I want to talk to you about the future of medicine. But before I do that, I want to talk a little bit about the past. Now, throughout much of the recent history of medicine, we've thought about illness and treatment in terms of a profoundly simple model. In fact, the model is so simple that you could summarize it in six words: have disease, take pill, kill something.
Rad bi vam govoril o prihodnosti medicine. Ampak prej bi rad govoril malo o preteklosti. Skozi večji del nedavne zgodovine medicine smo o bolezni in zdravljenju razmišljali na zelo preprost način. Dejansko, tako preprosto da lahko povzamemo v šestih besedah: biti bolan, vzeti tableto, nekaj ubiti.
Now, the reason for the dominance of this model is of course the antibiotic revolution. Many of you might not know this, but we happen to be celebrating the hundredth year of the introduction of antibiotics into the United States. But what you do know is that that introduction was nothing short of transformative. Here you had a chemical, either from the natural world or artificially synthesized in the laboratory, and it would course through your body, it would find its target, lock into its target -- a microbe or some part of a microbe -- and then turn off a lock and a key with exquisite deftness, exquisite specificity. And you would end up taking a previously fatal, lethal disease -- a pneumonia, syphilis, tuberculosis -- and transforming that into a curable, or treatable illness. You have a pneumonia, you take penicillin, you kill the microbe and you cure the disease.
Razlog za prevlado tega modela je seveda antibiotska revolucija. Veliko vas najbrž ne ve, ampak slučajno praznujemo stoletnico uvedbe antibiotikov v Združenih Državah. A kar veste je, da je ta uvedba pomenila pravo preobrazbo. Imeli smo kemikalijo, naravno ali umetno sintetizirano v laboratoriju, in ta bi potovala po vašem telesu, našla svoj cilj se nanj pritrdila-- neki mikrob ali delec mikroba-- in potem bi zaklenila ključavnico s ključem zelo spretno, zelo točno. Tako smo imeli neko prej smrtno bolezen --pljučnico, sifilis, tuberkulozo-- in jo spremenili v ozdravljivo bolezen. Imaš pljučnico, vzameš penicilin, ubiješ mikrobe in pozdraviš to bolezen.
So seductive was this idea, so potent the metaphor of lock and key and killing something, that it really swept through biology. It was a transformation like no other. And we've really spent the last 100 years trying to replicate that model over and over again in noninfectious diseases, in chronic diseases like diabetes and hypertension and heart disease. And it's worked, but it's only worked partly. Let me show you. You know, if you take the entire universe of all chemical reactions in the human body, every chemical reaction that your body is capable of, most people think that that number is on the order of a million. Let's call it a million. And now you ask the question, what number or fraction of reactions can actually be targeted by the entire pharmacopoeia, all of medicinal chemistry? That number is 250. The rest is chemical darkness. In other words, 0.025 percent of all chemical reactions in your body are actually targetable by this lock and key mechanism. You know, if you think about human physiology as a vast global telephone network with interacting nodes and interacting pieces, then all of our medicinal chemistry is operating on one tiny corner at the edge, the outer edge, of that network. It's like all of our pharmaceutical chemistry is a pole operator in Wichita, Kansas who is tinkering with about 10 or 15 telephone lines.
Tako zapeljiva je bila ta ideja, tako močna metafora ključavnice in ključa, in nekaj ubiti, da je prišla v biologijo. Je bila sprememba brez primere. Tako smo preživeli zadnjih 100 let, da smo skušali replicirati ta model vedno znova pri nenalezljivih boleznih, pri kroničnih boleznih, kot so diabetes, hipertenzija in srčna bolezen. In delovalo je, a samo delno. Vam bom pokazal. Veste, če vzamemo celoto vseh kemičnih reakcij v človeškem telesu, vsako možno kemično reakcijo v človeškem telesu, večina ljudi misli, da ta številka je okoli en milijon. Recimo da je en milijon. Sedaj vprašate kakšno je število teh reakcij, ki res lahko postanejo cilj v vsej farmakopeji, vsej farmacevtski kemiji? To število je 250. Ostalo je kemična tema. Z drugimi besedami, 0,025 % vseh kemičnih reakcij v vašem telesu lahko postane tarča tega mehanizma ključavnice in ključa. Če razmišljate o človeški fiziologiji kot o nekem velikem telefonskem omrežju s povezanimi vozliči in kosi potem vsa naša farmacevtska kemija deluje v majhnem kotu na robu, zunanjem robu tega omrežja. Kot, da je vsa naša farmacevtska kemija neki delavec v Wichita, Kansasu in nadzoruje 10 ali 15 telefonskih linij.
