WEBVTT 00:00:00.649 --> 00:00:04.944 I want to talk to you about the future of medicine, 00:00:04.944 --> 00:00:09.077 but before I do that, I want to talk a little bit about the past. 00:00:09.077 --> 00:00:12.700 Now, throughout much of the recent history of medicine, 00:00:12.700 --> 00:00:15.857 we've thought about illness and treatment 00:00:15.857 --> 00:00:19.967 in terms of a profoundly simple model. 00:00:19.967 --> 00:00:22.684 In fact, the model is so simple 00:00:22.684 --> 00:00:25.656 that you could summarize it in six words: 00:00:25.656 --> 00:00:31.043 have disease, take pill, kill something. NOTE Paragraph 00:00:31.043 --> 00:00:35.338 Now, the reason for the dominance of this model 00:00:35.338 --> 00:00:38.473 is of course the antibiotic revolution. 00:00:38.473 --> 00:00:41.677 Many of you might not know this, but we happen to be celebrating 00:00:41.677 --> 00:00:45.508 the hundredth year of the introduction of antibiotics into the United States, 00:00:45.508 --> 00:00:47.226 but what you do know 00:00:47.226 --> 00:00:52.311 is that that introduction was nothing short of transformative. 00:00:52.311 --> 00:00:56.746 Here you had a chemical, either from the natural world 00:00:56.746 --> 00:00:59.509 or artificially synthesized in the laboratory, 00:00:59.509 --> 00:01:02.806 and it would course through your body, 00:01:02.806 --> 00:01:05.592 it would find its target, 00:01:05.592 --> 00:01:07.404 lock into its target -- 00:01:07.404 --> 00:01:09.516 a microbe or some part of a microbe -- 00:01:09.516 --> 00:01:12.465 and then turn off a lock and a key 00:01:12.465 --> 00:01:17.527 with exquisite deftness, exquisite specificity, 00:01:17.527 --> 00:01:21.823 and you would end up taking a previously fatal, lethal disease, 00:01:21.823 --> 00:01:24.493 a pneumonia, syphilis, tuberculosis, 00:01:24.493 --> 00:01:30.181 and transforming that into a curable, or treatable illness. 00:01:30.181 --> 00:01:32.805 You have a pneumonia, you take penicillin, 00:01:32.805 --> 00:01:35.426 you kill the microbe, 00:01:35.426 --> 00:01:37.585 and you cure the disease. NOTE Paragraph 00:01:37.585 --> 00:01:40.719 So seductive was this idea, 00:01:40.719 --> 00:01:44.527 so potent the metaphor of lock and key 00:01:44.527 --> 00:01:46.315 and killing something, 00:01:46.315 --> 00:01:48.916 that it really swept through biology. 00:01:48.916 --> 00:01:51.888 It was a transformation like no other, 00:01:51.888 --> 00:01:55.440 and we've really spent the last 100 years 00:01:55.440 --> 00:01:58.598 trying to replicate that model over and over again 00:01:58.598 --> 00:02:00.757 in noninfectious diseases, 00:02:00.757 --> 00:02:05.146 in chronic diseases like diabetes and hypertension and heart disease. 00:02:05.146 --> 00:02:09.256 And it's worked, but it's only worked partly. 00:02:09.256 --> 00:02:11.090 Let me show you. 00:02:11.090 --> 00:02:13.714 You know, if you take the entire universe 00:02:13.714 --> 00:02:17.243 of all chemical reactions in the human body, 00:02:17.243 --> 00:02:20.888 every chemical reaction that your body is capable of, 00:02:20.888 --> 00:02:23.178 most people think that that number is on the order of a million. 00:02:23.178 --> 00:02:24.943 Let's call it a million. 00:02:24.943 --> 00:02:26.800 And now you ask the question, 00:02:26.800 --> 00:02:29.401 what number or fraction of reactions 00:02:29.401 --> 00:02:31.142 can actually be targeted 00:02:31.142 --> 00:02:35.662 by the entire pharmacopia, all of medicinal chemistry? 00:02:35.662 --> 00:02:39.222 That number is 250. 00:02:39.222 --> 00:02:42.334 The rest is chemical darkness. 