Psychology Lecture Series - The human genome

(applause) >> WELL, HELLO TO EVERYBODY AND THANK YOU VERY MUCH FOR GIVING ME THE OPPORTUNITY AND DR. CONNOR TO COME IN AND SPEAK HERE AT GRAND RAPIDS COMMUNITY COLLEGE. I'M HAPPY TO BE WITH YOU TODAY. UM, I HAVE ONE RULE FOR MY PRESENTATIONS WHEN I GIVE THEM AND THAT IS THAT WE KEEP THINGS INFORMAL. SO, IF THROUGHOUT THE COURSE OF THIS PARTICULAR DISCUSSION, YOU FEEL COMPELLED TO RAISE YOUR HAND AND ASK A QUESTION OR INTERJECT OR WHATEVER, I INSIST THAT YOU DO IT. LET'S KEEP THIS AS DISCUSSIONAL AS POSSIBLE. WE'VE GOT AN HOUR AND A HALF TOGETHER, AND, UH... I HAVE ABOUT A MILLION SLIDES TO GO THROUGH. SO, DEPENDING ON HOW MY NERVOUSNESS IS, THEY'LL BE DONE IN SIX MINUTES OR, YOU KNOW, A COUPLE HOURS. SO, WE'LL SEE HOW THIS GOES. UH, SO, YEAH, IT IS QUITE A LONG TITLE TO MY PRESENTATION TODAY, AND IT'S, "WILL YOU BE ABLE TO PREORDER THE SEX, HEIGHT, HAIR COLOR, "PERSONALITY OF YOUR NEW BABY? "AND IF YOU CAN, SHOULD YOU?" SO... UH-OH. THERE WE GO. SO, I'VE KINDA CONDENSED THAT TITLE TO BE "GENOMICS & YOU." SO, BEFORE WE GO REALLY FARTHER TODAY... I HAVE TO GIVE THIS DISCLAIMER, AND THIS IS ACTUALLY IMPORTANT AND THERE'S A REASON THAT I'M DOING IT. SO, I WANT YOU ALL TO UNDERSTAND THAT I'M HERE TODAY AND I'M NOT REPRESENTING MY COMPANY. I'M REPRESENTING MYSELF AND MY EXPERIENCES, AND ANYTHING THAT I SAY OR IMPLY COMES COMPLETELY FROM ME AND NOT FROM ANYTHING THAT MY COMPANY DOES OR BELIEVES IN... OR WHAT HAVE YOU. SO, THIS IS ALL ME, NONE THEM. AND THE REASON THAT I'M MAKING THIS DISCLAIMER IS BECAUSE WE'RE GONNA HEAD INTO SOME MURKY WATERS... AND A LOT OF PEOPLE FIND THE THINGS THAT I'M GONNA TALK ABOUT CONTROVERSIAL. AND I WANT TO BE FREE TO TALK ABOUT THIS STUFF WITH YOU AS AN INDIVIDUAL PERSON IN SOCIETY, RATHER THAN A REPRESENTATIVE OF A COMPANY, WHO MAY HAVE A DIFFERENT AGENDA AND SHAREHOLDERS TO ACCOUNT FOR. SO, THIS IS ABOUT US TODAY. UM, JUST TO EXTEND A LITTLE BIT ON THE INTRODUCTION, SO THAT YOU CAN DECIDE FOR YOURSELF WHETHER OR NOT YOU'D LIKE TO BELIEVE ANYTHING I HAVE TO SAY. SO, I DID GET SOME TRAINING, EARLY ON, AT HILLSDALE COLLEGE. I STUDIED BIOLOGY AND CHEMISTRY. I WENT TO OHIO UNIVERSITY AND I GOT A PhD IN MOLECULAR BIOLOGY, AND I STUDIED ONE PART OF MOLECULAR BIOLOGY CALLED "POST-TRANSCRIPTIONAL PROCESSING," WHICH JUST BASICALLY HAS TO DO WITH THE ACTIVITY OF THE GENOME. I WAS OF RESEARCH FELLOW AT THE DEFENSE DEPARTMENT IN THE DIVISION OF EXPERIMENTAL THERAPEUTICS, WHERE WE TRIED TO DEVELOP DRUGS TO FRONT-LOAD SOLDIERS WITH-- BEFORE THEY WENT INTO BATTLE, SO THAT IF THEY WOULD WALK INTO A FIELD OF SARIN GAS, THAT WE COULD GIVE THEM AN APPROPRIATE DRUG BEFOREHAND AND THEY'D BE IMPERVIOUS TO THE DRUG. ALL VERY SCI-FI MILITARY-TYPE STUFF... BUT I ALSO WORKED AT THE NATIONAL CANCER INSTITUTE DOING A BUNCH OF WORK AS A SCIENTIST, WITH CANCER. BUT IT WAS ABOUT THAT TIME, IN MY EARLY 30s, THAT I LEFT ACADEMIC RESEARCH AND WENT OVER TO THE DARK SIDE OF BUSINESS, AND I WORKED FOR A BIOTECH COMPANY CALLED AFFYMETRIX AS AN APPLICATION SCIENTIST. AND THEN, I HAD FIGURED IT WOULD BE A GOOD IDEA TO START MY OWN COMPANY. SO, YOU KNOW, THOSE SOMETIMES WORK OUT, SOMETIMES THEY DON'T, AND WE DID OKAY WITH THAT, BUT MY COMPANY, CALLED "TENEO SCIENCES"-- WE WORKED IN ARTIFICIAL INTELLIGENCE. AND WHAT WE DID WITH THAT COMPANY IS TRIED TO DEVELOP ARTIFICIAL INTELLIGENCES THAT WOULD COMB THROUGH LARGE SETS OF GENETIC DATA AND TRY TO MAKE SENSE OF IT. AND YOU MAY UNDERSTAND WHY THAT'S IMPORTANT LATER, BY THE END OF THIS TALK. I'VE ALSO BEEN A CONSULTANT AND INVENTOR FOR SHADY GROVE CENTER FOR PRE-IMPLANTATION GENETICS. THIS IS A LARGE, EAST COAST IN VITRO FERTILIZATION CLINIC, AND WE DEVELOPED TECHNOLOGIES TO INTERROGATE EMBRYOS BEFORE THEY WERE IMPLANTED IN THE RECIPIENT FEMALE. UM, I WAS A VICE PRESIDENT AT deCODE GENETICS, WHICH IS AN ICELANDIC COMPANY, AND WHILE I WAS THERE, WE WERE THE WORLD'S LARGEST GENETICS ANALYSIS COMPANY. THEY'RE STILL QUITE LARGE. AND THEY'VE BEEN SUPPLANTED BY COMPLETE GENOMICS, WHERE I WORK RIGHT NOW, WHERE WE DO WHOLE HUMAN GENOME SEQUENCING AND THAT'S IT. THAT'S ALL WE DO. THERE WE GO. SO, I HAVE ONE MAJOR OBJECTIVE HERE. (clearing throat) IF I COULD BE ONE THING TODAY WITH ALL OF YOU, I'D LIKE TO BRING WHOLE HUMAN GENOME SEQUENCING AND GENETICS AND GENOMICS TO THE FOREFRONT OF YOUR MIND AND GET YOU TO THINK ABOUT IT AND ITS IMPLICATIONS IN SOCIETY AND IN YOUR LIFE AND PERHAPS EVEN IN YOUR CAREERS, IF YOU ARE MOVING IN THE DIRECTION OF HAVING A CAREER. AND TO DO THAT, I'M GOING TO GIVE A VERY HIGH-LEVEL LOOK AT GENOMICS AND GENETICS. I'M NOT GOING TO GET INTO THE WEEDS OF HOW ALL THAT STUFF'S PUT TOGETHER OR ANALYSIS IS DONE. AND I WANNA MAKE THIS AS REAL AS POSSIBLE FOR ALL OF YOU. AND SO, TO DO THAT, I'M GONNA GIVE YOU REAL EXAMPLES FROM REAL PEOPLE, AND SOME OF THESE EXAMPLES WILL TEND FROM THE MUNDANE-- THE STUFF IN THE BEGINNING OF THE TALK-- TO RATHER EXOTIC STUFF TOWARDS THE END OF THE TALK. OKAY, SO, IN THE PROCESS, I WANT