Soon We'll Cure Diseases With a Cell, Not a Pill | Siddhartha Mukherjee | TED Talks

Translator: Tatiana Rozanec Reviewer: Nika Kotnik

I want to talk to you about the future of medicine.

Rad bi vam govoril o prihodnosti medicine.

But before I do that, I want to talk a little bit about the past.

Ampak prej bi rad govoril malo o preteklosti.

Now, throughout much of the recent history of medicine,

Skozi večji del nedavne zgodovine medicine

we've thought about illness and treatment

smo o bolezni in zdravljenju

in terms of a profoundly simple model.

razmišljali na zelo preprost način.

In fact, the model is so simple

Dejansko, tako preprosto

that you could summarize it in six words:

da lahko povzamemo v šestih besedah:

have disease, take pill, kill something.

biti bolan, vzeti tableto, nekaj ubiti.

Now, the reason for the dominance of this model

Razlog za prevlado tega modela

is of course the antibiotic revolution.

je seveda antibiotska revolucija.

Many of you might not know this, but we happen to be celebrating

Veliko vas najbrž ne ve, ampak slučajno praznujemo

the hundredth year of the introduction of antibiotics into the United States.

stoletnico uvedbe antibiotikov v Združenih Državah.

But what you do know

A kar veste je,

is that that introduction was nothing short of transformative.

da je ta uvedba pomenila pravo preobrazbo.

Here you had a chemical, either from the natural world

Imeli smo kemikalijo, naravno

or artificially synthesized in the laboratory,

ali umetno sintetizirano v laboratoriju,

and it would course through your body,

in ta bi potovala po vašem telesu,

it would find its target,

našla svoj cilj

lock into its target --

se nanj pritrdila--

a microbe or some part of a microbe --

neki mikrob ali delec mikroba--

and then turn off a lock and a key

in potem bi zaklenila ključavnico s ključem

with exquisite deftness, exquisite specificity.

zelo spretno, zelo točno.

And you would end up taking a previously fatal, lethal disease --

Tako smo imeli neko prej smrtno bolezen

a pneumonia, syphilis, tuberculosis --

--pljučnico, sifilis, tuberkulozo--

and transforming that into a curable, or treatable illness.

in jo spremenili v ozdravljivo bolezen.

You have a pneumonia,

Imaš pljučnico,

you take penicillin,

vzameš penicilin,

you kill the microbe

ubiješ mikrobe

and you cure the disease.

in pozdraviš to bolezen.

So seductive was this idea,

Tako zapeljiva je bila ta ideja,

so potent the metaphor of lock and key

tako močna metafora ključavnice in ključa,

and killing something,

in nekaj ubiti,

that it really swept through biology.

da je prišla v biologijo.

It was a transformation like no other.

Je bila sprememba brez primere.

And we've really spent the last 100 years

Tako smo preživeli zadnjih 100 let,

trying to replicate that model over and over again

da smo skušali replicirati ta model vedno znova

in noninfectious diseases,

pri nenalezljivih boleznih,

in chronic diseases like diabetes and hypertension and heart disease.

pri kroničnih boleznih, kot so diabetes, hipertenzija in srčna bolezen.

And it's worked, but it's only worked partly.

In delovalo je, a samo delno.

Let me show you.

Vam bom pokazal.

You know, if you take the entire universe

Veste, če vzamemo celoto

of all chemical reactions in the human body,

vseh kemičnih reakcij v človeškem telesu,

every chemical reaction that your body is capable of,

vsako možno kemično reakcijo v človeškem telesu,

most people think that that number is on the order of a million.

večina ljudi misli, da ta številka je okoli en milijon.

Let's call it a million.

Recimo da je en milijon.

And now you ask the question,

Sedaj vprašate

what number or fraction of reactions

kakšno je število teh reakcij,

can actually be targeted

ki res lahko postanejo cilj

by the entire pharmacopoeia, all of medicinal chemistry?

v vsej farmakopeji, vsej farmacevtski kemiji?

That number is 250.

To število je 250.

The rest is chemical darkness.

Ostalo je kemična tema.

