Is There a Link Between Cancer and Heart Disease? | Nicholas Leeper | TED

Translator: Laura Anido Reviewer: Servizo de Normalización Lingüística

In two decades of practicing medicine,

Nas miñas dúas décadas exercendo como médico,

I've encountered a wide number of medical diagnoses.

atopei un gran número de diagnósticos.

You see, it turns out that there are more than 60,000 different medical diagnoses

Resulta que hai máis de 60 000 diagnósticos

that you can list on a patient's chart.

para marcar no historial dun paciente.

You can actually be diagnosed with a burn injury

Poden diagnosticarte cunha lesión por queimadura

when your water skis catch on fire.

se os teus esquís acuáticos se incendian.

There are also codes if you need surgery after being bitten by a pig,

Tamén hai códigos por se necesitas cirurxía despois de que te morda un porco,

(Laughter)

(Risas)

hit by a spacecraft,

se te golpea unha nave espacial,

(Laughter)

(Risas)

stabbed while crocheting,

se te apuñalas ao facer gancho

or my favorite,

ou, o meu favorito,

due to extreme problems with your in-laws.

debido a problemas extremos cos teus sogros.

(Laughter)

(Risas)

But the best of all has got to be the code

Pero o mellor de todos é o código

for getting sucked into a jet engine.

de ser absorbido por un motor.

And the reason that I like this one is because this is not the code

A razón pola que me gusta é porque non é o código

for the first time this happens, but for the subsequent encounter.

para a primeira vez que ocorre, senón para o encontro posterior.

(Laughter)

(Risas)

So there must be people on this Earth

Debe haber xente neste mundo

that have been sucked into a jet engine twice.

que foi succionada por un motor dúas veces.

(Laughter)

(Risas)

But I think, you know, kidding aside,

Pero creo que, bromas aparte,

we have to recognize

temos que recoñecer

that every last one of us in this room

que ata o último dos presentes nesta sala

is most likely to die of only one of two diagnoses.

ten moitas posibilidades de morrer só dun de dous diagnósticos.

And these, of course, are either cancer

E estes, por suposto, son o cancro

or cardiovascular disease.

ou as enfermidades cardiovasculares.

This speaks to the incredible public health importance

Isto fala da incrible importancia na saúde pública

of these two diseases

destas dúas enfermidades

and the urgent, unmet medical need to develop new therapies

e da necesidade médica urxente e non cuberta de crear novas terapias

directed against them.

para elas.

A lot of people are not surprised

A moita xente non lle sorprende

that these two diseases claimed so many lives.

que estas dúas enfermidades cobrasen tantas vidas.

After all, they are very different biologically,

Son moi diferentes dende o punto de vista biolóxico,

they have different risk factors,

teñen distintos factores de risco

and they affect very different patient populations.

e afectan a poboacións de pacientes moi diferentes.

But for the next 15 minutes or so,

Durante os próximos 15 minutos,

I would like to propose a different hypothesis.

gustaríame propor unha hipótese diferente:

That perhaps they actually have quite a lot in common.

que talvez en realidade teñen moito en común.

And even more importantly,

E o que é máis importante:

I would like to suggest that if we think about them this way,

gustaríame suxerir que, se pensamos nelas desta maneira,

we might be able to develop new therapies

poderiamos desenvolver novas terapias

that could treat both diseases at the same time.

que poderían tratar ambas ao mesmo tempo.

So before I tell you why I believe this hypothesis,

Así que, antes de dicirvos por que creo nesta hipótese,

let me lay out the counter arguments against it.

permitídeme expor os argumentos en contra.

I think many people would say

Creo que moita xente diría

that the old man who smokes cigarettes his whole life

que o ancián que fuma cigarros toda a súa vida

and has a heart attack

e ten un infarto

shares very little in common with a young person

ten moi pouco en común cun mozo

who develops colon cancer out of the blue.

que desenvolve un cancro de colon da nada.

But we now know that the risk factors for these diseases

Pero agora sabemos que os factores de risco destas enfermidades

have significant overlap.

se solapan considerablemente.

And the things that cause one disease can also put you at risk for the other.

E que o que causa unha enfermidade pode poñerte en risco de sufrir a outra.

Well, that may be true,

Isto podería ser certo,

but we know that genetically these diseases couldn't be more different.

pero sabemos que estas enfermidades non poderían ser máis diferentes.

