the president: thankyou, everybody. thank you. (applause) well, thank you, alexis,for that introduction. i love that story -- shebumped into me on the elevator. what she didn't mention, bythe way, is that she started on her pre-med degree whenshe was 16, bumping into me on the elevator.
she was alreadywell on her way. so, to the rest ofyou -- good luck. (laughter) hope you already have tenure-- because alexis is coming. i'm only going to speakbriefly today because we have an amazing panel andi want to learn from the people who are inattendance here today. but i want to start byrecognizing mayor peduto of pittsburgh, who has been anextraordinary innovator and
city leader. and give -- yes. congressman doyle, who fullysupports our innovation agenda -- and we need strongallies in congress -- so give mike doyle a biground of applause, please. we also have people fromacross our agencies -- transportation secretaryanthony foxx -- -- nih directorfrancis collins -- -- national science foundation director france cordova.
and i want to thank twoextraordinary leaders who once served in myadministration and did extraordinary work --presidents suresh of carnegie mellon -- -- and chancellorgallagher of pitt. part of sort of theobama alumni mafia here. as well as all the facultyand students and staff here at cmu and pitt for allowingus to turn your campuses into a science fictionmovie for the day.
earlier today, i got achance to see some pretty cool stuff. a space capsule designed bythe private sector to carry humans out ofour atmosphere. small, unmanned quadcoptersthat can search disaster areas and surveyhard-to-reach places on bridges that mightneed repairs. i also successfully docked acapsule on the international space station.
it was a simulation, buttrust me -- i stuck the landing. but here's the thing aboutpittsburgh -- this kind of stuff is really nothing new. most folks have probablyheard about how this city is testing out a fleetof self-driving cars. but pittsburgh has beenrevitalizing itself through technology for avery long time. there is a reason that u.s.
steel tower is now alsothe corporate home of the university of pittsburghmedical center -- because the steel city is now hometo groundbreaking medical research and world-classuniversities. it's the birthplace ofsome of the most advanced artificial intelligence androbotics systems the world has ever seen. and you are investing inyour young people with after-school stem programs,and maker faires, and "girls
of steel" robotics teams. that's how this city cameback after an iconic industry fell on toughertimes -- doubling down on science, doubling down ontech, doubling down on innovation -- all of whichcan create amazing new jobs and opportunities. and stories like that arenot just happening here in pittsburgh, or insilicon valley. they're happening inchattanooga and in
charleston and in cincinnati-- cities where we're seeing science and technology spurnew jobs and new industries; new discoveries that areimproving our lives and, in many cases, saving lives. and that's consistent withthis nation, who we are -- a nation born from an ideathat became the world's laboratory. there aren't a lot ofcountries where one of your founding fathers has anidea to fly a kite in a
thunderstorm and helps tofundamentally change how we think about electricity. a place where the women whosolved the equations to take us into space, even thoughthey weren't always acknowledged. a nation whose engineersbrought us the internet. innovation is in our dna. science has always beencentral to our progress, and it's playing a leading rolein overcoming so many of our
greatest challenges. that's as true todayas it's ever been. only with science can wemake a shift to cleaner sources of energy and takesteps to save the only planet we have. only with science do we havethe chance to cure cancer, or parkinson's, or otherdiseases that steal our loved ones fromus way too soon. only through science willwe have the capacity to
reengineer our cities aspopulations grow, to be smarter and more productive,to lead humanity farther out into the final frontiers ofspace -- not just to visit, but to stay -- and ensurethat america keeps its competitive advantage asthe world's most innovative economy. and i was doing somepictures before i came out here with some folks, andthey said, thank you so much for what you'vedone for science.
and i confessed, iam a science geek. i'm a nerd. (laughter and applause) and i don't make anyapologies for it. i don't make anyapologies for it. it's cool stuff. and it is that thing thatsets us apart; that ability to imagine and hypothesize,and then test and figure stuff out, and tinker andmake things and make them
better, and then breakthem down and rework them. and that's why i get soriled up when i hear people willfully ignore facts -- -- or stick their heads in the sand about basic scientific consensus. it's not just that thatposition leads to that policy; it's also that itundermines the very thing that has always made americathe engine for innovation around the world.
it's not just that they'resaying climate change is a hoax, or taking a snowballon the senate floor to prove that the planet isnot getting warmer. it's that they're doingeverything they can to gut funding for research anddevelopment, failing to make the kinds of investmentsthat brought us breakthroughs like gps andmris and put siri on our smartphones, andstonewalling even military plans that don'tadhere to ideology.
that's not who we are. we don't listen to sciencejust when it fits our ideologies, or when itproduces the results that we want. that's the path to ruin. sixty years ago, when therussians beat us into space, we didn't deny thatsputnik was up there. that wouldn't have worked. no.
we acknowledged the facts,and then we built a space program almost overnight,and then beat them to the moon. and then we kept on going,becoming the first country to take an up-close look atevery planet in the solar system. that's who we are. that's where factswill get you. that's where sciencewill get you. and that's why, in my firstinaugural address, i vowed
to return science toits rightful place. and, by the way, i want tomake clear, this idea that facts and reason and scienceare somehow inimical to faith and feelings and humanvalues and passion -- i reject that. for us to use our brainsdoesn't mean that we lose our heart. it means that we can harnesswhat's in our heart to actually get things done.
and that's why in thefirst few months of my administration, we made thesingle largest investment in basic research in ourhistory -- because innovation is not a luxurythat we do away with when we're tightening our belts. it's precisely at thosemoments, when we've got real challenges, when we doubledown on new solutions that can lead to new jobs and newindustries and a stronger economy.
so over these last eightyears, we've worked to recruit the best andbrightest tech talent into the administration. we've partnered withacademia and the private sector. we've empowered citizenscientists to take on some of our biggest challenges. we've reimagined our federalapproach to science through incentive prizes and 21stcentury moonshots for cancer, and brain research,and solar energy.