In other words, 0.025 percent of all chemical reactions in your body

Z drugimi besedami, 0,025 % vseh kemičnih reakcij v vašem telesu

are actually targetable by this lock and key mechanism.

lahko postane tarča tega mehanizma ključavnice in ključa.

You know, if you think about human physiology

Če razmišljate o človeški fiziologiji

as a vast global telephone network

kot o nekem velikem telefonskem omrežju

with interacting nodes and interacting pieces,

s povezanimi vozliči in kosi

then all of our medicinal chemistry

potem vsa naša farmacevtska kemija

is operating on one tiny corner

deluje v majhnem kotu

at the edge, the outer edge, of that network.

na robu, zunanjem robu tega omrežja.

It's like all of our pharmaceutical chemistry

Kot, da je vsa naša farmacevtska kemija

is a pole operator in Wichita, Kansas

neki delavec v Wichita, Kansasu

who is tinkering with about 10 or 15 telephone lines.

in nadzoruje 10 ali 15 telefonskih linij.

So what do we do about this idea?

Kaj naredimo s to idejo?

What if we reorganized this approach?

Kaj, če preuredimo ta pristop?

In fact, it turns out that the natural world

Izkaže se, da nam narava

gives us a sense of how one might think about illness

pokaže smer, kako bi lahko premišljevali o bolezni

in a radically different way,

na zelo drugačen način,

rather than disease, medicine, target.

namesto bolezen-zdravilo- tarča.

In fact, the natural world is organized hierarchically upwards,

Narava je urejena hierarhično navzgor,

not downwards, but upwards,

ne navzdol, ampak navzgor.

and we begin with a self-regulating, semi-autonomous unit called a cell.

in začnemo s samoregulativno, deloma neodvisno enoto, imenovano celica.

These self-regulating, semi-autonomous units

Te samoregulativne, deloma samostojne enote

give rise to self-regulating, semi-autonomous units called organs,

naredijo samoregulativne, deloma samostojne enote -- organe,

and these organs coalesce to form things called humans,

in ti se združijo in naredijo človeka,

and these organisms ultimately live in environments,

in ti organizmi konec koncev živijo v okolju,

which are partly self-regulating and partly semi-autonomous.

ki so deloma samoregulativni in deloma samostojni.

What's nice about this scheme, this hierarchical scheme

Kar je lepo pri tej shemi, hierarhični shemi,

building upwards rather than downwards,

ki gradi raje navzgor kot navzdol,

is that it allows us to think about illness as well

je, da nam dovoli misliti tudi o bolezni

in a somewhat different way.

na nekako drugačen način.

Take a disease like cancer.

Vzemimo neko bolezen, na primer rak.

Since the 1950s,

Od 1950ih naprej

we've tried rather desperately to apply this lock and key model to cancer.

smo skušali na vse načine uporabiti ta model ključavnice in ključa pri raku.

We've tried to kill cells

Skušali smo ubiti celice

using a variety of chemotherapies or targeted therapies,

z raznimi kemoterapijami in usmerjenim terapijami,

and as most of us know, that's worked.

in tako kot nas ve večina, je učinkovalo.

It's worked for diseases like leukemia.

Je delovalo za bolezni kot je levkemija.

It's worked for some forms of breast cancer,

Tudi za nekaj vrst raka dojke,

but eventually you run to the ceiling of that approach.

ampak konec koncev pridemo do meje tega pristopa.

And it's only in the last 10 years or so

In šele v zadnjih 10 letih smo

that we've begun to think about using the immune system,

začeli razmišljato o uporabi imunskega sistema,

remembering that in fact the cancer cell doesn't grow in a vacuum.

ko smo se spomnili, da rakaste celice ne živijo v vakuumu.

It actually grows in a human organism.

Živijo v človeškem organizmu

And could you use the organismal capacity,

In lahko uporabimo te organizmske sposobnosti,

the fact that human beings have an immune system, to attack cancer?

dejstvo, da ima človek imunski sistem za napad raka?

In fact, it's led to the some of the most spectacular new medicines in cancer.

To je privedlo do nekaj od najbolj spektakularnih novih zdravil za raka.

And finally there's the level of the environment, isn't there?

In končno je tu raven okolja, kaj ne?

You know, we don't think of cancer as altering the environment.

Ne gledamo na rak kot na spremembo okolja.

