0:00:00.649,0:00:04.944
I want to talk to you[br]about the future of medicine,

0:00:04.944,0:00:09.077
but before I do that, I want to talk[br]a little bit about the past.

0:00:09.077,0:00:12.700
Now, throughout much[br]of the recent history of medicine,

0:00:12.700,0:00:15.857
we've thought about illness and treatment

0:00:15.857,0:00:19.967
in terms of a profoundly simple model.

0:00:19.967,0:00:22.684
In fact, the model is so simple

0:00:22.684,0:00:25.656
that you could summarize it in six words:

0:00:25.656,0:00:31.043
have disease, take pill, kill something.

0:00:31.043,0:00:35.338
Now, the reason for[br]the dominance of this model

0:00:35.338,0:00:38.473
is of course the antibiotic revolution.

0:00:38.473,0:00:41.677
Many of you might not know this,[br]but we happen to be celebrating

0:00:41.677,0:00:45.508
the hundredth year of the introduction[br]of antibiotics into the United States,

0:00:45.508,0:00:47.226
but what you do know

0:00:47.226,0:00:52.311
is that that introduction[br]was nothing short of transformative.

0:00:52.311,0:00:56.746
Here you had a chemical,[br]either from the natural world

0:00:56.746,0:00:59.509
or artificially synthesized[br]in the laboratory,

0:00:59.509,0:01:02.806
and it would course through your body,

0:01:02.806,0:01:05.592
it would find its target,

0:01:05.592,0:01:07.404
lock into its target --

0:01:07.404,0:01:09.516
a microbe or some part of a microbe --

0:01:09.516,0:01:12.465
and then turn off a lock and a key

0:01:12.465,0:01:17.527
with exquisite deftness,[br]exquisite specificity,

0:01:17.527,0:01:21.823
and you would end up taking[br]a previously fatal, lethal disease,

0:01:21.823,0:01:24.493
a pneumonia, syphilis, tuberculosis,

0:01:24.493,0:01:30.181
and transforming that into a curable,[br]or treatable illness.

0:01:30.181,0:01:32.805
You have a pneumonia,[br]you take penicillin,

0:01:32.805,0:01:35.426
you kill the microbe,

0:01:35.426,0:01:37.585
and you cure the disease.

0:01:37.585,0:01:40.719
So seductive was this idea,

0:01:40.719,0:01:44.527
so potent the metaphor of lock and key

0:01:44.527,0:01:46.315
and killing something,

0:01:46.315,0:01:48.916
that it really swept through biology.

0:01:48.916,0:01:51.888
It was a transformation like no other,

0:01:51.888,0:01:55.440
and we've really spent the last 100 years

0:01:55.440,0:01:58.598
trying to replicate that model[br]over and over again

0:01:58.598,0:02:00.757
in noninfectious diseases,

0:02:00.757,0:02:05.146
in chronic diseases like diabetes[br]and hypertension and heart disease.

0:02:05.146,0:02:09.256
And it's worked,[br]but it's only worked partly.

0:02:09.256,0:02:11.090
Let me show you.

0:02:11.090,0:02:13.714
You know, if you take the entire universe

0:02:13.714,0:02:17.243
of all chemical reactions[br]in the human body,

0:02:17.243,0:02:20.888
every chemical reaction[br]that your body is capable of,

0:02:20.888,0:02:23.178
most people think that that number[br]is on the order of a million.

0:02:23.178,0:02:24.943
Let's call it a million.

0:02:24.943,0:02:26.800
And now you ask the question,

0:02:26.800,0:02:29.401
what number or fraction of reactions

0:02:29.401,0:02:31.142
can actually be targeted

0:02:31.142,0:02:35.662
by the entire pharmacopia,[br]all of medicinal chemistry?

0:02:35.662,0:02:39.222
That number is 250.

0:02:39.222,0:02:42.334
The rest is chemical darkness.