we've turbo-charged theclean energy revolution. we built the architectureto unleash the potential of precision medicine, droppedenough new broadband infrastructure to circle theglobe four times; applied data and evidence to socialpolicy to find out what works -- scale up when itworks, stop funding things that don't, therebyfostering a new era of social innovation. we've helped once-darkfactories start humming
again, putting folks to workmanufacturing wind turbine blades longer than thewingspan of a 747. and we realized that wecan't look to the future if we're also not going to liftup the generation that's going to occupy that future. so we started the whitehouse science fair to teach our kids to send a messagethat the winner of the super bowl isn't the only one thatdeserves a celebration in the east room.
we hooked up more of ourclassrooms and communities to the high-speed internetthat will help our kids compete. we're pushing to bringcomputer science to every student. we're on track to prepare100,000 stem teachers in a decade. and as a running threadthroughout this, we are working to help all of ourchildren understand that they, too, have a place inscience and tech -- not just
boys in hoodies, butgirls on native american reservations, kids whoseparents can't afford personal tutors. we want jamal and mariasitting right next to jimmy and johnny -- because wedon't want them overlooked for a job of the future. america is about thomasedison and the wright brothers -- but we're alsothe place you can grow up to be a grace hopper, or georgewashington carver, or a
katherine johnson,or an ida b. wells. we're the nation that justhad six of our scientists and researchers win nobelprizes -- and every one of them was an immigrant. so part of science, part ofreason, part of facts is recognizing that to get towhere we need to go we need to lift everybody up,because we're going to be a better team if wegot the whole team. we don't want somebody witha brilliant idea not in the
room becausethey're a woman. we don't want some buddinggenius unavailable to cure cancer or come up with a newenergy source because they were languishing in asub-standard school as a child. so that's what i'vebeen focused on. alexis has done some things. i've done some things, too. but, look, i only get twoterms -- which is fine -- -- because thepresidency is a relay race.
we run our leg, thenwe hand off the baton. and that's why thisconference isn't just about where we've been, it'sabout where we're going. we're looking to tomorrow. we're trying toinstitutionalize the work that we've been doing overthese last eight years. but we also want to makesure that these partnerships continue to thrive wellbeyond my administration. the future isyours to create.
it's all of ours. and we've got a tremendousgroup here from all across america -- from thesciences, from industry, from academia. all of you in your ownfields are transformative. you're transforming theway we treat diseases, and building smarter andmore efficient, and more inclusive communities. you're unlocking the datathat make our criminal
justice systemsmarter and fairer. you're harnessing the powerof artificial intelligence -- big data robotics,automation -- for the good of all of us. you're breaking new groundon clean energy and giving us our best hope of stavingoff the worst consequences of climate change. and you're taking us on thatfinal frontier, firing up the boosters for humanity'sjourney to mars.
so, today, i am proudto build on your work. we've announced federal andprivate commitments totaling more than $300 millionto throw into the pot -- investing in smarter cities;expanding our precision medicine initiative;spurring the development in small satellite technology. we're supporting researchersworking to better understand our brains -- how we thinkand learn and remember. and, in fact, it's in thatarea where i'd like to close
-- brain research. before i came onstage, abouthalf an hour ago, i had the chance to meet anextraordinary young man named nathan copeland. and back in 2004, nathanwas a freshman in college, studying advancedsciences, interested in nanotechnology. and he was in a car accidentthat left him paralyzed. for years, nathan could notmove his arms, couldn't move
his legs -- needed helpwith day-to-day tasks. but one day, he wascontacted by a research team at pitt, and they asked ifhe wanted to be involved in an experimental trialsupported by darpa, the same agency that gave us theinternet, and night-vision goggles, and so much more. and since he was a scientisthimself, nathan readily agreed. so they implanted fourmicroelectrode arrays into his brain, each about thesize of half a button.
and those implants connectneurons in his brain with a robotic arm, so that today,he can move that arm the same way you and i do --just by thinking about it. but that's justthe beginning. nathan is also the firstperson in human history who can feel with hisprosthetic fingers. think about this. he hasn't been able to usehis arms or legs for over a decade, but now he can onceagain feel the touch of
another person. so we shook hands. he had a strong grip, but hehad kind of toned it down. and then we gave eachother a fist bump. and researchers will tellyou there's a long way to go -- he still can't feel withhis thumb or experience hot and cold, but he can feelpressure with precision. that's what science does. that's what americaninnovation can do.
and imagine thebreakthroughs that are around the corner. imagine what's possible fornathan if we keep on pushing the boundaries. and that's what thisfrontiers conference is all about, pushing the boundsof what is possible. and that's why i've been socommitted to science and innovation -- not justso that we can restore someone's sense of touch,but so we can revitalize
communities; revitalizeeconomies; reignite our shared sense ofpossibility and optimism. because here in america,with the right investments, with the unbelievablebrilliance and ingenuity of young people like alexis andnathan, there is nothing we cannot do. so let's keep it going. let's get to work. with that, i think it'stime to start our panel.
thank you, everybody. male speaker: pleasewelcome, the presidential panel on brain scienceand medical information. the president: it says you. okay. dr. gawande: well they toldme mr. president to treat you like any otherpanel member. the president: that'sexactly right. dr. gawande: right.
we'll try it right? so i'm atol gawande. i'm a surgeon. i'm a public healthresearcher and a staff writer at the new yorker. i'm the executive directorof arenoby labs, a health systems innovation centerat the brigham and women's hospital in harvard chanceschool of public health. i'd like to welcome you, i'mthe moderator today for
this panel. to my left is a lawyer. i want to start actually,you know, you challenged us in your talk and inwhat you wrote in wired. to think bigger. so i want to start with eachof you and i'm going to ask you what you think the bigopportunity is and so, first, is kafuidzirasa, m.d. ph.d., he's a rare bird.