But let me give you an example of a profoundly carcinogenic environment.

Ampak vam bom dal en primer zelo rakotvornega okolja.

It's called a prison.

Imenuje se ječa.

You take loneliness, you take depression, you take confinement,

Imamo samoto, depresijo, odvzem prostosti,

and you add to that,

in dodamo še enega

rolled up in a little white sheet of paper,

v bel papir zavitega

one of the most potent neurostimulants that we know, called nicotine,

najmočnejših nevrostimulantov ki jih poznamo, nikotin,

and you add to that one of the most potent addictive substances that you know,

in dodamo še eno najbolj zasvojljivih snovi, ki jih poznamo

and you have a pro-carcinogenic environment.

in dobimo pro-rakotvorno okolje.

But you can have anti-carcinogenic environments too.

Ampak lahko imamo tudi anti-rakotvorno okolje.

There are attempts to create milieus,

Obstajajo poskusi, ki ustvarjajo okolje,

change the hormonal milieu for breast cancer, for instance.

spreminjajo hormonsko okolje pri raku dojke, na primer.

We're trying to change the metabolic milieu for other forms of cancer.

Skušamo spremeniti metabolno okolje pri drugih vrstah raka.

Or take another disease, like depression.

Ali pa vzemimo drugo bolezen, na primer depresijo.

Again, working upwards,

Spet, če gradimo navzgor

since the 1960s and 1970s, we've tried, again, desperately

od 1960ih, 1970ih smo skušali na vse načine

to turn off molecules that operate between nerve cells --

ugasniti molekule, ki delujejo med živčnimi celicami

serotonin, dopamine --

--serotonin, dopamin--

and tried to cure depression that way,

smo poskušali tako zdraviti depresijo,

and that's worked, but then that reached the limit.

in je delovalo, ampak samo do neke mere.

And we now know that what you really probably need to do

In sedaj vemo, da kar moramo zares storiti,

is to change the physiology of the organ, the brain,

je spremeniti fiziologijo organa, to je možganov

rewire it, remodel it,

ga znova povezati, ga predelati,

and that, of course, we know study upon study has shown

in to seveda vidimo študijo za študijo,

that talk therapy does exactly that,

da to stori prav terapevtski pogovor,

and study upon study has shown that talk therapy

in študija za študijo kaže, da je terapevtski pogovor

combined with medicines, pills,

skupaj z zdravili, tabletami,

really is much more effective than either one alone.

res veliko bolj učinkovit kot katerakoli od obeh sama.

Can we imagine a more immersive environment that will change depression?

Si predstavljamo bolj poglobljeno okolje ki bi lahko spremenilo depresijo?

Can you lock out the signals that elicit depression?

Lahko zaklenemo signale ki izzovejo depresijo?

Again, moving upwards along this hierarchical chain of organization.

Spet, če gradimo navzgor skozi to hierarhično organizirano verigo.

What's really at stake perhaps here

Kar je res v igri tukaj

is not the medicine itself but a metaphor.

ni v bistvu zdravilo, ampak metafora.

Rather than killing something,

Namesto ubijati nekaj,

in the case of the great chronic degenerative diseases --

v primeru velikih kroničnih degenerativnih bolezni--

kidney failure, diabetes, hypertension, osteoarthritis --

odpoved ledvic, sladkorna, hipertenzija, osteoartritis

maybe what we really need to do is change the metaphor to growing something.

je morda to, kar moramo res spremeniti, metafora gojenja nečesa.

And that's the key, perhaps,

In to je ključno, morda,

to reframing our thinking about medicine.

za spremebmo našega mišlenja v medicini.

Now, this idea of changing,

Ta ideja o spremembi,

of creating a perceptual shift, as it were,

o ustvarjanju zaznavnega premika, od tega kar je,

came home to me to roost in a very personal manner about 10 years ago.

mi je prišla na misel na zelo oseben način pred približno 10 leti.

About 10 years ago -- I've been a runner most of my life --

Pred 10 leti -- večino življenja sem bil tekač-

I went for a run, a Saturday morning run,

sem šel na tek, sobotni jutranji tek,

I came back and woke up and I basically couldn't move.

se vrnil, zbudil in se v bistvu se nisem mogel premikati.