TO BE VERY CLEAR WITH YOU ON THE DIFFERENCE BETWEEN FACT AND OPINION. SO, I-- WHEN YOU WALK OUT HERE, I WANT YOU TO BE ABLE TO SAY, "THESE ARE FACTS-- "THESE THINGS WE KNOW TO BE TRUE, "AND THESE OTHER THINGS "THAT GUY IN THE FRONT OF THE ROOM SAID WERE HIS OPINIONS," 'CAUSE THEY ARE JUST THAT. BUT MY OPINIONS HAVE BEEN FORMED ON THIS SUBJECT, TRAVELING AROUND THE WORLD OVER THE LAST TEN YEARS, TALKING TO WORLD LEADERS IN GENETICS AND GENOMICS, AND MY OWN PERSONAL OPINIONS. OKAY. SO, TO START OFF-- THE CENTRAL DOGMA OF D.N.A. ACTUALLY, BEFORE I GO ANY FURTHER, I'D LIKE TO FIND OUT A LITTLE BIT ABOUT YOU. HOW MANY STUDENTS IN HERE ARE IN PSYCHOLOGY MAJOR? DON'T BE SHY. HOW ABOUT SOCIOLOGY? OKAY, HOW ABOUT BIOLOGY? AND THAT WAS ONLY ABOUT, LIKE, HALF THE ROOM. WHAT ARE THE REST OF YOU DOING? NURSING? OR WHAT ARE THE OTHER KINDS OF-- JUST GO AHEAD AND SHOUT OUT WHAT SOMEBODY ELSE IS DOING IN HERE. >> PRE-MED. >> PRE-MED, GOOD. >> CRIMINAL JUSTICE. >> CRIMINAL JUSTICE, EXCELLENT. VERY GOOD. ARCHITECTURE? FANTASTIC. YOU'RE GOING TO LIKE THE FIRST SLIDES. OKAY, ALL RIGHT. THAT'S GREAT. AND I SEE THAT THERE'S SOME FACULTY IN HERE AS WELL. IS THAT ALL FACULTY FROM GRCC? YEAH? OKAY. OKAY... SO, HERE IS THE VERY, VERY TRADITIONAL... EXPLANATION OF D.N.A. D.N.A. IS THE PLAN, RIGHT? THIS IS HOW, FOR AGES, PEOPLE HAVE TALKED ABOUT IT. IT'S THE ANALOGY THAT WE USE. SO, IN OTHER WORDS, YOU KNOW, WHAT WE HAVE RIGHT HERE IS ON... THE LEFT SIDE OF THE SCREEN, FOR ALL OF YOU-- IS SORT OF A BLUEPRINT RENDERING OF FRANK LLOYD WRIGHT'S "FALLING WATER." THAT'S THE BLUEPRINT FOR HIS BEAUTIFUL HOME IN PENNSYLVANIA, "FALLING WATER." AND SO, THE ANALOGY WOULD GO THAT THE D.N.A. ITSELF IS A SIMILAR PLAN, AND THAT THAT PLAN CREATES AN ORGANISM-- IN THIS CASE, THE HUMAN. SO, I THINK THAT-- I THINK THAT THAT IS... AN OLD FASHIONED WAY TO THINK ABOUT D.N.A. AND NOT REALLY TOTALLY CORRECT. SO, MORE THAN JUST THE PLAN, D.N.A.-- YOUR GENOME-- IS A INSTRUCTION MANUAL. IT DOES MORE THAN JUST LAY OUT WHAT THE STRUCTURE OF THINGS SHOULD BE. IT IS THE SET OF DIRECTIVES THAT ARE REQUIRED TO CREATE, GROW, MATURE, OBSOLETE, AND KILL AN ORGANISM. ALL THIS IS CONTAINED WITHIN IT. AND WE PASS THIS INFORMATION FROM GENERATION TO GENERATION THROUGH HERITABILITY. SO, I THINK IT AS THE INSTRUCTION MANUAL, FULL OF DIRECTIVES. (clearing throat) SO, MANY OF YOU HAVE HAD THIS IN YOUR INTRODUCTORY BIOLOGY CLASSES, PROBABLY FROM HIGH SCHOOL ONWARDS, BUT IT'S WORTH REVIEWING RIGHT NOW. ESSENTIALLY, WHAT IS THE GENOME? WHAT IS THE LOCATION AND ORGANIZATION OF THE GENETIC MATERIAL? SO, EVERY SINGLE CELL IN YOUR BODY HAS-- EXCEPT FOR THE BLOOD CELLS-- HAS A NUCLEUS, WHICH IS A SUB-CELLULAR ORGANELLE THAT HAS CHROMATIN-- CHROMOSOMES-- THAT MAKE UP THE GENOME. THOSE CHROMOSOMES ARE COMPOSED OF D.N.A. NOW, D.N.A. ITSELF IS A POLYMER THAT HAS FOUR DIFFERENT BASES IN IT-- A, C, T, AND G-- AND THESE THINGS ARE STRUNG TOGETHER IN A CERTAIN SEQUENCE. SO, THIS SEQUENCE OF A, C, Ts, AND Gs IS WHAT IS THE DIRECTIVE. THAT'S THE BOOK, ESSENTIALLY, THAT DECIDES HOW THINGS ARE GOING TO GO FOR THE DEVELOPMENT AND USE OF AN ORGANISM. SO, MY JOB-- MY COMPANY, AND WHAT MOST COMPANIES ARE INTERESTED IN RIGHT NOW, IS TO DETERMINE, "WHAT IS THE SEQUENCE? "WHAT IS THE ACTUAL ORDER OF THESE As, Cs, Ts, AND Gs, "AND WHAT DOES THAT MEAN FOR DISEASE, "HEALTHCARE, AGING, AND MANY OTHER THINGS?" OKAY, I LOVE THIS PICTURE. THIS IS A FALSE COLOR SCANNING ELECTRON MICROGRAPH OF THE HUMAN CHROMOSOME NUMBER TWO. I THINK IT'S ABSOLUTELY BEAUTIFUL, THAT WE GET TO SEE THESE THINGS. SO, WHAT YOU'RE LOOKING AT HERE IS A SET OF MOLECULES, ESSENTIALLY. IT'S THAT FINE OF RESOLUTION. EVERY CELL IN YOUR BODY, ESSENTIALLY, HAS A FULL COMPLEMENT OF CHROMOSOMES... JUST LIKE THIS. AND SO, IN THE UPPER LEFT THERE IS WHAT WE CALL A KARYOTYPE SPREAD, AND THIS IS THE CHROMOSOMES THAT HAVE BEEN CONDENSED AND ISOLATED FROM A CELL AND LAID OUT FOR MICROGRAPHY. AND ESSENTIALLY, THERE ARE 23 CHROMOSOMES. THERE'S 22 SETS OF CHROMOSOMES THAT ARE CALLED "AUTOSOMES." MALES AND FEMALES HAVE AUTOSOMES-- 22 SETS OF THEM. THEN, THERE'S SEX CHROMOSOMES-- "X" AND "Y"-- FEMALES HAVE TWO "X," MALES HAVE ONE "X" AND ONE "Y." SO, COMPRISING THIS WHOLE GENETIC COMPLIMENT, THE GENOME IS 6 BILLION NUCLEOTIDE PAIRS. SO, WHEN I WAS GOING TO SCHOOL, EVERYBODY SAID THAT THERE WERE 3 BILLION NUCLEOTIDE PAIRS, ALL RIGHT? IS THAT THE NUMBER THAT MOST OF YOU HAVE HEARD? THE TRUTH IS, THERE'S TWICE THAT MANY, BECAUSE YOU HAVE PAIRS OF CHROMOSOMES. YOU CAN SEE THAT EACH ONE OF THESE IS A CHROMOSOME PAIR, WITH THE EXCEPTION OF THE SEX CHROMOSOMES RIGHT THERE. SO, IT'S TWICE THAT MANY-- THERE'S 3 BILLION-- OR 6 BILLION PAIRS. AND THERE'S ABOUT 23,000 GENES THAT MAKE AROUND 400,000 DIFFERENT PROTEINS. SO, IN ADDITION TO D.N.A. BEING THE DIRECTIVES-- SET OF DIRECTIVES, THE INSTRUCTION MANUAL-- I'D LIKE YOU TO THINK ABOUT D.N.A. AND THE GENOME AS THE ULTIMATE INFORMATION REPOSITORY. THIS SEQUENCE THAT'S PUT TOGETHER IN THE GENOME IS ABLE TO