I'm sure many of you have heard about these cancer genes

Seguro que moitos escoitastes falar dos xenes do cancro

that can be mutated in families

que poden mutar nas familias

that could put both mother and daughter at risk for breast cancer.

e que poderían poñer a nai e a filla en risco de padecer cancro de mama.

We know that those genes have nothing to do with heart attack,

Sabemos que eses xenes non teñen nada que ver cos infartos,

and that's true also.

e iso tamén é certo.

But I would point out that those genes were discovered decades ago,

Gustaríame sinalar que eses xenes descubríronse hai décadas,

before the Human Genome Project

antes do Proxecto Xenoma Humano

and before we could scan all three billion base pairs at the same time.

e de que puidésemos escanear os tres mil millóns de pares de bases ao mesmo tempo.

And when we do this for patients having heart attack,

Cando facemos iso cos pacientes que teñen un ataque ao corazón,

we find that the top hotspot for having a heart attack

descubrirmos que o punto máis importante para ter un infarto

is located on chromosome nine,

encóntrase no cromosoma nove,

shown here with these blue dots.

que se amosa con estes puntos azuis.

And what shocked the world when this paper was first published

O que sorprendeu o mundo cando se publicou por primeira vez este traballo

was that this genetic locus has nothing to do with smoking

foi que este locus xenético non ten nada que ver co tabaquismo,

or cholesterol or diabetes.

o colesterol ou a diabetes.

But actually seems to control a well-known cancer gene

En realidade, parece controlar un coñecido xene do cancro

that's mutated in patients with melanoma, brain cancer,

que está mutado en pacientes con melanoma, cancro cerebral,

lung cancer, etc.

cancro de pulmón etc.

And so for decades,

Durante décadas,

we've been focusing on the traditional cardiac risk factors.

estivemos centrándonos nos factores de risco cardíaco tradicionais.

But the genetics now tell us

Pero a xenética indícanos

that the most important factor may actually have to do

que o factor máis importante podería ter que ver, en cambio,

with a well-known cancer gene instead.

cun coñecido xene do cancro.

Well, that's an interesting observation,

É unha observación interesante,

but we know that if you look under the microscope

pero se miramos polo microscopio

at these two diseases,

estas dúas enfermidades, son totalmente diferentes.

they couldn't be more different.

When I was in medical school,

Na facultade de medicina,

I was taught that cancer is really just about cells dividing too quickly.

ensináronme que o cancro débese a que as células se dividen moi rápido.

And you can imagine this lung tumor

Podemos imaxinar que ese tumor pulmonar

growing over time and taking over the lung,

que crece co tempo e se apodera do pulmón

and that this has nothing to do with what happens in heart disease,

non ten nada que ver co que ocorre nas enfermidades do corazón,

which is a problem that, I was taught,

que son un problema que, segundo me ensinaron,

was due to the buildup of cholesterol

se debía á acumulación de colesterol,

that can ultimately lead to the blockage of an artery

que pode conducir á obstrución dunha arteria,

and a heart attack or a stroke.

un ataque cardíaco ou un derramo.

And to be sure, both of these biological processes are critically important.

E, sen dúbida, ambos procesos biolóxicos son moi importantes.

But I would point out that the modern-day textbook of these diseases

Gustaríame sinalar que os libros de texto actuais destas enfermidades

is getting harder and harder to tell apart.

son cada vez máis difíciles de distinguir.

We now know that both of these conditions are dominated

Agora sabemos que ambas afeccións están marcadas

by the influx of inflammatory cells

polo afluencia de células inflamatorias

and immune cells and abnormal blood vessels

e inmunitarias e vasos sanguíneos anormais

and even stem cells.

e incluso células nai,

And so maybe the textbooks that I used are out of date.

así que talvez os libros de texto que usei están desactualizados.

Well, at this point, you might say these are interesting observations,

Neste punto, poderíase dicir que son observacións interesantes,

pero hai algún dato clínico que suxira

but is there any clinical data which would suggest

that patients with one disease are actually at higher risk of the other?

que os pacientes cunha enfermidade teñen un maior risco de padecer a outra?

Turns out that investigators, both in Asia and Europe,

Resulta que os investigadores, tanto en Asia como en Europa,

have now started to test this hypothesis.

empezaron a probar esta hipótese.