My right knee was swollen up,

Moje desno koleno je bilo otečeno,

and you could hear that ominous crunch of bone against bone.

in si lahko slišal tisti strašen zvok kosti proti kosti.

And one of the perks of being a physician is that you get to order your own MRIs.

Dobra stran tega, da si zdravnik je, da si lahko sam predpišeš MRI zase.

And I had an MRI the next week, and it looked like that.

Imel sem MRI naslednji teden, in izgledalo je tako:

Essentially, the meniscus of cartilage that is between bone

V glavnem, hrustančni meniskus, ki je med kostmi

had been completely torn and the bone itself had been shattered.

je bil popolnoma pretrgan in kost se je zdrobila.

Now, if you're looking at me and feeling sorry,

Če me gledate in se vam smilim,

let me tell you a few facts.

naj vam povem nekaj dejstev.

If I was to take an MRI of every person in this audience,

Če bi naredili MRI vsakemu poslušalcu tukaj

60 percent of you would show signs

60% bi pokazalo znake

of bone degeneration and cartilage degeneration like this.

kostne obrabe in hrustančne degeneracije kot je ta.

85 percent of all women by the age of 70

85% žensk do 70 leta

would show moderate to severe cartilage degeneration.

bi imelo znake srednje do resne obrabe hrustanca.

50 to 60 percent of the men in this audience

50 do 60% moških tukaj

would also have such signs.

bi imelo take znake.

So this is a very common disease.

To je torej zelo pogosta bolezen.

Well, the second perk of being a physician

Ta druga dobra plat tega, da ste zdravnik,

is that you can get to experiment on your own ailments.

je, da lahko eksperimentirate na vaših lastnih obolenjih.

So about 10 years ago we began,

Torej približno 10 let nazaj smo začeli,

we brought this process into the laboratory,

privedli smo ta proces v laboratorij,

and we began to do simple experiments,

in smo začeli z enostavnimi eksperimenti,

mechanically trying to fix this degeneration.

poskušali mehanično popraviti to obrabo.

We tried to inject chemicals into the knee spaces of animals

Poskusili smo vzbrizgati kemikalije v koleno živalim

to try to reverse cartilage degeneration,

da bi obrnili proces obrabe hrustanca,

and to put a short summary on a very long and painful process,

in na kratko povedano, ta dolgi in boleči postopek

essentially it came to naught.

ni pripeljal nikamor.

Nothing happened.

Nič se ni zgodilo.

And then about seven years ago, we had a research student from Australia.

Pred približno sedmimi leti smo dobili raziskavo avstralskega študenta.

The nice thing about Australians

Pri Avstralcih je fino,

is that they're habitually used to looking at the world upside down.

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.

Torej Dan mi je predlagal: "Veš, morda to ni mehaničen problem.

Maybe it isn't a chemical problem. Maybe it's a stem cell problem."

Morda to ni kemičen problem. Morda je problem matičnih celic."

In other words, he had two hypotheses.

Drugače rečeno, imel je dve hipotezi.

Number one, there is such a thing as a skeletal stem cell --

Prvič, obstaja nekaj imenovano skeletne izvorne celice--

a skeletal stem cell that builds up the entire vertebrate skeleton,

skeletne izvorne celice, ki naredijo vse okostje vretenčarjev

bone, cartilage and the fibrous elements of skeleton,

kosti, hrustanec in fibrozne elemente skeleta,

just like there's a stem cell in blood,

tako kot obstajajo krvne matične celice,

just like there's a stem cell in the nervous system.

tako kot so izvorne celice v živčnem sistemu.

And two, that maybe that, the degeneration or dysfunction of this stem cell

Drugič, da je morda degeneracija ali disfunkcija te izvorne celice

is what's causing osteochondral arthritis, a very common ailment.

to kar povzroča osteohondralni artritis, zelo pogosto bolezen.

So really the question was, were we looking for a pill

Pravo vprašanje je torej bilo, ali smo iskali tableto,

when we should have really been looking for a cell.

ko bi morali iskati celico.

So we switched our models,

Torej smo zamenjali model,

and now we began to look for skeletal stem cells.

začeli iskati matične celice okostja.