ENCAPSULATE EVERYTHING THAT'S REQUIRED, EVERYTHING THAT YOU ARE THINKING RIGHT NOW, ALL OF YOUR MEMORIES, WITHOUT THE D.N.A. TO CONSTRUCT THAT BRAIN, TO CONSTRUCT THE COMPUTERS-- THIS IS THE ULTIMATE INFORMATION REPOSITORY. OKAY. TRANSLATIONAL AND GENOMIC MEDICINE. IS THERE ANYBODY IN HERE WHO KNOWS THE DEFINITION OF "TRANSLATIONAL MEDICINE"? ANYBODY BRAVE ENOUGH TO ADMIT IT? OKAY, ALL RIGHT. SO, THIS IS A BIG DEAL. THIS IS, UM-- THIS IS SOMETHING THAT'S GOING TO AFFECT ALL YOUR LIVES. IT'S GOING TO AFFECT MY LIFE... BUT PARTICULARLY BECAUSE MOST OF YOU IN HERE ARE YOUNGER. THIS IS SOMETHING THAT YOU'RE GONNA SEE MANIFEST THROUGHOUT, YOU KNOW, THE NEXT FIVE TO FIFTY YEARS. WE'RE-- BIG, BIG CHANGES IN MEDICINE ARE UNDERWAY, AND THEY ARE THE CHANGES OF TRANSLATIONAL MEDICINE. SO, ESSENTIALLY, TRANSLATIONAL MEDICINE IS AN INTEGRATED APPROACH TO RESEARCH, DIAGNOSIS, AND TREATMENT OF MEDICAL AFFECTATIONS, WHERE WE'RE LEVERAGING THE TOOLS OF SCIENCE, OKAY? SO, WE'RE TRANSLATING THE TOOLS OF SCIENCE DIRECTLY INTO CLINICAL PRACTICE. MEDICINE ITSELF IS BECOMING MUCH MORE SCIENCE THAN IT USED TO BE AND MUCH LESS ART. SO, EVEN IN THE AREAS OF PSYCHOLOGY, PSYCHIATRY, WHERE YOU'RE MAYBE NOT THINKING OF IT IN TERMS OF, LIKE, "I'M GONNA CUT SOMEBODY OPEN WITH A SCALPEL," OR "CURE THEIR CANCER" OR WHATEVER-- TRANSLATIONAL MEDICINE WILL APPLY GENETIC AND GENOMIC TECHNOLOGIES IN ABUNDANCE. SO, THIS IS COMMONLY REFERRED TO... AS "BENCH TO BEDSIDE." THAT'S HOW WE THINK OF IT-- FROM THE RESEARCH BENCH TO THE BEDSIDE OF THE PATIENT. OKAY. SO, I'M TAKING SOME TIME TO EXPLAIN THIS, BECAUSE IT IS QUITE RELEVANT TO WHAT WILL BE HAPPENING IN THE FUTURE. UM, SO, IF YOU WERE TO LOOK AT A SPECTRUM, SAY BETWEEN RESEARCH ON ONE SIDE-- BEING A VERY, VERY SCIENTIFIC ENDEAVOR, SOMETHING THAT HAPPENS PURELY IN THE LABORATORY, YOU PUBLISH PAPERS IN ACADEMIC JOURNALS, THAT SORT OF THING-- TO CLINICAL PRACTICE ON THE EXACT OPPOSITE EXTREME OF THIS SPECTRUM. THIS IS SOMETHING WHERE IT'S NOT QUITE AS SCIENTIFIC. IT'S VERY WELL ESTABLISHED, IT'S A CONSERVATIVE APPROACH TO DOING WHAT THEY'RE DOING, IT'S INTERACTING DIRECTLY WITH PATIENTS. UM, TRANSLATIONAL MEDICINE FALLS KIND OF IN THE MIDDLE. OOP, THERE WE GO. SORRY. SO, TRANSLATIONAL MEDICINE, YOU KNOW, FIVE, TEN, SEVEN YEARS AGO, WAS REALLY PRACTICED BY PEOPLE WHO ARE M.D. PhDs, AND WHAT WE'VE SEEN OVER THE INTERVENING YEARS IS THAT IT'S GAINED GREATER AND GREATER ADOPTION, BUT NOT BY THE SCIENTISTS-- IT'S BY THE MEDICAL COMMUNITY, WHO HAVE SEEN THESE SCIENTIFIC TOOLS AND SAID, "WE NEED TO IMPLEMENT THESE THINGS IN OUR PRACTICE. "WE NEED TO USE THESE TOOLS TO HELP US CARE FOR OUR PATIENT BASE." SO, A COUPLE YEARS AGO, WE REALLY STARTED TO SEE, YOU KNOW, TRANSLATIONAL MEDICINE COME TO THE FOREFRONT, AND IN ANOTHER FEW YEARS, BY 2015, THE TRANSLATIONAL MEDICINE TOOLS OUT THERE, PARTICULARLY IN GENETICS AND GENOMICS, WILL HAVE REALLY COME MUCH FARTHER INTO CLINICAL PRACTICE. I THINK THAT PEOPLE THAT ARE PRACTICING PSYCHIATRY, IN PARTICULAR, WHO ARE PRESCRIBING DRUGS, WILL BE USING THE TOOLS OF TRANSLATIONAL MEDICINE. SO, MORE TO THE POINT FOR US TODAY, TRANSLATIONAL MEDICINE IS THIS-- IF YOU WERE TO THINK OF ALL THE TOOLS OF TRANSLATIONAL MEDICINE THAT WOULD BE AVAILABLE-- THE TOOLS OF BIOLOGIST'S, WHICH IS, YOU KNOW, PROTEIN CHEMISTRY AND GENETICS AND R.N.A. ANALYSIS-- ALL THAT SORT OF STUFF-- TRANSLATIONAL MEDICINE. I'M GONNA FOCUS ON GENOMIC MEDICINE. NOW, GENOMIC MEDICINE IS A TRANSLATIONAL MEDICINE. IT'S A SUBSET OF TRANSLATIONAL MEDICINE, AND THIS IS EXTRAORDINARILY POWERFUL. AND IT'S NOT ONLY IMPORTANT IN TERMS OF IMPROVEMENT IN CLINICAL CARE. IT'S ALSO IMPORTANT IN TERMS OF OUR UNDERLYING ECONOMY. THERE'S A HUGE INVESTMENT THAT'S BEING MADE-- I MEAN, YOU'VE SEEN THE BUILDING THAT'S HAPPENED AROUND HERE, IN GRAND RAPIDS, FOR RESEARCH. YOU KNOW, THE VAN ANDEL INSTITUTE OVER THERE. THAT'S HAPPENING ALL AROUND THE WORLD, AND IT'S LARGELY GENOMIC MEDICINE. WHY? WHY ARE THEY DOING THAT? WHY IS EVERYBODY INVESTING IN GENOMIC MEDICINE? WELL, IT'S BECAUSE OF THIS-- MOST PEOPLE, AT THIS POINT IN TIME, BELIEVE THAT THE ROOT OF ALL DISEASE CAN BE TRACED BACK TO THE GENOME. SO IT DOESN'T REALLY MATTER WHAT YOUR DISEASE IS-- PEOPLE OFTEN SAY TO ME, "WELL, RICK, WHAT ABOUT INFECTIOUS DISEASE? "HOW DO TRACE THAT BACK TO THE GENOME?" I MEAN, SOME THINGS ARE EASY TO EXPLAIN AWAY, LIKE DEVELOPMENTAL DELAY, ALZHEIMER'S DISEASE-- THESE VERY CLEARLY HAVE GENETIC COMPONENTS-- CANCER. SURE, THEY GET THAT, BUT WHAT ABOUT INFECTIOUS DISEASE? WELL, THERE'S A THING CALLED A "HOST RESPONSE." SO, YOUR ABILITY TO BE INFECTED OR NOT INFECTED IS, IN FACT, DETERMINED BY YOUR GENOME AS WELL. TRUE. SO, I WILL STAND BY THIS STATEMENT-- AND IT'S PRETTY WELL ACCEPTED, AND ANYBODY WHO'D LIKE TO GO TOE-TO-TOE WITH ME ON THIS, I'M READY. (audience chuckling) NO TAKERS? OKAY. THIS IS... THIS IS MENDEL'S EXPERIMENT RIGHT HERE. GREGOR MENDEL WAS THIS OLD MONK-- KINDA THE FATHER OF GENETICS. RAISE YOUR HAND YOU KNOW ABOUT GREGOR MENDEL-- HAVE