he is a psychiatrist, he'sa neuroscientist, and he's trained as anengineer as well. he's on the faculty at duke,and i want you to tell us what you think the bigopportunity is for the future. dr. dzirasa: yeah i thinkthe big opportunity is for us to begin to think ofthe brain as an engineered system. so i'll give anexample of what i mean. let me -- if i look out inthe crowd and i say anyone
who's excited of voting inthe next few weeks, put your hands up. so let me -- there we go. so let me -- the president: gotsomething to vote for. dr. dzirasa: that's right. so let me talk aboutwhat happened in that. my mouth created pressurewaves, the pressure waved traveled through the air andstruck your eardrum, your
tympanic membrane. that through the kinociliumin the tiplic cells in your ear. which change intochemical energy. the chemical energy travelsdown into electrical energy. travels through yourcochlear nucleus into your superior ogl nucleus intoyour auditory thalmus into your cortex whichchanged into pitch. for the majority of us onthe left side of our brain that changed into words.
those words then becomerepresentations. you're young in the room,perhaps you've released some dopamine into your nucleusaccumbens and you get excited about voting. if you're a little moreseasoned, your hippocampus activates and you rememberthe first time you voted. and if you're a politician(inaudible) lights up and you count the numberof hands in the room. and you count the numberthat are from north
carolina, philadelphia,pennsylvania, or ohio. this information is thensynthesized in your frontal cortex. it releases your mortalcortex activity down your spinal cord, through yoursacral plexus and your hand goes up. and all of that happenswithin half a second. so as we begin to thinkabout these illnesses, whether it's alzheimer's orautism, the challenges we're
talking about a systemthat evolves so quickly if information is processed inmultiple areas to generate behavior. you know, the first time iheard someone describe the brain that way, i was ajunior in college at the university of maryland,baltimore county. and we invited a speaker andhe was one of my childhood heroes. he was a neurosurgeon.
he will go unnamed. the president: i know. really good surgeon. dr. dzirasa: and i gotexcited about the brain. and i got excited aboutgoing off to study the brain. this was an academicpursuit for me. it was an intellectualpursuit until i got to graduate school. and while i was in graduateschool, one of my family
members went missing. and we hired a personalinvestigator and they found my family member in thealleyway in another continent hallucinating. and it was the first timethat i even began to understood my family'sdifficulty with mental illness. whether it was schizophrenia or bipolar disorder or depression. and as i sat in grad schoollearning about genetics all
of the genome wideassociation studies were happening. i started to learn aboutpsychiatric genetics and i spent the next ten years ofmy life worried that any given day i myself couldwake up hallucinating or hearing voices. and so i decided to pursuean interest in psychiatry and as i sat there withfamilies who experiencing some of the same challengesthat my family was
experiencing, i realizedthat we just needed a breakthrough in how we thinkabout and how we treat mental illness. that big breakthrough ithink, for me, is going to come through thisbrain initiative. it's the opportunity forengineers to engage in how we think aboutmental illness. to map out how the brain isprocessing information in real time.
the activity ofall of these cells. the promises that one daywe'll have a new form of treatment that comes out ofreading information from the brain, generating neuroprosthetics in the same way that individuals are nowmoving their hands by thinking about it. can we augment brainfunction in a way that allows those with mentalillness to come out of the shadows and to continue tocontribute to this great
american system. the president: that's great. dr. gawande: thankyou for that. i'd like to introducericcardo sabatini, who is a silicon valley quantumphysicists who has turned his training to usingmachine learning around genomics and health. and human longevityincorporated. want you to tell us what youthink the big opportunity is.
mr. sabatini: yes. so, i think one of the mostexciting thing that happened in the last 20 years isthat we digitalized life. we took -- open upbiology to computation. and that happened in themiddle of my studies. i'm a quantum physicist. i was working on nanotechfor the longest time. and i realized all of asudden, that i could move my expertise, my numericalmodeling on life.
on biology. on genomics. near 2000, as a humanspecies, we started to read our own code. this is a cameramoment in science. and you mr. president, gavea medal of science to the very two people that helped. francis collins and craig venter. these allowed to takecompletely different
techniques to studyhow our biology works. is the hardest problem thatwe will ever face and that we ever encountered. but we are learning. we are taking ai, we aretaking machine learning, quantum mechanics, and weare virtualizing parts of our biology to understandhow a specific molecule. a drug, works onjust your body. how another molecule canhit your specific cancer,
extracting thegenome of your cancer. we are learning how toread the weak signals. very early stage. to understand if we canpredict some pathology that is growing andintervene fast. and this is a fascinatingfield because the very field where numerical competitionis saving life. every day. it's the moment where we canpredict and act at the same time.
and this, when i saw thisopportunity, i think it's really last centurywas about the atom. the next centuryabout biology. digitalizing allowingto work in this field. and what i'm excited about,skipping on, virtualizing the human being better andbetter and the standing better and better. and taking this knowledge,opening up for all the community and allover the world.
scaling down the pricesas we did the genome sequencing. allowing more knowledge andtaking on board linguistics, physicians, mathematicians. this is the most importantproblem we have as a species. and we're going to crack it. dr. gawande: great. fantastic. i'd like to introducezoe keating who is not a scientist.
zoe is a, first of all,an amazing san francisco cellist and composer. she's someone who's hadnumber one classical recordings. at the same time, she'ssomeone who had the journey with the healthcare systemwith her husband who had a devastating cancer. and has been thinking a lotas a patient advocate about what that experiencehas meant.
and so i wanted to ask you,from what you went through, what is the opportunity thatyou see for the future? ms. keating: well, i'lltell you the story. but i'll you thesummary first. and in a nutshell, it's likehow can we make lives better for patients. how can we ease suffering? how can we endthe suffering? that's what it's about.
and our story was thatmy husband in 2014, was diagnosed with stagefour lung cancer. and it took five months andthree different doctors to find it. he had -- by the time theyfound it he had a softball sized tumor in his lungs. he had forty brain tumors. his femur was broken inhalf from the cancer. it was kind of theworst case scenario.