So what do we do about this idea? What if we reorganized this approach? In fact, it turns out that the natural world gives us a sense of how one might think about illness in a radically different way, rather than disease, medicine, target. In fact, the natural world is organized hierarchically upwards, not downwards, but upwards, and we begin with a self-regulating, semi-autonomous unit called a cell. These self-regulating, semi-autonomous units give rise to self-regulating, semi-autonomous units called organs, and these organs coalesce to form things called humans, and these organisms ultimately live in environments, which are partly self-regulating and partly semi-autonomous.
Kaj naredimo s to idejo? Kaj, če preuredimo ta pristop? Izkaže se, da nam narava pokaže smer, kako bi lahko premišljevali o bolezni na zelo drugačen način, namesto bolezen-zdravilo- tarča. Narava je urejena hierarhično navzgor, ne navzdol, ampak navzgor. in začnemo s samoregulativno, deloma neodvisno enoto, imenovano celica. Te samoregulativne, deloma samostojne enote naredijo samoregulativne, deloma samostojne enote -- organe, in ti se združijo in naredijo človeka, in ti organizmi konec koncev živijo v okolju, ki so deloma samoregulativni in deloma samostojni.
What's nice about this scheme, this hierarchical scheme building upwards rather than downwards, is that it allows us to think about illness as well in a somewhat different way. Take a disease like cancer. Since the 1950s, we've tried rather desperately to apply this lock and key model to cancer. We've tried to kill cells using a variety of chemotherapies or targeted therapies, and as most of us know, that's worked. It's worked for diseases like leukemia. It's worked for some forms of breast cancer, but eventually you run to the ceiling of that approach. And it's only in the last 10 years or so that we've begun to think about using the immune system, remembering that in fact the cancer cell doesn't grow in a vacuum. It actually grows in a human organism. And could you use the organismal capacity, the fact that human beings have an immune system, to attack cancer? In fact, it's led to the some of the most spectacular new medicines in cancer.
Kar je lepo pri tej shemi, hierarhični shemi, ki gradi raje navzgor kot navzdol, je, da nam dovoli misliti tudi o bolezni na nekako drugačen način. Vzemimo neko bolezen, na primer rak. Od 1950ih naprej smo skušali na vse načine uporabiti ta model ključavnice in ključa pri raku. Skušali smo ubiti celice z raznimi kemoterapijami in usmerjenim terapijami, in tako kot nas ve večina, je učinkovalo. Je delovalo za bolezni kot je levkemija. Tudi za nekaj vrst raka dojke, ampak konec koncev pridemo do meje tega pristopa. In šele v zadnjih 10 letih smo začeli razmišljato o uporabi imunskega sistema, ko smo se spomnili, da rakaste celice ne živijo v vakuumu. Živijo v človeškem organizmu In lahko uporabimo te organizmske sposobnosti, dejstvo, da ima človek imunski sistem za napad raka? To je privedlo do nekaj od najbolj spektakularnih novih zdravil za raka.
And finally there's the level of the environment, isn't there? You know, we don't think of cancer as altering the environment. But let me give you an example of a profoundly carcinogenic environment. It's called a prison. You take loneliness, you take depression, you take confinement, and you add to that, rolled up in a little white sheet of paper, one of the most potent neurostimulants that we know, called nicotine, and you add to that one of the most potent addictive substances that you know, and you have a pro-carcinogenic environment. But you can have anti-carcinogenic environments too. There are attempts to create milieus, change the hormonal milieu for breast cancer, for instance. We're trying to change the metabolic milieu for other forms of cancer.