0:02:42.334,0:02:48.510
In other words, 0.025 percent[br]of all chemical reactions in your body

0:02:48.510,0:02:53.827
are actually targetable[br]by this lock and key mechanism.

0:02:53.827,0:02:57.287
You know, if you think about[br]human physiology

0:02:57.287,0:03:01.489
as a vast global telephone network

0:03:01.489,0:03:04.740
with interacting nodes[br]and interacting pieces,

0:03:04.740,0:03:07.759
then all of our medicinal chemistry

0:03:07.759,0:03:10.220
is all operating on one tiny corner

0:03:10.220,0:03:12.890
at the edge, the outer edge,[br]of that network.

0:03:12.890,0:03:16.651
It's like all of our[br]pharmaceutical chemistry

0:03:16.651,0:03:20.436
is a pole operator in Wichita, Kansas

0:03:20.436,0:03:24.360
who is tinkering with[br]about 10 or 15 telephone lines.

0:03:24.360,0:03:28.238
So what do about this idea?

0:03:28.238,0:03:31.140
What if we reorganized this approach?

0:03:31.140,0:03:36.155
In fact, it turns out[br]that the natural world

0:03:36.155,0:03:40.567
gives us a sense of how one[br]might think about illness

0:03:40.567,0:03:42.564
in a radically different way,

0:03:42.564,0:03:47.231
rather than disease, medicine, target.

0:03:47.231,0:03:51.248
In fact, the natural world[br]is organized hierarchically upwards,

0:03:51.248,0:03:53.129
not downwards, but upwards,

0:03:53.129,0:03:59.676
and we begin with a self-regulating,[br]semi-autonomous unit called a cell.

0:03:59.676,0:04:02.834
These self-regulating,[br]semi-autonomous units

0:04:02.834,0:04:08.174
give rise to self-regulating,[br]semi-autonomous units called organs,

0:04:08.174,0:04:12.029
and these organs coalesce[br]to form things called humans,

0:04:12.029,0:04:16.208
and these organisms ultimately live[br]in environments,

0:04:16.208,0:04:21.038
which are partly self-regulating[br]and partly semi-autonomous.

0:04:21.038,0:04:23.769
What's nice about this scheme,[br]this hierarchical scheme

0:04:23.769,0:04:26.369
building upwards rather than downwards

0:04:26.369,0:04:29.899
is that it allows us to think[br]about illness as well

0:04:29.899,0:04:32.383
in a somewhat different way.

0:04:32.383,0:04:35.657
Take a disease like cancer.

0:04:35.657,0:04:40.292
Since the 1950s, we've tried[br]rather desperately to apply

0:04:40.292,0:04:42.962
this lock and key model to cancer.

0:04:42.962,0:04:50.439
We've tried to kill cells using a variety[br]of chemotherapies or targeted therapies,

0:04:50.439,0:04:52.737
and as most of us know, that's worked.

0:04:52.737,0:04:54.316
It's worked for diseases like leukemia.

0:04:54.316,0:04:56.893
It's worked for some forms[br]of breast cancer,

0:04:56.893,0:05:00.748
but eventually you run[br]to the ceiling of that approach,

0:05:00.748,0:05:03.464
and it's only in the last 10 years or so

0:05:03.464,0:05:06.436
that we've begun to think[br]about using the immune system,

0:05:06.436,0:05:09.144
remembering that in fact the cancer cell[br]doesn't grow in a vacuum.

0:05:09.144,0:05:11.745
It actually grows in a human organism,

0:05:11.745,0:05:14.090
and could you use the organismal capacity,

0:05:14.090,0:05:17.155
the fact that human beings[br]have an immune system, to attack cancer?

0:05:17.155,0:05:22.031
In fact, it's led to the some of the most[br]spectacular new medicines in cancer.

0:05:22.031,0:05:24.654
And finally, I mean, there's the level[br]of the environment, isn't there.