and so first of all, thatit took so long to find it. with all of these differentdoctors, nobody gave him a scan. like it was so hard to findout what was going on. and then, going through theactual treatment itself. cancer is a reallycomplex disease. and so he was being treatedin multiple institutions. we live in the countrysidebut we had doctors at the ucsf and uc davis. and i experience this sortof, as a caregiver, this
what i wrote down as"fractured, impersonal, and cruel." and these gaping holes in asystem that left just lots of suffering. and so i'm always struck bythese incredible, incredible things that we're doing. incredible opportunities andsomebody in the panel this morning said we have starwars medicine and flintstone system.
and the result of that isjust a lot of suffering. and so i think for me, i wasthinking opportunities are -- i would love to be ableto walk into an office and to have the doctor know somuch about me already so i don't have to fill out thepaperwork every time i go in. you wouldn't believewhat i had to do. i had to drive discsfrom institutions with a four-year-old in the car. you know, i had to drive 100miles just a couple of times
a week just to deliverthe discs because the institutionswouldn't share data. and then, some thingsare getting better like insurance. when my husband wasdiagnosed, we got a letter a couple of weeks later fromthe insurance company saying oh this is not covered. and we had one of those,remember in the beginning of obamacare, we had thegrandfathered plans?
and we all thoughtthose plans were okay. turns out, there'slots of loopholes. so, i quickly realizedthat we were going to go bankrupt. and the first bills fromthat first few weeks were tens of thousandsof dollars. and so i quickly, you know,went up on healthcare california site. we covered california.
got us a new plan. and i still had to deal withlike hours and hours on the phone. i became an expert inlike not ever letting go. following through all theway to the end until finally that bill would get paid. but thanks to the presidentand your -- what you did, we didn't go bankrupt. so that's another --
if i could just saysomething else about patients, it's that duringour journey, we never had the sense there was oneperson keeping track of all of the data. that if there was data,and i tried really hard to digitize all of my husband'sand get it to where it needed to go. where could i put it? who do i give it to?
who do i trust? and in this future scenarioi can imagine where i would go into the doctor'soffice and they would know everything about me. and i would imagine therewould be some ai that had done some like analysis onmy data to like pop some things up for the doctor. but still, there's a human. no matter how muchtechnology you have, there's
a human at the end of it tohelp a patient through their journey. and to keep track of it all. and to think about theircaregivers, their life, everything. it's all a big package. it's not just patientsare the users. so -- dr. gawande: if i were totie together -- you know, it
sounds incredibly disparate-- but the story that is coming out from everythingyou're saying -- i'm going to take what you said,riccardo, about the last century, one step farther. the last century was thecentury of the molecule. we were trying to -- thepower of reductionism -- boil it down to the mostsmall possible part -- the atom, the gene, the neuron. give me the drug,the device, the
super-specialist. and that providedenormous good. but in this century, whatthey're all describing is now we're trying to figureout how do they all fit together. how do the neurons fittogether to create the kinds of behaviors that you're tosolve in mental illness. how do they fit -- the genesnetwork can fit together in epigenetics to account forthe health and disease of
the future thatwe all may face. and zoe is describing asuper-highway of information and science that is plugginginto the patient through a bike path called thedoctor's office. and trying to make a systemthat can actually bring it all together really is acompletely different kind of science from thelast century. it's surroundingthese problems. people come from incrediblydifferent perspectives now.
you're all of them in one. we normally might bring apsychiatrist and an engineer and a neuroscientisttogether. but it really isn't theage of the hero scientist anymore. and so i want to ask you:what do we have to reinvent about the way we do scienceto make all of this possible, genuinely,scientifically, with real innovation?
the president: well, firstof all, i want to thank the panelists, especially zoe,because of the story you're telling. although, kaf, it soundslike you were also inspired in part because of verypersonal experiences. at the end of the day,they're people who want to enhance their lives. and so being able to bringit down from 40,000 feet down to what you'reexperiencing while you're
waiting on the phone to helpsomebody you love so deeply i think is a good reminderof why we do this. as you say, atul, what we'vebeen calling this precision medicine initiative isreally how we stitch together systems that canmaximize the potential of the research that a kaf or ariccardo are doing, and end up with zoe's husbandgetting better treatment. and a couple of things thatwe've tried to do that i think are helping.
number one is to make surethat the data that is being generated by genomicsequencing, as its price comes down, is betterintegrated and better shared, which is goingto require us rethinking research models. in the past, what's happenedis, is that if a researcher wants to look into cancer,they get some samples from an arrangement, maybe, witha teaching university close by, and their plugging away,somewhat in isolation.
and what we now have is theopportunity to -- as we discover, particularly, thatwhat we used to think of as cancer might turn out to be20 different types of cancer -- we're now in a positionwhere we can actually generate a huge database,and as a consequence, not only identify some of thespecific features of that cancer, not only identifywhat kinds of genetic variants might make you morepredisposed to that cancer, but we're also breaking downthose silos in such a way
where we canaccelerate research. not everybody has tohave one small sample. now, potentially, we've gota million people who are contributing to a databasethat somebody like a kaf or a riccardo can work on. and what that allows us todo in developing cures is, over time, as riccardo said,to identify, first of all, do you have a predispositiontowards a particular disease, and can weintervene more quickly
before you develop it. second, can we developbetter cures, interventions, as kaf said. but third, are we alsoin a position to get this information to patientssooner to empower them so that they can be in chargeof their own health. because part of our goalhere is to shift from what is really a disease-caresystem to actual health care system.