And just last year,

O ano pasado,

a very important article was published out of Germany,

publicouse un artigo moi importante en Alemaña

where they looked at more than 100,000 individuals

no que se analizaron máis de 100 000 persoas

with congestive heart failure

con insuficiencia cardíaca conxestiva

and they found that these people were at much higher risk

e descubriron que estas persoas tiñan un risco moito maior

of developing cancer.

de desenvolver cancro.

This is really interesting

É realmente interesante

and suggests to me that indeed having one disease

e faime pensar que, efectivamente, ter unha enfermidade

may put you at risk of the other.

pode supor un risco para sufrir a outra.

But this also raises a very important scientific principle

Pero tamén suxire un principio científico moi importante:

that association is not the same as causation.

a asociación non é o mesmo que a causalidade.

And if you wanted to test that hypothesis,

Se se quixese probar esa hipótese,

you would have to do an experiment where you took a healthy individual

habería que facer un experimento no que se collese un individuo san

and then intentionally gave them a heart attack.

e se lle provocase á mantenta un ataque ao corazón.

You'd have to let some time go by

Habería que deixar pasar un tempo

to see what changes occur throughout the body.

para ver que cambios ocorren en todo o corpo.

And then you could determine if their rate of cancer was higher

Entón poderíase determinar se a taxa de cancro era máis alta

or vice versa, if their rate of heart disease was higher.

ou viceversa, se a taxa de enfermidades cardíacas era máis alta.

Now, obviously, we can't do this type of an experiment in human beings.

Evidentemente, non podemos facer este tipo de experimento en humanos.

This would be unethical.

Non sería ético.

But this type of an experiment is done in research laboratories

Porén, este tipo de experimentos realízanse a diario nos laboratorios

every day around the world

de todo o mundo

in mouse models of human disease.

en modelos en ratos de enfermidades humanas.

Just last year, two very important studies were published

O ano pasado publicáronse dous estudos moi importantes

where investigators took healthy mice

nos que os investigadores tomaron ratos sans

and then implanted small tumors underneath their skin.

e implantáronlles pequenos tumores baixo a pel.

They looked at the rate at which these cancers would grow over time.

Observaron o ritmo de crecemento destes cancros ao longo do tempo

And what they found in both studies was that the mice who had heart disease

e o que descubriron en ambos estudos foi que os ratos con enfermidades cardíacas

had much higher rates of cancer.

tiñan taxas de cancro moito máis altas.

And what was fascinating to me

O que me fascinou

was that they were able to confirm these findings

foi que puideron confirmar estes achados

across a wide range of tumors,

nunha ampla gama de tumores,

suggesting to me that really the presence of heart disease

o que suxire que, realmente, a presenza dunha enfermidade cardíaca

is sufficient to accelerate cancer growth.

é suficiente para acelerar o crecemento do cancro.

So having heard all this,

Despois de escoitar todo isto,

the natural question is whether we can do anything about this.

a pregunta natural é se podemos facer algo ao respecto.

So outside of my work at Stanford, one of my volunteer roles

Ademais do meu traballo en Stanford, traballo como voluntario

is with the American Heart Association.

na Asociación Estadounidense do Corazón

And one of our public health initiatives is called Life’s Simple Seven.

e unha das nosas iniciativas da saúde pública chámase Life’s Simple Seven.

We try to get patients with a history of heart disease

Intentamos que os pacientes con antecedentes cardíacos

to control these very simple and straightforward risk factors

controlen factores de risco tan simples e sinxelos

like exercise, cholesterol and diet.

como o exercicio, o colesterol e a dieta.

The idea here is that if you can control these,

A idea é que, se se poden controlar,

you should be able to lower your risk

debería poderse reducir o risco

of having additional cardiovascular events.

de sufrir outros episodios cardiovasculares.

This is now pretty widely accepted.

Isto é algo que está bastante aceptado.

But what's fascinating to me

Pero o que me fascina

is that a group of investigators have now looked at the association

é que un grupo de investigadores estudaron agora a asociación

with these risk factors and cancer.

entre estes factores de risco e o cancro.

And in a study with more than 10,000 individuals

Nun estudo con máis de 10 000 individuos

who were followed for almost two decades,

aos que se fixo un seguimento durante case 20 anos,

they found the people who had optimal control

descubriron que as persoas que tiñan un control óptimo

of all their risk factors

de todos os seus factores de risco

had a pretty low rate of developing cancer.

tiñan unha taxa bastante baixa de cancro.