00:02:42.334 --> 00:02:48.510 In other words, 0.025 percent of all chemical reactions in your body 00:02:48.510 --> 00:02:53.827 are actually targetable by this lock and key mechanism. 00:02:53.827 --> 00:02:57.287 You know, if you think about human physiology 00:02:57.287 --> 00:03:01.489 as a vast global telephone network 00:03:01.489 --> 00:03:04.740 with interacting nodes and interacting pieces, 00:03:04.740 --> 00:03:07.759 then all of our medicinal chemistry 00:03:07.759 --> 00:03:10.220 is all operating on one tiny corner 00:03:10.220 --> 00:03:12.890 at the edge, the outer edge, of that network. 00:03:12.890 --> 00:03:16.651 It's like all of our pharmaceutical chemistry 00:03:16.651 --> 00:03:20.436 is a pole operator in Wichita, Kansas 00:03:20.436 --> 00:03:24.360 who is tinkering with about 10 or 15 telephone lines. NOTE Paragraph 00:03:24.360 --> 00:03:28.238 So what do about this idea? 00:03:28.238 --> 00:03:31.140 What if we reorganized this approach? 00:03:31.140 --> 00:03:36.155 In fact, it turns out that the natural world 00:03:36.155 --> 00:03:40.567 gives us a sense of how one might think about illness 00:03:40.567 --> 00:03:42.564 in a radically different way, 00:03:42.564 --> 00:03:47.231 rather than disease, medicine, target. 00:03:47.231 --> 00:03:51.248 In fact, the natural world is organized hierarchically upwards, 00:03:51.248 --> 00:03:53.129 not downwards, but upwards, 00:03:53.129 --> 00:03:59.676 and we begin with a self-regulating, semi-autonomous unit called a cell. 00:03:59.676 --> 00:04:02.834 These self-regulating, semi-autonomous units 00:04:02.834 --> 00:04:08.174 give rise to self-regulating, semi-autonomous units called organs, 00:04:08.174 --> 00:04:12.029 and these organs coalesce to form things called humans, 00:04:12.029 --> 00:04:16.208 and these organisms ultimately live in environments, 00:04:16.208 --> 00:04:21.038 which are partly self-regulating and partly semi-autonomous. NOTE Paragraph 00:04:21.038 --> 00:04:23.769 What's nice about this scheme, this hierarchical scheme 00:04:23.769 --> 00:04:26.369 building upwards rather than downwards 00:04:26.369 --> 00:04:29.899 is that it allows us to think about illness as well 00:04:29.899 --> 00:04:32.383 in a somewhat different way. 00:04:32.383 --> 00:04:35.657 Take a disease like cancer. 00:04:35.657 --> 00:04:40.292 Since the 1950s, we've tried rather desperately to apply 00:04:40.292 --> 00:04:42.962 this lock and key model to cancer. 00:04:42.962 --> 00:04:50.439 We've tried to kill cells using a variety of chemotherapies or targeted therapies, 00:04:50.439 --> 00:04:52.737 and as most of us know, that's worked. 00:04:52.737 --> 00:04:54.316 It's worked for diseases like leukemia. 00:04:54.316 --> 00:04:56.893 It's worked for some forms of breast cancer, 00:04:56.893 --> 00:05:00.748 but eventually you run to the ceiling of that approach, 00:05:00.748 --> 00:05:03.464 and it's only in the last 10 years or so 00:05:03.464 --> 00:05:06.436 that we've begun to think about using the immune system, 00:05:06.436 --> 00:05:09.144 remembering that in fact the cancer cell doesn't grow in a vacuum. 00:05:09.144 --> 00:05:11.745 It actually grows in a human organism, 00:05:11.745 --> 00:05:14.090 and could you use the organismal capacity, 00:05:14.090 --> 00:05:17.155 the fact that human beings have an immune system, to attack cancer? 00:05:17.155 --> 00:05:22.031 In fact, it's led to the some of the most spectacular new medicines in cancer. NOTE Paragraph 00:05:22.031 --> 00:05:24.654 And finally, I mean, there's the level of the environment, isn't there. 