SEEN IT. OKAY. SO, THIS IS LIKE THIS VERY TRADITIONAL, CLASSIC WAY TO THINK ABOUT GENETICS, AND IN THIS EXPERIMENT-- MENDEL WAS A MONK, AND HE WATCHED HIS GARDEN GROW AND HE WATCHED THESE PEA PLANTS AND HE TRIED TO EXPLAIN AWAY THE VARIATION IN FLOWER COLOR, AS THESE THINGS GREW EVERY SPRING, AND HE WOULD CROSS THE PLANTS. AND HE FOUND... THAT IF HE CROSSED A PLANT WITH A RED FLOWER ON IT AND A PLANT WITH A WHITE FLOWER ON IT, THAT THE RESULT WAS A PLANT WITH A PINK FLOWER, KINDA HALFWAY BETWEEN RED AND WHITE. AND HE FURTHER FOUND THAT IF HE TOOK THE PINK FLOWERS AND HE TOOK TWO PINK FLOWERS AND HE CROSSED THEM TOGETHER, THAT HE WOULD GET FLOWERS THAT RESULTED THAT WERE RED AND PINK AND WHITE, AND MORE SPECIFICALLY, THAT THEY WERE IN A SPECIFIC RATIO-- 25 PERCENT OF THE FLOWERS WERE RED, 50 PERCENT OF FLOWERS WERE PINK, AND 25 PERCENT OF THE FLOWERS WERE WHITE. AND SO, THIS IS THE KIND OF THING THAT WE ALL HAVE LEARNED IN GENETICS. THIS IS, YOU KNOW, AS WE WENT TO SCHOOL, THIS IS HOW WE LEARNED GENETICS, AND IT PROPAGATES THIS THOUGHT THAT I SEE ALL THE TIME, WHICH IS... "HEY, MY DAD HAD HEART DISEASE. "THAT MEANS I'M GOING TO HAVE HEART DISEASE." OR, "MY UNCLE WAS CRAZY. "AM I GOING TO BE CRAZY?" AND YOU KNOW, WHEN I SIT ON THE AIRPLANE, WHICH IS WHAT I DO 90 PERCENT OF THE TIME, AND I TELL PEOPLE WHAT I DO, THEY ASK ME A LOT OF QUESTIONS ABOUT THIS SORT OF THING-- "AM I GOING TO GET SICK BECAUSE MY RELATIVE GOT SICK?" WELL, THE TRUTH IS THAT GENETICS DOESN'T REALLY WORK THAT WAY VERY OFTEN. THIS IS MENDELIAN GENETICS-- STRICTLY MENDELIAN GENETICS-- AND IT'S WHAT WE CALL "SIMPLE GENETICS." AND THERE'S NOT VERY MANY HUMAN DISEASES... THAT FALL INTO MENDELIAN GENETICS. THEY'RE ACTUALLY ALL CATEGORIZED AT O.M.I.M., WHICH IS "ONLINE MENDELIAN INHERITANCE IN MAN." THIS IS A WEBSITE FROM THE NATIONAL INSTITUTES OF HEALTH AND JOHNS HOPKINS, WHERE IT ACTUALLY TAKES ALL THE KINDS OF DISEASES THAT FIT THAT CRITERIA OF, YOU KNOW, DOMINANT-RECESSIVE, "MY DAD HAD IT, I'M GONNA HAVE IT," SORT OF PARADIGM, AND LISTS THEM FOR YOU. AND THERE'S NOT THAT MANY-- THERE'S ONLY LIKE 1,500. SO, OUT OF ALL THE DIFFERENT KINDS OF HUMAN AFFLICTION THAT YOU CAN THINK OF, ONLY A SMALL FRACTION OF THEM-- AND LARGELY NONE OF THEM-- ARE COMMON DISEASES. YOU KNOW, YOU WON'T FIND SOMETHING LIKE HEART DISEASE IN THERE. YOU WON'T FIND ANY OF THAT SORT OF STUFF. IT'S OBSCURE THINGS. SO, THERE IS THIS RELATIONSHIP THAT EXISTS BETWEEN YOUR GENES AND DISEASE, AND THE NUMBER OF GENETIC VARIANTS-- YOU'RE GONNA HEAR ME USE THIS WORD "GENETIC VARIANTS" ALL THE TIME TODAY. AND IT GOES LIKE THIS... BASICALLY, IT SAYS THAT THE FEWER NUMBER OF VARIANTS THAT ARE RESPONSIBLE FOR PRODUCING A DISEASE, THE STRONGER INFLUENCE OF THAT VARIANT ON THE DISEASE, OKAY? SO, IN OTHER WORDS, AN EXAMPLE OF THAT WOULD BE SOMETHING LIKE SICKLE CELL ANEMIA, OR IF YOU HAVE A SINGLE-- SINGLE!-- NUCLEOTIDE VARIATION, YOU'VE GOT SICKLE CELL ANEMIA. VERY STRONG. ON THE OTHER HAND, MORE COMPLEX STUFF-- STUFF THAT YOU ALL MIGHT BE DEALING WITH-- DISEASES OF THE MIND. THEY HAVE MANY, MANY, MANY GENETIC VARIANTS THAT WORK TOGETHER TO PRODUCE THIS PHENOTYPE, THIS PRODUCT THAT YOU SEE-- IF SOMEBODY'S SCHIZOPHRENIC OR WHAT HAVE YOU. IT'S NOT ONE THING THAT PRODUCES IT, IT'S QUITE A NUMBER. COMPLEX DISEASES. OKAY, ANY QUESTIONS ON THAT? THAT'S KIND OF AN IMPORTANT TOPIC, SO MORE GENETIC VARIATION FOR COMPLEX DISEASES, LESS GENETIC VARIATION FOR SIMPLE DISEASES. OKAY, SO... HERE'S THE DEAL-- WE'VE KNOW THIS FOR A LONG TIME, THIS WHOLE PARADIGM ABOUT THE NUMBER OF VARIANTS REQUIRED TO PRODUCE A GIVEN DISEASE. WE'VE DONE THIS FOR A LONG, LONG TIME, AND BACK IN 1980s-- I'M SURE BEFORE ANY OF YOU WERE BORN-- THE GOVERNMENT MADE A DECISION, AND THEY SAID, "WHAT WE'RE GONNA DO IS WE'RE GOING TO SEQUENCE THE HUMAN GENOME," AND THAT WAS THE BIRTH OF THE HUMAN GENOME SEQUENCING PROJECT. AND THEY EMBARKED ON THIS THING THAT WAS ESSENTIALLY LIKE THE MOON SHOT FOR GENETICS, AND THAT'S, YOU KNOW, THIS BIT ABOUT SEQUENCING A GENOME IS NON-TRIVIAL. THIS IS DIFFICULT. YOU KNOW, 6 BILLION NUCLEOTIDE PAIRS HAVE TO BE READ AND UNDERSTOOD, SO THAT THE DATA ANALYSIS ALONE IS VAST, NOT TO MENTION THE MACHINERY AND PEOPLE REQUIRED TO DO THIS. UM, AND THE REASON THAT THEY WANTED TO DO THIS IS BECAUSE THEY WANTED TO GET A HANDLE ON HEALTHCARE AND HOW DO WE TREAT PEOPLE? HOW DO WE UNDERSTAND THE ROOTS OF DISEASE? REMEMBER, I SAID THAT THE ROOT OF DISEASE IS GENETIC. WELL, WE CAN'T GET AT IT UNTIL WE UNDERSTAND THE GENOME, RIGHT? SO, THEY SAID, "FINE, LET'S GO AFTER THIS THING. "WE'RE GONNA PUT SOME MONEY AT THIS AND SOME SMART PEOPLE," SO THEY STARTED IN 1985-1986. THEY PUT THESE TWO GUYS TOGETHER IN A LABORATORY, WHICH TURNED OUT TO BE A MISTAKE. THEY SPENT $3 BILLION IN 15 YEARS. WELL, SOME PLACE ALONG THE WAY, THOSE TWO GUYS GOT IN A FIGHT, AND ONE GUY LEFT THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE-- N.H.G.R.I.