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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 was that
the Earth must be the center

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of the Universe.

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The prediction: everything
should circle around the Earth.

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This was first really tested
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
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,

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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.
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 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

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that try to figure out how to pay for it.

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The ethicists and epidemiologists
try to figure out how best

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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 healthcare

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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
for the provision of healthcare

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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

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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
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 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
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

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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

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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 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
a similar albeit distinct patient

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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 chatrooms

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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

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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,
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
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 forests,
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
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
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
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
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
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
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
cancers called sarcoma.

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In 1966, Peyton Rous