0:00:00.760,0:00:04.936 I want to talk to you[br]about the future of medicine, 0:00:04.960,0:00:09.056 but before I do that, I want to talk[br]a little bit about the past. 0:00:09.080,0:00:12.696 Now, throughout much[br]of the recent history of medicine, 0:00:12.720,0:00:16.536 we've thought about illness and treatment 0:00:16.560,0:00:19.936 in terms of a profoundly simple model. 0:00:19.960,0:00:22.656 In fact, the model is so simple 0:00:22.680,0:00:25.736 that you could summarize it in six words: 0:00:25.760,0:00:29.840 have disease, take pill, kill something. 0:00:31.080,0:00:35.816 Now, the reason[br]for the dominance of this model 0:00:35.840,0:00:38.456 is of course the antibiotic revolution. 0:00:38.480,0:00:41.656 Many of you might not know this,[br]but we happen to be celebrating 0:00:41.680,0:00:45.736 the hundredth year of the introduction[br]of antibiotics into the United States, 0:00:45.760,0:00:47.376 but what you do know 0:00:47.400,0:00:51.640 is that that introduction[br]was nothing short of transformative. 0:00:52.880,0:00:56.736 Here you had a chemical,[br]either from the natural world 0:00:56.760,0:00:59.496 or artificially synthesized[br]in the laboratory, 0:00:59.520,0:01:02.776 and it would course through your body, 0:01:02.800,0:01:05.576 it would find its target, 0:01:05.600,0:01:07.256 lock into its target -- 0:01:07.280,0:01:09.496 a microbe or some part of a microbe -- 0:01:09.520,0:01:12.960 and then turn off a lock and a key 0:01:13.960,0:01:17.496 with exquisite deftness,[br]exquisite specificity, 0:01:17.520,0:01:21.816 and you would end up taking[br]a previously fatal, lethal disease, 0:01:21.840,0:01:24.976 a pneumonia, syphilis, tuberculosis, 0:01:25.000,0:01:29.040 and transforming that[br]into a curable, or treatable illness. 0:01:30.080,0:01:31.560 You have a pneumonia, 0:01:32.480,0:01:33.856 you take penicillin, 0:01:33.880,0:01:35.416 you kill the microbe, 0:01:35.440,0:01:37.576 and you cure the disease. 0:01:37.600,0:01:40.536 So seductive was this idea, 0:01:40.560,0:01:44.736 so potent the metaphor of lock and key 0:01:44.760,0:01:46.296 and killing something, 0:01:46.320,0:01:48.336 that it really swept through biology. 0:01:48.360,0:01:50.480 It was a transformation like no other, 0:01:52.160,0:01:55.336 and we've really spent the last 100 years 0:01:55.360,0:01:58.816 trying to replicate that model[br]over and over again 0:01:58.840,0:02:00.079 in noninfectious diseases, 0:02:00.103,0:02:04.223 in chronic diseases like diabetes[br]and hypertension and heart disease. 0:02:05.120,0:02:08.759 And it's worked,[br]but it's only worked partly. 0:02:09.120,0:02:10.776 Let me show you. 0:02:10.800,0:02:13.696 You know, if you take the entire universe 0:02:13.720,0:02:17.216 of all chemical reactions[br]in the human body, 0:02:17.240,0:02:20.536 every chemical reaction[br]that your body is capable of, 0:02:20.560,0:02:23.576 most people think that that number[br]is on the order of a million. 0:02:23.600,0:02:24.896 Let's call it a million. 0:02:24.920,0:02:26.616 And now you ask the question, 0:02:26.640,0:02:29.296 what number or fraction of reactions 0:02:29.320,0:02:31.136 can actually be targeted 0:02:31.160,0:02:35.976 by the entire pharmacopoeia,[br]all of medicinal chemistry? 0:02:36.000,0:02:38.040 That number is 250. 0:02:39.680,0:02:42.216 The rest is chemical darkness. 