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

Prevodilac: Ivana Krivokuća Lektor: Tijana Mihajlović

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

Želim da vam govorim o budućnosti medicine,

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

a pre nego što to uradim, želeo bih da malo govorim o prošlosti.

Now, throughout much of the recent history of medicine,

Većim delom skorije istorije medicine,

we've thought about illness and treatment

razmišljali smo o bolestima i lečenju

in terms of a profoundly simple model.

u okvirima jako jednostavnog modela.

In fact, the model is so simple

Zapravo, model je tako jednostavan

that you could summarize it in six words:

da ga možete rezimirati u šest reči:

have disease, take pill, kill something.

imate bolest, uzmite pilulu, ubijte nešto.

Now, the reason for the dominance of this model

E, sad, razlog dominantnosti ovog modela,

is of course the antibiotic revolution.

naravno, predstavlja revolucija antibiotika.

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

Mnogi od vas možda ovo ne znaju, ali upravo slavimo

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

stotu godinu od uvođenja antibiotika u Sjedinjene Države.

But what you do know

Ipak, ono što znate

is that that introduction was nothing short of transformative.

jeste da to uvođenje nije bilo ništa manje nego transformišuće.

Here you had a chemical, either from the natural world

Imali ste hemikaliju, bilo iz sveta prirode

or artificially synthesized in the laboratory,

ili veštački sintetizovanu u laboratoriji,

and it would course through your body,

ona bi prolazila kroz vaše telo,

it would find its target,

našla bi svoju metu,

lock into its target --

naciljala bi svoju metu -

a microbe or some part of a microbe --

mikrob ili deo mikroba -

and then turn off a lock and a key

a zatim onesposobila i bravu i ključ

with exquisite deftness, exquisite specificity.

sa izuzetnom spretnošću, izuzetnom specifičnošću.

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

Na kraju biste uzeli prethodno fatalnu, smrtonosnu bolest -

a pneumonia, syphilis, tuberculosis --

upalu pluća, sifilis, tuberkulozu -

and transforming that into a curable, or treatable illness.

i pretvorili je u izlečivu bolest ili bolest za koju postoji tretman.

You have a pneumonia,

Imate upalu pluća,

you take penicillin,

uzmete penicilin,

you kill the microbe

ubijete mikrobe

and you cure the disease.

i izlečite bolest.

So seductive was this idea,

Toliko je bila zavodljiva ta ideja,

so potent the metaphor of lock and key

tako moćna metafora o bravi i ključu

and killing something,

i ubijanju nečega,

that it really swept through biology.

da se brzo probila kroz biologiju.

It was a transformation like no other.

Bila je to transformacija kao nijedna druga.

And we've really spent the last 100 years

Zaista smo proveli poslednjih sto godina

trying to replicate that model over and over again

pokušavajući da iznova i iznova ponovimo taj model

in noninfectious diseases,

kod neinfektivnih bolesti,

in chronic diseases like diabetes and hypertension and heart disease.

kod hroničnih bolesti poput dijabetesa, hipertenzije i srčanih oboljenja.

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

Uspelo je, ali samo delimično.

Let me show you.

Dozvolite da vam pokažem.

You know, if you take the entire universe

Znate, ako uzmete čitav univerzum

of all chemical reactions in the human body,

hemijskih reakcija u ljudskom telu,

every chemical reaction that your body is capable of,

svaku hemijsku reakciju za koju je vaše telo sposobno,

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

većina ljudi misli da je taj broj blizu miliona.

Let's call it a million.

Recimo da je milion.

And now you ask the question,

Da vas sada pitam,

what number or fraction of reactions

koji broj ili deo reakcija

can actually be targeted

zaista može biti meta

by the entire pharmacopoeia, all of medicinal chemistry?

čitave farmakopeje, cele medicinske hemije?

That number is 250.

Taj broj je 250.

The rest is chemical darkness.

Ostatak je u hemijskoj tami.

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

Drugim rečima, 0,025 posto svih hemijskih reakcija u vašem telu

are actually targetable by this lock and key mechanism.

mogu postati meta ovog mehanizma ključa i brave.

You know, if you think about human physiology

Znate, ako razmišljate o ljudskoj fiziologiji

as a vast global telephone network

kao o ogromnoj globalnoj telefonskoj mreži

with interacting nodes and interacting pieces,

sa čvorovima i delovima u interakciji,

then all of our medicinal chemistry

tada celokupna naša medicinska hemija

is operating on one tiny corner

funkcioniše u jednom malom uglu

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

na ivici, spoljnoj ivici te mreže.