0:05:24.654,0:05:29.080
You know, we don't think of cancer[br]as altering the environment.

0:05:29.080,0:05:34.096
Let me give you an example[br]of a profoundly carcinogenic environment.

0:05:34.096,0:05:36.209
It's called a prison.

0:05:36.209,0:05:41.549
You take loneliness, you take depression,[br]you take confinement,

0:05:41.549,0:05:43.398
and you add to that,

0:05:43.398,0:05:47.113
rolled up in a little white[br]sheet of paper,

0:05:47.113,0:05:50.224
one of the most potent neurostimulants[br]that we know, called nicotine,

0:05:50.224,0:05:55.913
and you add to that one of the most potent[br]addictive substances that you know,

0:05:55.913,0:05:59.976
and you have a pro-carcinogenic[br]environment.

0:05:59.976,0:06:02.089
But you can have anti-carcinogenic[br]environments too.

0:06:02.089,0:06:05.572
There are attempts to create milieus,

0:06:05.572,0:06:08.451
change the hormonal milieu[br]for breast cancer, for instance.

0:06:08.451,0:06:11.887
We're trying to change the metabolic[br]milieu for other forms of cancer.

0:06:11.887,0:06:14.395
Or take another disease, like depression.

0:06:14.395,0:06:16.996
Again, working others,

0:06:16.996,0:06:20.757
since the 1960s and 1970s,[br]we've tried, again, desperately

0:06:20.757,0:06:25.192
to turn off molecules that operate[br]between nerve cells --

0:06:25.192,0:06:27.723
serotonin, dopamine --

0:06:27.723,0:06:30.370
and tried to cure depression that way,[br]and that's worked,

0:06:30.370,0:06:33.110
but then that reached the limit.

0:06:33.110,0:06:35.478
And we now know that what you[br]really probably need to do

0:06:35.478,0:06:38.427
is to change the physiology[br]of the organ, the brain,

0:06:38.427,0:06:40.888
rewire it, remodel it,

0:06:40.888,0:06:43.512
and that of course, we know[br]study upon study has shown

0:06:43.512,0:06:45.485
that talk therapy does exactly that,

0:06:45.485,0:06:48.030
and study upon study has shown[br]that talk therapy combined

0:06:48.030,0:06:50.561
with medicines, pills,

0:06:50.561,0:06:53.998
really is much more effective[br]than either one alone.

0:06:53.998,0:06:57.457
Can we imagine a more immersive[br]environment that will change depression?

0:06:57.457,0:07:01.683
Can you lock out the signals[br]that elicit depression?

0:07:01.683,0:07:07.883
Again, moving upwards along this[br]hierarchical chain of organization.

0:07:07.883,0:07:10.460
What's really at stake perhaps here

0:07:10.460,0:07:12.318
is not the medicine itself but a metaphor.

0:07:12.318,0:07:15.963
Rather than killing something,

0:07:15.963,0:07:19.678
in the case of the great[br]chronic degenerative diseases --

0:07:19.678,0:07:23.300
kidney failure, diabetes,[br]hypertension, osteoarthritis --

0:07:23.300,0:07:26.644
maybe what we really need to do is change[br]the metaphor to growing something.

0:07:26.644,0:07:28.571
And that's the key, perhaps,

0:07:28.571,0:07:31.218
to reframing our thinking about medicine.

0:07:31.218,0:07:34.538
Now, this idea of changing,

0:07:34.538,0:07:36.837
of creating a perceptual shift,[br]as it were,

0:07:36.837,0:07:40.204
came home to me to roost in a very,[br]very personal matter about 10 years ago.

0:07:40.204,0:07:42.734
About 10 years ago --[br]I've been a runner most of my life --

0:07:42.734,0:07:44.824
I went for a run, a Saturday morning run,

0:07:44.824,0:07:47.819
I came back and woke up[br]and I basically couldn't move.

