[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.84,0:00:02.04,Default,,0000,0000,0000,,Science.
Dialogue: 0,0:00:02.76,0:00:06.18,Default,,0000,0000,0000,,The very word for many of you conjures\Nunhappy memories of boredom
Dialogue: 0,0:00:06.20,0:00:09.10,Default,,0000,0000,0000,,in high school biology or physics class.
Dialogue: 0,0:00:09.12,0:00:12.22,Default,,0000,0000,0000,,But let me assure that what you did there
Dialogue: 0,0:00:12.24,0:00:14.42,Default,,0000,0000,0000,,had very little to do with science.
Dialogue: 0,0:00:14.44,0:00:16.74,Default,,0000,0000,0000,,That was really the "what" of science.
Dialogue: 0,0:00:16.76,0:00:19.48,Default,,0000,0000,0000,,It was the history\Nof what other people had discovered.
Dialogue: 0,0:00:20.72,0:00:23.06,Default,,0000,0000,0000,,What I'm most interested in as a scientist
Dialogue: 0,0:00:23.08,0:00:25.22,Default,,0000,0000,0000,,is the "how" of science.
Dialogue: 0,0:00:25.24,0:00:29.06,Default,,0000,0000,0000,,Because science is knowledge in process.
Dialogue: 0,0:00:29.08,0:00:32.54,Default,,0000,0000,0000,,We make an observation,\Nguess an explanation for that observation,
Dialogue: 0,0:00:32.56,0:00:34.62,Default,,0000,0000,0000,,and then make a prediction\Nthat we can test
Dialogue: 0,0:00:34.64,0:00:36.56,Default,,0000,0000,0000,,with an experiment or other observation.
Dialogue: 0,0:00:37.08,0:00:38.42,Default,,0000,0000,0000,,A couple of examples.
Dialogue: 0,0:00:38.44,0:00:42.02,Default,,0000,0000,0000,,First of all, people noticed\Nthat the Earth was below, the sky above,
Dialogue: 0,0:00:42.04,0:00:45.92,Default,,0000,0000,0000,,and both the Sun and the Moon\Nseemed to go around them.
Dialogue: 0,0:00:46.72,0:00:48.26,Default,,0000,0000,0000,,Their guessed explanation
Dialogue: 0,0:00:48.28,0:00:51.36,Default,,0000,0000,0000,,was that the Earth must be\Nthe center of the universe.
Dialogue: 0,0:00:52.24,0:00:55.44,Default,,0000,0000,0000,,The prediction: everything\Nshould circle around the Earth.
Dialogue: 0,0:00:56.12,0:00:57.78,Default,,0000,0000,0000,,This was first really tested
Dialogue: 0,0:00:57.80,0:01:00.62,Default,,0000,0000,0000,,when Galileo got his hands\Non one of the first telescopes,
Dialogue: 0,0:01:00.64,0:01:03.02,Default,,0000,0000,0000,,and as he gazed into the night sky,
Dialogue: 0,0:01:03.04,0:01:06.74,Default,,0000,0000,0000,,what he found there was a planet, Jupiter,
Dialogue: 0,0:01:06.76,0:01:10.76,Default,,0000,0000,0000,,with four moons circling around it.
Dialogue: 0,0:01:11.76,0:01:16.14,Default,,0000,0000,0000,,He then used those moons\Nto follow the path of Jupiter
Dialogue: 0,0:01:16.16,0:01:19.90,Default,,0000,0000,0000,,and found that Jupiter\Nalso was not going around the Earth
Dialogue: 0,0:01:19.92,0:01:21.88,Default,,0000,0000,0000,,but around the Sun.
Dialogue: 0,0:01:23.16,0:01:25.44,Default,,0000,0000,0000,,So the prediction test failed.
Dialogue: 0,0:01:26.40,0:01:28.50,Default,,0000,0000,0000,,And this led to\Nthe discarding of the theory
Dialogue: 0,0:01:28.52,0:01:30.70,Default,,0000,0000,0000,,that the Earth was the center\Nof the universe.
Dialogue: 0,0:01:30.72,0:01:34.82,Default,,0000,0000,0000,,Another example: Sir Isaac Newton\Nnoticed that things fall to the Earth.
Dialogue: 0,0:01:34.84,0:01:37.76,Default,,0000,0000,0000,,The guessed explanation was gravity,
Dialogue: 0,0:01:38.52,0:01:41.66,Default,,0000,0000,0000,,the prediction that everything\Nshould fall to the Earth.
Dialogue: 0,0:01:41.68,0:01:45.24,Default,,0000,0000,0000,,But of course, not everything\Ndoes fall to the Earth.
Dialogue: 0,0:01:46.20,0:01:47.76,Default,,0000,0000,0000,,So did we discard gravity?
Dialogue: 0,0:01:48.92,0:01:53.34,Default,,0000,0000,0000,,No. We revised the theory and said,\Ngravity pulls things to the Earth
Dialogue: 0,0:01:53.36,0:01:57.56,Default,,0000,0000,0000,,unless there is an equal\Nand opposite force in the other direction.
Dialogue: 0,0:01:58.16,0:02:00.32,Default,,0000,0000,0000,,This led us to learn something new.
Dialogue: 0,0:02:00.92,0:02:04.18,Default,,0000,0000,0000,,We began to pay more attention\Nto the bird and the bird's wings,
Dialogue: 0,0:02:04.20,0:02:06.58,Default,,0000,0000,0000,,and just think of all the discoveries
Dialogue: 0,0:02:06.60,0:02:08.64,Default,,0000,0000,0000,,that have flown\Nfrom that line of thinking.
Dialogue: 0,0:02:09.64,0:02:14.78,Default,,0000,0000,0000,,So the test failures,\Nthe exceptions, the outliers
Dialogue: 0,0:02:14.80,0:02:19.36,Default,,0000,0000,0000,,teach us what we don't know\Nand lead us to something new.
Dialogue: 0,0:02:20.00,0:02:23.20,Default,,0000,0000,0000,,This is how science moves forward.\NThis is how science learns.