00:05:24.654 --> 00:05:29.080 You know, we don't think of cancer as altering the environment. 00:05:29.080 --> 00:05:34.096 Let me give you an example of a profoundly carcinogenic environment. 00:05:34.096 --> 00:05:36.209 It's called a prison. 00:05:36.209 --> 00:05:41.549 You take loneliness, you take depression, you take confinement, 00:05:41.549 --> 00:05:43.398 and you add to that, 00:05:43.398 --> 00:05:47.113 rolled up in a little white sheet of paper, 00:05:47.113 --> 00:05:50.224 one of the most potent neurostimulants that we know, called nicotine, 00:05:50.224 --> 00:05:55.913 and you add to that one of the most potent addictive substances that you know, 00:05:55.913 --> 00:05:59.976 and you have a pro-carcinogenic environment. 00:05:59.976 --> 00:06:02.089 But you can have anti-carcinogenic environments too. 00:06:02.089 --> 00:06:05.572 There are attempts to create milieus, 00:06:05.572 --> 00:06:08.451 change the hormonal milieu for breast cancer, for instance. 00:06:08.451 --> 00:06:11.887 We're trying to change the metabolic milieu for other forms of cancer. NOTE Paragraph 00:06:11.887 --> 00:06:14.395 Or take another disease, like depression. 00:06:14.395 --> 00:06:16.996 Again, working others, 00:06:16.996 --> 00:06:20.757 since the 1960s and 1970s, we've tried, again, desperately 00:06:20.757 --> 00:06:25.192 to turn off molecules that operate between nerve cells -- 00:06:25.192 --> 00:06:27.723 serotonin, dopamine -- 00:06:27.723 --> 00:06:30.370 and tried to cure depression that way, and that's worked, 00:06:30.370 --> 00:06:33.110 but then that reached the limit. 00:06:33.110 --> 00:06:35.478 And we now know that what you really probably need to do 00:06:35.478 --> 00:06:38.427 is to change the physiology of the organ, the brain, 00:06:38.427 --> 00:06:40.888 rewire it, remodel it, 00:06:40.888 --> 00:06:43.512 and that of course, we know study upon study has shown 00:06:43.512 --> 00:06:45.485 that talk therapy does exactly that, 00:06:45.485 --> 00:06:48.030 and study upon study has shown that talk therapy combined 00:06:48.030 --> 00:06:50.561 with medicines, pills, 00:06:50.561 --> 00:06:53.998 really is much more effective than either one alone. 00:06:53.998 --> 00:06:57.457 Can we imagine a more immersive environment that will change depression? 00:06:57.457 --> 00:07:01.683 Can you lock out the signals that elicit depression? 00:07:01.683 --> 00:07:07.883 Again, moving upwards along this hierarchical chain of organization. 00:07:07.883 --> 00:07:10.460 What's really at stake perhaps here 00:07:10.460 --> 00:07:12.318 is not the medicine itself but a metaphor. 00:07:12.318 --> 00:07:15.963 Rather than killing something, 00:07:15.963 --> 00:07:19.678 in the case of the great chronic degenerative diseases -- 00:07:19.678 --> 00:07:23.300 kidney failure, diabetes, hypertension, osteoarthritis -- 00:07:23.300 --> 00:07:26.644 maybe what we really need to do is change the metaphor to growing something. 00:07:26.644 --> 00:07:28.571 And that's the key, perhaps, 00:07:28.571 --> 00:07:31.218 to reframing our thinking about medicine. NOTE Paragraph 00:07:31.218 --> 00:07:34.538 Now, this idea of changing, 00:07:34.538 --> 00:07:36.837 of creating a perceptual shift, as it were, 00:07:36.837 --> 00:07:40.204 came home to me to roost in a very, very personal matter about 10 years ago. 00:07:40.204 --> 00:07:42.734 About 10 years ago -- I've been a runner most of my life -- 00:07:42.734 --> 00:07:44.824 I went for a run, a Saturday morning run, 00:07:44.824 --> 00:07:47.819 I came back and woke up and I basically couldn't move. 00:07:47.819 --> 00:07:50.002 My right knee was swollen up, 00:07:50.002 --> 00:07:53.392 and you could hear that ominous crunch of bone against bone. 00:07:53.392 --> 00:07:59.174 And one of the perks of being a physician is that you get to order your own MRIs. 00:07:59.174 --> 00:08:03.167 And I had an MRI the next week, and it looked like that. 00:08:03.167 --> 00:08:07.463 Essentially, the meniscus of cartilage that is between bone 00:08:07.463 --> 00:08:10.992 had been completely torn and the bone itself had been shattered. NOTE Paragraph 00:08:10.992 --> 00:08:13.407 Now, if you're looking at me and feeling sorry, 00:08:13.407 --> 00:08:15.241 let me tell you a few facts. 00:08:15.241 --> 00:08:19.351 If I was to take an MRI of every person in this audience, 00:08:19.351 --> 00:08:21.539 60 percent of you would show signs 00:08:21.539 --> 00:08:24.325 of bone degeneration and cartilage degeneration like this; 00:08:24.325 --> 00:08:28.133 85 percent of all women by the age of 70 00:08:28.133 --> 00:08:31.384 would show moderate to severe cartilage degeneration; 00:08:31.384 --> 00:08:34.959 50 to 60 percent of the men in this audience would also have such signs. 00:08:34.959 --> 00:08:37.258 So this is a very common disease. 00:08:37.258 --> 00:08:39.371 Well, the second perk of being a physician 00:08:39.371 --> 00:08:42.250 is that you can get to experiment on your own ailments. 00:08:42.250 --> 00:08:45.524 So about 10 years ago we began, 00:08:45.524 --> 00:08:47.405 we brought this process into the laboratory, 00:08:47.405 --> 00:08:49.030 and we began to do simple experiments, 00:08:49.030 --> 00:08:53.279 mechanically trying to fix this degeneration. 00:08:53.279 --> 00:08:56.414 We tried to inject chemicals into the knee spaces of animals 00:08:56.414 --> 00:08:59.038 to try to reverse cartilage degeneration, 00:08:59.038 --> 00:09:03.240 and to put a short summary on a very long and painful process, 00:09:03.240 --> 00:09:05.400 essentially it came to naught. 00:09:05.400 --> 00:09:07.048 Nothing happened. 00:09:07.048 --> 00:09:11.878 And then about seven years ago, we had a research student from Australia. 00:09:11.878 --> 00:09:14.409 Now, the nice thing about Australians is that they're habitually used 00:09:14.409 --> 00:09:17.658 to looking at the world upside down, and so -- (Laughter) -- 00:09:17.658 --> 00:09:21.838 Dan suggested to me, "You know, maybe it isn't a mechanical problem. 00:09:21.838 --> 00:09:27.889 Maybe it isn't a chemical problem. Maybe it's a stem cell problem." 00:09:27.889 --> 00:09:30.048 In other words, he had two hypotheses. 00:09:30.048 --> 00:09:33.601 Number one, there is such a thing as a skeletal stem cell 00:09:33.601 --> 00:09:37.711 that builds up the entire vertebrate skeleton: 00:09:37.711 --> 00:09:39.893 bone, cartilage, and the fibrous elements of skeleton, 00:09:39.893 --> 00:09:41.426 just like there's a stem cell in blood, 00:09:41.426 --> 00:09:43.283 just like there's a stem cell in the nervous system, 00:09:43.283 --> 00:09:47.161 and two, that maybe that, the degeneration or dysfunction of this stem cell 00:09:47.161 --> 00:09:50.365 that is causing osteochondral arthritis, a very common ailment. 00:09:50.365 --> 00:09:54.312 So really the question was, were we looking for a pill 00:09:54.312 --> 00:09:56.750 when we should have really been looking for a cell. 00:09:56.750 --> 00:09:59.885 So we switched our models, 00:09:59.885 --> 00:10:03.670 and now we began to look for skeletal stem cells, 00:10:03.670 --> 00:10:06.224 and to cut again a long story short, 00:10:06.224 --> 00:10:10.255 about five years ago, we found these cells. 