It's like all of our pharmaceutical chemistry

To bi bilo kao da je čitava naša farmaceutska hemija

is a pole operator in Wichita, Kansas

potporni operater u Vičiti, u Kanzasu,

who is tinkering with about 10 or 15 telephone lines.

koji petlja sa oko deset ili petnaest telefonskih linija.

So what do we do about this idea?

Pa, šta da radimo u vezi sa ovom idejom?

What if we reorganized this approach?

Šta ako bismo reorganizovali ovaj pristup?

In fact, it turns out that the natural world

U stvari, ispostavilo se da nam svet prirode

gives us a sense of how one might think about illness

daje nagoveštaj kako bismo mogli razmišljati o bolestima

in a radically different way,

na potpuno drugačiji način,

rather than disease, medicine, target.

umesto zaraze, lekova, meta.

In fact, the natural world is organized hierarchically upwards,

Zapravo, svet prirode je organizovan hijerarhijski prema gore,

not downwards, but upwards,

nije usmeren nadole, već nagore,

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

a započinjemo samoregulišućom, poluautonomnom jedinicom zvanom ćelija.

These self-regulating, semi-autonomous units

Te samoregulišuće, poluautonomne jedinice

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

dovode do samoregulišućih, poluautonomnih jedinica zvanih organi,

and these organs coalesce to form things called humans,

a ti organi se sjedinjuju da bi formirali ono što se zovu ljudi,

and these organisms ultimately live in environments,

a ti organizmi na kraju žive u sredinama

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

koje su delom samoregulišuće, a delom poluautonomne.

What's nice about this scheme, this hierarchical scheme

Ono što je fino u vezi sa ovom šemom, ovom hijerarhijskom šemom

building upwards rather than downwards,

koja se izgrađuje nagore umesto nadole,

is that it allows us to think about illness as well

je to što nam omogućava da razmišljamo o bolestima

in a somewhat different way.

na donekle drugačiji način.

Take a disease like cancer.

Uzmite bolest poput raka.

Since the 1950s,

Od 1950-ih godina,

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

pokušavali smo zaista očajnički da model ključa i brave primenimo na raku.

We've tried to kill cells

Pokušavali smo da ubijemo ćelije

using a variety of chemotherapies or targeted therapies,

koristeći mnoštvo hemoterapija ili usmerenih terapija,

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

i kao što je većini poznato, to je uspelo.

It's worked for diseases like leukemia.

Uspelo je kod bolesti kao što je leukemija.

It's worked for some forms of breast cancer,

Uspelo je kod nekih oblika raka dojke,

but eventually you run to the ceiling of that approach.

ali na kraju stignete do gornje granice tog pristupa.

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

Tek smo poslednjih desetak godina

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

počeli da razmišljamo o korišćenju imunog sistema,

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

setivši se da ćelije raka u stvari ne rastu u vakuumu.

It actually grows in a human organism.

Zapravo rastu u ljudskom organizmu.

And could you use the organismal capacity,

A da li možete koristiti organizmički kapacitet,

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

činjenicu da ljudska bića imaju imuni sistem, da biste napali rak?

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

Naime, to je dovelo

do nekih od najspektakularnijih novih lekova protiv raka.

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

Konačno, tu je nivo okruženja, zar ne?

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

Znate, mi ne mislimo o raku kao o menjanju sredine.

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

Dozvolite da vam dam primer duboko karcinogenog okruženja.

It's called a prison.

Zove se zatvor.

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

Uzmite usamljenost, uzmite depresiju, uzmite pritvaranje,

and you add to that,

i tome dodajte,

rolled up in a little white sheet of paper,

urolan u malo belo parče papira,

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

jedan od najsnažnijih neurostimulansa za koje znamo, zvani nikotin,

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

i tome dodate jednu od najjačih zavisničkih supstanci za koje znate,

and you have a pro-carcinogenic environment.

i imate prokancerogeno okruženje.

But you can have anti-carcinogenic environments too.

Možete imati i antikarcinogena okruženja.

There are attempts to create milieus,

Postoje pokušaji stvaranja sredina,

change the hormonal milieu for breast cancer, for instance.

menjanja hormonalne sredine za rak dojke, na primer.

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

Pokušavamo da menjamo metaboličko okruženje

kod drugih oblika raka.