0:07:47.819,0:07:50.002
My right knee was swollen up,

0:07:50.002,0:07:53.392
and you could hear that ominous crunch[br]of bone against bone.

0:07:53.392,0:07:59.174
And one of the perks of being a physician[br]is that you get to order your own MRIs.

0:07:59.174,0:08:03.167
And I had an MRI the next week,[br]and it looked like that.

0:08:03.167,0:08:07.463
Essentially, the meniscus of cartilage[br]that is between bone

0:08:07.463,0:08:10.992
had been completely torn[br]and the bone itself had been shattered.

0:08:10.992,0:08:13.407
Now, if you're looking at me[br]and feeling sorry,

0:08:13.407,0:08:15.241
let me tell you a few facts.

0:08:15.241,0:08:19.351
If I was to take an MRI[br]of every person in this audience,

0:08:19.351,0:08:21.539
60 percent of you would show signs

0:08:21.539,0:08:24.325
of bone degeneration[br]and cartilage degeneration like this;

0:08:24.325,0:08:28.133
85 percent of all women by the age of 70

0:08:28.133,0:08:31.384
would show moderate to severe[br]cartilage degeneration;

0:08:31.384,0:08:34.959
50 to 60 percent of the men in[br]this audience would also have such signs.

0:08:34.959,0:08:37.258
So this is a very common disease.

0:08:37.258,0:08:39.371
Well, the second perk of being a physician

0:08:39.371,0:08:42.250
is that you can get to experiment[br]on your own ailments.

0:08:42.250,0:08:45.524
So about 10 years ago we began,

0:08:45.524,0:08:47.405
we brought this process[br]into the laboratory,

0:08:47.405,0:08:49.030
and we began to do simple experiments,

0:08:49.030,0:08:53.279
mechanically trying[br]to fix this degeneration.

0:08:53.279,0:08:56.414
We tried to inject chemicals[br]into the knee spaces of animals

0:08:56.414,0:08:59.038
to try to reverse cartilage degeneration,

0:08:59.038,0:09:03.240
and to put a short summary[br]on a very long and painful process,

0:09:03.240,0:09:05.400
essentially it came to naught.

0:09:05.400,0:09:07.048
Nothing happened.

0:09:07.048,0:09:11.878
And then about seven years ago,[br]we had a research student from Australia.

0:09:11.878,0:09:14.409
Now, the nice thing about Australians[br]is that they're habitually used

0:09:14.409,0:09:17.658
to looking at the world upside down,[br]and so -- (Laughter) --

0:09:17.658,0:09:21.838
Dan suggested to me, "You know,[br]maybe it isn't a mechanical problem.

0:09:21.838,0:09:27.889
Maybe it isn't a chemical problem.[br]Maybe it's a stem cell problem."

0:09:27.889,0:09:30.048
In other words, he had two hypotheses.

0:09:30.048,0:09:33.601
Number one, there is such a thing[br]as a skeletal stem cell

0:09:33.601,0:09:37.711
that builds up the entire[br]vertebrate skeleton:

0:09:37.711,0:09:39.893
bone, cartilage,[br]and the fibrous elements of skeleton,

0:09:39.893,0:09:41.426
just like there's a stem cell in blood,

0:09:41.426,0:09:43.283
just like there's a stem cell[br]in the nervous system,

0:09:43.283,0:09:47.161
and two, that maybe that, the degeneration[br]or dysfunction of this stem cell

0:09:47.161,0:09:50.365
that is causing osteochondral arthritis,[br]a very common ailment.

0:09:50.365,0:09:54.312
So really the question was,[br]were we looking for a pill

0:09:54.312,0:09:56.750
when we should have really[br]been looking for a cell.

0:09:56.750,0:09:59.885
So we switched our models,

0:09:59.885,0:10:03.670
and now we began to look[br]for skeletal stem cells,

0:10:03.670,0:10:06.224
and to cut again a long story short,

0:10:06.224,0:10:10.255
about five years ago,[br]we found these cells.