00:10:10.255 --> 00:10:12.321 They live inside the skeleton. 00:10:12.321 --> 00:10:15.340 Here's a schematic and then a real photograph of one of them. 00:10:15.340 --> 00:10:17.267 The white stuff is bone, 00:10:17.267 --> 00:10:19.566 and these red columns that you see and the yellow cells 00:10:19.566 --> 00:10:23.745 are cells that have arisen from one single skeleton stem cell, 00:10:23.745 --> 00:10:26.926 columns of cartilage, columns of bone coming out a single cell. 00:10:26.926 --> 00:10:29.852 These cells are fascinating. They have four properties. 00:10:29.852 --> 00:10:32.824 Number one is that they live where they're expected to live. 00:10:32.824 --> 00:10:36.191 They live just underneath the surface of the bone, 00:10:36.191 --> 00:10:38.164 underneath cartilage. 00:10:38.164 --> 00:10:40.463 You know, in biology, it's location, location, location, 00:10:40.463 --> 00:10:43.690 and they move into the appropriate areas and form bone and cartilage. That's one. 00:10:43.690 --> 00:10:46.941 Here's an interesting property. 00:10:46.941 --> 00:10:50.168 You can take them out of the vertebrate skeleton, 00:10:50.168 --> 00:10:52.978 you can culture them in petri dishes in the laboratory, 00:10:52.978 --> 00:10:55.137 and they are dying to form cartilage. 00:10:55.137 --> 00:10:57.273 Remember how we couldn't form cartilage for love or money? 00:10:57.273 --> 00:10:59.410 These cells are dying to form cartilage. 00:10:59.410 --> 00:11:02.730 They form their own furls of cartilage around themselves. 00:11:02.730 --> 00:11:04.518 They're also, number three, the most efficient repairers 00:11:04.518 --> 00:11:09.022 of fractures that we've ever encountered. 00:11:09.022 --> 00:11:11.280 This is a little bone, a mouse bone that we fractured 00:11:11.280 --> 00:11:13.161 and then let it heal by itself. 00:11:13.161 --> 00:11:16.217 These stem cells have come in and repaired, in yellow, the bone, 00:11:16.217 --> 00:11:19.073 in white, the cartilage, almost completely, 00:11:19.073 --> 00:11:21.720 so much so that if you label them with a fluorescent dye 00:11:21.720 --> 00:11:26.479 you can see them like some kind of peculiar cellular glue 00:11:26.479 --> 00:11:28.407 coming into the area of a fracture, fixing it locally, 00:11:28.407 --> 00:11:31.379 and then stopping their work. 00:11:31.379 --> 00:11:34.063 Now, the fourth one is the most ominous, 00:11:34.063 --> 00:11:37.871 and that is that their numbers decline precipitously, 00:11:37.871 --> 00:11:42.538 precipitously, tenfold, fiftyfold, as you age. NOTE Paragraph 00:11:42.538 --> 00:11:45.580 And so what had happened, really, is that we found ourselves 00:11:45.580 --> 00:11:47.228 in perceptual shift. 00:11:47.228 --> 00:11:49.968 We had gone hunting for pills 00:11:49.968 --> 00:11:52.290 but we ended up finding theories, 00:11:52.290 --> 00:11:56.144 and in some ways, we had hooked ourselves back onto this idea: 00:11:56.144 --> 00:11:58.908 cells, organisms, environments, 00:11:58.908 --> 00:12:02.112 because we were now thinking about bone stem cells, 00:12:02.112 --> 00:12:05.850 we were thinking about arthritis in terms of a cellular disease. NOTE Paragraph 00:12:05.850 --> 00:12:08.015 And then the next question was, are there organs? 00:12:08.015 --> 00:12:10.406 Can you build this as an organ outside the body? 00:12:10.406 --> 00:12:13.866 Can you implant cartilage into areas of trauma? 00:12:13.866 --> 00:12:16.272 And perhaps most interestingly, 00:12:16.272 --> 00:12:18.696 can you ascend right up and create environments? 