Or take another disease, like depression.

Ili uzmite drugu bolest, kao što je depresija.

Again, working upwards,

Opet, radeći nagore,

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

od 60-ih i 70-ih godina smo pokušavali, takođe očajnički,

to turn off molecules that operate between nerve cells --

da isključimo molekule koji deluju između nervnih ćelija -

serotonin, dopamine --

serotonin, dopamin -

and tried to cure depression that way,

i pokušavali da tako izlečimo depresiju, i to je uspevalo,

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

ali je onda doseglo granicu.

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

Sada znamo da je verovatno ono što mora da se uradi -

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

promeniti fiziologiju organa, mozga,

rewire it, remodel it,

prespojiti ga, preoblikovati ga,

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

i to, naravno, znamo jer je studija za studijom pokazala

that talk therapy does exactly that,

da terapija razgovorom upravo to čini,

and study upon study has shown that talk therapy

i studija za studijom je pokazala

da je terapija razgovorom u kombinaciji sa lekovima, pilulama,

combined with medicines, pills,

really is much more effective than either one alone.

zapravo mnogo delotvornija nego bilo koje od ta dva zasebno.

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

Možemo li zamisliti obuhvatnije okruženje koje će promeniti depresiju?

Can you lock out the signals that elicit depression?

Možete li da blokirate signale koji izazivaju depresiju?

Again, moving upwards along this hierarchical chain of organization.

Još jednom, krećući se nagore ovim hijerahijskim lancem organizacije.

What's really at stake perhaps here

Možda ovde zapravo u pitanju

is not the medicine itself but a metaphor.

nije lek sam po sebi, već metafora.

Rather than killing something,

Umesto ubijanja nečega,

in the case of the great chronic degenerative diseases --

u slučaju velikih hroničnih degenerativnih oboljenja -

kidney failure, diabetes, hypertension, osteoarthritis --

otkazivanja bubrega, dijabetesa, hipertenzija, artroze -

možda je ono što zaista treba da uradimo promena metafore na uzgajanje nečega,

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

And that's the key, perhaps,

a to je ključ, možda,

to reframing our thinking about medicine.

za preformulisanje našeg razmišljaja o medicini.

Now, this idea of changing,

E, sad, ta ideja o menjanju,

of creating a perceptual shift, as it were,

stvaranju preokreta u percepciji, takoreći,

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

ugnezdila se kod mene na vrlo ličan način pre oko 10 godina.

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

Pre oko 10 godina -

bavio sam se trčanjem većim delom života -

I went for a run, a Saturday morning run,

otišao sam na trčanje u subotu ujutu.

Vratio sam se i probudio se i bukvalno nisam mogao da se pomerim.

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

My right knee was swollen up,

Moje desno koleno je bilo natečeno

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

i mogli ste da čujete to zlokobno krckanje kost o kost.

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

Jedna od privilegija lekara

je da ste možete da zatražite svoju magnetnu rezonancu.

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

Sledeće nedelje sam otišao na magnetnu rezonancu

i to je ovako izgledalo.

Essentially, the meniscus of cartilage that is between bone

U suštini, meniskus hrskavice koji se nalazi između kostiju

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

bio je potpuno iskidan, a sama kost je bila oštećena.

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

Ako me gledate sa sažaljenjem,

let me tell you a few facts.

da vam kažem nekoliko činjenica.

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

Ako bih odveo na magnetnu rezonancu svaku osobu u ovoj publici,

60 percent of you would show signs

60 procenata vas bi pokazivalo znake

of bone degeneration and cartilage degeneration like this.

ovakvog propadanja kostiju i hrskavice.

85 percent of all women by the age of 70

Osamdeset pet posto svih žena do 70. godine

would show moderate to severe cartilage degeneration.

pokazuje znake umerene do ozbiljne degeneracije hrskavice,

50 to 60 percent of the men in this audience

a 50 do 60 procenata muškaraca u ovoj publici

would also have such signs.

takođe bi imalo takve simptome.

So this is a very common disease.

Dakle, ovo je veoma učestalo oboljenje.

Well, the second perk of being a physician

Druga prednost koju imaju lekari

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

je da mogu da eksperimentišu sa svojim tegobama.

So about 10 years ago we began,

Dakle, pre oko 10 godina smo započeli,

we brought this process into the laboratory,

doneli smo ovaj proces u laboratoriju

and we began to do simple experiments,

i započeli smo sa jednostavnim eksperimentima,

mechanically trying to fix this degeneration.

pokušavajući mehanički da popravimo ovu degeneraciju.