0:10:10.255,0:10:12.321
They live inside the skeleton.

0:10:12.321,0:10:15.340
Here's a schematic and then[br]a real photograph of one of them.

0:10:15.340,0:10:17.267
The white stuff is bone,

0:10:17.267,0:10:19.566
and these red columns that you see[br]and the yellow cells

0:10:19.566,0:10:23.745
are cells that have arisen[br]from one single skeleton stem cell,

0:10:23.745,0:10:26.926
columns of cartilage, columns of bone[br]coming out a single cell.

0:10:26.926,0:10:29.852
These cells are fascinating.[br]They have four properties.

0:10:29.852,0:10:32.824
Number one is that they live[br]where they're expected to live.

0:10:32.824,0:10:36.191
They live just underneath[br]the surface of the bone,

0:10:36.191,0:10:38.164
underneath cartilage.

0:10:38.164,0:10:40.463
You know, in biology,[br]it's location, location, location,

0:10:40.463,0:10:43.690
and they move into the appropriate areas[br]and form bone and cartilage. That's one.

0:10:43.690,0:10:46.941
Here's an interesting property.

0:10:46.941,0:10:50.168
You can take them out[br]of the vertebrate skeleton,

0:10:50.168,0:10:52.978
you can culture them[br]in petri dishes in the laboratory,

0:10:52.978,0:10:55.137
and they are dying to form cartilage.

0:10:55.137,0:10:57.273
Remember how we couldn't[br]form cartilage for love or money?

0:10:57.273,0:10:59.410
These cells are dying to form cartilage.

0:10:59.410,0:11:02.730
They form their own furls[br]of cartilage around themselves.

0:11:02.730,0:11:04.518
They're also, number three,[br]the most efficient repairers

0:11:04.518,0:11:09.022
of fractures that we've ever encountered.

0:11:09.022,0:11:11.280
This is a little bone, a mouse bone[br]that we fractured

0:11:11.280,0:11:13.161
and then let it heal by itself.

0:11:13.161,0:11:16.217
These stem cells have come in[br]and repaired, in yellow, the bone,

0:11:16.217,0:11:19.073
in white, the cartilage,[br]almost completely,

0:11:19.073,0:11:21.720
so much so that if you label them[br]with a fluorescent dye

0:11:21.720,0:11:26.479
you can see them like some kind of[br]peculiar cellular glue

0:11:26.479,0:11:28.407
coming into the area of a fracture,[br]fixing it locally,

0:11:28.407,0:11:31.379
and then stopping their work.

0:11:31.379,0:11:34.063
Now, the fourth one is the most ominous,

0:11:34.063,0:11:37.871
and that is that their numbers[br]decline precipitously,

0:11:37.871,0:11:42.538
precipitously, tenfold,[br]fiftyfold, as you age.

0:11:42.538,0:11:45.580
And so what had happened, really,[br]is that we found ourselves

0:11:45.580,0:11:47.228
in perceptual shift.

0:11:47.228,0:11:49.968
We had gone hunting for pills

0:11:49.968,0:11:52.290
but we ended up finding theories,

0:11:52.290,0:11:56.144
and in some ways, we had hooked ourselves[br]back onto this idea:

0:11:56.144,0:11:58.908
cells, organisms, environments,

0:11:58.908,0:12:02.112
because we were now thinking[br]about bone stem cells,

0:12:02.112,0:12:05.850
we were thinking about arthritis[br]in terms of a cellular disease.

0:12:05.850,0:12:08.015
And then the next question was,[br]are there organs?

0:12:08.015,0:12:10.406
Can you build this as an organ[br]outside the body?

0:12:10.406,0:12:13.866
Can you implant cartilage[br]into areas of trauma?