Dialogue: 0,0:02:23.84,0:02:26.10,Default,,0000,0000,0000,,Sometimes in the media,\Nand even more rarely,
Dialogue: 0,0:02:26.12,0:02:28.54,Default,,0000,0000,0000,,but sometimes even scientists will say
Dialogue: 0,0:02:28.56,0:02:31.32,Default,,0000,0000,0000,,that something or other\Nhas been scientifically proven.
Dialogue: 0,0:02:31.88,0:02:36.46,Default,,0000,0000,0000,,But I hope that you understand\Nthat science never proves anything
Dialogue: 0,0:02:36.48,0:02:38.36,Default,,0000,0000,0000,,definitively forever.
Dialogue: 0,0:02:39.52,0:02:43.34,Default,,0000,0000,0000,,Hopefully science remains curious enough
Dialogue: 0,0:02:43.36,0:02:44.78,Default,,0000,0000,0000,,to look for
Dialogue: 0,0:02:44.80,0:02:46.78,Default,,0000,0000,0000,,and humble enough to recognize
Dialogue: 0,0:02:46.80,0:02:48.30,Default,,0000,0000,0000,,when we have found
Dialogue: 0,0:02:48.32,0:02:50.02,Default,,0000,0000,0000,,the next outlier,
Dialogue: 0,0:02:50.04,0:02:51.54,Default,,0000,0000,0000,,the next exception,
Dialogue: 0,0:02:51.56,0:02:53.86,Default,,0000,0000,0000,,which, like Jupiter's moons,
Dialogue: 0,0:02:53.88,0:02:56.48,Default,,0000,0000,0000,,teaches us what we don't actually know.
Dialogue: 0,0:02:57.16,0:02:59.70,Default,,0000,0000,0000,,We're going to change gears\Nhere for a second.
Dialogue: 0,0:02:59.72,0:03:01.66,Default,,0000,0000,0000,,The caduceus, or the symbol of medicine,
Dialogue: 0,0:03:01.68,0:03:04.14,Default,,0000,0000,0000,,means a lot of different things\Nto different people,
Dialogue: 0,0:03:04.16,0:03:06.42,Default,,0000,0000,0000,,but most of our\Npublic discourse on medicine
Dialogue: 0,0:03:06.44,0:03:09.22,Default,,0000,0000,0000,,really turns it into\Nan engineering problem.
Dialogue: 0,0:03:09.24,0:03:10.98,Default,,0000,0000,0000,,We have the hallways of Congress,
Dialogue: 0,0:03:11.00,0:03:15.00,Default,,0000,0000,0000,,and the boardrooms of insurance companies\Nthat try to figure out how to pay for it.
Dialogue: 0,0:03:15.68,0:03:17.30,Default,,0000,0000,0000,,The ethicists and epidemiologists
Dialogue: 0,0:03:17.32,0:03:20.02,Default,,0000,0000,0000,,try to figure out\Nhow best to distribute medicine,
Dialogue: 0,0:03:20.04,0:03:22.70,Default,,0000,0000,0000,,and the hospitals and physicians\Nare absolutely obsessed
Dialogue: 0,0:03:22.72,0:03:24.66,Default,,0000,0000,0000,,with their protocols and checklists,
Dialogue: 0,0:03:24.68,0:03:28.22,Default,,0000,0000,0000,,trying to figure out\Nhow best to safely apply medicine.
Dialogue: 0,0:03:28.24,0:03:30.36,Default,,0000,0000,0000,,These are all good things.
Dialogue: 0,0:03:30.96,0:03:33.70,Default,,0000,0000,0000,,However, they also all assume
Dialogue: 0,0:03:33.72,0:03:35.70,Default,,0000,0000,0000,,at some level
Dialogue: 0,0:03:35.72,0:03:38.24,Default,,0000,0000,0000,,that the textbook of medicine is closed.
Dialogue: 0,0:03:39.16,0:03:41.66,Default,,0000,0000,0000,,We start to measure\Nthe quality of our health care
Dialogue: 0,0:03:41.68,0:03:44.22,Default,,0000,0000,0000,,by how quickly we can access it.
Dialogue: 0,0:03:44.24,0:03:46.34,Default,,0000,0000,0000,,It doesn't surprise me\Nthat in this climate,
Dialogue: 0,0:03:46.36,0:03:49.18,Default,,0000,0000,0000,,many of our institutions\Nfor the provision of health care
Dialogue: 0,0:03:49.20,0:03:51.70,Default,,0000,0000,0000,,start to look a heck of a lot\Nlike Jiffy Lube.
Dialogue: 0,0:03:51.72,0:03:54.30,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:03:54.32,0:03:58.26,Default,,0000,0000,0000,,The only problem is that\Nwhen I graduated from medical school,
Dialogue: 0,0:03:58.28,0:04:00.34,Default,,0000,0000,0000,,I didn't get one of those\Nlittle doohickeys
Dialogue: 0,0:04:00.36,0:04:02.74,Default,,0000,0000,0000,,that your mechanic\Nhas to plug into your car
Dialogue: 0,0:04:02.76,0:04:05.14,Default,,0000,0000,0000,,and find out exactly what's wrong with it,
Dialogue: 0,0:04:05.16,0:04:07.26,Default,,0000,0000,0000,,because the textbook of medicine
Dialogue: 0,0:04:07.28,0:04:08.80,Default,,0000,0000,0000,,is not closed.
Dialogue: 0,0:04:09.32,0:04:11.16,Default,,0000,0000,0000,,Medicine is science.
Dialogue: 0,0:04:11.56,0:04:14.24,Default,,0000,0000,0000,,Medicine is knowledge in process.
Dialogue: 0,0:04:15.28,0:04:16.66,Default,,0000,0000,0000,,We make an observation,
Dialogue: 0,0:04:16.68,0:04:18.82,Default,,0000,0000,0000,,we guess an explanation\Nof that observation,
Dialogue: 0,0:04:18.84,0:04:21.46,Default,,0000,0000,0000,,and then we make a prediction\Nthat we can test.