so that's one big chunkof the initiative. and just to be morespecific, part of what we're doing with the precisionmedicine initiative is to get a bunch of collaboratorsto start digitalizing, pooling, andsharing their data. within the va, we've gothalf a million folks who have signed up and arecontributing their genetic samples. we now have more and moreinstitutions that are
coming together. and as a consequence, ourhope is, is that if you are a cancer researcher in anyparticular cancer, you're going to have a big data setthat you can start working off of. and, by the way, we're beingvery intentional about making sure that we'rereaching out to communities that sometimes are forgotten-- whether it's african american communities, women-- so that we can really
pinpoint what works for who. just one last thing i wantto say, though, because it goes to what zoesaid about systems. even as we're doing all thiscool stuff to come up with greater cures, what we'realso having to do is try to figure out what are theincentives -- the perverse incentives that are set upin the health care system that prevent it fromreaching a patient earlier. so i'll just givetwo quick examples.
the first is what you weretalking about in terms of your individualpatient data. we're trying to promote thenotion, number one, that this data belongs to you,the patient, as opposed to the institution that istreating you -- because once you understand that it'syours and you have agency in this process, it meansthat as you're looking for different treatment options,as you're consulting with different doctors, you'reable to be a more effective
advocate without havingto constantly fill our paperwork and so forth. so that's important. and one of the things thatwe've discovered is, is that even the software where yourindividual patient is stored -- because it's a commercialenterprise oftentimes -- it's not interoperable, it'snot sharable in easy form. and so we've actually beentrying to get some of the major providers to startworking together so that it
makes it easier for somebodylike zoe, if she's moving from system tosystem to system. the second this is -- and,atul, you've written about this -- to the extent thatwe are reimbursing doctors and hospitals and otherproviders based on outcomes rather than discreteservices that are being provided, we can startincentivizing the kind of holistic system thinking inhealth care -- rather than you come in, you get atest, then you got to go to
another place to do this,and then you got to go to another thing to do that,and then maybe the surgeon hasn't spoken to the primarycare physician and you don't have the outpatientcoordination that would make sure that you're not comingback into the hospital. and one of the things thatwe've been trying to do with the affordable care act,obamacare, that hasn't gotten as much attentionas just providing people insurance is to make surethat we're pushing, we're
nudging the system moreand more to do that. so, that was a long answer,but it's a big topic. the good news is, is that ithink we've identified the pathways where we can startmaking real progress. dr. gawande: i wantto live in your world. i want to live in the worldwhere -- i'm i'm only going to be herefor four more months. three and a half. dr. gawande: -- in a worldwhere i get to own -- i have
my genomic information, ihave my medical records, i have --everything about mebelongs to me, and it's easy to access, and i can bringit to the doctors that i need to get it to. the second level -- youknow, you announced an initiative today, the allof us research initiative, where you would be able to,a, get that data and then share it with researchersso that they can learn more from you -- trustingthat that data is safe.
i worked in the clintonadministration, and i got notified that my backgroundrecords, my clearance records were hacked, right? if you can hack all of mybackground records now, suppose you can hack mygenetic information, all of my electronic records, mymental health information and more. and being able to trust --so we're in this world where having system science onlyworks if it's transparent
and information iswidely available. and yet, we're in deep fearabout what happens with information and makingit widely available. i'd love to hear what youhave to think about that. and i'm going to jump toriccardo and think in the variety of the world thatyou've been in, how do we trust that this researchis in the right hands? the president: i'llbe very quick on this. this is going to be anongoing problem that we have
across disciplines. it's not justin health care. as riccardo said, ourlives become digitalized. it means that how weprovide security for that information -- whether it'sfinancial, health, you name it -- is going tobe challenging. now, the good news is thatwe are making real progress in understanding thearchitecture that we have to build across sectors,private and public, in order
to make this work. in fact, our outstandingpresident of pitt has been working with ourcybersecurity committee to really crack someof these problems. and we've put someguidelines for the private sector and providers toassure best practices on cybersecurity. but it is going to besomething that will be increasingly challenging.
here's the only thingi would say, though. the opportunities to hackyour information will be just as great or greaterin a poorly integrated, broken-down health caresystem as it will be in a highly integrated, effectivehealth care system. so i think it's importantfor us not to overstate the dangers of -- the very realdangers of cybersecurity and ensuring the privacyof our health records. we don't want to sooverstate it that that ends
up becoming a significantimpediment to us making the system work better. dr. gawande: are theretechnological solutions, riccardo, to thisproblem of privacy? mr. sabatini: so we startedto -- one of the questions we started about a year agois exactly can we identify someone from his own genome. so we started to builda class of algorithm to predict and extractinformation from your genes
-- some common traits --your height, your eye color, your skin color, thestructure of your face. every single model has itsown limitations, sometimes for the lack of data,sometimes because the data is not only in your genes. but what we learned is thatusing them collectively, we can go a long way to reallyidentify a person from his genome. so this is something that wehave to face, is a digital
asset is one of the mostcomplicated ways to be handled. we want to publish it, wewant to share it, but it's still something -- there issome concern about identity and security. we worked across the boardto find different solutions, let's say, the old systemwill have to work to find what is the right way. we are proposing -- andwe started to work on a platform called opensearch.
it is a way where we decidedto share the thousands of genomes in a very secure waywith the community a month ago. we launched it, it's calledopensearch -- search.hli. -- you get inside there, andyou can have this google feeling of shufflingthousands and thousands of genomes, million of records,and hundreds of databases in a very secure way. now, this is one of theefforts to try to match security and open accessand sharing of information.