And to cut again a long story short,

In spet na kratko povedano,

about five years ago, we found these cells.

pred približno petimi leti smo našli te celice.

They live inside the skeleton.

Živijo v okostju.

Here's a schematic and then a real photograph of one of them.

Tukaj je shema in potem prava fotografija ene izmed njih.

The white stuff is bone,

Ta belo je kost,

and these red columns that you see and the yellow cells

in ti rdeči stebri, ki jih vidite in rumene celice

are cells that have arisen from one single skeletal stem cell --

so celice ki so nastale iz ene same matične celice--

columns of cartilage, columns of bone coming out of a single cell.

hrustanec in kosti iz ene same celice.

These cells are fascinating. They have four properties.

Te celice so zelo zanimive. Imajo štiri lastnosti.

Number one is that they live where they're expected to live.

Ena, živijo tam, kjer pričakujemo da živijo.

They live just underneath the surface of the bone,

Živijo točno pod površino kosti,

underneath cartilage.

pod hrustancem.

You know, in biology, it's location, location, location.

Veste, pri biologiji je lokacija, lokacija, lokacija.

And they move into the appropriate areas and form bone and cartilage.

In gredo v primerne prostore in naredijo kost in hrustanec.

That's one.

To je ena.

Here's an interesting property.

Tu je še ena zanimiva lastnost.

You can take them out of the vertebrate skeleton,

lahko jih vzamete iz vretenčnega okostja,

you can culture them in petri dishes in the laboratory,

jih lahko gojite v petrijevkah v laboratoriju

and they are dying to form cartilage.

in rade bi izdelovale hrustančaste celice.

Remember how we couldn't form cartilage for love or money?

Se spomnite kako nismo mogli narediti hrustanca za noben denar?

These cells are dying to form cartilage.

Te celice želijo izdelovati hrustanec.

They form their own furls of cartilage around themselves.

Okrog sebe naredijo zvitke hrustanca.

They're also, number three,

So tudi, številka tri,

the most efficient repairers of fractures that we've ever encountered.

najbolj efektivni popravljalci zlomov, kar smo jih videli.

This is a little bone, a mouse bone that we fractured

To je mala kost, mišja kost, ki smo jo zlomili

and then let it heal by itself.

in potem pustili, da se sama pozdravi.

These stem cells have come in and repaired, in yellow, the bone,

Te iste celice so prišle in popravile, rumeno, kost,

in white, the cartilage, almost completely.

belo, hrustanec, skoraj v celoti.

So much so that if you label them with a fluorescent dye

V tolikšni meri, da če jih označimo s fluorescento barvo

you can see them like some kind of peculiar cellular glue

jih lahko vidimo kot neke vrste posebno lepilo za kosti

coming into the area of a fracture,

ki pride v prostor zloma,

fixing it locally and then stopping their work.

ga v popravi na mestu in potem ustavi svoje delo.

Now, the fourth one is the most ominous,

Ta četrta je ta najbolj nevarna,

and that is that their numbers decline precipitously,

in to je, da število upade zelo hitro,

precipitously, tenfold, fiftyfold, as you age.

strmo, desetkrat, petdesetkrat ko se starate.

And so what had happened, really,

A kar se je v resnici zgodilo je,

is that we found ourselves in a perceptual shift.

da smo se znajdli v premiku percepcije.

We had gone hunting for pills

Začeli smo tako, da smo iskali tablete

but we ended up finding theories.

a smo končali z iznajdbo teorij.

And in some ways

In na nek način

we had hooked ourselves back onto this idea:

smo spet zasvojeni s to idejo:

cells, organisms, environments,

celice, organizmi, okolje,

because we were now thinking about bone stem cells,

ker zdaj smo mislili na kostne matične celice

we were thinking about arthritis in terms of a cellular disease.

smo mislili na artrozo kot na neko celično bolezen.

And then the next question was, are there organs?

In naslednje vprašanje je bilo: obstajajo organi?

Can you build this as an organ outside the body?

Lahko naredimo to kot organe, izven telesa?

Can you implant cartilage into areas of trauma?

Lahko vsadimo hrustanec na področja poškodbe?

And perhaps most interestingly,

In morda še bolj zanimivo,

can you ascend right up and create environments?

lahko se povzpnemo še višje in naredimo nova okolja?