0:02:42.240,0:02:48.416 In other words, 0.025 percent[br]of all chemical reactions in your body 0:02:48.440,0:02:52.560 are actually targetable[br]by this lock and key mechanism. 0:02:53.680,0:02:56.736 You know, if you think[br]about human physiology 0:02:56.760,0:03:00.216 as a vast global telephone network 0:03:00.240,0:03:04.120 with interacting nodes[br]and interacting pieces, 0:03:04.600,0:03:07.776 then all of our medicinal chemistry 0:03:07.800,0:03:10.056 is operating on one tiny corner 0:03:10.080,0:03:12.776 at the edge, the outer edge,[br]of that network. 0:03:12.800,0:03:16.616 It's like all of our[br]pharmaceutical chemistry 0:03:16.640,0:03:20.416 is a pole operator in Wichita, Kansas 0:03:20.440,0:03:23.400 who is tinkering with about[br]10 or 15 telephone lines. 0:03:24.880,0:03:27.040 So what do we do about this idea? 0:03:28.160,0:03:30.520 What if we reorganized this approach? 0:03:32.080,0:03:35.456 In fact, it turns out[br]that the natural world 0:03:35.480,0:03:40.536 gives us a sense of how one[br]might think about illness 0:03:40.560,0:03:42.216 in a radically different way, 0:03:42.240,0:03:45.960 rather than disease, medicine, target. 0:03:47.080,0:03:50.456 In fact, the natural world[br]is organized hierarchically upwards, 0:03:50.480,0:03:52.336 not downwards, but upwards, 0:03:52.360,0:03:58.600 and we begin with a self-regulating,[br]semi-autonomous unit called a cell. 0:03:59.640,0:04:02.856 These self-regulating,[br]semi-autonomous units 0:04:02.880,0:04:07.696 give rise to self-regulating,[br]semi-autonomous units called organs, 0:04:07.720,0:04:10.720 and these organs coalesce[br]to form things called humans, 0:04:11.920,0:04:15.816 and these organisms[br]ultimately live in environments, 0:04:15.840,0:04:19.440 which are partly self-regulating[br]and partly semi-autonomous. 0:04:20.920,0:04:23.736 What's nice about this scheme,[br]this hierarchical scheme 0:04:23.760,0:04:26.456 building upwards rather than downwards 0:04:26.480,0:04:29.856 is that it allows us[br]to think about illness as well 0:04:29.880,0:04:31.214 in a somewhat different way. 0:04:32.400,0:04:34.520 Take a disease like cancer. 0:04:36.120,0:04:37.416 Since the 1950s, 0:04:37.440,0:04:42.967 we've tried rather desperately to apply[br]this lock and key model to cancer. 0:04:42.991,0:04:45.880 We've tried to kill cells 0:04:45.905,0:04:50.252 using a variety of chemotherapies [br]or targeted therapies, 0:04:50.276,0:04:52.696 and as most of us know, that's worked. 0:04:52.720,0:04:54.578 It's worked for diseases like leukemia. 0:04:54.602,0:04:56.976 It's worked for some forms[br]of breast cancer, 0:04:57.000,0:05:00.736 but eventually you run[br]to the ceiling of that approach, 0:05:00.760,0:05:03.256 and it's only in the last 10 years or so 0:05:03.280,0:05:06.416 that we've begun to think[br]about using the immune system, 0:05:06.440,0:05:09.536 remembering that in fact the cancer cell[br]doesn't grow in a vacuum. 0:05:09.560,0:05:11.616 It actually grows in a human organism, 0:05:11.640,0:05:13.936 and could you use the organismal capacity, 0:05:13.960,0:05:17.103 the fact that human beings[br]have an immune system, to attack cancer? 0:05:17.127,0:05:21.327 In fact, it's led to the some of the most[br]spectacular new medicines in cancer. 0:05:22.480,0:05:25.814 And finally, I mean, there's the level[br]of the environment, isn't there? 0:05:26.160,0:05:29.136 You know, we don't think of cancer[br]as altering the environment. 