered a genetic disease.

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By genetic disease, we mean that cancer[br]is caused by oncogenes

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that are turned on in cancer

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and tumor suppressor genes[br]that are turned off to cause cancer.

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You might think that we learned[br]about oncogenes

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and tumor suppressor genes[br]from common cancers

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like breast cancer and prostate cancer[br]and lung cancer,

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but you'd be wrong.

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We learned about oncogenes[br]and tumor suppressor genes

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for the first time

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in that itty bitty little one percent[br]cancers called sarcoma.

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In 1966, Peyton Rous