You know, we know that exercise remodels bone,

Veste, vemo da trening preoblikuje kosti

but come on, none of us is going to exercise.

ampak noben od nas noče trenirati.

So could you imagine ways of passively loading and unloading bone

Si predstavljate torej način za pasivno obremenitiev in razbremenitev kosti,

so that you can recreate or regenerate degenerating cartilage?

da lahko naredimo ali obnovimo obrabljen hrustanec?

And perhaps more interesting, and more importantly,

In kar je morda še bolj pomembno in zanimivo,

the question is, can you apply this model more globally outside medicine?

vprašanje je, lahko uporabimo ta model izven medicine?

Kar je v igri, kot sem omenil, ni nekaj ubiti,

What's at stake, as I said before, is not killing something,

but growing something.

ampak nekaj novega vzgojiti.

And it raises a series of, I think, some of the most interesting questions

Menim, da to nam postavi nekaj najbolj zanimivih vprašanj

about how we think about medicine in the future.

o tem, kako razmišljamo o medicini v prihodnosti.

Could your medicine be a cell and not a pill?

Je lahko tvoje zdravilo ena celica, in ne ena tableta?

How would we grow these cells?

Kako bi gojili te celice?

What we would we do to stop the malignant growth of these cells?

Kaj lahko naredimo, da ustavimo maligno rast teh celic?

We heard about the problems of unleashing growth.

Slišali smo o problemih nebrzdane rasti.

Could we implant suicide genes into these cells

Lahko vsadimo samomorilne gene v te celice,

to stop them from growing?

da preprečimo njihovo rast?

Could your medicine be an organ that's created outside the body

Je lahko tvoje zdravilo organ, ustvarjen izven telesa

and then implanted into the body?

in potem vsajen v telo?

Could that stop some of the degeneration?

Lahko to prepreči kakšno degeneracijo?

What if the organ needed to have memory?

Kaj če mora organ imeti spomin?

In cases of diseases of the nervous system some of those organs had memory.

V primerih bolezni živčevja so imeli nekateri izmed teh organov spomin.

How could we implant those memories back in?

Kako lahko vsadimo te spomine nazaj?

Could we store these organs?

Lahko hranimo te organe?

Would each organ have to be developed for an individual human being

Bo moral biti vsak organ oblikovan za posameznika

and put back?

in nato vrnjen?

And perhaps most puzzlingly,

In morda še najbolj zapleteno,

could your medicine be an environment?

je lahko tvoje zdravilo neko okolje?

Could you patent an environment?

Lahko patentiramo neko okolje?

You know, in every culture,

Veste, v vsaki kulturi,

shamans have been using environments as medicines.

šamani so uporabljali okolja kot zdravila.

Could we imagine that for our future?

Si lahko predstavljamo to kot našo prihodnost?

I've talked a lot about models. I began this talk with models.

Precej sem govoril o modelih, to predavanje sem pričel z modeli.

So let me end with some thoughts about model building.

Naj torej končam z mislimi o gradnji modelov.

That's what we do as scientists.

To je to, kar kot znanstveniki počnemo.

You know, when an architect builds a model,

Veste, ko arhitekt pripravi model,

he or she is trying to show you a world in miniature.

vam skuša pokazati svet v miniaturi.

But when a scientist is building a model,

Ampak ko znanstvenik gradi model,

he or she is trying to show you the world in metaphor.

vam skuša pokazati svet kot metaforo.

He or she is trying to create a new way of seeing.

Skuša ustvariti novi način gledanja.

The former is a scale shift. The latter is a perceptual shift.

Prvi je sprememba dimenzije. Drugi je spremeba percepcije.

Now, antibiotics created such a perceptual shift

Antibiotiki so povzročili tako spremembo percepcije

in our way of thinking about medicine that it really colored, distorted,

v našem načinu gledanja na medicino, da je res pobarvala, popačila,

very successfully, the way we've thought about medicine for the last hundred years.

na zelo učinkovit način, kako premišljujemo o medicini zadnjih sto let.

But we need new models to think about medicine in the future.

Ampak potrebujemo nove modele za razmišljanje o medicini v prihodnosti.

That's what's at stake.