In končno je tu raven okolja, kaj ne? Ne gledamo na rak kot na spremembo okolja. Ampak vam bom dal en primer zelo rakotvornega okolja. Imenuje se ječa. Imamo samoto, depresijo, odvzem prostosti, in dodamo še enega v bel papir zavitega najmočnejših nevrostimulantov ki jih poznamo, nikotin, in dodamo še eno najbolj zasvojljivih snovi, ki jih poznamo in dobimo pro-rakotvorno okolje. Ampak lahko imamo tudi anti-rakotvorno okolje. Obstajajo poskusi, ki ustvarjajo okolje, spreminjajo hormonsko okolje pri raku dojke, na primer. Skušamo spremeniti metabolno okolje pri drugih vrstah raka.
Or take another disease, like depression. Again, working upwards, since the 1960s and 1970s, we've tried, again, desperately to turn off molecules that operate between nerve cells -- serotonin, dopamine -- and tried to cure depression that way, and that's worked, but then that reached the limit. And we now know that what you really probably need to do is to change the physiology of the organ, the brain, rewire it, remodel it, and that, of course, we know study upon study has shown that talk therapy does exactly that, and study upon study has shown that talk therapy combined with medicines, pills, really is much more effective than either one alone. Can we imagine a more immersive environment that will change depression? Can you lock out the signals that elicit depression? Again, moving upwards along this hierarchical chain of organization. What's really at stake perhaps here is not the medicine itself but a metaphor. Rather than killing something, in the case of the great chronic degenerative diseases -- kidney failure, diabetes, hypertension, osteoarthritis -- maybe what we really need to do is change the metaphor to growing something. And that's the key, perhaps, to reframing our thinking about medicine.
Ali pa vzemimo drugo bolezen, na primer depresijo. Spet, če gradimo navzgor od 1960ih, 1970ih smo skušali na vse načine ugasniti molekule, ki delujejo med živčnimi celicami --serotonin, dopamin-- smo poskušali tako zdraviti depresijo, in je delovalo, ampak samo do neke mere. In sedaj vemo, da kar moramo zares storiti, je spremeniti fiziologijo organa, to je možganov ga znova povezati, ga predelati, in to seveda vidimo študijo za študijo, da to stori prav terapevtski pogovor, in študija za študijo kaže, da je terapevtski pogovor skupaj z zdravili, tabletami, res veliko bolj učinkovit kot katerakoli od obeh sama. Si predstavljamo bolj poglobljeno okolje ki bi lahko spremenilo depresijo? Lahko zaklenemo signale ki izzovejo depresijo? Spet, če gradimo navzgor skozi to hierarhično organizirano verigo. Kar je res v igri tukaj ni v bistvu zdravilo, ampak metafora. Namesto ubijati nekaj, v primeru velikih kroničnih degenerativnih bolezni-- odpoved ledvic, sladkorna, hipertenzija, osteoartritis je morda to, kar moramo res spremeniti, metafora gojenja nečesa. In to je ključno, morda, za spremebmo našega mišlenja v medicini.
Now, this idea of changing, of creating a perceptual shift, as it were, came home to me to roost in a very personal manner about 10 years ago. About 10 years ago -- I've been a runner most of my life -- I went for a run, a Saturday morning run, I came back and woke up and I basically couldn't move. My right knee was swollen up, and you could hear that ominous crunch of bone against bone. And one of the perks of being a physician is that you get to order your own MRIs. And I had an MRI the next week, and it looked like that. Essentially, the meniscus of cartilage that is between bone had been completely torn and the bone itself had been shattered.