0:05:29.160,0:05:34.056 But let me give you an example[br]of a profoundly carcinogenic environment. 0:05:34.080,0:05:35.280 It's called a prison. 0:05:36.160,0:05:41.296 You take loneliness, you take depression,[br]you take confinement, 0:05:41.320,0:05:42.520 and you add to that, 0:05:43.400,0:05:45.960 rolled up in a little[br]white sheet of paper, 0:05:47.000,0:05:50.776 one of the most potent neurostimulants[br]that we know, called nicotine, 0:05:50.800,0:05:55.736 and you add to that one of the most potent[br]addictive substances that you know, 0:05:55.760,0:05:56.976 and you have 0:05:57.000,0:05:58.520 a pro-carcinogenic environment. 0:05:59.520,0:06:01.976 But you can have anti-carcinogenic[br]environments too. 0:06:02.000,0:06:04.696 There are attempts to create milieus, 0:06:04.720,0:06:07.482 change the hormonal milieu[br]for breast cancer, for instance. 0:06:08.440,0:06:11.856 We're trying to change the metabolic[br]milieu for other forms of cancer. 0:06:11.880,0:06:14.296 Or take another disease, like depression. 0:06:14.320,0:06:16.976 Again, working upwards, 0:06:17.000,0:06:21.016 since the 1960s and 1970s,[br]we've tried, again, desperately 0:06:21.040,0:06:25.216 to turn off molecules[br]that operate between nerve cells -- 0:06:25.240,0:06:27.416 serotonin, dopamine -- 0:06:27.440,0:06:29.256 and tried to cure depression that way, 0:06:29.280,0:06:31.720 and that's worked,[br]but then that reached the limit. 0:06:33.000,0:06:35.620 And we now know that what you[br]really probably need to do 0:06:35.644,0:06:38.616 is to change the physiology[br]of the organ, the brain, 0:06:38.640,0:06:40.776 rewire it, remodel it, 0:06:40.800,0:06:43.376 and that, of course,[br]we know study upon study has shown 0:06:43.400,0:06:45.115 that talk therapy does exactly that, 0:06:45.139,0:06:47.395 and study upon study[br]has shown that talk therapy 0:06:47.419,0:06:50.536 combined with medicines, pills, 0:06:50.560,0:06:52.989 really is much more effective[br]than either one alone. 0:06:53.840,0:06:57.416 Can we imagine a more immersive[br]environment that will change depression? 0:06:57.440,0:07:01.496 Can you lock out the signals[br]that elicit depression? 0:07:01.520,0:07:07.000 Again, moving upwards along this[br]hierarchical chain of organization. 0:07:07.760,0:07:10.456 What's really at stake perhaps here 0:07:10.480,0:07:13.736 is not the medicine itself but a metaphor. 0:07:13.760,0:07:15.816 Rather than killing something, 0:07:15.840,0:07:19.536 in the case of the great[br]chronic degenerative diseases -- 0:07:19.560,0:07:23.056 kidney failure, diabetes,[br]hypertension, osteoarthritis -- 0:07:23.080,0:07:26.652 maybe what we really need to do is change[br]the metaphor to growing something. 0:07:26.676,0:07:28.616 And that's the key, perhaps, 0:07:28.640,0:07:31.136 to reframing our thinking about medicine. 0:07:31.160,0:07:34.616 Now, this idea of changing, 0:07:34.640,0:07:36.976 of creating a perceptual[br]shift, as it were, 0:07:37.000,0:07:40.296 came home to me to roost in a very[br]personal matter about 10 years ago. 0:07:40.320,0:07:43.096 About 10 years ago --[br]I've been a runner most of my life -- 0:07:43.120,0:07:45.096 I went for a run, a Saturday morning run, 0:07:45.120,0:07:47.776 I came back and woke up[br]and I basically couldn't move. 0:07:47.800,0:07:49.816 My right knee was swollen up, 0:07:49.840,0:07:53.360 and you could hear that ominous crunch[br]of bone against bone. 0:07:54.240,0:07:59.136 And one of the perks of being a physician[br]is that you get to order your own MRIs. 0:07:59.160,0:08:03.136 And I had an MRI the next week,[br]and it looked like that. 0:08:03.160,0:08:07.456 Essentially, the meniscus of cartilage[br]that is between bone 0:08:07.480,0:08:10.896 had been completely torn[br]and the bone itself had been shattered. 