-- AND THAT WOULD BE THE GUY IN FRONT, CRAIG VENTER-- AND HE STARTED HIS OWN COMPANY CALLED "CELERA." AND THEN, THERE BECAME A COMPETITION TO SEE WHO COULD SEQUENCE THE HUMAN GENOME FIRST-- THE GOVERNMENT-FUNDED N.H.G.R.I. OR CELERA. AND SO, THESE TWO GUYS WENT AT IT, AND THEY ULTIMATELY SEQUENCED THE GENOME. AND THE FIRST DRAFT OF THE GENOME WAS COMPLETED IN ABOUT 2000, THE FINAL DRAFT IN ABOUT 2003. SO, THAT WASN'T THAT LONG AGO. SINCE 2003-- YOU KNOW, IT'S LIKE LESS THAN TEN YEARS AGO, $3 BILLION, 15 YEARS, THOUSANDS OF SCIENTISTS TO DO ONE HUMAN GENOME SEQUENCE. SO-- AND JUST A COUPLE YEARS AFTER THAT, BY 2006, IT TOOK, STILL, YEARS TO SEQUENCE ANOTHER HUMAN GENOME. AND THAT WAS, UH-- THAT GENOME WAS JAMES WATSON, WHO WAS ONE OF THE GUYS WHO DISCOVERED THE STRUCTURE OF D.N.A. AND THAT TOOK A FEW MILLION DOLLARS. 2007, FIRST COMPANY TOOK ITS FIRST CLIENT TO SEQUENCE SOMEBODY FOR MONEY. THAT'S (indistinct). AND DID THAT FOR $350,000 AND IT STILL TOOK MONTHS TO DO JUST ONE SINGLE HUMAN GENOME. AND THAT'S $350,000 AT NO PROFIT. COUPLE OF YEARS LATER, 2009, IT'S DOWN TO $5,000 TO DO A WHOLE HUMAN GENOME AND THERE'S PROBABLY, AT THIS POINT, 40 HUMAN GENOMES IN ALL OF HUMAN HISTORY THAT HAVE BEEN SEQUENCED. THAT'S TWO, THREE YEARS AGO, YOU KNOW? TWO, THREE YEARS AGO, THERE'S ONLY 40 HUMAN GENOMES DONE. AFTER ALL THIS. NINE WEEKS-- LAST YEAR-- AT THE END OF LAST YEAR, JUST A COUPLE OF MONTHS AGO, WE WERE DOWN TO ABOUT $3,000 TO DO A HUMANE GENOME SEQUENCE, AND IT TAKES LESS THAN TWO WEEKS-- ABOUT 15 DAYS. SO, IF YOU THINK ABOUT THIS, THERE'S A MILLION-FOLD DECREASE IN PRICE, BETWEEN TEN YEARS AGO AND TODAY, AND THE TIME TO DO IT HAS GONE FROM 15 YEARS TO ABOUT A WEEK. ALL RIGHT, SO I'M TELLING YOU THIS BECAUSE AS THE ECONOMICS OF THIS THING CHANGE AND THE FEASIBILITY OF HAVING THE SEQUENCE DONE CHANGES, IT WILL BEGIN TO COME INTO YOUR LIVES ON A DAILY BASIS. AND SO, A LOT OF THIS TALK IS GONE EXPLORE WHY THAT IS AND HOW IT CAN BE USED. 2015, DOWN TO ABOUT $100. NOW, THAT'S THE ESTIMATE-- I PERSONALLY DON'T BELIEVE IT. SO, LET'S JUST SAY THAT FROM HERE UP, THAT'S FACT. FROM HERE DOWN, THAT'S OPINION. OKAY, UM... IT'S IMPORTANT TO UNDERSTAND GENOMIC VARIATION, AND I SAID I WAS GONNA KEEP THIS TALK AT A HIGH LEVEL, AND SO, I'VE TRIED TO PUT AN ANALOGY TOGETHER THAT MAY HELP YOU UNDERSTAND WHAT GENETIC VARIATION IS. SO, IF YOU THINK OF THE GENOME AS A DIRECTIVE, AND THAT DIRECTIVE, LET'S SAY IN THIS CASE, IS "POUR CREAM IN MY COFFEE." THAT'S A DIRECTIVE, THAT'S A DIRECTION. SO, THE GENOME HAS DIRECTIVES THAT ARE OBVIOUSLY NOT THAT COMPLICATED, BUT YOU COULD THINK OF THIS DIRECTIVE AS A GENE OR A SET OF GENES, AND THIS IS WHAT WE WOULD EXPECT TO BE A STANDARD CORRECT DIRECTIVE. BUT IF YOU HAVE GENOME VARIATION-- THERE'S LOTS OF KINDS A VARIATION THAT OCCUR, RIGHT? SO, THIS IS ONE KIND. IF WE JUST CHANGE ONE LETTER-- IF YOU CHANGE THE "P" TO AN "S"-- IN OTHER WORDS, IF YOU WERE TO, LIKE, CHANGE ONE OF THOSE NUCLEOTIDES FROM SAY, AN "A" TO A "C"-- JUST ONE LETTER CHANGE CAN CHANGE THE DIRECTIVE ENTIRELY. I MEAN, YOU CAN SEE THE CONTEXT OF IT-- "SOUR CREAM IN YOUR COFFEE"? I'M NOT SO INTO THAT, PERSONALLY. (clearing throat) SO, THAT FIRST THING WAS A SINGLE NUCLEOTIDE VARIATION. THIS NEXT ONE WE'RE LOOKING AT IS WHEN YOU TAKE ENTIRE CHUNKS AND CHANGE WHERE THEY'RE LOCATED INSIDE THE DIRECTIVE, OKAY? THIS IS A TRANS-LOCATION. SO, IN OTHER WORDS, "POUR COFFEE IN MY CREAM." WELL, OKAY, THAT MAY WORK. YOU MAY GET SOME OF WHAT YOU WERE AFTER THERE. IT'S NOT QUITE CORRECT. TRANS-LOCATIONS. AND THERE'S ALL KINDS OF TRANS-LOCATIONS. THIS, YOU WOULD NEED TO READ THIS IN A MIRROR, BUT IT'S INVERTED, OKAY? SO, THAT'S CALLED "INVERSION," ANOTHER KIND OF VARIATION. AND THEN, THERE'S SOMETHING LIKE THIS-- "POUR SUGAR MY COFFEE." WELL, THIS IS A SUBSTITUTION. IN THIS CASE, WE'VE SUBSTITUTED THE WORD "SUGAR" FOR "CREAM," AND YOU KNOW, THAT'S PROBABLY OKAY. MAYBE IT'S AN OKAY SUBSTITUTION. THE POINT HERE BEING THAT EVEN IF THERE ARE SUBSTITUTIONS IN THE GENOME, IT MADE MAY STILL RESULT IN FUNCTIONAL PROTEINS, FUNCTIONAL GENES, FUNCTIONAL ACTIVITIES FOR THE BODY, THAT NOT ALL SUBSTITUTIONS ARE BAD, OKAY? THIS IS HOW EVOLUTION KIND OF OCCURS BY THIS SORT OF MECHANISM. AND I JUST STUCK THIS ONE IN HERE TODAY-- ER, YESTERDAY, ACTUALLY-- FOR ALL OF YOU, BECAUSE THIS IS ONE THAT YOU'LL NEED TO KNOW ABOUT, SINCE THIS IS THE PSYCHOLOGY DEPARTMENT. THIS KIND OF CHANGE, "POUR CREAM CREAM CREAM CREAM CREAM CREAM," AND ONWARD, "IN MY COFFEE." THIS IS CALLED A "COPY NUMBER VARIATION." SO, IN OTHER WORDS, IT'S THE NUMBER OF COPIES OF THE GIVEN PART OF A DIRECTIVE OR DIRECTIVE INSIDE OF A CELL CHANGES HOW THAT CELL FUNCTIONS. SO, FOR INSTANCE, IF THAT DIRECTIVE IS TO MAKE A CERTAIN GLYCOPROTEIN, AND YOU HAVE A COPY NUMBER VARIATION LIKE THIS, WHICH IS AN AMPLIFICATION, YOU MAY HAVE WANTED TO HAVE ONE COPY OF THE GLYCOPROTEIN. YOU MAY HAVE ENDED UP WITH THOUSANDS OF COPIES OF THE GLYCOPROTEIN. THAT CHANGES THE CELL SURFACE STRUCTURE OF THE BRAIN OR ANY OTHER KIND OF CELL, WHATEVER IT MAY BE. I'M JUST THROWING THINGS