We tried to inject chemicals into the knee spaces of animals

Pokušali smo da ubrizgavamo hemikalije u kolena životinja

to try to reverse cartilage degeneration,

da bismo probali da preokrenemo propadanje hrskavice,

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

i da rezimiramo ukratko veoma dug i bolan proces,

essentially it came to naught.

u suštini se to svelo ni na šta.

Nothing happened.

Ništa se nije dogodilo.

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

Zatim, pre oko sedam godina, imali smo studenta istraživača iz Australije.

The nice thing about Australians

Dobra stvar kod Australijanaca

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

je da su navikli da posmatraju svet naopako.

(Laughter)

(Smeh)

And so Dan suggested to me, "You know, maybe it isn't a mechanical problem.

Tako mi je Den predložio: „Znaš, možda nije u pitanju mehanički problem.

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

Možda nije hemijski problem. Možda je problem matičnih ćelija.“

In other words, he had two hypotheses.

Drugim rečima, imali smo dve hipoteze.

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

Broj jedan, postoji tako nešto kao skeletne matične ćelije -

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

skeletne matične ćelije koje grade čitav skelet kičmenjaka,

bone, cartilage and the fibrous elements of skeleton,

kosti, hrskavicu i vlaknaste elemente skeleta,

just like there's a stem cell in blood,

baš kao što postoje matične ćelije u krvi,

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

baš kao što postoje matične ćelije u nervnom sistemu.

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

I pod dva, da možda je degeneracija ili disfunkcija ovih matičnih ćelija

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

ono što izaziva kostohondralni artritis, vrlo učestalu bolest.

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

Dakle, pitanje je zapravo, da li smo tragali za pilulom

when we should have really been looking for a cell.

kada je u stvari trebalo da tragamo za ćelijom.

So we switched our models,

Stoga smo preokrenuli naše modele

and now we began to look for skeletal stem cells.

i počeli da tragamo za skeletnim matičnim ćelijama.

And to cut again a long story short,

Da ponovo skratimo priču,

about five years ago, we found these cells.

pre oko pet godina pronašli smo te ćelije.

They live inside the skeleton.

One žive unutar skeleta.

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

Ovde je šematski prikaz, a potom i prava fotografija jedne od njih.

The white stuff is bone,

Belo na slici je kost, a te crvene kolone koje vidite i žute ćelije

and these red columns that you see and the yellow cells

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

su ćelije koje su nastale iz samo jedne skeletne matične ćelije -

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

kolone hrskavice, kolone kostiju koje proizilaze iz samo jedne ćelije.

These cells are fascinating. They have four properties.

Ove ćelije su fascinantne. Imaju četiri svojstva.

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

Prvo je da žive gde se to i očekuje.

They live just underneath the surface of the bone,

Žive baš ispod površine kosti,

underneath cartilage.

ispod hrskavice.

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

Znate, u biologiji se sve vrti oko lokacije.

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

Pređu u odgovarajuća područja i formiraju kost i hrskavicu.

That's one.

To je prvo svojstvo.

Here's an interesting property.

Evo zanimljivog svojstva.

You can take them out of the vertebrate skeleton,

Možete da ih izvadite iz skeleta kičmenjaka,

you can culture them in petri dishes in the laboratory,

možete da ih kultivišete u petrijevoj šolji u laboratoriji,

and they are dying to form cartilage.

a one strašno žele da formiraju hrskavicu.

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

Sećate se kako nikako nismo mogli da formiramo hrskavicu?

These cells are dying to form cartilage.

Ove ćelije užasno žele da formiraju hrskavicu.

They form their own furls of cartilage around themselves.

One formiraju naslage hrskavice oko sebe.

They're also, number three,

One su takođe, broj tri,

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

najefikasniji remonteri preloma sa kojima smo se ikada susreli.

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

Ovo je mala kost, kost miša koju smo prelomili

and then let it heal by itself.

i zatim pustili da sama zaceli.

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

Ove matične ćelije su došle i popravile kost, žuto na slici,

in white, the cartilage, almost completely.

hrskavica je belo, skoro u potpunosti.

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

Toliko da, ako ih obeležite fluorescentnom bojom,

you can see them like some kind of peculiar cellular glue

možete da ih posmatrate kao vrstu čudnog ćelijskog lepka

coming into the area of a fracture,

koji dolazi u oblast preloma,

fixing it locally and then stopping their work.

popravljajući ga lokalno i zatim zaustavljajući njegovo dejstvo.