0:08:10.920,0:08:13.376 Now, if you're looking at me[br]and feeling sorry, 0:08:13.400,0:08:15.216 let me tell you a few facts. 0:08:15.240,0:08:19.416 If I was to take an MRI[br]of every person in this audience, 0:08:19.440,0:08:21.496 60 percent of you would show signs 0:08:21.520,0:08:24.296 of bone degeneration[br]and cartilage degeneration like this. 0:08:24.320,0:08:28.096 85 percent of all women by the age of 70 0:08:28.120,0:08:31.376 would show moderate to severe[br]cartilage degeneration. 0:08:31.400,0:08:33.696 50 to 60 percent[br]of the men in this audience 0:08:33.720,0:08:35.056 would also have such signs. 0:08:35.080,0:08:36.856 So this is a very common disease. 0:08:36.880,0:08:38.976 Well, the second perk of being a physician 0:08:39.000,0:08:42.135 is that you can get[br]to experiment on your own ailments. 0:08:42.159,0:08:44.376 So about 10 years ago we began, 0:08:44.400,0:08:46.816 we brought this process[br]into the laboratory, 0:08:46.840,0:08:48.856 and we began to do simple experiments, 0:08:48.880,0:08:51.336 mechanically trying[br]to fix this degeneration. 0:08:51.360,0:08:56.176 We tried to inject chemicals[br]into the knee spaces of animals 0:08:56.200,0:08:58.856 to try to reverse cartilage degeneration, 0:08:58.880,0:09:03.416 and to put a short summary[br]on a very long and painful process, 0:09:03.440,0:09:05.216 essentially it came to naught. 0:09:05.240,0:09:06.440 Nothing happened. 0:09:06.880,0:09:11.656 And then about seven years ago,[br]we had a research student from Australia. 0:09:11.680,0:09:14.680 The nice thing about Australians[br]is that they're habitually used 0:09:14.705,0:09:16.521 to looking at the world upside down -- 0:09:16.546,0:09:17.703 (Laughter) 0:09:17.727,0:09:21.816 And so Dan suggested to me, "You know,[br]maybe it isn't a mechanical problem. 0:09:21.840,0:09:25.840 Maybe it isn't a chemical problem.[br]Maybe it's a stem cell problem." 0:09:27.760,0:09:29.656 In other words, he had two hypotheses. 0:09:29.680,0:09:33.496 Number one, there is such a thing[br]as a skeletal stem cell. 0:09:33.520,0:09:37.040 A skeletal stem cell that builds up[br]the entire vertebrate skeleton: 0:09:37.064,0:09:39.596 bone, cartilage, and the fibrous[br]elements of skeleton, 0:09:39.620,0:09:41.485 just like there's a stem cell in blood, 0:09:41.510,0:09:43.945 just like there's a stem cell[br]in the nervous system, 0:09:43.969,0:09:47.529 and two, that maybe that, the degeneration[br]or dysfunction of this stem cell 0:09:47.554,0:09:51.056 is what's causing osteochondral arthritis,[br]a very common ailment. 0:09:51.080,0:09:54.296 So really the question was,[br]were we looking for a pill 0:09:54.320,0:09:56.936 when we should have really[br]been looking for a cell. 0:09:56.960,0:09:59.816 So we switched our models, 0:09:59.840,0:10:02.960 and now we began[br]to look for skeletal stem cells, 0:10:03.560,0:10:06.056 and to cut again a long story short, 0:10:06.080,0:10:09.000 about five years ago,[br]we found these cells. 