Dialogue: 0,0:04:21.48,0:04:25.06,Default,,0000,0000,0000,,Now, the testing ground\Nof most predictions in medicine
Dialogue: 0,0:04:25.08,0:04:26.62,Default,,0000,0000,0000,,is populations,
Dialogue: 0,0:04:26.64,0:04:30.22,Default,,0000,0000,0000,,and you may remember\Nfrom those boring days in biology class
Dialogue: 0,0:04:30.24,0:04:32.42,Default,,0000,0000,0000,,that populations tend to distribute
Dialogue: 0,0:04:32.44,0:04:33.66,Default,,0000,0000,0000,,around a mean
Dialogue: 0,0:04:33.68,0:04:35.54,Default,,0000,0000,0000,,as a Gaussian or a normal curve.
Dialogue: 0,0:04:35.56,0:04:37.22,Default,,0000,0000,0000,,Therefore, in medicine,
Dialogue: 0,0:04:37.24,0:04:40.46,Default,,0000,0000,0000,,after we make a prediction\Nfrom a guessed explanation,
Dialogue: 0,0:04:40.48,0:04:42.36,Default,,0000,0000,0000,,we test it in a population.
Dialogue: 0,0:04:43.32,0:04:46.26,Default,,0000,0000,0000,,That means that what we know in medicine,
Dialogue: 0,0:04:46.28,0:04:48.54,Default,,0000,0000,0000,,our knowledge and our know-how,
Dialogue: 0,0:04:48.56,0:04:50.82,Default,,0000,0000,0000,,comes from populations,
Dialogue: 0,0:04:50.84,0:04:53.62,Default,,0000,0000,0000,,but extends only as far
Dialogue: 0,0:04:53.64,0:04:55.38,Default,,0000,0000,0000,,as the next outlier,
Dialogue: 0,0:04:55.40,0:04:56.62,Default,,0000,0000,0000,,the next exception,
Dialogue: 0,0:04:56.64,0:04:58.38,Default,,0000,0000,0000,,which, like Jupiter's moons,
Dialogue: 0,0:04:58.40,0:05:00.80,Default,,0000,0000,0000,,will teach us what we don't actually know.
Dialogue: 0,0:05:02.08,0:05:03.42,Default,,0000,0000,0000,,Now, I am a surgeon
Dialogue: 0,0:05:03.44,0:05:05.86,Default,,0000,0000,0000,,who looks after patients with sarcoma.
Dialogue: 0,0:05:05.88,0:05:08.08,Default,,0000,0000,0000,,Sarcoma is a very rare form of cancer.
Dialogue: 0,0:05:08.72,0:05:10.76,Default,,0000,0000,0000,,It's the cancer of flesh and bones.
Dialogue: 0,0:05:11.24,0:05:15.58,Default,,0000,0000,0000,,And I would tell you that every one\Nof my patients is an outlier,
Dialogue: 0,0:05:15.60,0:05:16.80,Default,,0000,0000,0000,,is an exception.
Dialogue: 0,0:05:18.00,0:05:21.22,Default,,0000,0000,0000,,There is no surgery I have ever performed\Nfor a sarcoma patient
Dialogue: 0,0:05:21.24,0:05:25.50,Default,,0000,0000,0000,,that has ever been guided\Nby a randomized controlled clinical trial,
Dialogue: 0,0:05:25.52,0:05:29.24,Default,,0000,0000,0000,,what we consider the best kind\Nof population-based evidence in medicine.
Dialogue: 0,0:05:30.40,0:05:32.70,Default,,0000,0000,0000,,People talk about thinking\Noutside the box,
Dialogue: 0,0:05:32.72,0:05:35.46,Default,,0000,0000,0000,,but we don't even have a box in sarcoma.
Dialogue: 0,0:05:35.48,0:05:38.82,Default,,0000,0000,0000,,What we do have as we take\Na bath in the uncertainty
Dialogue: 0,0:05:38.84,0:05:42.98,Default,,0000,0000,0000,,and unknowns and exceptions\Nand outliers that surround us in sarcoma
Dialogue: 0,0:05:43.00,0:05:47.54,Default,,0000,0000,0000,,is easy access to what I think\Nare those two most important values
Dialogue: 0,0:05:47.56,0:05:49.10,Default,,0000,0000,0000,,for any science:
Dialogue: 0,0:05:49.12,0:05:51.32,Default,,0000,0000,0000,,humility and curiosity.
Dialogue: 0,0:05:52.00,0:05:54.30,Default,,0000,0000,0000,,Because if I am humble and curious,
Dialogue: 0,0:05:54.32,0:05:56.62,Default,,0000,0000,0000,,when a patient asks me a question,
Dialogue: 0,0:05:56.64,0:05:58.08,Default,,0000,0000,0000,,and I don't know the answer,
Dialogue: 0,0:05:58.92,0:06:00.14,Default,,0000,0000,0000,,I'll ask a colleague
Dialogue: 0,0:06:00.16,0:06:03.18,Default,,0000,0000,0000,,who may have a similar\Nalbeit distinct patient with sarcoma.
Dialogue: 0,0:06:03.20,0:06:05.90,Default,,0000,0000,0000,,We'll even establish\Ninternational collaborations.
Dialogue: 0,0:06:05.92,0:06:09.06,Default,,0000,0000,0000,,Those patients will start\Nto talk to each other through chat rooms
Dialogue: 0,0:06:09.08,0:06:10.28,Default,,0000,0000,0000,,and support groups.
Dialogue: 0,0:06:10.80,0:06:14.38,Default,,0000,0000,0000,,It's through this kind\Nof humbly curious communication
Dialogue: 0,0:06:14.40,0:06:17.96,Default,,0000,0000,0000,,that we begin to try and learn new things.
Dialogue: 0,0:06:19.24,0:06:21.30,Default,,0000,0000,0000,,As an example, this is a patient of mine
Dialogue: 0,0:06:21.32,0:06:23.00,Default,,0000,0000,0000,,who had a cancer near his knee.