0:12:13.866,0:12:16.272
And perhaps most interestingly,

0:12:16.272,0:12:18.696
can you ascend right up[br]and create environments?

0:12:18.696,0:12:21.821
You know, we know[br]that exercise remodels bone,

0:12:21.821,0:12:24.190
but come on, none of us[br]is going to exercise.

0:12:24.190,0:12:29.414
So could you imagine ways of passively[br]loading and unloading bone

0:12:29.414,0:12:34.360
so that you can recreate[br]or regenerate degenerating catilage?

0:12:34.360,0:12:37.564
And perhaps more interesting,[br]and more importantly,

0:12:37.564,0:12:39.816
the question is, can you apply this model[br]more globally outside medicine?

0:12:39.816,0:12:44.181
What's at stake, as I said before,[br]is not killing something,

0:12:44.181,0:12:46.317
but growing something.

0:12:46.317,0:12:50.172
And it raises a series of, I think,[br]some of the most interesting questions

0:12:50.172,0:12:54.490
about how we think[br]about medicine in the future.

0:12:54.490,0:12:58.902
Could your medicine be a cell[br]and not a pill?

0:12:58.902,0:13:01.224
How would we grow these cells?

0:13:01.224,0:13:04.266
What we would we do to stop[br]the malignant growth of these cells?

0:13:04.266,0:13:07.911
We heard about the problems[br]of unleashing growth.

0:13:07.911,0:13:11.092
Would we have to implant[br]suicide genes into these cells

0:13:11.092,0:13:13.205
to stop them from growing?

0:13:13.205,0:13:16.061
Could your medicine be an organ[br]that's created outside the body

0:13:16.061,0:13:18.940
and then implanted into the body?

0:13:18.940,0:13:21.703
Could that stop some of the degeneration?

0:13:21.703,0:13:23.630
What if the organ needed to have memory?

0:13:23.630,0:13:28.428
In cases of diseases of the nervous system[br]some of those organs had memory.

0:13:28.428,0:13:30.912
How could we implant[br]those memories back in?

0:13:30.912,0:13:32.839
Could we store these organs?

0:13:32.839,0:13:35.719
Could each organ have to be developed[br]for an individual human being

0:13:35.719,0:13:38.551
and put back?

0:13:38.551,0:13:41.175
And perhaps most puzzlingly,

0:13:41.175,0:13:44.170
could your medicine be an environment?

0:13:44.170,0:13:46.097
Could you patent an environment?

0:13:46.097,0:13:52.320
In every culture, shamans have been[br]using environments as medicines.

0:13:52.320,0:13:55.455
Could we imagine that for our future?

0:13:55.455,0:13:59.602
I've talked a lot about models.[br]I began this talk with models.

0:13:59.602,0:14:02.319
So let me end with some thoughts[br]about model building.

0:14:02.319,0:14:04.315
That's what we do as scientists.

0:14:04.315,0:14:07.659
You know, when an architect[br]builds a model,

0:14:07.659,0:14:10.863
he or she is trying to show you[br]a world in miniature.

0:14:10.863,0:14:13.882
But when a scientist is building a model,

0:14:13.882,0:14:16.807
he or she is trying to show you[br]the world in metaphor.

0:14:16.807,0:14:21.637
He or she is trying to create[br]a new way of seeing.

0:14:21.637,0:14:26.977
The former is a scale shift.[br]The latter is a perceptual shift.

0:14:26.977,0:14:31.435
Now, antibiotics created[br]such a perceptual shift

0:14:31.435,0:14:35.731
in our way of thinking about medicine[br]that it really colored, distorted,

0:14:35.731,0:14:40.212
very successfully, the way we've thought[br]about medicine for the last hundred years.

0:14:40.212,0:14:44.833
But we need new models[br]to think about medicine in the future.

0:14:44.833,0:14:46.690
That's what's at stake.