But for each risk factor which fell out of control,

Porén, por cada factor de risco que se descontrolaba,

the risk of malignancy went up.

o risco de malignidade aumentaba.

And you can see that the group who had poor control of all seven risk factors

Pódese ver que o grupo que tiña un peor control dos sete factores de risco

had by far the highest rates of cancer,

tiña, con moito, as taxas máis altas de cancro,

with nearly a doubling of the risk.

con case o dobre do risco.

So this suggests to me that,

Isto suxíreme que,

in fact, if we want to control cancer,

se de feito queremos controlar o cancro,

we might start by controlling our cardiac risk profile.

poderiamos empezar por controlar o noso perfil de risco cardíaco.

So this is fine and we continue to encourage our patients to do this.

Isto está ben e seguimos animando os nosos pacientes a facelo.

But the reality is that even if I had a magic wand

Pero a realidade é que, mesmo se tivese unha variña máxica

and could somehow optimally control everybody's risk factors,

e puidese controlar os factores de risco de todo o mundo de forma óptima,

we know that we would still be dealing with both the number one

sabemos que seguiriamos lidando coa primeira

and number two causes of death worldwide.

e a segunda causa de morte en todo o mundo.

This tells us that we need to find new therapies

Isto indícanos que necesitamos atopar novas terapias

that could treat or even prevent these conditions in the first place.

que poidan tratar ou mesmo previr estas afeccións en primeiro lugar.

Now our laboratory chooses to do this

O noso laboratorio opta por facelo

with an unbiased genetics approach.

cun enfoque xenético imparcial.

We take biopsies from patients

Tomamos biopsias de pacientes

with or without a wide variety of tumors,

con ou sen unha ampla variedade de tumores

or with and without cardiovascular disease.

e con ou sen enfermidade cardiovascular.

And instead of looking at one gene at a time,

En lugar de examinar un xene de cada vez,

we scan the whole genome and look at the expression of all 20,000 genes.

escaneamos todo o xenoma e observamos a expresión dos 20 000 xenes.

You can plot these on a plot like this

Podemos mostralos nun gráfico coma este,

where each gray dot represents its own gene.

no que cada punto gris representa o seu propio xene.

And when you acquire enough samples,

Cando se adquiren suficientes mostras,

you can begin to identify patterns of those genes

pódense empezar a identificar padróns daqueles xenes

which are bad for cancer

que son malos para o cancro

versus those that protect against it.

fronte aos que nos protexen del

And do the same type of an experiment

e facer o mesmo tipo de experimento

to find those things that will accelerate or prevent against cardiovascular disease.

para atopar o que acelera ou prevén as enfermidades cardiovasculares.

Now, I think the clever part of this approach

Creo que a parte intelixente deste enfoque

is to integrate these

é integrar isto

and to run these analyses simultaneously.

e executar estes análises simultaneamente.

When you do this, we can begin to look at factors in the red quadrant.

Ao facer isto, podemos observar os factores do cuadrante vermello.

These are genes that we suspect should be bad

Son xenes que sospeitamos que deben ser malos

for both heart disease disease and cancer

para as enfermidades cardíacas e para o cancro

and must be avoided at all costs.

e deben evitarse a toda costa.

Or even better,

Ou mellor aínda,

perhaps we can find factors in the blue quadrant

quizais atopemos factores no cuadrante azul

that should be able to protect against both diseases.

que nos protexan contra ambas enfermidades.

We hypothesize that those factors in the blue quadrant could be prioritized

A nosa hipótese é que os factores do cuadrante azul poderían priorizarse

to help us find new medicines to cure these two leading killers.

para axudarnos a atopar novos medicamentos para curar estes dous asasinos principais.

Now our group has run these analyses on several thousand individuals.

O noso grupo realizou estas análises en varios miles de individuos.

This work is still underway,

Este traballo aínda está en marcha,

but so far we've identified a list of about three dozen pathways

pero ata agora identificamos unha lista dunhas tres ducias de vías

that we do think should be prioritized.

que si cremos que deben ser prioritarias.

Now, time will tell if these work.

O tempo dirá se estas funcionan,

If all of them work, if some, if any of them work.

se todas funcionan, se algunha delas funciona.

