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