Now, the fourth one is the most ominous,

E sad, četvrto je najkobnije,

and that is that their numbers decline precipitously,

a to je da njihov broj naglo opada,

precipitously, tenfold, fiftyfold, as you age.

strmoglavo, desetostruko, pedesetostruko, dok starimo.

And so what had happened, really,

Dakle, ono što se zapravo desilo

is that we found ourselves in a perceptual shift.

je da smo pronašli perceptivni preokret.

We had gone hunting for pills

Krenuli smo u potragu za pilulama

but we ended up finding theories.

a završili s pronalaženjem teorija.

And in some ways

Na neki način,

we had hooked ourselves back onto this idea:

upecali smo se ponovo na ovu ideju:

cells, organisms, environments,

ćelije, organizmi, sredine,

jer kako smo sada razmišljali o koštanim matičnim ćelijama,

because we were now thinking about bone stem cells,

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

razmišljali smo o artritisu u smislu ćelijske bolesti.

And then the next question was, are there organs?

Zatim je sledeće pitanje bilo da li postoje organi?

Can you build this as an organ outside the body?

Da li možete ovo da izgradite kao organ izvan tela?

Can you implant cartilage into areas of trauma?

Možete li da usadite hrskavicu u oblast povrede?

And perhaps most interestingly,

I možda najinteresantnije,

can you ascend right up and create environments?

možete li da doprete iznad i stvorite sredine?

You know, we know that exercise remodels bone,

Znate, poznato nam je da vežbanje preoblikuje kosti,

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

ali dajte, niko od nas neće da vežba.

So could you imagine ways of passively loading and unloading bone

Možete li da zamislite načine da se kosti pasivno pune i prazne

so that you can recreate or regenerate degenerating cartilage?

tako da možete da iznova stvarate ili regenerišete hrskavicu koja propada?

And perhaps more interesting, and more importantly,

Možda je zanimljivije i važnije

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

pitanje da li možete primeniti ovaj model globalnije izvan medicine.

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

Nije u pitanju, kao što sam već rekao,

ubijanje nečega, već uzgajanje nečega.

but growing something.

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

To pokreće niz, rekao bih, nekih od najzanimljivijih pitanja

about how we think about medicine in the future.

o tome kako ćemo razmišljati o lekovima u budućnosti.

Could your medicine be a cell and not a pill?

Da li bi vaš lek mogla biti ćelija, a ne pilula?

How would we grow these cells?

Kako bismo uzgajali te ćelije?

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

Šta bismo uradili da zaustavimo maligni rast ovih ćelija?

We heard about the problems of unleashing growth.

Čuli smo za probleme neobuzdanog rasta.

Could we implant suicide genes into these cells

Da li bismo mogli da ugradimo suicidne gene u te ćelije

to stop them from growing?

da ih sprečimo da rastu?

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

Da li bi vaš lek mogao biti organ koji je stvoren izvan tela

and then implanted into the body?

i zatim ugrađen u telo?

Could that stop some of the degeneration?

Da li bi to moglo da zaustavi deo propadanja?

What if the organ needed to have memory?

Šta ako organ mora da ima memoriju?

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

U slučajevima bolesti nervnog sistema, neki od tih organa su imali memoriju.

How could we implant those memories back in?

Kako bismo mogli da ponovo ugradimo tu memoriju?

Could we store these organs?

Možemo li da skladištimo te organe?

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

Da li bi svaki organ morao da bude stvoren za pojedinačno ljudsko biće i vraćen?

and put back?

And perhaps most puzzlingly,

I možda najzagonetnije,

could your medicine be an environment?

da li bi vaš lek mogla da bude sredina?

Da li biste mogli da patentirate sredinu?

Could you patent an environment?

You know, in every culture,

Znate, u svakoj kulturi,

shamans have been using environments as medicines.

šamani su koristili okruženje kao lek.

Could we imagine that for our future?

Da li možemo to da zamislimo u našoj budućnosti?

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

Dosta sam govorio o modelima. Započeo sam ovaj govor modelima.

So let me end with some thoughts about model building.

Dopustite mi da završim mislima o izgradnji modela.

That's what we do as scientists.

To je ono što mi radimo kao naučnici.