Ta ideja o spremembi, o ustvarjanju zaznavnega premika, od tega kar je, mi je prišla na misel na zelo oseben način pred približno 10 leti. Pred 10 leti -- večino življenja sem bil tekač- sem šel na tek, sobotni jutranji tek, se vrnil, zbudil in se v bistvu se nisem mogel premikati. Moje desno koleno je bilo otečeno, in si lahko slišal tisti strašen zvok kosti proti kosti. Dobra stran tega, da si zdravnik je, da si lahko sam predpišeš MRI zase. Imel sem MRI naslednji teden, in izgledalo je tako: V glavnem, hrustančni meniskus, ki je med kostmi je bil popolnoma pretrgan in kost se je zdrobila.
Now, if you're looking at me and feeling sorry, let me tell you a few facts. If I was to take an MRI of every person in this audience, 60 percent of you would show signs of bone degeneration and cartilage degeneration like this. 85 percent of all women by the age of 70 would show moderate to severe cartilage degeneration. 50 to 60 percent of the men in this audience would also have such signs. So this is a very common disease. Well, the second perk of being a physician is that you can get to experiment on your own ailments. So about 10 years ago we began, we brought this process into the laboratory, and we began to do simple experiments, mechanically trying to fix this degeneration. We tried to inject chemicals into the knee spaces of animals to try to reverse cartilage degeneration, and to put a short summary on a very long and painful process, essentially it came to naught. Nothing happened. And then about seven years ago, we had a research student from Australia. The nice thing about Australians is that they're habitually used to looking at the world upside down.
Če me gledate in se vam smilim, naj vam povem nekaj dejstev. Če bi naredili MRI vsakemu poslušalcu tukaj 60% bi pokazalo znake kostne obrabe in hrustančne degeneracije kot je ta. 85% žensk do 70 leta bi imelo znake srednje do resne obrabe hrustanca. 50 do 60% moških tukaj bi imelo take znake. To je torej zelo pogosta bolezen. Ta druga dobra plat tega, da ste zdravnik, je, da lahko eksperimentirate na vaših lastnih obolenjih. Torej približno 10 let nazaj smo začeli, privedli smo ta proces v laboratorij, in smo začeli z enostavnimi eksperimenti, poskušali mehanično popraviti to obrabo. Poskusili smo vzbrizgati kemikalije v koleno živalim da bi obrnili proces obrabe hrustanca, in na kratko povedano, ta dolgi in boleči postopek ni pripeljal nikamor. Nič se ni zgodilo. Pred približno sedmimi leti smo dobili raziskavo avstralskega študenta. Pri Avstralcih je fino, je, da so že navajeni gledati na svet od spodaj navzgor.
(Laughter)
(smeh)
And so Dan suggested to me, "You know, maybe it isn't a mechanical problem. Maybe it isn't a chemical problem. Maybe it's a stem cell problem." In other words, he had two hypotheses. Number one, there is such a thing as a skeletal stem cell -- a skeletal stem cell that builds up the entire vertebrate skeleton, bone, cartilage and the fibrous elements of skeleton, just like there's a stem cell in blood, just like there's a stem cell in the nervous system. And two, that maybe that, the degeneration or dysfunction of this stem cell is what's causing osteochondral arthritis, a very common ailment. So really the question was, were we looking for a pill when we should have really been looking for a cell. So we switched our models, and now we began to look for skeletal stem cells. And to cut again a long story short, about five years ago, we found these cells. They live inside the skeleton. Here's a schematic and then a real photograph of one of them. The white stuff is bone, and these red columns that you see and the yellow cells are cells that have arisen from one single skeletal stem cell -- columns of cartilage, columns of bone coming out of a single cell. These cells are fascinating. They have four properties. Number one is that they live where they're expected to live. They live just underneath the surface of the bone, underneath cartilage. You know, in biology, it's location, location, location. And they move into the appropriate areas and form bone and cartilage. That's one. Here's an interesting property. You can take them out of the vertebrate skeleton, you can culture them in petri dishes in the laboratory, and they are dying to form cartilage. Remember how we couldn't form cartilage for love or money? These cells are dying to form cartilage. They form their own furls of cartilage around themselves. They're also, number three, the most efficient repairers of fractures that we've ever encountered. This is a little bone, a mouse bone that we fractured and then let it heal by itself. These stem cells have come in and repaired, in yellow, the bone, in white, the cartilage, almost completely. So much so that if you label them with a fluorescent dye you can see them like some kind of peculiar cellular glue coming into the area of a fracture, fixing it locally and then stopping their work. Now, the fourth one is the most ominous, and that is that their numbers decline precipitously, precipitously, tenfold, fiftyfold, as you age.