0:10:09.800,0:10:12.296 They live inside the skeleton. 0:10:12.320,0:10:15.216 Here's a schematic and then[br]a real photograph of one of them. 0:10:15.240,0:10:17.176 The white stuff is bone, 0:10:17.200,0:10:20.216 and these red columns that you see[br]and the yellow cells 0:10:20.240,0:10:23.496 are cells that have arisen[br]from one single skeleton stem cell, 0:10:23.520,0:10:26.816 columns of cartilage, columns of bone[br]coming out a single cell. 0:10:26.840,0:10:30.136 These cells are fascinating.[br]They have four properties. 0:10:30.160,0:10:33.936 Number one is that they live[br]where they're expected to live. 0:10:33.960,0:10:36.336 They live just underneath[br]the surface of the bone, 0:10:36.360,0:10:37.896 underneath cartilage. 0:10:37.920,0:10:40.540 You know, in biology,[br]it's location, location, location. 0:10:40.564,0:10:44.816 And they move into the appropriate areas[br]and form bone and cartilage. 0:10:44.840,0:10:46.096 That's one. 0:10:46.120,0:10:47.656 Here's an interesting property. 0:10:47.680,0:10:50.336 You can take them out[br]of the vertebrate skeleton, 0:10:50.360,0:10:52.936 you can culture them[br]in petri dishes in the laboratory, 0:10:52.960,0:10:54.936 and they are dying to form cartilage. 0:10:54.960,0:10:57.682 Remember how we couldn't[br]form cartilage for love or money? 0:10:57.706,0:10:59.625 These cells are dying to form cartilage. 0:10:59.650,0:11:02.655 They form their own furls[br]of cartilage around themselves. 0:11:02.680,0:11:04.296 They're also, number three, 0:11:04.320,0:11:08.496 the most efficient repairers[br]of fractures that we've ever encountered. 0:11:08.520,0:11:11.816 This is a little bone,[br]a mouse bone that we fractured 0:11:11.840,0:11:13.376 and then let it heal by itself. 0:11:13.400,0:11:16.416 These stem cells have come in[br]and repaired, in yellow, the bone, 0:11:16.440,0:11:19.056 in white, the cartilage,[br]almost completely. 0:11:19.080,0:11:22.616 So much so that if you label them[br]with a fluorescent dye 0:11:22.640,0:11:26.376 you can see them like some kind[br]of peculiar cellular glue 0:11:26.400,0:11:28.256 coming into the area of a fracture, 0:11:28.280,0:11:31.256 fixing it locally,[br]and then stopping their work. 0:11:31.280,0:11:33.616 Now, the fourth one is the most ominous, 0:11:33.640,0:11:37.776 and that is that their numbers[br]decline precipitously, 0:11:37.800,0:11:42.496 precipitously, tenfold,[br]fiftyfold, as you age. 0:11:42.520,0:11:44.096 And so what had happened, really, 0:11:44.120,0:11:46.976 is that we found ourselves[br]in a perceptual shift. 0:11:47.000,0:11:49.736 We had gone hunting for pills 0:11:49.760,0:11:52.256 but we ended up finding theories, 0:11:52.280,0:11:53.496 and in some ways, 0:11:53.520,0:11:56.136 we had hooked ourselves[br]back onto this idea: 0:11:56.160,0:11:59.056 cells, organisms, environments, 0:11:59.080,0:12:01.656 because we were now thinking[br]about bone stem cells, 0:12:01.680,0:12:05.120 we were thinking about arthritis[br]in terms of a cellular disease. 0:12:05.840,0:12:08.126 And then the next question was,[br]are there organs? 0:12:08.150,0:12:10.389 Can you build this[br]as an organ outside the body? 0:12:10.413,0:12:14.256 Can you implant cartilage[br]into areas of trauma? 0:12:14.280,0:12:16.256 And perhaps most interestingly, 0:12:16.280,0:12:18.656 can you ascend right up[br]and create environments? 