OUT HERE. BUT THIS IS WELL KNOWN IN THE WORLD OF PSYCHOLOGY AND PSYCHIATRY-- THESE COPY NUMBER VARIATIONS-- TO CAUSE PROBLEMS. AND SCHIZOPHRENIA IS ONE OF THE BIG DISEASES OF STUDY, AS FAR AS COPY NUMBER VARIATION. AND SO, THIS IS-- THESE ARE VERY IMPORTANT FOR PSYCHOLOGY, PSYCHIATRY. UH, AUTISM, AS WELL-- COPY NUMBER VARIATION. AND THERE ARE HUNDREDS OF MILLIONS OF DOLLARS THAT ARE BEING INVESTED BY OUR COUNTRY AND OTHER COUNTRIES AROUND THE WORLD, DIFFERENT KINDS OF INSTITUTIONS, WHETHER IT'S THE MILITARY, WHETHER IT'S WHOLE COUNTRIES, NON-PROFITS LIKE "AUTISM SPEAKS"-- THEY'RE TRYING TO UNDERSTAND THIS QUESTION, "WHAT ARE THE COPY NUMBER DIFFERENCES THAT PRODUCE THIS DISEASE?" OKAY. WE'RE DOING GOOD ON TIME. SO, CLINICAL UTILITY. ACTIONABLE INFORMATION. SO, IN GENOMIC MEDICINE, REALLY THE IMPORTANT THING IS-- I DON'T CARE HOW MUCH VARIATION IS THERE IN THE GENOME, WHAT I CARE ABOUT IS HOW MUCH OF THIS VARIATION IN THE GENOME CAN I ACT UPON? IN OTHER WORDS, IF THERE IS A GENOMIC VARIANT, IS THERE SOMETHING I CAN DO ABOUT IT? OKAY. SO, TO THAT POINT, GENOMIC MEDICINE TRIES TO DO THINGS LIKE DIAGNOSE IDIOPATHIC DISEASE, PRESCRIBE APPROPRIATE MEDICATIONS-- THAT'S PHARMACOGENOMICS. THAT'S VERY, VERY IMPORTANT, PARTICULARLY FOR PSYCHOLOGY, PSYCHIATRY. UH, MAKE BETTER INFORMED TREATMENT DECISIONS FOR CANCER OR WHATEVER. IDENTIFY SPECIFIC PERSONAL HEALTH RISKS EARLY... AND THIS IS PERSONALIZED MEDICINE. EVERYBODY RESPONDS DIFFERENTLY TO DRUGS. YOU MAY HAVE HEARD OF PERSONALIZED MEDICINE-- THAT'S THE BIG WORDS THAT GET TOSSED AROUND IN PUBLIC THESE DAYS. AND WHAT THAT MEANS IS THE RIGHT DRUG FOR THE RIGHT PERSON AT THE RIGHT TIME. WE'RE GONNA TALK ABOUT THAT A LITTLE BIT. OKAY. THIS... REALLY BUMS ME OUT. THIS GUY IS... NICK VOLKER. NICK VOLKER LIVES ACROSS THE LAKE IN MILWAUKEE-- RIGHT OUTSIDE MILWAUKEE. AND NICK IS ABOUT SEVEN YEARS OLD RIGHT NOW. I'M GONNA TELL YOU NICK VOLKER'S STORY TO HELP ILLUSTRATE WHY GENOMIC MEDICINE IS SO IMPORTANT TO ALL OF US. SO, NICK-- BEAUTIFUL LITTLE BABY BOY, TO TWO LOVING PARENTS IN WISCONSIN. BY THE TIME HE WAS TWO YEARS OLD, HE HAD FAILED TO THRIVE. HE WASN'T GAINING WEIGHT, HE WASN'T GROWING, AND THERE WAS DEVELOPMENT OF FISTULA. SO, FISTULA ARE ESSENTIALLY LITTLE HOLES-- LITTLE FORAMEN-- THAT GO FROM THE COLON AND THE *** TO THE OUTSIDE OF THE BODY AND EXPEL FECES AND FECAL MATERIAL. THEY CAUSE SEPSIS-- INFECTION. THEY'RE VERY DAMAGING. SO, HIS PARENTS, COMPLETELY DISTRAUGHT ABOUT THIS THING, SET OFF ON WHAT IS COMMONLY CALLED "THE DIAGNOSTIC ODYSSEY," WHICH MEANS, "LET'S TRY THIS-- THAT DIDN'T WORK. "WELL, LET'S TRY THIS-- THAT DIDN'T WORK." AND SO ON AND SO FORTH. AND IT'S KIND OF LIKE THROWING A BUNCH OF SPAGHETTI AT THE WALL AND SEEING WHICH NOODLES STICK. "THE DIAGNOSTIC ODYSSEY." SO, NICK WENT THROUGH THE DIAGNOSTIC ODYSSEY, AS THEY TRIED TO FIND OUT WHAT WAS WRONG WITH HIM. AND IN THE PROCESS, BETWEEN THE AGE OF TWO AND FOUR, HE WENT THROUGH A HUNDRED-- A HUNDRED!-- SEPARATE GENERAL ANAESTHESIA OPERATIONS, TO REPAIR THE FISTULA THAT CONTINUED TO FORM BETWEEN HIS *** AND THE OUTSIDE OF HIS BODY. AND IT WAS TOTALLY UNSUCCESSFUL. AND BY THE TIME NICK WAS FOUR YEARS OLD-- FOUR YEAR OLD KID-- HE WEIGHED NINE KILOGRAMS. THAT'S 20 POUNDS! FOUR YEAR OLD WEIGHED 20 POUNDS, AND HE WAS FAILING. LITERALLY, FAILING. THE KID WAS JUST NOT GOING TO MAKE IT. AND THE SURGERIES GOT MORE AND MORE RADICAL. AT FIRST, THEY TRIED TO DO RE-SECTIONS ON HIS COLON. THAT DIDN'T WORK. MEANING, TAKE SECTIONS OUT OF HIS COLON. AND ULTIMATELY, WHAT THEY HAD TO DO, WAS COMPLETELY REMOVE HIS COLON FROM THE END OF THE SMALL INTESTINE, THROUGH THE ***. SO, HERE HE IS, FOUR YEARS OLD, STARTING OUT HIS LIFE LIKE THAT. AND ABOUT THE AGE OF FOUR, WHEN HE WAS RECOVERING FROM THIS SURGERY, HE BEGAN TO BE FED THROUGH A G-TUBE. AND ALL HIS BROTHERS AND SISTERS AND FRIENDS WERE OUT HAVING A GOOD TIME WITH HALLOWEEN AND EATING HALLOWEEN CANDY, AND POOR NICK VOLKER COULD NOT EAT, HE COULDN'T DRINK. HE WASN'T ALLOWED TO HAVE THESE THINGS. AND AWARE OF HOW MUCH SICKNESS HE WOULD GET EVERY TIME HE WOULD EAT AND DRINK, HE WOULD CONTINUALLY BEG HIS MOTHER FOR FOOD AND WATER. HE DIDN'T CARE IF HE GOT SICK. HE JUST WANTED TO EAT. I MEAN, THIS BREAKS MY HEART. SO, FINALLY, THEY GOT WISE, AND THEY SAID, "WE TRIED EVERYTHING ELSE." SO, AT 100 SURGERIES, HE HAD CAPPED-OUT HIS MEDICAL EXPENSE. MORE THAN $2 MILLION HAD GONE INTO DIAGNOSIS AT THIS POINT. STILL DIDN'T HAVE ANY IDEA WHAT IT WAS. THEY SAID, "FINE, LET'S TRY THIS ONE LAST THING. "LET'S SEQUENCE HIS GENOME." SO, THEY DID. THEY DID THIS AT THE MEDICAL COLLEGE OF WISCONSIN. THIS IS A VERY FAMOUS CASE-- YOU GUYS CAN LOOK THIS UP. IT'S ALL OVER THE PLACE. AND WHAT THEY FOUND WHEN THEY SEQUENCED HIS GENOME WAS THAT THERE WAS A VARIATION IN A PRO-INFLAMMATORY PROTEIN CALLED X.I.A.P. AND THAT ONE VARIATION, BASICALLY, EXPLAINED AWAY THE DISEASE THAT HE HAD. AND SO, WHAT THEY DID IS THEY GAVE HIM A BONE MARROW TRANSPLANT. SO, TO GIVE SOMEBODY A BONE MARROW TRANSPLANT