Torej Dan mi je predlagal: "Veš, morda to ni mehaničen problem. Morda to ni kemičen problem. Morda je problem matičnih celic." Drugače rečeno, imel je dve hipotezi. Prvič, obstaja nekaj imenovano skeletne izvorne celice-- skeletne izvorne celice, ki naredijo vse okostje vretenčarjev kosti, hrustanec in fibrozne elemente skeleta, tako kot obstajajo krvne matične celice, tako kot so izvorne celice v živčnem sistemu. Drugič, da je morda degeneracija ali disfunkcija te izvorne celice to kar povzroča osteohondralni artritis, zelo pogosto bolezen. Pravo vprašanje je torej bilo, ali smo iskali tableto, ko bi morali iskati celico. Torej smo zamenjali model, začeli iskati matične celice okostja. In spet na kratko povedano, pred približno petimi leti smo našli te celice. Živijo v okostju. Tukaj je shema in potem prava fotografija ene izmed njih. Ta belo je kost, in ti rdeči stebri, ki jih vidite in rumene celice so celice ki so nastale iz ene same matične celice-- hrustanec in kosti iz ene same celice. Te celice so zelo zanimive. Imajo štiri lastnosti. Ena, živijo tam, kjer pričakujemo da živijo. Živijo točno pod površino kosti, pod hrustancem. Veste, pri biologiji je lokacija, lokacija, lokacija. In gredo v primerne prostore in naredijo kost in hrustanec. To je ena. Tu je še ena zanimiva lastnost. lahko jih vzamete iz vretenčnega okostja, jih lahko gojite v petrijevkah v laboratoriju in rade bi izdelovale hrustančaste celice. Se spomnite kako nismo mogli narediti hrustanca za noben denar? Te celice želijo izdelovati hrustanec. Okrog sebe naredijo zvitke hrustanca. So tudi, številka tri, najbolj efektivni popravljalci zlomov, kar smo jih videli. To je mala kost, mišja kost, ki smo jo zlomili in potem pustili, da se sama pozdravi. Te iste celice so prišle in popravile, rumeno, kost, belo, hrustanec, skoraj v celoti. V tolikšni meri, da če jih označimo s fluorescento barvo jih lahko vidimo kot neke vrste posebno lepilo za kosti ki pride v prostor zloma, ga v popravi na mestu in potem ustavi svoje delo. Ta četrta je ta najbolj nevarna, in to je, da število upade zelo hitro, strmo, desetkrat, petdesetkrat ko se starate.
And so what had happened, really, is that we found ourselves in a perceptual shift. We had gone hunting for pills but we ended up finding theories. And in some ways we had hooked ourselves back onto this idea: cells, organisms, environments, because we were now thinking about bone stem cells, we were thinking about arthritis in terms of a cellular disease.
A kar se je v resnici zgodilo je, da smo se znajdli v premiku percepcije. Začeli smo tako, da smo iskali tablete a smo končali z iznajdbo teorij. In na nek način smo spet zasvojeni s to idejo: celice, organizmi, okolje, ker zdaj smo mislili na kostne matične celice smo mislili na artrozo kot na neko celično bolezen.
And then the next question was, are there organs? Can you build this as an organ outside the body? Can you implant cartilage into areas of trauma? And perhaps most interestingly, can you ascend right up and create environments? You know, we know that exercise remodels bone, but come on, none of us is going to exercise. So could you imagine ways of passively loading and unloading bone so that you can recreate or regenerate degenerating cartilage?