the one thing i guess westill have to learn is both how every single personfeels about tracking or not. so we always talk aboutsharing our own information, but do we own ourown information? how many of you haveyour genomes sequences? how many of us havesequenced their genome? can you raise yourhands, for example? how many of you haveyour genomes sequenced? so a very fraction --typically it's 2, 3 percent
of the audienceswhen i speak. so we need to remove a fear,and allow people to engage more in their own healthand in their own data. there are technologies tokeep them safe and to keep them secure. the one thing that is veryimportant is overcoming this barrier of knowing yourself,which i think is the most -- is the hardest hurdle toscale up the databases. security -- there are thebest people working on it
across the board, both inthe scientific domain and governmental domain. but this should not be alimitation to access your own information and feelcomfortable to own your own information and feelcomfortable to share it with a governmentalinfrastructure, and with companies that implementthe security right. dr. gawande: at the centerof this i think is a question about optimism andpessimism about whether we
can solve these problems. and i think i would like toask a question of all of you about our values, thescientific values of a scientific orientation. and behind that orientationis a fundamental belief -- we have an allegiance tothe idea that the way you discover -- the way youexplain nature, the way you describe the world, the wayyou intervene in the world is through factualobservation and through testing.
and there's a certain senseof -- it's an orientation, it's a way of beingthat we're describing. it's an openness, it'san inquisitiveness, it's curiosity. it's a willingness toacknowledge good arguments and recognize ones that arebad and that haven't tested out. and that orientation feelslike, at times -- on the one hand, it's been the mostpowerful, collective enterprise in human history,the scientific community.
and at other timesit feels embattled. and i wonder, why does itseem under fire when we're -- you mentioned, presidentobama, that in certain areas like climate change, oraround nutrition, or around other parts of medical care,we have enormously fraught debates. and it feels at this momentalmost like we're not just debating what it means tobe a scientist, but what it means to be a citizen.
what do you take away, kafand zoe, about where we are, and why are we under fire,and how do we get past this? dr. dzirasa: i think, in alot of ways, science, the outcome changesperspective, right. so when science is useful,we don't have people arguing about whether polio vaccinesare great or not, right. and so i think there are alot of areas in medicine where we facethis challenge. i actually think debate isvery healthy for science.
i think contentious debatecan actually be very helpful for science, in the same wayour country was set up in way that healthy,constructive debate can be extremely useful. i think what we wantto do, especially as neuroscientists, i thinkwe're at a place where we need to draw as many peoplein as possible and have healthy, constructivedebates about how we get the outcomes we want.
i'll give you an example. i talked to twoscientists recently. one was last weekend --steve mccarrol at harvard -- and he'd recently come upwith a technique where he could sequence the genes ofevery cell in the brain. and so when you think aboutthe challenge of something like genetics, you've gotthree billion base pairs in the human genome. in the brain, we've gotabout a 150 billion cells,
half of those which carryelectricity, and the electricity is changingevery millisecond. so the problem isenormously scaled. the brain initiative allowsus to come up with these tools where now, if youcan understand what each individual cell type is, youcan now start to have these debates about how tounderstand what they mean. i'll give youanother example. i sat with anotherinvestigator, lauren frank
and he's now using thebrain initiative to record many, many channels in thebrain, simultaneously, from an animal, where he'sstudying how memory works. this, of course, could oneday be useful for something like alzheimer's. and he says now, that he'sable -- within 24 hours, he's pulling in about20 terra-bytes of data. so i'm not that old, iremember when i was in high school, my hard drive had100 megabytes of data.
so we're at a place nowwhere we're going to have to bring in other disciplinesto know how to handle that data. i sat with a high school kidlast night, gabe, and it was pretty clear to me that thepeople who were going to solve this challenge of thebrain are probably in like seventh or eighthgrade right now. and so how do we create anecosystem where all those different perspectivescan come in.
the utility is, when allthose different perspectives come in, there has tobe contentious debate. but i think the solutionsthat will come out of it are what will move people'sperspective on the usefulness of science. dr. gawande: zoe, whatdo you think about the constructive debate youhear, how we get to the more constructive debate, andenough optimism that we want to actually put funding intothe kind of work that kaf is
talking about. dr. keating: well, i thinkjust making it broader. i was really inspired thismorning by a lot of the speakers on the healthtrack, and one of them was steven keating -- who's notrelated to me at all -- and i was really struck how --he was a phd student and he was doing 3d printing. and he wanted to study hisbrain tumor, because he had a brain tumor.
but in order to study histumor, he had to become a medical student in order toget some of the tumor so he could study it. and that seemed really --like, wow, that's limiting. think of all these amazingpeople we have in our country who are doingthings, and increasingly people are doing thingsoutside of institutions. and i feel like that's wheresolutions are going to come from.
i think that we should alsolook at silicon valley. i was thinking aboutpatients and how the whole patient issue i washaving is kind of like a user-experience problemthat somebody might tackle at a software start-up, and maybe we should approach these things from differentperspectives that way. and i think that's partof this trust -- you were talking about trust in data-- that somehow expanding, bringing in voices,figuring out how people can
contribute data, how we canall just be more involved will be a waytowards making trust. the same thing istrue with government. the president:no, absolutely. i'll just pick up ona couple of themes. any scientific revolutionis, by definition, contesting the status quo. and we're going througha period in which our knowledge is expandingvery quickly.
it is going to have a widerange of ramifications and you've got a whole bunchof legacy systems that are going to be affected. so if self-driving cars arepervasive, a huge percentage of the american populationmakes its living, and oftentimes a prettygood living, driving. and so, understandably,people are going to be concerned aboutwhat does this mean. we've heard of thecontroversies around uber
versus those who havetaxi medallions, but it's actually driverless uberthat is going to be even more challenging. the same is true inthe health care field. one of the things thatyou discover is this rube goldberg contraption thatgrew up over the last 50 years or 60 years, in termsof our health care system, is there's all kinds ofeconomics that are embedded in every aspect of it.