00:12:18.696 --> 00:12:21.821 You know, we know that exercise remodels bone, 00:12:21.821 --> 00:12:24.190 but come on, none of us is going to exercise. 00:12:24.190 --> 00:12:29.414 So could you imagine ways of passively loading and unloading bone 00:12:29.414 --> 00:12:34.360 so that you can recreate or regenerate degenerating catilage? NOTE Paragraph 00:12:34.360 --> 00:12:37.564 And perhaps more interesting, and more importantly, 00:12:37.564 --> 00:12:39.816 the question is, can you apply this model more globally outside medicine? 00:12:39.816 --> 00:12:44.181 What's at stake, as I said before, is not killing something, 00:12:44.181 --> 00:12:46.317 but growing something. 00:12:46.317 --> 00:12:50.172 And it raises a series of, I think, some of the most interesting questions 00:12:50.172 --> 00:12:54.490 about how we think about medicine in the future. 00:12:54.490 --> 00:12:58.902 Could your medicine be a cell and not a pill? 00:12:58.902 --> 00:13:01.224 How would we grow these cells? 00:13:01.224 --> 00:13:04.266 What we would we do to stop the malignant growth of these cells? 00:13:04.266 --> 00:13:07.911 We heard about the problems of unleashing growth. 00:13:07.911 --> 00:13:11.092 Would we have to implant suicide genes into these cells 00:13:11.092 --> 00:13:13.205 to stop them from growing? 00:13:13.205 --> 00:13:16.061 Could your medicine be an organ that's created outside the body 00:13:16.061 --> 00:13:18.940 and then implanted into the body? 00:13:18.940 --> 00:13:21.703 Could that stop some of the degeneration? 00:13:21.703 --> 00:13:23.630 What if the organ needed to have memory? 00:13:23.630 --> 00:13:28.428 In cases of diseases of the nervous system some of those organs had memory. 00:13:28.428 --> 00:13:30.912 How could we implant those memories back in? 00:13:30.912 --> 00:13:32.839 Could we store these organs? 00:13:32.839 --> 00:13:35.719 Could each organ have to be developed for an individual human being 00:13:35.719 --> 00:13:38.551 and put back? 00:13:38.551 --> 00:13:41.175 And perhaps most puzzlingly, 00:13:41.175 --> 00:13:44.170 could your medicine be an environment? 00:13:44.170 --> 00:13:46.097 Could you patent an environment? 00:13:46.097 --> 00:13:52.320 In every culture, shamans have been using environments as medicines. 00:13:52.320 --> 00:13:55.455 Could we imagine that for our future? 00:13:55.455 --> 00:13:59.602 I've talked a lot about models. I began this talk with models. 00:13:59.602 --> 00:14:02.319 So let me end with some thoughts about model building. 00:14:02.319 --> 00:14:04.315 That's what we do as scientists. 00:14:04.315 --> 00:14:07.659 You know, when an architect builds a model, 00:14:07.659 --> 00:14:10.863 he or she is trying to show you a world in miniature. 00:14:10.863 --> 00:14:13.882 But when a scientist is building a model, 00:14:13.882 --> 00:14:16.807 he or she is trying to show you the world in metaphor. 00:14:16.807 --> 00:14:21.637 He or she is trying to create a new way of seeing. 00:14:21.637 --> 00:14:26.977 The former is a scale shift. The latter is a perceptual shift. NOTE Paragraph 00:14:26.977 --> 00:14:31.435 Now, antibiotics created such a perceptual shift 00:14:31.435 --> 00:14:35.731 in our way of thinking about medicine that it really colored, distorted, 00:14:35.731 --> 00:14:40.212 very successfully, the way we've thought about medicine for the last hundred years. 00:14:40.212 --> 00:14:44.833 But we need new models to think about medicine in the future. 