To je v igri.

You know, there's a popular trope out there

Obstaja neki popularen trop, ki pravi,

that the reason we haven't had the transformative impact

da je razlog zakaj nismo imeli transformativnega učinka

on the treatment of illness

na zdravljenje bolezni

is because we don't have powerful-enough drugs,

pomanjkanje dovolj močnih zdravil,

and that's partly true.

in to je v neki meri res.

But perhaps the real reason is

Ampak morda je pravi razlog ,

that we don't have powerful-enough ways of thinking about medicines.

da nimamo dovolj močnih pogledov na zdravila.

It's certainly true that

Brez dvoma je res, da

it would be lovely to have new medicines.

bi bilo krasno imeti nova zdravila.

But perhaps what's really at stake are three more intangible M's:

Ampak morda so res v igri trije neotipljivi pojmi:

mechanisms, models, metaphors.

mahanizmi, modeli, metafore.

Thank you.

Hvala lepa.

(Applause)

(Aplavz)

Chris Anderson: I really like this metaphor.

Chris Andreson: zelo mi je všeč ta metafora.

How does it link in?

Kako se to poveže?

There's a lot of talk in technologyland

Veliko se govori na področju tehnologije

about the personalization of medicine,

o personalizaciji medicine,

that we have all this data and that medical treatments of the future

da imamo vse te podatke in da bo zdravljenje v prihodnosti

will be for you specifically, your genome, your current context.

specifično za vsakega, tvoj genom, tvoj današnji položaj.

Does that apply to this model you've got here?

Velja to za te modele?

Siddhartha Mukherjee: It's a very interesting question.

Siddharta Mukherjee: Zanimivo vprašanje.

We've thought about personalization of medicine

O personalizaciji medicine smo razmišljali

very much in terms of genomics.

v smislu genomike.

That's because the gene is such a dominant metaphor,

To je, ker je ta metafora o genih tako prevladujoča

again, to use that same word, in medicine today,

spet, da uporabim isto besedo, v današnji medicini,

that we think the genome will drive the personalization of medicine.

da mislimo da bo genomika pripeljala do personalizacije medicine.

But of course the genome is just the bottom

Ampak genom je samo začetek

of a long chain of being, as it were.

dolge verige.

That chain of being, really the first organized unit of that, is the cell.

Ta veriga bitij, pravzaprav je ta prva organizirana enota tega celica.

So, if we are really going to deliver in medicine in this way,

Torej, če res mislimo izvajati medicino na ta način,

we have to think of personalizing cellular therapies,

moramo misliti na personalizacijo celičnih terapij,

and then personalizing organ or organismal therapies,

in potem o personalizaciji terapij za organe in organizme,

and ultimately personalizing immersion therapies for the environment.

in končno o personalizaciji imerzijskih terapij za okolje.

So I think at every stage, you know --

Torej mislim, da na vseh področjih

there's that metaphor, there's turtles all the way.

obstaja metafora, ta pot se nikoli ne konča.

Well, in this, there's personalization all the way.

Tako da, tudi personalizacija se ne konča.

CA: So when you say medicine could be a cell

CA: Torej, ko pravite, da je zdravilo lahko celica,

and not a pill,

in ne tableta,

you're talking about potentially your own cells.

govorite potencialno o vaših celicah.

SM: Absolutely. CA: So converted to stem cells,

SM: Absolutno. CA: Torej v terminih matičnih celic,

perhaps tested against all kinds of drugs or something, and prepared.

morda testiranih za vse vrste zdravil ipd., in pripravljene.

SM: And there's no perhaps. This is what we're doing.

SM: In ni nobenega 'morda'. To je kar delamo.

This is what's happening, and in fact, we're slowly moving,

To je kar se dogaja, in dejansko, se počasi premikamo,

not away from genomics, but incorporating genomics

ne stran od genomike, ampak uporabljamo genomiko

into what we call multi-order, semi-autonomous, self-regulating systems,

za deloma samostojne, samoregulativne sisteme v več redih,

like cells, like organs, like environments.

kot so celice, organi, okolja.

CA: Thank you so much.

CA: Najlepša hvala!

SM: Pleasure. Thanks.

SM: V veselje mi je, hvala.