In naslednje vprašanje je bilo: obstajajo organi? Lahko naredimo to kot organe, izven telesa? Lahko vsadimo hrustanec na področja poškodbe? In morda še bolj zanimivo, lahko se povzpnemo še višje in naredimo nova okolja? Veste, vemo da trening preoblikuje kosti ampak noben od nas noče trenirati. Si predstavljate torej način za pasivno obremenitiev in razbremenitev kosti, da lahko naredimo ali obnovimo obrabljen hrustanec?
And perhaps more interesting, and more importantly, the question is, can you apply this model more globally outside medicine? What's at stake, as I said before, is not killing something, but growing something. And it raises a series of, I think, some of the most interesting questions about how we think about medicine in the future. Could your medicine be a cell and not a pill? How would we grow these cells? What we would we do to stop the malignant growth of these cells? We heard about the problems of unleashing growth. Could we implant suicide genes into these cells to stop them from growing? Could your medicine be an organ that's created outside the body and then implanted into the body? Could that stop some of the degeneration? What if the organ needed to have memory? In cases of diseases of the nervous system some of those organs had memory. How could we implant those memories back in? Could we store these organs? Would each organ have to be developed for an individual human being and put back? And perhaps most puzzlingly, could your medicine be an environment? Could you patent an environment? You know, in every culture, shamans have been using environments as medicines. Could we imagine that for our future? I've talked a lot about models. I began this talk with models. So let me end with some thoughts about model building. That's what we do as scientists. You know, when an architect builds a model, he or she is trying to show you a world in miniature. But when a scientist is building a model, he or she is trying to show you the world in metaphor. He or she is trying to create a new way of seeing. The former is a scale shift. The latter is a perceptual shift.
In kar je morda še bolj pomembno in zanimivo, vprašanje je, lahko uporabimo ta model izven medicine? Kar je v igri, kot sem omenil, ni nekaj ubiti, ampak nekaj novega vzgojiti. Menim, da to nam postavi nekaj najbolj zanimivih vprašanj o tem, kako razmišljamo o medicini v prihodnosti. Je lahko tvoje zdravilo ena celica, in ne ena tableta? Kako bi gojili te celice? Kaj lahko naredimo, da ustavimo maligno rast teh celic? Slišali smo o problemih nebrzdane rasti. Lahko vsadimo samomorilne gene v te celice, da preprečimo njihovo rast? Je lahko tvoje zdravilo organ, ustvarjen izven telesa in potem vsajen v telo? Lahko to prepreči kakšno degeneracijo? Kaj če mora organ imeti spomin? V primerih bolezni živčevja so imeli nekateri izmed teh organov spomin. Kako lahko vsadimo te spomine nazaj? Lahko hranimo te organe? Bo moral biti vsak organ oblikovan za posameznika in nato vrnjen? In morda še najbolj zapleteno, je lahko tvoje zdravilo neko okolje? Lahko patentiramo neko okolje? Veste, v vsaki kulturi, šamani so uporabljali okolja kot zdravila. Si lahko predstavljamo to kot našo prihodnost? Precej sem govoril o modelih, to predavanje sem pričel z modeli. Naj torej končam z mislimi o gradnji modelov. To je to, kar kot znanstveniki počnemo. Veste, ko arhitekt pripravi model, vam skuša pokazati svet v miniaturi. Ampak ko znanstvenik gradi model, vam skuša pokazati svet kot metaforo. Skuša ustvariti novi način gledanja. Prvi je sprememba dimenzije. Drugi je spremeba percepcije.
Now, antibiotics created such a perceptual shift in our way of thinking about medicine that it really colored, distorted, very successfully, the way we've thought about medicine for the last hundred years. But we need new models to think about medicine in the future. That's what's at stake.
Antibiotiki so povzročili tako spremembo percepcije v našem načinu gledanja na medicino, da je res pobarvala, popačila, na zelo učinkovit način, kako premišljujemo o medicini zadnjih sto let. Ampak potrebujemo nove modele za razmišljanje o medicini v prihodnosti. To je v igri.