so it's not surprising,then, that when we passed the affordable care act,that there are going to be people who push back notjust because they really want to make it work andthey've got some legitimate, factual critiques of it, butbecause people's pocketbooks may be threatened. and, zoe, you just usedone example, which was the enormous controversy we hadwhen we said that we should phase out certain types ofinsurance that, on their
face, look really cheap,until you have a tumor and it turns out thatthey don't cover you. and that very low-costinsurance, sort of the equivalent of the bare-bonesinsurance you have to get for driving but when you getin an accident it turns out doesn't do anything to fixyour car -- but obviously much more is at stake here. we still have debates todaywhere people will say, you know, people aren't havingthe choices that they used
to have. well, the choices, in somecases, that they used to have were choices to getinsurance that weren't going to cover them duringa catastrophe. so i think that the way iwould like to see us operate -- and we're not there atthe moment, and it will never be perfect -- is,yes, significant debate, contentious debate, butwhere we are still operating on the same basic platform,basic rules about how do we
determine what'strue and what's not. and one of the ironies ithink of the internet has been the degree towhich it's bringing us unprecedented knowledge, buteverything on the internet looks like it might be true. and so in this politicalseason, we've seen just -- you just say stuff. and so everything suddenlybecomes contested. that i do not think is goodfor our democracy, and it's
certainly not good forscience or progress or government orfixing systems. we've got to be able toagree on certain baseline facts. if you want to argue withme about how to deal with climate change, that'sa legitimate argument. some people might argue it'sunrealistic to think that we're going to be able tofix this so we should just start adapting to the oceansbeing six feet higher. you might want to suggestto me that it's got to be a
market-based solution, andit's all going to come through innovation;regulation is not going to help; we need a huge --i'm happy to have those arguments. but what you can't do isargue with me that we've had over the last 10, 15 years,each year is the hottest year ever, or that theglaciers are melting and greenland is melting. you can't argue with meabout that because i can see
it, and we're recording it. and in the same way aroundhealth, i think any good scientist or doctor wouldnot presume to suggest that the sum total of ourknowledge is all contained in our current medicalschools, and there may be holistic medicines oralternative medicines that are remarkable, but we alsoshould be able to test them. and you can't just assertthat this works and more conventional therapies don'twork and not be subject to
that kind oftesting regimen. so that's where i thinkwe have to move our conversation generally ifwe're going to have the kind of debate thatkaf talked about. mr. gawande: so how do wemove our conversation in that way, right? there was a time whenscientists were arguing about climate change,and reasonably so. the president: right.
mr. gawande: so how do weset up frameworks where we say, this is our time periodwhere we're going to collect facts, and at the end ofthe day we will accept the consensus of fact? how do we do that inour current political enterprise? the president: if i had theperfect answer to that, then i'd run for president. look, this takes us a littlebit far afield, but i do
think that it's relevant tothe scientific community, it's relevant to ourdemocracy, citizenship. we're going to have torebuild, within this wild, wild west of informationflow, some sort of curating function thatpeople agree to. i use the analogy inpolitics -- it used to be there were three televisionstations and walter cronkite is on there and noteverybody agreed, and there were always outliers whothought that it was all
propaganda, and we didn'treally land on the moon, and elvis is stillalive, and so forth. but, generally, that was inthe papers that you bought at the supermarket rightas you were checking out. and generally, peopletrusted a basic body of information. it wasn't always asdemocratic as it should have been. and zoe is exactly rightthat -- for example, on
something like climatechange, we've actually been doing some interestinginitiatives where we're essentially deputizingcitizens with hand-held technologies to startrecording information that then gets pooled -- they'rebecoming scientists without getting the phd. and we can do that in a lotof other fields as well. but there has to be, ithink, some sort of way in which we can sort throughinformation that passes some
basic truthiness testsand those that we have to discard because they justdon't have any basis in anything that's actuallyhappening in the world. and that's hard to do, buti think it's going to be necessary, it'sgoing to be possible. i think the answer isobviously not censorship, but it's creating placeswhere people can say, this is reliable and i'm stillable to argue about -- safely -- about facts andwhat we should do about it
while still -- notjust making stuff up. dr. gawande: focusing on theidea of places where the scientific orientation canbe -- the ethos can be protected isreally important. science is alwaysprobable knowledge. it's never nailed down. but we're at cmu, we're atuniversity of pittsburgh, because they are placesthat hold those values of there are places that livelike that online, in
patient communities. there are places thatprofessional societies are making happen. it's crucial, though, thatit also happen in government and it also happen inthe private sector. and i guess my finalquestion would be, for any and all of us, what's themost important thing we can make sure that we do to keepthat scientific orientation, that optimism, and thatstriving for the big
opportunity going? that we can keep thesevalues as part of the places where we are, whetherthey're in the virtual world or in our institutions. and maybe, i'll let you havethe last word, so i'll start on that end, ifthat's okay, zoe. dr. keating: well, i reallyfeel like it's just this huge opportunity and thisway for -- if people feel like they can contribute,that then they
will trust things. they will trustinstitutions, they will trust government if theyfeel that they have a voice. and it's our job to figureout how can we make this thing the president wastalking about -- how can we make the system that allowspeople to contribute, but it's somehow vetted so thatall that knowledge can be shared, because weneed all hands on deck. dr. gawande: and a chancefor people to participate in
the science itself. dr. keating: yes, a chancefor people to participate. and that's beyond healthcare, that's across the board. and i feel like that's ahuge challenge for our time. right now, just how canwe do that so that we can really -- because weneed everybody's help in everything that'scoming for us. dr. gawande: riccardo. dr. sabatini: the one thingthat -- the fight is a
little bit unfair becausemagic has all the answers -- things that you find around. there's alwaysstrong answers. there is the cure of cancer,but it's closed in a closet somewhere. science cannot state thosestrong answers, because it's a constantly evolving field,and it wouldn't be a fair. but we have a cool storythat sometimes we don't say enough.
when we describe how thebrain works, when we describe the majesty of whatit means watching inside your genes and how theproteins flow, and the molecules, and when iexplain these stories and i make them human, and iexplain cases -- stories of patients and people thataccess their health and they really got incredibleadvancements on that. when we nail the storyright, then we engage the young people, the vastmajority of the population.