You know, when an architect builds a model,

Znate, kada arhitekta napravi model,

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

on ili ona pokušava da vam pokaže svet u malom,

But when a scientist is building a model,

a kada naučnik pravi model,

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

on ili ona pokušava da vam pokaže svet kroz metaforu.

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

On ili ona pokušava da stvori novi način sagledavanja stvari.

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

Prvo je promena razmere. Drugo je promena percepcije.

Now, antibiotics created such a perceptual shift

E, sad, antibiotici su stvorili takvu perceptivnu promenu

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

u našem načinu razmišljanja o medicini koji je zaista obojen, iskrivljen,

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

vrlo uspešno, tako smo razmišljali o medicini poslednjih sto godina.

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

Ipak, u budućnosti su nam potrebni novi modeli za razmišljanje o medicini.

That's what's at stake.

O tome se radi.

You know, there's a popular trope out there

Znate, prisutna je popularna fraza

that the reason we haven't had the transformative impact

da je razlog zbog kojeg nismo ostvarili transformišući uticaj

on the treatment of illness

u lečenju bolesti

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

taj da nemamo dovoljno jake lekove,

and that's partly true.

i to je delom istina.

But perhaps the real reason is

Ipak, možda je pravi razlog

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

da nemamo dovoljno jake načine razmišljanja o lekovima.

It's certainly true that

Svakako je istina

it would be lovely to have new medicines.

da bi bilo lepo imati nove lekove,

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

ali možda ono što je zaista u igri leži na trima nedodirljivim M:

mechanisms, models, metaphors.

mehanizmima, modelima, metaforama.

Thank you.

Hvala.

(Applause)

(Aplauz)

Chris Anderson: I really like this metaphor.

Kris Anderson: Baš mi se dopada ova metafora.

How does it link in?

Kako se to povezuje?

There's a lot of talk in technologyland

Dosta se priča u oblasti tehnologije

about the personalization of medicine,

o personalizaciji lekova,

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

da imamo sve te podatke i da će medicinski tretmani u budućnosti

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

biti posebno prilagođeni za vas, za vaš genom, vaš aktuelni kontekst.

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

Da li to važi za ovaj model koji vi imate?

Siddhartha Mukherjee: It's a very interesting question.

Sidarta Makhardži: To je vrlo zanimljivo pitanje.

We've thought about personalization of medicine

Dosta smo razmišljali o personalizaciji medicine

very much in terms of genomics.

u pogledu genomike.

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

Zato što je gen tako dominantna metafora,

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

opet, da upotrebim tu istu reč, u današnjoj medicini,

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

smatramo da će genom biti pokretač personalizacije medicine.

But of course the genome is just the bottom

Naravno, genom je samo kraj

of a long chain of being, as it were.

dugog lanca bića, takoreći.

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

Prva organizovana jedinica na tom lancu bića je ćelija.

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

Dakle, ako ćemo to zaista tako izneti u medicini,

we have to think of personalizing cellular therapies,

moramo da razmišljamo o personalizaciji ćelijskih terapija,

and then personalizing organ or organismal therapies,

a zatim i personalizaciji organskih ili organizmičkih terapija,

and ultimately personalizing immersion therapies for the environment.

na kraju personalizujući terapije izlaganja za okruženje.

So I think at every stage, you know --

Dakle, ja mislim da u svakoj fazi, znate -

postoji ona metafora sa kornjačama koje se pružaju sve do kraja.

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

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

Pa, ovde to važi za personalizaciju.

CA: So when you say medicine could be a cell

KA: Dakle, kada kažete da ćelija može biti lek,

and not a pill,

a ne pilula,

you're talking about potentially your own cells.

govorite potencijalno o sopstvenim ćelijama.

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

SM: Apsolutno. KA: Dakle, preobraćene u matične ćelije,

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

možda testirane u odnosu na razne lekove ili tako nešto, i pripremljene.

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

SM: I nema možda. To je ono što radimo.

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

To je ono što se dešava, i zapravo, polako se krećemo,

not away from genomics, but incorporating genomics

ne udaljavamo se od genomike već je ugrađujemo

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

u ono što nazivamo sistemima sa više poretka,

poluautonomnim, samoregulišućim sistemima,

like cells, like organs, like environments.

kao što su ćelije, organi, sredine.

CA: Thank you so much.

KA: Mnogo vam hvala.

SM: Pleasure. Thanks.

SM: Sa zadovoljstvom. Hvala.

(Aplauz)