You know, there's a popular trope out there that the reason we haven't had the transformative impact on the treatment of illness is because we don't have powerful-enough drugs, and that's partly true. But perhaps the real reason is that we don't have powerful-enough ways of thinking about medicines. It's certainly true that it would be lovely to have new medicines. But perhaps what's really at stake are three more intangible M's: mechanisms, models, metaphors.
Obstaja neki popularen trop, ki pravi, da je razlog zakaj nismo imeli transformativnega učinka na zdravljenje bolezni pomanjkanje dovolj močnih zdravil, in to je v neki meri res. Ampak morda je pravi razlog , da nimamo dovolj močnih pogledov na zdravila. Brez dvoma je res, da bi bilo krasno imeti nova zdravila. Ampak morda so res v igri trije neotipljivi pojmi: mahanizmi, modeli, metafore.
Thank you.
Hvala lepa.
(Applause)
(Aplavz)
Chris Anderson: I really like this metaphor. How does it link in? There's a lot of talk in technologyland about the personalization of medicine, that we have all this data and that medical treatments of the future will be for you specifically, your genome, your current context. Does that apply to this model you've got here?
Chris Andreson: zelo mi je všeč ta metafora. Kako se to poveže? Veliko se govori na področju tehnologije o personalizaciji medicine, da imamo vse te podatke in da bo zdravljenje v prihodnosti specifično za vsakega, tvoj genom, tvoj današnji položaj. Velja to za te modele?
Siddhartha Mukherjee: It's a very interesting question. We've thought about personalization of medicine very much in terms of genomics. That's because the gene is such a dominant metaphor, again, to use that same word, in medicine today, that we think the genome will drive the personalization of medicine. But of course the genome is just the bottom of a long chain of being, as it were. That chain of being, really the first organized unit of that, is the cell. So, if we are really going to deliver in medicine in this way, we have to think of personalizing cellular therapies, and then personalizing organ or organismal therapies, and ultimately personalizing immersion therapies for the environment. So I think at every stage, you know -- there's that metaphor, there's turtles all the way. Well, in this, there's personalization all the way.
Siddharta Mukherjee: Zanimivo vprašanje. O personalizaciji medicine smo razmišljali v smislu genomike. To je, ker je ta metafora o genih tako prevladujoča spet, da uporabim isto besedo, v današnji medicini, da mislimo da bo genomika pripeljala do personalizacije medicine. Ampak genom je samo začetek dolge verige. Ta veriga bitij, pravzaprav je ta prva organizirana enota tega celica. Torej, če res mislimo izvajati medicino na ta način, moramo misliti na personalizacijo celičnih terapij, in potem o personalizaciji terapij za organe in organizme, in končno o personalizaciji imerzijskih terapij za okolje. Torej mislim, da na vseh področjih obstaja metafora, ta pot se nikoli ne konča. Tako da, tudi personalizacija se ne konča.
CA: So when you say medicine could be a cell and not a pill, you're talking about potentially your own cells.
CA: Torej, ko pravite, da je zdravilo lahko celica, in ne tableta, govorite potencialno o vaših celicah.
SM: Absolutely. CA: So converted to stem cells, perhaps tested against all kinds of drugs or something, and prepared.
SM: Absolutno. CA: Torej v terminih matičnih celic, morda testiranih za vse vrste zdravil ipd., in pripravljene.
SM: And there's no perhaps. This is what we're doing. This is what's happening, and in fact, we're slowly moving, not away from genomics, but incorporating genomics into what we call multi-order, semi-autonomous, self-regulating systems, like cells, like organs, like environments.
SM: In ni nobenega 'morda'. To je kar delamo. To je kar se dogaja, in dejansko, se počasi premikamo, ne stran od genomike, ampak uporabljamo genomiko za deloma samostojne, samoregulativne sisteme v več redih, kot so celice, organi, okolja.
CA: Thank you so much.
CA: Najlepša hvala!
SM: Pleasure. Thanks.
SM: V veselje mi je, hvala.