Dialogue: 0,0:06:23.48,0:06:25.86,Default,,0000,0000,0000,,Because of humbly curious communication
Dialogue: 0,0:06:25.88,0:06:27.98,Default,,0000,0000,0000,,in international collaborations,
Dialogue: 0,0:06:28.00,0:06:32.54,Default,,0000,0000,0000,,we have learned that we can repurpose\Nthe ankle to serve as the knee
Dialogue: 0,0:06:32.56,0:06:34.82,Default,,0000,0000,0000,,when we have to remove the knee\Nwith the cancer.
Dialogue: 0,0:06:34.84,0:06:37.68,Default,,0000,0000,0000,,He can then wear a prosthetic\Nand run and jump and play.
Dialogue: 0,0:06:38.36,0:06:41.38,Default,,0000,0000,0000,,This opportunity was available to him
Dialogue: 0,0:06:41.40,0:06:44.18,Default,,0000,0000,0000,,because of international collaborations.
Dialogue: 0,0:06:44.20,0:06:45.90,Default,,0000,0000,0000,,It was desirable to him
Dialogue: 0,0:06:45.92,0:06:48.88,Default,,0000,0000,0000,,because he had contacted other patients\Nwho had experienced it.
Dialogue: 0,0:06:49.92,0:06:53.98,Default,,0000,0000,0000,,And so exceptions and outliers in medicine
Dialogue: 0,0:06:54.00,0:06:57.96,Default,,0000,0000,0000,,teach us what we don't know,\Nbut also lead us to new thinking.
Dialogue: 0,0:06:59.08,0:07:00.94,Default,,0000,0000,0000,,Now, very importantly,
Dialogue: 0,0:07:00.96,0:07:04.82,Default,,0000,0000,0000,,all the new thinking that outliers\Nand exceptions lead us to in medicine
Dialogue: 0,0:07:04.84,0:07:08.20,Default,,0000,0000,0000,,does not only apply\Nto the outliers and exceptions.
Dialogue: 0,0:07:08.92,0:07:12.10,Default,,0000,0000,0000,,It is not that we only learn\Nfrom sarcoma patients
Dialogue: 0,0:07:12.12,0:07:14.08,Default,,0000,0000,0000,,ways to manage sarcoma patients.
Dialogue: 0,0:07:14.92,0:07:16.98,Default,,0000,0000,0000,,Sometimes, the outliers
Dialogue: 0,0:07:17.00,0:07:18.70,Default,,0000,0000,0000,,and the exceptions
Dialogue: 0,0:07:18.72,0:07:21.96,Default,,0000,0000,0000,,teach us things that matter quite a lot\Nto the general population.
Dialogue: 0,0:07:23.36,0:07:25.22,Default,,0000,0000,0000,,Like a tree standing outside a forest,
Dialogue: 0,0:07:25.24,0:07:29.26,Default,,0000,0000,0000,,the outliers and the exceptions\Ndraw our attention
Dialogue: 0,0:07:29.28,0:07:33.62,Default,,0000,0000,0000,,and lead us into a much greater sense\Nof perhaps what a tree is.
Dialogue: 0,0:07:33.64,0:07:36.14,Default,,0000,0000,0000,,We often talk about\Nlosing the forests for the trees,
Dialogue: 0,0:07:36.16,0:07:37.98,Default,,0000,0000,0000,,but one also loses a tree
Dialogue: 0,0:07:38.00,0:07:39.52,Default,,0000,0000,0000,,within a forest.
Dialogue: 0,0:07:41.00,0:07:42.86,Default,,0000,0000,0000,,But the tree that stands out by itself
Dialogue: 0,0:07:42.88,0:07:45.78,Default,,0000,0000,0000,,makes those relationships\Nthat define a tree,
Dialogue: 0,0:07:45.80,0:07:49.62,Default,,0000,0000,0000,,the relationships between trunk\Nand roots and branches,
Dialogue: 0,0:07:49.64,0:07:50.88,Default,,0000,0000,0000,,much more apparent.
Dialogue: 0,0:07:51.36,0:07:53.06,Default,,0000,0000,0000,,Even if that tree is crooked
Dialogue: 0,0:07:53.08,0:07:56.06,Default,,0000,0000,0000,,or even if that tree\Nhas very unusual relationships
Dialogue: 0,0:07:56.08,0:07:58.38,Default,,0000,0000,0000,,between trunk and roots and branches,
Dialogue: 0,0:07:58.40,0:08:01.10,Default,,0000,0000,0000,,it nonetheless draws our attention
Dialogue: 0,0:08:01.12,0:08:03.02,Default,,0000,0000,0000,,and allows us to make observations
Dialogue: 0,0:08:03.04,0:08:05.28,Default,,0000,0000,0000,,that we can then test\Nin the general population.
Dialogue: 0,0:08:06.00,0:08:07.98,Default,,0000,0000,0000,,I told you that sarcomas are rare.
Dialogue: 0,0:08:08.00,0:08:10.64,Default,,0000,0000,0000,,They make up about one percent\Nof all cancers.
Dialogue: 0,0:08:11.28,0:08:15.24,Default,,0000,0000,0000,,You also probably know that cancer\Nis considered a genetic disease.
Dialogue: 0,0:08:15.84,0:08:19.18,Default,,0000,0000,0000,,By genetic disease we mean\Nthat cancer is caused by oncogenes
Dialogue: 0,0:08:19.20,0:08:20.58,Default,,0000,0000,0000,,that are turned on in cancer
Dialogue: 0,0:08:20.60,0:08:23.64,Default,,0000,0000,0000,,and tumor suppressor genes\Nthat are turned off to cause cancer.
Dialogue: 0,0:08:24.16,0:08:26.58,Default,,0000,0000,0000,,You might think\Nthat we learned about oncogenes
Dialogue: 0,0:08:26.60,0:08:28.82,Default,,0000,0000,0000,,and tumor suppressor genes\Nfrom common cancers
Dialogue: 0,0:08:28.84,0:08:30.82,Default,,0000,0000,0000,,like breast cancer and prostate cancer
Dialogue: 0,0:08:30.84,0:08:32.34,Default,,0000,0000,0000,,and lung cancer,
Dialogue: 0,0:08:32.36,0:08:33.56,Default,,0000,0000,0000,,but you'd be wrong.