00:14:44.833 --> 00:14:46.690 That's what's at stake. NOTE Paragraph 00:14:46.690 --> 00:14:50.637 You know, there's a popular trope out there 00:14:50.637 --> 00:14:54.886 that the reason we haven't had the transformative impact 00:14:54.886 --> 00:14:56.860 on the treatment of illness 00:14:56.860 --> 00:14:59.739 is because we don't have powerful enough drugs, 00:14:59.739 --> 00:15:01.504 and that's partly true, 00:15:01.504 --> 00:15:05.373 but perhaps the real reason is that we don't have powerful enough 00:15:05.373 --> 00:15:08.437 ways of thinking about medicines. 00:15:08.437 --> 00:15:11.201 It's certainly true that 00:15:11.201 --> 00:15:14.799 it would be lovely to have new medicines, 00:15:14.799 --> 00:15:19.466 but perhaps what's really at stake are three more intangible ends: 00:15:19.466 --> 00:15:23.507 mechanisms, models, metaphors. NOTE Paragraph 00:15:23.507 --> 00:15:25.434 Thank you. NOTE Paragraph 00:15:25.434 --> 00:15:31.515 (Applause) NOTE Paragraph 00:15:33.700 --> 00:15:36.950 Chris Anderson: I really like this metaphor. 00:15:36.950 --> 00:15:40.712 How does it link in? There's a lot of talk 00:15:40.712 --> 00:15:43.922 in technologyland about the personalization of medicine, 00:15:43.922 --> 00:15:45.709 that we have all this data and that medical treatments of the future 00:15:45.709 --> 00:15:51.886 will be for you specifically, your genome, your current context. 00:15:51.886 --> 00:15:55.670 Does that apply to this model you've got here? NOTE Paragraph 00:15:55.670 --> 00:15:57.348 Siddhartha Mukherjee: It's a very interesting question. 00:15:57.348 --> 00:16:00.087 You know, we've thought about personalization of medicine 00:16:00.087 --> 00:16:02.386 very much in terms of genomics. 00:16:02.386 --> 00:16:05.173 That's because the gene is such a dominant metaphor, 00:16:05.173 --> 00:16:08.191 again, to use that same word, in medicine today, 00:16:08.191 --> 00:16:11.628 that we think the genome will drive the personalization of medicine. 00:16:11.628 --> 00:16:15.111 But of course the genome is just the bottom 00:16:15.111 --> 00:16:17.642 of a long chain of being, as it were. 00:16:17.642 --> 00:16:22.495 That chain of being, really the first organized unit of that, is the cell. 00:16:22.495 --> 00:16:25.443 So, if we are really going to deliver in medicine in this way, 00:16:25.443 --> 00:16:28.346 we have to think of personalizing cellular therapies, 00:16:28.346 --> 00:16:31.480 and then personalizing organ or organismal therapies, 00:16:31.480 --> 00:16:35.335 and ultimately personalizing emersion therapies for the environment. 00:16:35.335 --> 00:16:37.796 So I think at every stage, you know, 00:16:37.796 --> 00:16:40.698 there's that metaphor, there's turtles all the way. 00:16:40.698 --> 00:16:43.113 Well, in this, there's personalization all the way. NOTE Paragraph 00:16:43.113 --> 00:16:46.201 CA: So when you say medicine could be a cell 00:16:46.201 --> 00:16:48.221 and not a pill, 00:16:48.221 --> 00:16:49.847 I mean, you're talking about potentially your own cells. NOTE Paragraph 00:16:49.847 --> 00:16:52.703 SM: Absolutely. CA: So converted to stem cells, 00:16:52.703 --> 00:16:57.300 perhaps tested against all kinds of drugs or something, and prepared. NOTE Paragraph 00:16:57.300 --> 00:16:59.900 SM: And there's no perhaps. This is what we're doing. 00:16:59.900 --> 00:17:03.616 This is what's happening, and in fact, we're slowly moving, 00:17:03.616 --> 00:17:07.420 not away from genomics, but incorporating genomics 00:17:07.420 --> 00:17:11.556 into what we call multi-order, semi-autonomous, self-regulating systems, 00:17:11.556 --> 00:17:14.830 like cells, like organs, like environments. 00:17:14.830 --> 00:17:18.187 CA: Thank you so much. SM: Thank you.