0:12:18.680,0:12:21.736 You know, we know[br]that exercise remodels bone, 0:12:21.760,0:12:24.176 but come on, none of us[br]is going to exercise. 0:12:24.200,0:12:29.376 So could you imagine ways of passively[br]loading and unloading bone 0:12:29.400,0:12:34.216 so that you can recreate[br]or regenerate degenerating cartilage? 0:12:34.240,0:12:36.621 And perhaps more interesting,[br]and more importantly, 0:12:36.645,0:12:40.096 the question is, can you apply this model[br]more globally outside medicine? 0:12:40.120,0:12:44.176 What's at stake, as I said before,[br]is not killing something, 0:12:44.200,0:12:45.640 but growing something. 0:12:46.280,0:12:51.096 And it raises a series of, I think,[br]some of the most interesting questions 0:12:51.120,0:12:53.640 about how we think[br]about medicine in the future. 0:12:55.040,0:12:57.920 Could your medicine[br]be a cell and not a pill? 0:12:58.840,0:13:01.216 How would we grow these cells? 0:13:01.240,0:13:04.256 What we would we do to stop[br]the malignant growth of these cells? 0:13:04.280,0:13:08.176 We heard about the problems[br]of unleashing growth. 0:13:08.200,0:13:10.976 Could we implant[br]suicide genes into these cells 0:13:11.000,0:13:12.440 to stop them from growing? 0:13:13.040,0:13:16.976 Could your medicine be an organ[br]that's created outside the body 0:13:17.000,0:13:18.936 and then implanted into the body? 0:13:18.960,0:13:21.696 Could that stop some of the degeneration? 0:13:21.720,0:13:23.625 What if the organ needed to have memory? 0:13:23.649,0:13:28.416 In cases of diseases of the nervous system[br]some of those organs had memory. 0:13:28.440,0:13:30.896 How could we implant[br]those memories back in? 0:13:30.920,0:13:32.736 Could we store these organs? 0:13:32.760,0:13:35.903 Could each organ have to be developed[br]for an individual human being 0:13:35.927,0:13:37.127 and put back? 0:13:38.520,0:13:41.136 And perhaps most puzzlingly, 0:13:41.160,0:13:42.970 could your medicine be an environment? 0:13:44.160,0:13:45.816 Could you patent an environment? 0:13:45.840,0:13:49.296 You know, in every culture, 0:13:49.320,0:13:52.256 shamans have been using[br]environments as medicines. 0:13:52.280,0:13:54.600 Could we imagine that for our future? 0:13:56.080,0:13:59.456 I've talked a lot about models.[br]I began this talk with models. 0:13:59.480,0:14:02.176 So let me end with some thoughts[br]about model building. 0:14:02.200,0:14:04.296 That's what we do as scientists. 0:14:04.320,0:14:07.616 You know, when an architect[br]builds a model, 0:14:07.640,0:14:10.936 he or she is trying to show you[br]a world in miniature. 0:14:10.960,0:14:13.856 But when a scientist is building a model, 0:14:13.880,0:14:16.404 he or she is trying to show you[br]the world in metaphor. 0:14:17.600,0:14:21.456 He or she is trying to create[br]a new way of seeing. 0:14:21.480,0:14:25.600 The former is a scale shift.[br]The latter is a perceptual shift. 0:14:26.920,0:14:31.856 Now, antibiotics created[br]such a perceptual shift 0:14:31.880,0:14:35.696 in our way of thinking about medicine[br]that it really colored, distorted, 0:14:35.720,0:14:39.640 very successfully, the way we've thought[br]about medicine for the last hundred years. 0:14:40.400,0:14:44.816 But we need new models[br]to think about medicine in the future. 0:14:44.840,0:14:46.320 That's what's at stake. 