Dialogue: 0,0:08:34.00,0:08:36.90,Default,,0000,0000,0000,,We learned about oncogenes\Nand tumor suppressor genes
Dialogue: 0,0:08:36.92,0:08:38.14,Default,,0000,0000,0000,,for the first time
Dialogue: 0,0:08:38.16,0:08:41.60,Default,,0000,0000,0000,,in that itty-bitty little one percent\Nof cancers called sarcoma.
Dialogue: 0,0:08:42.76,0:08:45.34,Default,,0000,0000,0000,,In 1966, Peyton Rous got the Nobel Prize
Dialogue: 0,0:08:45.36,0:08:47.38,Default,,0000,0000,0000,,for realizing that chickens
Dialogue: 0,0:08:47.40,0:08:50.52,Default,,0000,0000,0000,,had a transmissible form of sarcoma.
Dialogue: 0,0:08:51.32,0:08:54.10,Default,,0000,0000,0000,,30 years later, Harold Varmus\Nand Mike Bishop discovered
Dialogue: 0,0:08:54.12,0:08:56.66,Default,,0000,0000,0000,,what that transmissible element was.
Dialogue: 0,0:08:56.68,0:08:58.26,Default,,0000,0000,0000,,It was a virus
Dialogue: 0,0:08:58.28,0:08:59.70,Default,,0000,0000,0000,,carrying a gene,
Dialogue: 0,0:08:59.72,0:09:01.16,Default,,0000,0000,0000,,the src oncogene.
Dialogue: 0,0:09:01.88,0:09:05.54,Default,,0000,0000,0000,,Now, I will not tell you\Nthat src is the most important oncogene.
Dialogue: 0,0:09:05.56,0:09:06.78,Default,,0000,0000,0000,,I will not tell you
Dialogue: 0,0:09:06.80,0:09:10.30,Default,,0000,0000,0000,,that src is the most frequently\Nturned on oncogene in all of cancer.
Dialogue: 0,0:09:10.32,0:09:12.76,Default,,0000,0000,0000,,But it was the first oncogene.
Dialogue: 0,0:09:13.96,0:09:16.30,Default,,0000,0000,0000,,The exception, the outlier
Dialogue: 0,0:09:16.32,0:09:18.84,Default,,0000,0000,0000,,drew our attention and led us to something
Dialogue: 0,0:09:19.52,0:09:23.56,Default,,0000,0000,0000,,that taught us very important things\Nabout the rest of biology.
Dialogue: 0,0:09:24.88,0:09:28.98,Default,,0000,0000,0000,,Now, TP53 is the most important\Ntumor suppressor gene.
Dialogue: 0,0:09:29.00,0:09:31.74,Default,,0000,0000,0000,,It is the most frequently turned off\Ntumor suppressor gene
Dialogue: 0,0:09:31.76,0:09:33.56,Default,,0000,0000,0000,,in almost every kind of cancer,
Dialogue: 0,0:09:34.36,0:09:36.66,Default,,0000,0000,0000,,but we didn't learn about it\Nfrom common cancers.
Dialogue: 0,0:09:36.68,0:09:39.10,Default,,0000,0000,0000,,We learned about it\Nwhen doctors Li and Fraumeni
Dialogue: 0,0:09:39.12,0:09:40.70,Default,,0000,0000,0000,,were looking at families
Dialogue: 0,0:09:40.72,0:09:42.74,Default,,0000,0000,0000,,and they realized that these families
Dialogue: 0,0:09:42.76,0:09:45.28,Default,,0000,0000,0000,,had way too many sarcomas.
Dialogue: 0,0:09:45.92,0:09:47.70,Default,,0000,0000,0000,,I told you that sarcoma is rare.
Dialogue: 0,0:09:47.72,0:09:50.90,Default,,0000,0000,0000,,Remember that a one\Nin a million diagnosis,
Dialogue: 0,0:09:50.92,0:09:53.06,Default,,0000,0000,0000,,if it happens twice in one family,
Dialogue: 0,0:09:53.08,0:09:55.48,Default,,0000,0000,0000,,is way too common in that family.
Dialogue: 0,0:09:56.64,0:09:59.34,Default,,0000,0000,0000,,The very fact that these are rare
Dialogue: 0,0:09:59.36,0:10:00.80,Default,,0000,0000,0000,,draws our attention
Dialogue: 0,0:10:01.76,0:10:04.00,Default,,0000,0000,0000,,and leads us to new kinds of thinking.
Dialogue: 0,0:10:05.48,0:10:06.94,Default,,0000,0000,0000,,Now, many of you may say,
Dialogue: 0,0:10:06.96,0:10:08.50,Default,,0000,0000,0000,,and may rightly say,
Dialogue: 0,0:10:08.52,0:10:10.42,Default,,0000,0000,0000,,that yeah, Kevin, that's great,
Dialogue: 0,0:10:10.44,0:10:12.50,Default,,0000,0000,0000,,but you're not talking\Nabout a bird's wing.
Dialogue: 0,0:10:12.52,0:10:16.00,Default,,0000,0000,0000,,You're not talking about moons\Nfloating around some planet Jupiter.
Dialogue: 0,0:10:16.52,0:10:18.06,Default,,0000,0000,0000,,This is a person.
Dialogue: 0,0:10:18.08,0:10:21.34,Default,,0000,0000,0000,,This outlier, this exception,\Nmay lead to the advancement of science,
Dialogue: 0,0:10:21.36,0:10:22.56,Default,,0000,0000,0000,,but this is a person.
Dialogue: 0,0:10:24.28,0:10:25.90,Default,,0000,0000,0000,,And all I can say
Dialogue: 0,0:10:25.92,0:10:28.28,Default,,0000,0000,0000,,is that I know that all too well.