We just don't know.

Non o sabemos.

But I do want to show you a couple of examples

Pero quero mostrarvos un par de exemplos

that would suggest that we're on the right path.

que suxiren que imos polo bo camiño.

In the red quadrant, one of the factors we found relates to inflammation.

No vermello, un dos factores que atopamos está relacionado coa inflamación.

And we often think of inflammation as being bad,

A miúdo pensamos que a inflamación é mala,

but in reality, this is a process

pero, en realidade, é un proceso

that our body evolved to help us recover from injury

que o noso corpo desenvolveu para axudarnos a recuperarnos das lesións

or to mount a fever to fight off an infection.

ou a combater a febre ou as infeccións.

But of course, there are always times

Por suposto, sempre hai momentos

where our body has too much of something.

nos que o noso corpo ten demasiado de algo.

In this case,

Neste caso,

there's a rare genetic syndrome

hai unha rara síndrome xenética

where children can be born with overactive inflammation,

na que os nenos poden nacer con inflamación hiperactiva

and they can have recurrent episodes of high fevers and rashes

e ter episodios recorrentes de febres altas e urticarias

and other neurocognitive and developmental delays.

e outros retrasos neurocognitivos e do desenvolvemento.

Now in a triumph of science,

No que é un triunfo da ciencia,

investigators have pinpointed the exact molecule responsible for this,

os investigadores identificaron a molécula exacta responsable disto

and they developed a drug that can block it.

e desenvolveron un fármaco que a bloquea.

These children who have these rashes that I mentioned before

Os nenos que teñen estas erupcións que mencionei antes

can have a relatively remarkable improvement on these drugs

poden ter unha mellora relativamente notable con estes medicamentos

and almost get back to a normal quality of life.

e case volver ter unha calidade de vida normal.

But relevant to today's talk,

Na liña do que estamos falando,

it turns out that there are a group of cardiologists

resulta que hai un grupo de cardiólogos

who, for decades, have hypothesized

que, durante décadas, tiveron a hipótese

that these same inflammatory factors may also be driving heart disease.

de que os mesmos factores poderían fomentar as enfermidades cardíacas.

They were able to convince the company that makes this drug

Lograron convencer á empresa detrás dun medicamento

to do a trial to look at the effect of this medicine

de que fixese un ensaio para ver o efecto deste

in patients who had had a heart attack or a stroke in the past.

en pacientes que tiveran un infarto ou un derramo no pasado.

And really, it was no surprise to many of us

Para moitos de nós non foi ningunha sorpresa

when the results of this trial were published.

cando se publicaron os resultados deste ensaio.

And they showed that, in fact, compared to a placebo,

Demostraron que, en comparación cun placebo,

that this medicine could prevent recurrent cardiovascular events.

este medicamento podería prever os eventos cardiovasculares recorrentes.

But our algorithms predict that this drug

Os nosos algoritmos predín que este medicamento

should not only help prevent heart disease

non só debería prever as enfermidades do corazón,

but also should be able to prevent cancer.

senón que tamén debería ser capaz de previr o cancro.

And so this particular article gained a lot of attention

Este artigo recibiu moita atención

because when they unblinded their results,

porque cando se revelaron os seus resultados,

the investigators were shocked to find

aos investigadores sorprendeulles

that not only were the patients having fewer heart attacks

que non só os pacientes tiñan menos ataques ao corazón,

but they were having a much lower rate of developing lung cancer

senón que tiñan unha taxa moito menor de desenvolver cancro de pulmón

and a much lower rate of even dying from cancer.

e unha taxa moito menor aínda de morrer de cancro.

In fact, these results were so surprising and powerful

De feito, estes resultados foron tan sorprendentes e importantes

that I understand the company that makes this drug

que teño entendido que a empresa que o fabrica

is now pivoting and prioritizing this as a cancer drug,

está cambiándoo e priorizandoo como un fármaco contra o cancro

because the effects were so significant.

porque os efectos foron significativos.

How about another example from the blue quadrant this time?

Que tal outro exemplo do cuadrante azul esta vez?

Well, here we come to one of my favorite cells in the body,

Chegamos a unha das miñas células favoritas do corpo,

which is an immune cell called the macrophage.

que é unha célula inmunitaria chamada macrófago.

Now, macrophage is from the Greek, meaning "big eater."