FOR SOME SORT OF DIGESTIVE DISORDER, THAT DIDN'T QUITE JIVE. THEY WOULD NEVER REALLY HAVE KNOWN TO DO THAT, HAD THEY NOT SEQUENCED HIS GENOME. AND IT'S A RISKY THING IN A LITTLE KID, PARTICULARLY, SICK-- SOMEONE WHO IS AS SICK AS NICK WAS. SO, THEY GAVE HIM THE BONE MARROW TRANSPLANT. FORTY-TWO DAYS LATER, HE WAS OUT OF THE HOSPITAL, GAINING WEIGHT, EATING AND DRINKING. AND SINCE THAT TIME, HE HAS GROWN NORMALLY. I FIND THIS TO BE COMPLETELY UNACCEPTABLE, AS A SOCIETY. WE ARE BETTER THAN THIS. WE KNEW THE RIGHT THING TO DO AHEAD OF TIME-- THE SMART THING TO DO. WE SPENT $2 MILLION AND PUT THIS KID AND HIS FAMILY ON A DIAGNOSTIC MEDICAL ODYSSEY THAT WAS PAINFUL AND EXPENSIVE. WE COULD SPENT $30,000 WHEN WE FIRST SAW THE PROBLEM, SEQUENCED HIS GENOME, SAVED HIS COLON, AND RECTIFIED HIS ENTIRE LIFE. THIS IS WHY GENOMIC MEDICINE IS IMPORTANT. THIS IS WHY YOU WILL SEE IT IN YOUR LIVES. IT'S SO POWERFUL, THAT IT'S GONNA HELP A LOT OF PEOPLE AND A LOT OF DIFFERENT DISEASES. AND BY THE WAY, THAT DISEASE IS IDIOPATHIC AND CRYPTOGENIC, MEANING THAT THE ANSWER IS HIDDEN INSIDE THE GENOME. OKAY... PHARMACOGENOMICS. (clearing throat) SO, PHARMACOGENOMICS IS THE RELATIONSHIP BETWEEN YOUR GENOME-- AND THE VARIATIONS IN YOUR GENOME-- AND YOUR ABILITY TO METABOLIZE DIFFERENT DRUGS. SO, LOTS OF PEOPLE ARE ON PRESCRIPTION DRUGS, MANY PEOPLE IN THIS AUDIENCE ARE ON PRESCRIPTION DRUGS. HAVE YOU EVER ASKED YOURSELF WHETHER OR NOT THAT DRUG WAS WORKING? HAVE YOU EVER KNOWN SOMEBODY WHO WAS SICK AND PRESCRIBED DRUGS, AND THE DRUGS DIDN'T SEEM TO WORK? TURNS OUT THAT THIS HAPPENS ALL THE TIME... AND IT'S BECAUSE EVERYBODY METABOLIZES THINGS SLIGHTLY DIFFERENT. SO, RIGHT NOW, THERE IS ABOUT 125 DRUGS THAT ARE COMMERCIALLY MANUFACTURED, FOR WHICH THERE ARE GENETIC VARIANTS KNOWN THAT AFFECT THE METABOLISM AND ACTIVITY OF THOSE DRUGS. SO, THIS IS A SMALL LIST, AND THERE'S THE REFERENCE AT THE BOTTOM, IF YOU WANT TO CHECK THIS. AND I'D LIKE TO FOCUS ON ONE OF THESE. OKAY, SO THESE ARE REALLY THE TOP TWO PRESCRIBED DRUGS IN OUR COUNTRY-- THIS IS STATINS. PEOPLE WHO HAVE HIGH CHOLESTEROL, TRIGLYCERIDES, THAT KIND OF THING. AND THIS IS PLAVIX CLOPIDOGREL. OKAY, SO IN THIS CASE, WHAT WE KNOW FOR CLOPIDOGREL-- THAT THERE IS A VARIANT IN A GENE CALLED CYP2C19, AND THAT PARTICULAR VARIATION MAKES THE DIFFERENCE BETWEEN BEING ABLE TO METABOLIZE THE PRO-DRUG INTO ITS ACTIVE FORM OR NOT. IF YOU HAVE ONE VARIATION, YOU SIMPLY CAN NEVER METABOLIZE THE DRUG, YOU WILL DERIVE NO BENEFIT FROM THE DRUG. SO... THIS IS THE DRUG, CLOPIDOGREL-- PLAVIX. NOW, FIRST OF ALL, I HAVE TO SAY THAT MANY, MANY PEOPLE ARE HELPED BY THIS DRUG. THIS DRUG IS AN ANTI-PLATELET. SO, FOR PEOPLE WHO HAVE CARDIAC DISEASE OR ANCILLARY-RELATED DISEASES LIKE STROKE, THIS IS A VERY EFFECTIVE DRUG AND IT HELPS MILLIONS AND MILLIONS OF PEOPLE, ALL AROUND THE WORLD. I DON'T WANNA BASH THIS DRUG-- IT'S A GOOD DRUG. BUT THE DRUG JUST ACTUALLY DOESN'T WORK ON EVERYBODY. OKAY, SO... WHEN I SAY APPROXIMATELY 30 PERCENT OF PEOPLE-- THIS IS GONNA-- REMEMBER THIS PART, FOR THE NEXT SECTION, WHEN I TALK ABOUT EVOLUTION AND GLOBAL GENOGRAPHY. HOW WELL THIS DRUG WORKS HAS SOMETHING TO DO, IN MANY CASES, WITH WHAT YOUR ETHNICITY IS... BECAUSE EVERYBODY'S ETHNICITY BRINGS WITH IT A DIFFERENT SET OF GENOMIC INFORMATION, AND SMALL LITTLE VARIATIONS CAN CHANGE HOW WELL YOU METABOLIZE DRUGS. SO, 30 PERCENT OF THE PEOPLE, ON AVERAGE, WHO ARE PRESCRIBED THIS DRUG, CANNOT USE IT-- CAN'T METABOLIZE IT. OKAY. THAT WE TALKED ABOUT. SO, LET'S JUST TALK ABOUT THE BUSINESS OF THIS DRUG FOR A SECOND. UH, PLAVIX IS MANUFACTURED GLOBALLY. IT IS DISTRIBUTED GLOBALLY TO 125 COUNTRIES AROUND THE WORLD. HUNDREDS OF MILLIONS OF PEOPLE TAKE THIS DRUG. IN THE UNITED STATES, THE ANNUAL REVENUES-- AT LEAST IN 2009-- FOR PLAVIX WERE $6.6 BILLION. OKAY, THAT'S A LOT OF MONEY. NOW, ANY OF YOU, UNLESS YOU'VE BEEN LIVING UNDER A ROCK, KNOW THAT OUR HEALTHCARE SYSTEM HAS GOT SOME FINANCIAL PROBLEMS, RIGHT? OKAY, SO CHECK IT OUT. YOU DO THE MATH ON THIS-- AND IT'S PRETTY SIMPLE MATH-- 6.6 BILLION TIMES 30 PERCENT OF THE PEOPLE THAT CAN'T ACTUALLY USE IT, THAT'S $2 BILLION WASTED, EVERY SINGLE YEAR. THAT'S ONE DRUG, ONE COUNTRY, ONE YEAR. IF YOU BEGIN TO EXTRAPOLATE THIS KIND OF THING OUT TO LOTS OF DRUGS AND ALL COUNTRIES THAT COULD USE THIS SORT OF TECHNOLOGY, YOU BEGIN TO SEE, THAT BY TARGETING PEOPLE WITH THEIR DRUG BETTER, WE SAVE A LOT OF MONEY, NOT TO MENTION THAT THERE ARE 30 PERCENT OF THE PEOPLE OUT THERE THAT DERIVE NO BENEFIT FROM THIS DRUG! IT'S NOT HELPING THEM! AND SO, WHAT HAPPENS? THEY GET SICK. WHEN THEY GET SICK, WHAT DO THEY DO? THEY GO TO THE HOSPITAL. AND HOSPITALS ARE EXPENSIVE. YOUR GOAL IS TO STAY OUT OF THE HOSPITAL. OKAY, THIS IS JUST ONE EXAMPLE. THERE'S, YOU KNOW, 125 THAT WE KNOW OF LIKE THIS. NOW, THIS-- (chuckling) THIS DRIVES ME CRAZY, AND FORGIVE ME FOR BEING PASSIONATE, BUT... PLAVIX HAS ACTUALLY A WARNING ON THE BOX... THAT THE F.D.A. MANDATES HAS TO BE ON THE BOX-- A BLACK BOX WARNING. WHEN