0:14:46.690,0:14:50.637
You know, there's[br]a popular trope out there

0:14:50.637,0:14:54.886
that the reason we haven't had[br]the transformative impact

0:14:54.886,0:14:56.860
on the treatment of illness

0:14:56.860,0:14:59.739
is because we don't have[br]powerful enough drugs,

0:14:59.739,0:15:01.504
and that's partly true,

0:15:01.504,0:15:05.373
but perhaps the real reason is[br]that we don't have powerful enough

0:15:05.373,0:15:08.437
ways of thinking about medicines.

0:15:08.437,0:15:11.201
It's certainly true that

0:15:11.201,0:15:14.799
it would be lovely to have new medicines,

0:15:14.799,0:15:19.466
but perhaps what's really at stake[br]are three more intangible ends:

0:15:19.466,0:15:23.507
mechanisms, models, metaphors.

0:15:23.507,0:15:25.434
Thank you.

0:15:25.434,0:15:31.515
(Applause)

0:15:33.700,0:15:36.950
Chris Anderson: I really[br]like this metaphor.

0:15:36.950,0:15:40.712
How does it link in?[br]There's a lot of talk

0:15:40.712,0:15:43.922
in technologyland about[br]the personalization of medicine,

0:15:43.922,0:15:45.709
that we have all this data[br]and that medical treatments of the future

0:15:45.709,0:15:51.886
will be for you specifically,[br]your genome, your current context.

0:15:51.886,0:15:55.670
Does that apply to this model[br]you've got here?

0:15:55.670,0:15:57.348
Siddhartha Mukherjee: It's[br]a very interesting question.

0:15:57.348,0:16:00.087
You know, we've thought[br]about personalization of medicine

0:16:00.087,0:16:02.386
very much in terms of genomics.

0:16:02.386,0:16:05.173
That's because the gene[br]is such a dominant metaphor,

0:16:05.173,0:16:08.191
again, to use that same word,[br]in medicine today,

0:16:08.191,0:16:11.628
that we think the genome will drive[br]the personalization of medicine.

0:16:11.628,0:16:15.111
But of course the genome[br]is just the bottom

0:16:15.111,0:16:17.642
of a long chain of being, as it were.

0:16:17.642,0:16:22.495
That chain of being, really the first[br]organized unit of that, is the cell.

0:16:22.495,0:16:25.443
So, if we are really going to deliver[br]in medicine in this way,

0:16:25.443,0:16:28.346
we have to think of personalizing[br]cellular therapies,

0:16:28.346,0:16:31.480
and then personalizing[br]organ or organismal therapies,

0:16:31.480,0:16:35.335
and ultimately personalizing[br]emersion therapies for the environment.

0:16:35.335,0:16:37.796
So I think at every stage, you know,

0:16:37.796,0:16:40.698
there's that metaphor,[br]there's turtles all the way.

0:16:40.698,0:16:43.113
Well, in this, there's[br]personalization all the way.

0:16:43.113,0:16:46.201
CA: So when you say[br]medicine could be a cell

0:16:46.201,0:16:48.221
and not a pill,

0:16:48.221,0:16:49.847
I mean, you're talking about[br]potentially your own cells.

0:16:49.847,0:16:52.703
SM: Absolutely.[br]CA: So converted to stem cells,

0:16:52.703,0:16:57.300
perhaps tested against all kinds[br]of drugs or something, and prepared.

0:16:57.300,0:16:59.900
SM: And there's no perhaps.[br]This is what we're doing.

0:16:59.900,0:17:03.616
This is what's happening, and in fact,[br]we're slowly moving,

0:17:03.616,0:17:07.420
not away from genomics,[br]but incorporating genomics

0:17:07.420,0:17:11.556
into what we call multi-order,[br]semi-autonomous, self-regulating systems,

0:17:11.556,0:17:14.830
like cells, like organs,[br]like environments.

0:17:14.830,0:17:18.187
CA: Thank you so much.[br]SM: Thank you.