Dialogue: 0,0:10:29.76,0:10:33.16,Default,,0000,0000,0000,,I have conversations with these patients\Nwith rare and deadly diseases.
Dialogue: 0,0:10:33.80,0:10:35.74,Default,,0000,0000,0000,,I write about these conversations.
Dialogue: 0,0:10:35.76,0:10:38.06,Default,,0000,0000,0000,,These conversations are terribly fraught.
Dialogue: 0,0:10:38.08,0:10:39.90,Default,,0000,0000,0000,,They're fraught with horrible phrases
Dialogue: 0,0:10:39.92,0:10:43.16,Default,,0000,0000,0000,,like "I have bad news"\Nor "there's nothing more we can do."
Dialogue: 0,0:10:43.76,0:10:46.96,Default,,0000,0000,0000,,Sometimes these conversations\Nturn on a single word:
Dialogue: 0,0:10:47.76,0:10:48.96,Default,,0000,0000,0000,,"terminal."
Dialogue: 0,0:10:52.92,0:10:55.84,Default,,0000,0000,0000,,Silence can also be rather uncomfortable.
Dialogue: 0,0:10:57.36,0:10:59.94,Default,,0000,0000,0000,,Where the blanks are in medicine
Dialogue: 0,0:10:59.96,0:11:01.82,Default,,0000,0000,0000,,can be just as important
Dialogue: 0,0:11:01.84,0:11:04.08,Default,,0000,0000,0000,,as the words that we use\Nin these conversations.
Dialogue: 0,0:11:05.08,0:11:06.62,Default,,0000,0000,0000,,What are the unknowns?
Dialogue: 0,0:11:06.64,0:11:08.84,Default,,0000,0000,0000,,What are the experiments\Nthat are being done?
Dialogue: 0,0:11:09.68,0:11:11.38,Default,,0000,0000,0000,,Do this little exercise with me.
Dialogue: 0,0:11:11.40,0:11:14.62,Default,,0000,0000,0000,,Up there on the screen,\Nyou see this phrase, "no where."
Dialogue: 0,0:11:14.64,0:11:15.92,Default,,0000,0000,0000,,Notice where the blank is.
Dialogue: 0,0:11:16.68,0:11:19.88,Default,,0000,0000,0000,,If we move that blank one space over
Dialogue: 0,0:11:20.64,0:11:22.22,Default,,0000,0000,0000,,"no where"
Dialogue: 0,0:11:22.24,0:11:24.94,Default,,0000,0000,0000,,becomes "now here,"
Dialogue: 0,0:11:24.96,0:11:26.86,Default,,0000,0000,0000,,the exact opposite meaning,
Dialogue: 0,0:11:26.88,0:11:29.08,Default,,0000,0000,0000,,just by shifting the blank one space over.
Dialogue: 0,0:11:31.68,0:11:33.26,Default,,0000,0000,0000,,I'll never forget the night
Dialogue: 0,0:11:33.28,0:11:35.52,Default,,0000,0000,0000,,that I walked into\None of my patients' rooms.
Dialogue: 0,0:11:36.28,0:11:37.94,Default,,0000,0000,0000,,I had been operating long that day
Dialogue: 0,0:11:37.96,0:11:39.98,Default,,0000,0000,0000,,but I still wanted to come and see him.
Dialogue: 0,0:11:40.00,0:11:43.20,Default,,0000,0000,0000,,He was a boy I had diagnosed\Nwith a bone cancer a few days before.
Dialogue: 0,0:11:43.84,0:11:46.90,Default,,0000,0000,0000,,He and his mother had been meeting\Nwith the chemotherapy doctors
Dialogue: 0,0:11:46.92,0:11:48.14,Default,,0000,0000,0000,,earlier that day
Dialogue: 0,0:11:48.16,0:11:51.14,Default,,0000,0000,0000,,and he had been admitted\Nto the hospital to begin chemotherapy.
Dialogue: 0,0:11:51.16,0:11:53.34,Default,,0000,0000,0000,,It was almost midnight\Nwhen I got to his room.
Dialogue: 0,0:11:53.36,0:11:55.54,Default,,0000,0000,0000,,He was asleep, but I found his mother
Dialogue: 0,0:11:55.56,0:11:57.14,Default,,0000,0000,0000,,reading by flashlight
Dialogue: 0,0:11:57.16,0:11:58.62,Default,,0000,0000,0000,,next to his bed.
Dialogue: 0,0:11:58.64,0:12:01.44,Default,,0000,0000,0000,,She came out in the hall\Nto chat with me for a few minutes.
Dialogue: 0,0:12:02.28,0:12:04.38,Default,,0000,0000,0000,,It turned out that\Nwhat she had been reading
Dialogue: 0,0:12:04.40,0:12:06.58,Default,,0000,0000,0000,,was the protocol\Nthat the chemotherapy doctors
Dialogue: 0,0:12:06.60,0:12:07.84,Default,,0000,0000,0000,,had given her that day.
Dialogue: 0,0:12:08.20,0:12:09.44,Default,,0000,0000,0000,,She had memorized it.
Dialogue: 0,0:12:11.20,0:12:14.74,Default,,0000,0000,0000,,She said, "Doctor Jones, you told me
Dialogue: 0,0:12:14.76,0:12:16.94,Default,,0000,0000,0000,,that we don't always win
Dialogue: 0,0:12:16.96,0:12:18.24,Default,,0000,0000,0000,,with this type of cancer,
Dialogue: 0,0:12:19.68,0:12:23.16,Default,,0000,0000,0000,,but I've been studying this protocol,\Nand I think I can do it.
Dialogue: 0,0:12:23.96,0:12:27.54,Default,,0000,0000,0000,,I think I can comply\Nwith these very difficult treatments.
Dialogue: 0,0:12:27.56,0:12:30.54,Default,,0000,0000,0000,,I'm going to quit my job.\NI'm going to move in with my parents.
Dialogue: 0,0:12:30.56,0:12:32.52,Default,,0000,0000,0000,,I'm going to keep my baby safe."
