Why curiosity is the key to science and medicine

Science.

The very word for many of you conjures
unhappy memories of boredom

in high school biology or physics class.

But let me assure that what you did there

had very little to do with science.

That was really the "what" of science.

It was the history of what
other people had discovered.

What I'm most interested in as a scientist

is the "how" of science.

Because science is knowledge in process.

We make an observation,
guess an explanation for that observation,

and then make a prediction
that we can test

with an experiment or other observation.

A couple of examples.

First of all, people noticed
that the Earth was below, the sky above,

and both the Sun and the Moon
seemed to go around them.

Their guessed explanation was that
the Earth must be the center

of the Universe.

The prediction: everything
should circle around the Earth.

This was first really tested
when Galileo got his hands

on one of the first telescopes,

and as he gazed into the night sky,

what he found there was a planet, Jupiter,

with four moons circling around it.

He then used those moons
to follow the path of Jupiter

and found that Jupiter also
was not going around the Earth

but around the Sun.

So the prediction test failed.

And this led to the discarding
of the theory

that the Earth was the center
of the Universe.

Another example: Sir Isaac Newton
noticed that things fall to the Earth.

The guessed explanation was gravity,

the prediction that everything
should fall to the Earth.

But of course, not everything
does fall to the Earth.

So did we discard gravity?

No. We revised the theory and said,
gravity pulls things to the Earth

unless there is an equal
and opposite force in the other direction.

This led us to learn something new.

We began to pay more attention
to the bird and the bird's wings,

and just think of all the discoveries

that have flown from
that line of thinking.

So the test failures, the exceptions,

the outliers, teach us what we don't know

and lead us to something new.

This is how science moves forward.
This is how science learns.

Sometimes in the media,
and even more rarely,

but sometimes even scientists will say

that something or has been
scientifically proven.

But I hope that you understand
that science never proves anything

definitively forever.

Hopefully science remains curious enough

to look for

and humble enough to recognize

when we have found

the next outlier,

the next exception,

which, like Jupiter's moons,

teaches us what we don't actually know.

We're going to change gears
here for a second.

The caduceus, or the symbol of medicine,

means a lot of different things
to different people,

but most of our public
discourse on medicine

really turns it into
an engineering problem.

We have the hallways of Congress,

and the boardrooms of insurance companies

that try to figure out how to pay for it.

The ethicists and epidemiologists
try to figure out how best

to distribute medicine,

and the hospitals and physicians
are absolutely obsessed

with their protocols and checklists,

trying to figure out how best
to safely apply medicine.

These are all good things.

However, they also all assume

at some level

that the textbook of medicine is closed.

We start to measure the quality
of our healthcare

by how quickly we can access it.

It doesn't surprise me that
in this climate,

many of our institutions for
for the provision of healthcare

start to look a heck of a lot
like Jiffy Lube.

(Laughter)

The only problem is that when
I graduated from medical school,

I didn't get one of those
little doohickeys

that your mechanic has
to plug into your car

and find out exactly what's wrong with it,

because the textbook of medicine

is not closed.

Medicine is science.

Medicine is knowledge in process.

We make an observation,

we guess an explanation
of that observation,

and then we make a prediction
that we can test.

Now the testing ground

of most predictions in medicine

is populations,

and you may remember from those
boring days in biology class

that populations tend to distribute

around a mean

as a Gaussian or a normal curve.

Therefore, in medicine,

after we make a prediction
from a guessed explanation,

we test it in a population.

That means that what we know in medicine,

our knowledge and our knowhow,

comes from populations,

but extends only as far

as the next outlier,

the next exception,

which, like Jupiter's moons,

will teach us what we don't actually know.

Now I am a surgeon

who looks after patients with sarcoma.

Sarcoma is a very rare form of cancer.

It's the cancer of flesh and bones.

And I would tell you that every one
of my patients is an outlier,

is an exception.

There is no surgery I have ever performed
for a sarcoma patient

that has ever been guided

by a randomized controlled clinical trial,

what we consider the best kind
of population-based evidence in medicine.

People talk about thinking
outside the box,

but we don't even have a box

in sarcoma.

What we do have as we take
a bath in the uncertainty

and unknowns and exceptions
and outliers that surround us in sarcoma

is easy access to what I think are
those two more important values

for any science:

humility and curiosity.

Because if I am humble and curious,

when a patient asks me a question,

and I don't know the answer,

I'll ask a colleague who may have
a similar albeit distinct patient

with sarcoma.

We'll even establish international
collaborations.

Those patients will start to talk
to each other through chatrooms

and support groups.

It's through this kind of
humbly curious communication

that we begin to try and learn new things.

As an example, this is a patient of mine

who had a cancer near his knee.

Because of humbly curious communication

in international collaborations,

we have learned that we can repurpose
the ankle to serve as the knee

when we have to remove the knee
with the cancer.

He can then wear a prosthetic
and run and jump and play.

This opportunity was available to him

because of international collaborations.

It was desirable to him

because he had contacted other patients

who had experienced it.

And so exceptions and outliers in medicine

teach us what we don't know,
but also lead us to new thinking.

Now very importantly,

all the new thinking that outliers

and exceptions lead us to in medicine

does not only apply
to the outliers and exceptions.

It is not that we only learn
from sarcoma patients

ways to manage sarcoma patients.

Sometimes, the outliers

and the exceptions

teach us things that matter
quite a lot to the general population.

Like a tree standing outside a forests,
the outliers and the exceptions

draw our attention

and lead us into a much greater sense

of perhaps what a tree is.

We often talk about losing the forests
for the trees,

but one also loses a tree

within a forest.

But the tree that stands out by itself

makes those relationships

that define a tree,

the relationships between trunk
and roots and branches,

much more apparent.

Even if that tree is crooked

or even if that tree

has very unusual relationships
between trunk and roots and branches,

it nonetheless draws our attention

and allows us to make observation

that we can then test
in the general population.

I told you that sarcomas are rare.

They make up about 1 percent
of all cancers.

You also probably know that cancer
is considered a genetic disease.

By genetic disease, we mean that cancer
is caused by oncogenes

that are turned on in cancer

and tumor suppressor genes
that are turned off to cause cancer.

You might think that we learned
about oncogenes

and tumor suppressor genes
from common cancers

like breast cancer and prostate cancer
and lung cancer,

but you'd be wrong.

We learned about oncogenes
and tumor suppressor genes

for the first time

in that itty bitty little one percent
cancers called sarcoma.

In 1966, Peyton Rous