Macrófago ven do grego e significa “gran comedor”.

And the role of this cell is to patrol the body,

O papel desta célula é patrullar o corpo

like a sentinel,

como unha sentinela

and it looks for invading bacteria.

e buscar bacterias invasoras.

When it sees them, it actually will eat them

Cando as ve, cómeas

and remove them from our body before they can expand

e elimínaas do noso corpo antes de que poidan expandirse

and cause an infection.

e causar unha infección.

But just like in the last example, there are oncologists

Como no último exemplo, hai oncólogos

who have hypothesized that these macrophages

que formularon a hipótese de que estes macrófagos

don't just have to eat bacteria,

non só teñen que comer bacterias,

but they also have to look for and eat cancer cells

senón que tamén teñen que buscar e comer células canceríxenas

and hopefully get rid of them before they can grow

e, con sorte, desfacerse delas antes de que crezan

and metastasize.

e facer metástase.

And so there's been a major initiative to develop medicines

Houbo unha gran iniciativa para desenvolver medicamentos

that can increase the appetite of these cells

que poidan aumentar o apetito destas células

to help them go after those tumors.

para axudalas a ir a por eses tumores.

Now, this story is still in its early days,

Esta historia aínda está nos seus inicios

and it's unclear if this type of an approach will work.

e non está claro se este tipo de enfoque funcionará.

But some of the early studies would suggest

Algúns dos primeiros estudos suxerían

that patients who have metastatic lymphoma,

que os pacientes con linfoma metastásico,

which you can see spread throughout this person's body on their CAT scan,

que vemos estendido por todo o corpo desta persoa no seu TAC,

that they may have a remarkable response to these types of drugs.

poden ter unha resposta notable a este tipo de fármacos.

And you can imagine here that the tumors are melting away

Podemos imaxinar os tumores como derreténdose

as they're being eaten by these cells

cando os comen estas células

due to their increased appetite.

debido ao seu maior apetito.

But once again, what we found is that our algorithms predict

Unha vez máis, o que descubrimos é que os nosos algoritmos predín

that, yes, this drug should work for cancer,

que este medicamento debería funcionar para o cancro,

but we think it might also work for heart disease.

pero igual tamén para as enfermidades cardíacas.

And so we've now gone back and retrospectively analyzed

Agora volvemos analizar retrospectivamente

the same CAT scans from the same cancer patients.

as mesmas tomografías dos mesmos pacientes con cancro.

But this time, instead of looking at the signal from their tumors,

Esta vez, en lugar de mirar o sinal dos seus tumores,

we can look at the signal in their blood vessels.

podemos mirar o dos seus vasos sanguíneos.

And here I'm pointing with the arrow to the carotid artery.

Aquí estou sinalando a arteria carótide.

This is the artery

É a arteria

that brings the blood to the brain,

que leva sangue ao cerebro,

this is where cardiovascular disease will build up

onde se forman as enfermidades cardiovasculares

in patients before they have a stroke.

nos pacientes antes de ter un ictus.

And what we found is that while their cancer was melting away,

O que descubrimos é que, mentres o seu cancro se ía,

it looks like their cardiovascular disease was melting away, too.

parece que a enfermidade cardiovascular tamén o facía.

And so, once again,

E así, unha vez máis,

these algorithms are predicting

estes algoritmos predín

that we may be able to identify therapies

que podemos identificar terapias

that could be dual purposed to attack both conditions at the same time.

que poderían atacar ambas enfermidades ao mesmo tempo.

We don't yet know if any of these other pathways

Aínda non sabemos se algunha destas vías

will have the same type of success.

terá o mesmo tipo de éxito.

But what we do know for sure is the lesson that Galileo taught us

Pero o que sabemos con certeza é a lección que Galileo nos ensinou

almost four centuries ago,

hai case catro séculos

and that there is no such thing as settled science.

e é que non existe a ciencia establecida.

We must challenge dogma,

Debemos desafiar o dogma,

we must break down traditional silos.

romper os silos tradicionais.

Because if we do,

Porque se o facemos,

we may no longer be powerless against these leading killers,

pode que xa non esteamos desvalidos fronte a estes asasinos principais,

but may, in fact find ways to treat the world's two leading killers.

senón que atopemos maneiras de tratar os dous principais asasinos do mundo.

Thank you.

Grazas.

(Applause)

(Aplauso)