Dialogue: 0,0:12:35.32,0:12:36.52,Default,,0000,0000,0000,,I didn't tell her.
Dialogue: 0,0:12:37.84,0:12:40.76,Default,,0000,0000,0000,,I didn't stop to correct her thinking.
Dialogue: 0,0:12:41.68,0:12:43.94,Default,,0000,0000,0000,,She was trusting in a protocol
Dialogue: 0,0:12:43.96,0:12:47.18,Default,,0000,0000,0000,,that even if complied with,
Dialogue: 0,0:12:47.20,0:12:49.60,Default,,0000,0000,0000,,wouldn't necessarily save her son.
Dialogue: 0,0:12:51.96,0:12:53.16,Default,,0000,0000,0000,,I didn't tell her.
Dialogue: 0,0:12:54.36,0:12:55.76,Default,,0000,0000,0000,,I didn't fill in that blank.
Dialogue: 0,0:12:57.08,0:12:59.06,Default,,0000,0000,0000,,But a year and a half later
Dialogue: 0,0:12:59.08,0:13:01.80,Default,,0000,0000,0000,,her boy nonetheless died of his cancer.
Dialogue: 0,0:13:03.40,0:13:04.72,Default,,0000,0000,0000,,Should I have told her?
Dialogue: 0,0:13:05.36,0:13:07.62,Default,,0000,0000,0000,,Now, many of you may say, "So what?
Dialogue: 0,0:13:07.64,0:13:08.90,Default,,0000,0000,0000,,I don't have sarcoma.
Dialogue: 0,0:13:08.92,0:13:10.82,Default,,0000,0000,0000,,No one in my family has sarcoma.
Dialogue: 0,0:13:10.84,0:13:12.30,Default,,0000,0000,0000,,And this is all fine and well,
Dialogue: 0,0:13:12.32,0:13:15.02,Default,,0000,0000,0000,,but it probably doesn't\Nmatter in my life."
Dialogue: 0,0:13:15.04,0:13:16.30,Default,,0000,0000,0000,,And you're probably right.
Dialogue: 0,0:13:16.32,0:13:19.00,Default,,0000,0000,0000,,Sarcoma may not matter\Na whole lot in your life.
Dialogue: 0,0:13:21.04,0:13:23.38,Default,,0000,0000,0000,,But where the blanks are in medicine
Dialogue: 0,0:13:23.40,0:13:24.72,Default,,0000,0000,0000,,does matter in your life.
Dialogue: 0,0:13:26.52,0:13:28.82,Default,,0000,0000,0000,,I didn't tell you one dirty little secret.
Dialogue: 0,0:13:28.84,0:13:33.22,Default,,0000,0000,0000,,I told you that in medicine,\Nwe test predictions in populations,
Dialogue: 0,0:13:33.24,0:13:34.50,Default,,0000,0000,0000,,but I didn't tell you,
Dialogue: 0,0:13:34.52,0:13:36.74,Default,,0000,0000,0000,,and so often medicine never tells you
Dialogue: 0,0:13:36.76,0:13:39.62,Default,,0000,0000,0000,,that every time an individual
Dialogue: 0,0:13:39.64,0:13:41.74,Default,,0000,0000,0000,,encounters medicine,
Dialogue: 0,0:13:41.76,0:13:45.80,Default,,0000,0000,0000,,even if that individual is firmly\Nembedded in the general population,
Dialogue: 0,0:13:47.36,0:13:49.74,Default,,0000,0000,0000,,neither the individual\Nnor the physician knows
Dialogue: 0,0:13:49.76,0:13:52.44,Default,,0000,0000,0000,,where in that population\Nthe individual will land.
Dialogue: 0,0:13:53.04,0:13:55.74,Default,,0000,0000,0000,,Therefore, every encounter with medicine
Dialogue: 0,0:13:55.76,0:13:57.20,Default,,0000,0000,0000,,is an experiment.
Dialogue: 0,0:13:57.92,0:13:59.94,Default,,0000,0000,0000,,You will be a subject
Dialogue: 0,0:13:59.96,0:14:01.64,Default,,0000,0000,0000,,in an experiment.
Dialogue: 0,0:14:02.56,0:14:07.40,Default,,0000,0000,0000,,And the outcome will be either\Na better or a worse result for you.
Dialogue: 0,0:14:08.32,0:14:10.34,Default,,0000,0000,0000,,As long as medicine works well,
Dialogue: 0,0:14:10.36,0:14:13.38,Default,,0000,0000,0000,,we're fine with fast service,
Dialogue: 0,0:14:13.40,0:14:16.84,Default,,0000,0000,0000,,bravado, brimmingly\Nconfident conversations,
Dialogue: 0,0:14:17.72,0:14:19.38,Default,,0000,0000,0000,,but when things don't work well,
Dialogue: 0,0:14:19.40,0:14:21.24,Default,,0000,0000,0000,,sometimes we want something different.
Dialogue: 0,0:14:22.52,0:14:25.80,Default,,0000,0000,0000,,A colleague of mine\Nremoved a tumor from a patient's limb.
Dialogue: 0,0:14:26.92,0:14:28.74,Default,,0000,0000,0000,,He was concerned about this tumor.
Dialogue: 0,0:14:28.76,0:14:31.78,Default,,0000,0000,0000,,In our physician conferences,\Nhe talked about his concern
Dialogue: 0,0:14:31.80,0:14:33.22,Default,,0000,0000,0000,,that this was a type of tumor
Dialogue: 0,0:14:33.24,0:14:35.80,Default,,0000,0000,0000,,that had a high risk\Nfor coming back in the same limb.
Dialogue: 0,0:14:36.68,0:14:38.66,Default,,0000,0000,0000,,But his conversations with the patient
Dialogue: 0,0:14:38.68,0:14:40.78,Default,,0000,0000,0000,,were exactly what a patient might want:
Dialogue: 0,0:14:40.80,0:14:42.06,Default,,0000,0000,0000,,brimming with confidence.