0:14:47.480,0:14:50.816 You know, there's[br]a popular trope out there 0:14:50.840,0:14:54.816 that the reason we haven't had[br]the transformative impact 0:14:54.840,0:14:56.816 on the treatment of illness 0:14:56.840,0:14:59.696 is because we don't have[br]powerful enough drugs, 0:14:59.720,0:15:01.080 and that's partly true, 0:15:02.120,0:15:03.616 but perhaps the real reason is 0:15:03.640,0:15:06.840 that we don't have powerful enough[br]ways of thinking about medicines. 0:15:08.560,0:15:10.976 It's certainly true that 0:15:11.000,0:15:14.776 it would be lovely to have new medicines, 0:15:14.800,0:15:19.456 but perhaps what's really at stake[br]are three more intangible ends: 0:15:19.480,0:15:23.296 mechanisms, models, metaphors. 0:15:23.320,0:15:24.656 Thank you. 0:15:24.680,0:15:31.520 (Applause) 0:15:33.600,0:15:37.016 Chris Anderson:[br]I really like this metaphor. 0:15:37.040,0:15:38.576 How does it link in? 0:15:38.600,0:15:41.736 There's a lot of talk in technologyland 0:15:41.760,0:15:43.896 about the personalization of medicine, 0:15:43.920,0:15:47.336 that we have all this data[br]and that medical treatments of the future 0:15:47.360,0:15:51.856 will be for you specifically,[br]your genome, your current context. 0:15:51.880,0:15:55.816 Does that apply to this model[br]you've got here? 0:15:55.840,0:15:58.456 Siddhartha Mukherjee:[br]It's a very interesting question. 0:15:58.480,0:16:00.696 We've thought about[br]personalization of medicine 0:16:00.720,0:16:02.256 very much in terms of genomics. 0:16:02.280,0:16:04.856 That's because the gene[br]is such a dominant metaphor, 0:16:04.880,0:16:07.856 again, to use that same word,[br]in medicine today, 0:16:07.880,0:16:11.616 that we think the genome will drive[br]the personalization of medicine. 0:16:11.640,0:16:14.736 But of course the genome[br]is just the bottom 0:16:14.760,0:16:18.576 of a long chain of being, as it were. 0:16:18.600,0:16:22.416 That chain of being, really the first[br]organized unit of that, is the cell. 0:16:22.440,0:16:25.416 So, if we are really going to deliver[br]in medicine in this way, 0:16:25.440,0:16:28.256 we have to think of personalizing[br]cellular therapies, 0:16:28.280,0:16:31.456 and then personalizing[br]organ or organismal therapies, 0:16:31.480,0:16:35.296 and ultimately personalizing[br]immersion therapies for the environment. 0:16:35.320,0:16:38.416 So I think at every stage, you know -- 0:16:38.440,0:16:40.856 There's that metaphor,[br]there's turtles all the way. 0:16:40.880,0:16:43.261 Well, in this, there's[br]personalization all the way. 0:16:43.285,0:16:46.176 CA: So when you say[br]medicine could be a cell 0:16:46.200,0:16:48.016 and not a pill, 0:16:48.040,0:16:50.296 you're talking about[br]potentially your own cells. 0:16:50.320,0:16:52.696 SM: Absolutely.[br]CA: So converted to stem cells, 0:16:52.720,0:16:57.256 perhaps tested against all kinds[br]of drugs or something, and prepared. 0:16:57.280,0:16:59.816 SM: And there's no perhaps.[br]This is what we're doing. 0:16:59.840,0:17:03.576 This is what's happening,[br]and in fact, we're slowly moving, 0:17:03.600,0:17:07.415 not away from genomics,[br]but incorporating genomics 0:17:07.440,0:17:12.175 into what we call multi-order,[br]semi-autonomous, self-regulating systems, 0:17:12.200,0:17:14.816 like cells, like organs,[br]like environments. 0:17:14.839,0:17:18.200 CA: Thank you so much. SM: Thank you.