we tend to fightthese bogus messages. but on one side itmeans we are failing. we are failing to tell theamazing advancements that we are doing in the rightstories, beating fake stories withgreat realities. and this is a challengethat we have to do. and i'm engaging as much aspossible, explaining the excitement that there is inthe time in history when we have access to things thatwe were never even dreaming
15 years ago. this is the story that wehave to tell outside these doors. you are some of the smartestpeople in this country. you have to be advocates ofhow amazing things we're doing, without giving strongsolutions and fake results, but telling that there arethe best people chasing this dream and we'regoing to crack it. it is our duty, makingpeople feel confident that
this is the rightstory to follow. dr. dzirasa: i'm honoredthat you chose to sit on this panel, because ithink health is the real truth-teller andthe real equalizer. when you think about thiscountry by 2050, we'll be spending about a trilliondollars a year on alzheimer's. if, lord willing, we getover 85, half of us will have alzheimer's. one out of every 48 boys inthis country are born with
autism now. and so it's thereal truth-teller. it is the real commonenemy that all of us, as americans, as scientists,as educators have. the reason i'm optimisticis because i fundamentally believe there is aseven-year-old sitting in a classroom somewhere thatwill take all of these investments and all of thiswork that we've made and transform thingsfor my family.
the challenge for me isthat i would love to see an america in which, whetherthat seven-year-old is sitting in a school indetroit or baltimore or gentry high school in themississippi delta, that they will also have theopportunity for their ideas to bubble upand be nurtured. because, at the end of theday, the solution to that common enemy that we allface might be sitting in that classroom right now.
the president: well, i'mgoing to steal some ideas from what my other panelistshave already said. first of all, zoe's pointabout opening up systems so that people understand themand don't just feel like cogs in that system, butrather, have agency in that system i think iscritically important. so what we've been trying todo across the board -- and we're not even close tobeing there yet -- is to use technology as a way to doexactly what you are
whether it's releasing bigdata -- and the easiest example, i think, for thegeneral public to think about is all the apps thatnow give us the weather over our phones, and those areall generated from inside government, but what used tobe closed data now we let out there. well, it turns out thatwe've got huge data sets on all kinds of stuff. and the more we're openingthat up and allowing
businesses, individuals, towork with that information i think the more theyfeel empowered. and that makes ahuge difference. the second thing that i wantto emphasize is the most important curator to be ableto sort through what's true and false and sustain thosescientific values you talk about is the human brain,and making sure that our kids are getting thatability to analyze and do that sorting early.
and so part of the reasonwhy we've been emphasizing stem education is notbecause we don't value the humanities -- and i wasa political science and english major, and iprobably learned more reading novels thantextbooks -- but what it does do is, it helpseveryone as citizens, even if you don't become adoctor or a scientist or a physicist, it helps youevaluate information in a way that allows you to makegood decisions in your own
life but also allows you toparticipate in the country as a whole. and so we want everybody-- we're putting a special emphasis on girls, youngpeople of color, who so often are underrepresentedin the stem fields. we want to make sure theyfeel a confidence about so much of the technology andinformation, revolutions and science that is transformingtheir lives all around them. and we want them to becreators of science, not
just consumers or if. so i think that'svery important. the final thing i'll say isthat government will never run the way silicon valleyruns because, by definition, democracy is messy. this is a big, diversecountry with a lot of interests and a lot ofdisparate points of view. and part of government'sjob, by the way, is dealing with problems that nobodyelse wants to deal with.
so sometimes i talk to ceos,they come in and they start telling me about leadership,and here's how we do things. and i say, well, if alli was doing was making a widget or producing an app,and i didn't have to worry about whether poor peoplecould afford the widget, or i didn't have to worry aboutwhether the app had some unintended consequences --setting aside my syria and yemen portfolio -- then ithink those suggestions are terrific.
that's not, by the way, to say that there aren'thuge efficiencies and improvements thathave to be made. but the reason i say this issometimes we get, i think, in the scientific community,the tech community, the entrepreneurial community,the sense of we just have to blow up the system, orcreate this parallel society and culture becausegovernment is inherently wrecked.
no, it's not inherentlywrecked; it's just government has to care for,for example, veterans who come home. that's not on your balancesheet, that's on our collective balance sheet,because we have a sacred duty to take careof those veterans. and that's hard and it'smessy, and we're building up legacy systems thatwe can't just blow up. we've been pushing very hardin the area of medicine to
have the fda reimagine howit does regulations in the genetic space so that it'sdifferent from how they might deal with amechanical prosthetic. but i don't want to justblow up the fda because part of government's job is tomake sure that snake oil and stuff that could hurt youisn't out there on the market being advertisedon a daily basis. so there are going to besome inherent balances that have to be taken, and thereare equities that are
complicated in government. and i guess the reason i'msaying this is i don't want this audience of people whoare accustomed to things happening faster andsmoother in their narrow fields to somehow getdiscouraged and say, i'm just not going todeal with government. because, at the end of theday, if you're not willing to do what kaf said earlier,which is just get in the arena and wrestle with thisstuff, and argue with people
who may not agree with you,and tolerate sometimes not perfect outcomes but betteroutcomes, then the space to continue scientific progressisn't going to be there. and what gives me confidenceis that i've met a lot of people as president of theunited states, and the american peoplefundamentally are good, they're decent, and they'resmart, and they just don't have time tofollow everything. the more we empower them,the more we bring them in
and include them, i have nodoubt that we're going to be able to makeenormous strides. and the audience here ithink is representative of the amazing possibilitiesthat we confront. dr. gawande: well,let's thank the panel. and i'd also like to thankthe president for having the frontiers conference. i think you set anexpectation which can apply to any president in thefuture of any party that you
can be a president forscience and health and that we can live upto those values. so, thank you.
Just got my check for $500
Sometimes people don't believe me when I tell them about how much you can make taking paid surveys online...
So I took a video of myself actually getting paid $500 for paid surveys to finally set the record straight.
Comments
Post a Comment