Dialogue: 0,0:14:42.08,0:14:45.10,Default,,0000,0000,0000,,He said, "I got it all\Nand you're good to go."
Dialogue: 0,0:14:45.12,0:14:46.86,Default,,0000,0000,0000,,She and her husband were thrilled.
Dialogue: 0,0:14:46.88,0:14:50.96,Default,,0000,0000,0000,,They went out, celebrated, fancy dinner,\Nopened a bottle of champagne.
Dialogue: 0,0:14:52.04,0:14:54.34,Default,,0000,0000,0000,,The only problem was a few weeks later,
Dialogue: 0,0:14:54.36,0:14:57.46,Default,,0000,0000,0000,,she started to notice\Nanother nodule in the same area.
Dialogue: 0,0:14:57.48,0:15:01.62,Default,,0000,0000,0000,,It turned out he hadn't gotten it all\Nand she wasn't good to go.
Dialogue: 0,0:15:01.64,0:15:04.48,Default,,0000,0000,0000,,But what happened at this juncture\Nabsolutely fascinates me.
Dialogue: 0,0:15:05.20,0:15:06.82,Default,,0000,0000,0000,,My colleague came to me and said,
Dialogue: 0,0:15:06.84,0:15:09.56,Default,,0000,0000,0000,,"Kevin, would you mind\Nlooking after this patient for me?"
Dialogue: 0,0:15:10.24,0:15:13.46,Default,,0000,0000,0000,,I said, "Why, you know the right thing\Nto do as well as I do.
Dialogue: 0,0:15:13.48,0:15:15.10,Default,,0000,0000,0000,,You haven't done anything wrong."
Dialogue: 0,0:15:15.12,0:15:19.60,Default,,0000,0000,0000,,He said, "Please, just look\Nafter this patient for me."
Dialogue: 0,0:15:21.20,0:15:22.74,Default,,0000,0000,0000,,He was embarrassed --
Dialogue: 0,0:15:22.76,0:15:24.16,Default,,0000,0000,0000,,not by what he had done,
Dialogue: 0,0:15:25.15,0:15:27.04,Default,,0000,0000,0000,,but by the conversation that he had had,
Dialogue: 0,0:15:27.76,0:15:29.20,Default,,0000,0000,0000,,by the overconfidence.
Dialogue: 0,0:15:30.60,0:15:33.22,Default,,0000,0000,0000,,So I performed\Na much more invasive surgery
Dialogue: 0,0:15:33.24,0:15:36.38,Default,,0000,0000,0000,,and had a very different conversation\Nwith the patient afterwards.
Dialogue: 0,0:15:36.40,0:15:38.74,Default,,0000,0000,0000,,I said, "Most likely I've gotten it all
Dialogue: 0,0:15:38.76,0:15:41.18,Default,,0000,0000,0000,,and you're most likely good to go,
Dialogue: 0,0:15:41.20,0:15:44.36,Default,,0000,0000,0000,,but this is the experiment\Nthat we're doing.
Dialogue: 0,0:15:45.04,0:15:47.06,Default,,0000,0000,0000,,This is what you're going to watch for.
Dialogue: 0,0:15:47.08,0:15:48.98,Default,,0000,0000,0000,,This is what I'm going to watch for.
Dialogue: 0,0:15:49.00,0:15:52.94,Default,,0000,0000,0000,,And we're going to work together\Nto find out if this surgery will work
Dialogue: 0,0:15:52.96,0:15:54.28,Default,,0000,0000,0000,,to get rid of your cancer."
Dialogue: 0,0:15:54.92,0:15:56.86,Default,,0000,0000,0000,,I can guarantee you, she and her husband
Dialogue: 0,0:15:56.88,0:15:59.80,Default,,0000,0000,0000,,did not crack another bottle of champagne\Nafter talking to me.
Dialogue: 0,0:16:01.60,0:16:04.46,Default,,0000,0000,0000,,But she was now a scientist,
Dialogue: 0,0:16:04.48,0:16:07.84,Default,,0000,0000,0000,,not only a subject in her experiment.
Dialogue: 0,0:16:09.96,0:16:11.58,Default,,0000,0000,0000,,And so I encourage you
Dialogue: 0,0:16:11.60,0:16:15.06,Default,,0000,0000,0000,,to seek humility and curiosity
Dialogue: 0,0:16:15.08,0:16:16.28,Default,,0000,0000,0000,,in your physicians.
Dialogue: 0,0:16:16.76,0:16:19.74,Default,,0000,0000,0000,,Almost 20 billion times each year,
Dialogue: 0,0:16:19.76,0:16:23.70,Default,,0000,0000,0000,,a person walks into a doctor's office,
Dialogue: 0,0:16:23.72,0:16:26.00,Default,,0000,0000,0000,,and that person becomes a patient.
Dialogue: 0,0:16:27.32,0:16:30.84,Default,,0000,0000,0000,,You or someone you love\Nwill be that patient sometime very soon.
Dialogue: 0,0:16:31.84,0:16:33.48,Default,,0000,0000,0000,,How will you talk to your doctors?
Dialogue: 0,0:16:34.64,0:16:35.84,Default,,0000,0000,0000,,What will you tell them?
Dialogue: 0,0:16:36.76,0:16:38.28,Default,,0000,0000,0000,,What will they tell you?
Dialogue: 0,0:16:40.60,0:16:42.82,Default,,0000,0000,0000,,They cannot tell you
Dialogue: 0,0:16:42.84,0:16:44.36,Default,,0000,0000,0000,,what they do not know,
Dialogue: 0,0:16:45.56,0:16:49.12,Default,,0000,0000,0000,,but they can tell you when they don't know
Dialogue: 0,0:16:50.28,0:16:51.64,Default,,0000,0000,0000,,if only you'll ask.
Dialogue: 0,0:16:52.16,0:16:55.00,Default,,0000,0000,0000,,So please, join the conversation.
Dialogue: 0,0:16:56.20,0:16:57.42,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:16:57.44,0:16:59.08,Default,,0000,0000,0000,,(Applause)