[Script Info] Title: [Events] Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Science. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The very word for many of you conjures\Nunhappy memories of boredom Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in high school biology or physics class. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,But let me assure that what you did there Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,had very little to do with science. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,That was really the "what" of science. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,It was the history of what\Nother people had discovered. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,What I'm most interested in as a scientist Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,is the "how" of science. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Because science is knowledge in process. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We make an observation,\Nguess an explanation for that observation, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and then make a prediction\Nthat we can test Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,with an experiment or other observation. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,A couple of examples. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,First of all, people noticed\Nthat the Earth was below, the sky above, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and both the Sun and the Moon\Nseemed to go around them. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Their guessed explanation was that\Nthe Earth must be the center Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,of the Universe. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The prediction: everything\Nshould circle around the Earth. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,This was first really tested\Nwhen Galileo got his hands Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,on one of the first telescopes, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and as he gazed into the night sky, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,what he found there was a planet, Jupiter, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,with four moons circling around it. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,He then used those moons\Nto follow the path of Jupiter Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and found that Jupiter also\Nwas not going around the Earth Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but around the Sun. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,So the prediction test failed. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,And this led to the discarding\Nof the theory Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that the Earth was the center\Nof the Universe. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Another example: Sir Isaac Newton\Nnoticed that things fall to the Earth. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The guessed explanation was gravity, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the prediction that everything\Nshould fall to the Earth. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,But of course, not everything\Ndoes fall to the Earth. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,So did we discard gravity? Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,No. We revised the theory and said,\Ngravity pulls things to the Earth Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,unless there is an equal\Nand opposite force in the other direction. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,This led us to learn something new. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We began to pay more attention\Nto the bird and the bird's wings, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and just think of all the discoveries Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that have flown from\Nthat line of thinking. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,So the test failures, the exceptions, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the outliers, teach us what we don't know Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and lead us to something new. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,This is how science moves forward.\NThis is how science learns. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Sometimes in the media,\Nand even more rarely, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but sometimes even scientists will say Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that something or has been\Nscientifically proven. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,But I hope that you understand\Nthat science never proves anything Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,definitively forever. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Hopefully science remains curious enough Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,to look for Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and humble enough to recognize Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,when we have found Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the next outlier, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the next exception, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,which, like Jupiter's moons, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,teaches us what we don't actually know. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We're going to change gears\Nhere for a second. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The caduceus, or the symbol of medicine, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,means a lot of different things\Nto different people, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but most of our public\Ndiscourse on medicine Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,really turns it into\Nan engineering problem. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We have the hallways of Congress, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and the boardrooms of insurance companies Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that try to figure out how to pay for it. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The ethicists and epidemiologists\Ntry to figure out how best Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,to distribute medicine, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and the hospitals and physicians\Nare absolutely obsessed Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,with their protocols and checklists, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,trying to figure out how best\Nto safely apply medicine. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,These are all good things. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,However, they also all assume Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,at some level Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that the textbook of medicine is closed. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We start to measure the quality\Nof our healthcare Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,by how quickly we can access it. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,It doesn't surprise me that\Nin this climate, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,many of our institutions for\Nfor the provision of healthcare Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,start to look a heck of a lot\Nlike Jiffy Lube. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,(Laughter) Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The only problem is that when\NI graduated from medical school, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,I didn't get one of those\Nlittle doohickeys Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that your mechanic has\Nto plug into your car Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and find out exactly what's wrong with it, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,because the textbook of medicine Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,is not closed. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Medicine is science. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Medicine is knowledge in process. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We make an observation, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,we guess an explanation\Nof that observation, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and then we make a prediction\Nthat we can test. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Now the testing ground Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,of most predictions in medicine Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,is populations, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and you may remember from those\Nboring days in biology class Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that populations tend to distribute Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,around a mean Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,as a Gaussian or a normal curve. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Therefore, in medicine, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,after we make a prediction\Nfrom a guessed explanation, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,we test it in a population. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,That means that what we know in medicine, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,our knowledge and our knowhow, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,comes from populations, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but extends only as far Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,as the next outlier, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the next exception, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,which, like Jupiter's moons, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,will teach us what we don't actually know. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Now I am a surgeon Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,who looks after patients with sarcoma. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Sarcoma is a very rare form of cancer. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,It's the cancer of flesh and bones. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,And I would tell you that every one\Nof my patients is an outlier, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,is an exception. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,There is no surgery I have ever performed\Nfor a sarcoma patient Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that has ever been guided Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,by a randomized controlled clinical trial, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,what we consider the best kind\Nof population-based evidence in medicine. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,People talk about thinking\Noutside the box, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but we don't even have a box Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in sarcoma. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,What we do have as we take\Na bath in the uncertainty Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and unknowns and exceptions\Nand outliers that surround us in sarcoma Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,is easy access to what I think are\Nthose two more important values Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,for any science: Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,humility and curiosity. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Because if I am humble and curious, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,when a patient asks me a question, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and I don't know the answer, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,I'll ask a colleague who may have\Na similar albeit distinct patient Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,with sarcoma. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We'll even establish international\Ncollaborations. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Those patients will start to talk\Nto each other through chatrooms Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and support groups. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,It's through this kind of\Nhumbly curious communication Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that we begin to try and learn new things. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,As an example, this is a patient of mine Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,who had a cancer near his knee. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Because of humbly curious communication Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in international collaborations, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,we have learned that we can repurpose\Nthe ankle to serve as the knee Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,when we have to remove the knee\Nwith the cancer. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,He can then wear a prosthetic\Nand run and jump and play. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,This opportunity was available to him Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,because of international collaborations. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,It was desirable to him Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,because he had contacted other patients Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,who had experienced it. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,And so exceptions and outliers in medicine Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,teach us what we don't know,\Nbut also lead us to new thinking. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Now very importantly, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,all the new thinking that outliers Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and exceptions lead us to in medicine Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,does not only apply\Nto the outliers and exceptions. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,It is not that we only learn\Nfrom sarcoma patients Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,ways to manage sarcoma patients. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Sometimes, the outliers Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and the exceptions Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,teach us things that matter\Nquite a lot to the general population. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Like a tree standing outside a forests,\Nthe outliers and the exceptions Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,draw our attention Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and lead us into a much greater sense Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,of perhaps what a tree is. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We often talk about losing the forests\Nfor the trees, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but one also loses a tree Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,within a forest. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,But the tree that stands out by itself Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,makes those relationships Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that define a tree, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the relationships between trunk\Nand roots and branches, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,much more apparent. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Even if that tree is crooked Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,or even if that tree Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,has very unusual relationships\Nbetween trunk and roots and branches, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,it nonetheless draws our attention Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and allows us to make observation Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that we can then test\Nin the general population. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,I told you that sarcomas are rare. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,They make up about 1 percent\Nof all cancers. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,You also probably know that cancer\Nis considered a genetic disease. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,By genetic disease, we mean that cancer\Nis caused by oncogenes Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that are turned on in cancer Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and tumor suppressor genes\Nthat are turned off to cause cancer. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,You might think that we learned\Nabout oncogenes Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and tumor suppressor genes\Nfrom common cancers Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,like breast cancer and prostate cancer\Nand lung cancer, Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but you'd be wrong. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,We learned about oncogenes\Nand tumor suppressor genes Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,for the first time Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in that itty bitty little one percent\Ncancers called sarcoma. Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,In 1966, Peyton Rous