YOU LIKE-- IF YOU EVER BUY A PACK OF CIGARETTES, THE BLACK BOX WARNING THAT SAYS, "WARNING-- IF YOU SMOKE THIS, "YOU WILL GET CANCER AND DIE. "IT WILL BE AWFUL." (audience laughing) WELL-- RIGHT? SO, PLAVIX HAS A BLACK BOX WARNING RIGHT ON THAT BOX THAT I SHOWED YOU THAT SAYS, "TO TAKE THIS DRUG, "YOU NEED TO TEST WHICH VARIANT OF CYP2C19 YOU ACTUALLY HAVE." AND NOBODY DOES THE TESTING. CRAZY. OKAY. PRENATAL GENETIC DIAGNOSTICS. SO, IF YOU CAN SEQUENCE AN ADULT HUMAN AND DETERMINE ALL THESE THINGS FOR AN ADULT HUMAN, YOU OUGHT TO BE ABLE TO DO IT FOR SOMEBODY THAT'S DEVELOPING TO BE AN ADULT, ALL THE WAY IN THE EMBRYO. SO, WE DO SOME OF THIS KIND OF STUFF RIGHT NOW ON A LIMITED BASIS FOR DOWN SYNDROME OR CYSTIC FIBROSIS OR VARIOUS OTHER THINGS. UM... USUALLY, WHEN I SHOW THIS SLIDE, PEOPLE'S FIRST REACTION IS, "THE REASON WE'RE DOING PRENATAL DIAGNOSTICS "IS TO DETERMINE WHETHER OR NOT THIS PARTICULAR INFANT "HAS SOME SORT OF MAJOR MEDICAL PROBLEM "AND DO WE WANT TO CONTINUE THIS PREGNANCY?" I WOULD SUBMIT TO YOU THAT THERE ARE FAR LESS DARKER THINGS THAT WE COULD BE GAINING FROM PRENATAL DIAGNOSTIC SCREENING. FOR INSTANCE, JUST LIKE SOME ADULTS CANNOT METABOLIZE CERTAIN DRUGS, YOU PROBABLY HAVE MET PEOPLE WITH FOOD ALLERGIES OR HAVE PROBLEMS WITH CHOLESTEROL-- HYPERCHOLESTEROLEMIA. MIGHT BE NICE TO KNOW, BEFORE THE BABY ACTUALLY COMES OUT OF THE MOM, WHETHER OR NOT THEY HAVE, LIKE, A PROBLEM METABOLIZING CHOLESTEROL, AND IF SO, WE MAYBE DON'T WANT TO BREASTFEED THE BABY, OR MAYBE WE WANT TO MONITOR THE CHOLESTEROL LEVEL IN MOM, WHILE SHE'S BREASTFEEDING, OR PUT HER ON STATINS. THESE KINDS OF THINGS THAT WILL LEAD TO HEALTHCARE, YOU KNOW, RIGHT FROM THE START, FROM THE FIRST BREATH. AND SO, THIS INFORMATION, YOU KNOW, WHEN IT'S COLLECTED IN UTERO CAN FOLLOW YOU FOR THE REST OF YOUR LIFE, BECAUSE YOUR D.N.A. IS INVARIANT. IT DOESN'T REALLY CHANGE. THEY ONLY TIME IT REALLY CHANGES IS WHEN YOU GET CANCER, ALL RIGHT? SO, ONE OF THE OTHER GREAT USES OF IN-- YOU KNOW, IN UTERO DIAGNOSTICS, IS THAT YOU HAVE A BASELINE FOR THE REST OF YOUR LIFE. YOU KNOW, BEFORE YOU HAVE BEEN EXPOSED TO ANY KIND OF ENVIRONMENTAL HAZARD, YOU KNOW WHAT YOUR NASCENT GENOME SHOULD LOOK LIKE. SO, EVERYBODY KNOWS THAT THERE'S THIS RELATIONSHIP BETWEEN THE ENVIRONMENT AND THE GENOME, ALL RIGHT? SO, SOME OF THE ST-- THIS IS JUST AN EXAMPLE RIGHT HERE-- IT TURNS OUT THAT FOR EVERY THREE CIGARETTES YOU SMOKE-- THE QUANTITATIVE ANALYSIS HAS BEEN DONE ON THIS-- AGAIN, FALLING IN THE CATEGORY OF FACT. FOR EVERY THREE CIGARETTES YOU SMOKE, YOU ACCUMULATE ONE SINGLE NUCLEOTIDE POLYMORPHISM MUTATION. IN OTHER WORDS, YOU CHANGE ONE BASE IN YOUR GENOME. WELL, SO THE PROBABILITY IS THAT EVERY TIME-- YOU GOT 6 BILLION BASES TO CHANGE. YOU CHANGE ONE OF 'EM, PROBABLY THAT BASE CHANGE IS NOT GONNA HAPPEN IN ANYTHING IMPORTANT, BUT THERE'S NO GUARANTEE. AND SO, THIS IS THE KIND OF THING THAT LEADS TO CANCER PROGRESSION, RIGHT? IT'S WHEN YOU GET THESE ACCUMULATED BASE CHANGES AND MODIFICATIONS THROUGH TOXICOLOGY OF YOUR GENOME. THAT'S ONE PART OF THE DISEASE. RIGHT, SO I SAID I WAS GONNA MAKE HIS PERSONAL... AND GIVE YOU ALL REAL EXAMPLES OF WHAT I'M TALKING ABOUT WITH REAL PEOPLE. AND RIGHT NOW, I'M GOING TO GIVE YOU AN EXAMPLE FROM ME. SO, I'VE HAD MY GENOME ANALYZED, AND I'M GONNA SHARE WITH YOU THE ACTUAL RESULTS FROM MY GENOME ANALYSIS-- AT LEAST PARTS OF THEM-- I'M NOT HIDING ANYTHING. I'M NOT AFRAID OF DISCRIMINATION BASED ON MY GENETIC MATERIAL. MANY ARE. (clearing throat) SO, MY GENOME WAS ANALYZED. ABOUT 1.2 MILLION DATA POINTS WERE COLLECTED FROM ALL THROUGHOUT MY GENOME, AND THOSE WERE USED TO PROVIDE RISK ASSESSMENTS FOR VARIOUS COMMON DISEASE, FOR WHICH GENETIC INFORMATION IS CURRENT KNOWN. IN OTHER WORDS, THESE ARE PROBABILITIES. IN THIS PARTICULAR SLIDE, WHAT YOU'RE LOOKING AT IS THE GENETIC RISK OR THE GENETIC PROBABILITY THAT I WILL GET A CERTAIN KIND OF DISEASE. AND THESE ARE ACTUALLY, UM... RANKED. AT LEAST THEY SHOULD BE RANKED IN TERMS OF GENETIC RISK, FROM HIGHEST TO LOWEST. SO, RIGHT AT THE TOP-- CROHN'S DISEASE. THAT'S A GASTROINTESTINAL DISORDER. RIGHT BELOW IT, ULCERATIVE COLITIS-- ALSO GASTROINTESTINAL DISORDER. NOW, I'VE NEVER BEEN DIAGNOSED WITH CROHN'S DISEASE, BUT THAT'S PROBABLY BECAUSE I ABSOLUTELY HATE GOING TO THE DOCTOR AND I NEVER GO, BUT I CAN TELL YOU THAT SOMETHING'S NOT RIGHT AND I PROBABLY SHOULD GO TO THE DOCTOR. AND SO, FOR ALL OF YOU WHO ARE DOING SOCIOLOGY AND PSYCHOLOGY, THIS IS A BIG AREA OF RESEARCH IN THE FUTURE, STARTING RIGHT NOW, AND THAT IS "WHAT DO PEOPLE DO WITH THE GENETIC INFORMATION, "ONCE THEY HAVE IT? "WHAT'S THEIR BEHAVIOR?" IF I TOLD YOU THAT YOU HAD A PRETTY CHANCE GETTING DIABETES, WOULD YOU PUT DOWN THE CHEESEBURGER? WELL, THEY'RE TELLING ME THAT I HAVE A PRETTY GOOD, YOU KNOW, CHANCE OF GETTING CROHN'S DISEASE. DID I GO TO THE DOCTOR? I DID NOT! AND OSTENSIBLY, I AM SUPPOSED TO BE A SMART PERSON-- BRINGS THAT INTO QUESTION, I WOULD THINK. SO, THAT'S THE GENETIC RISK. THIS IS THE LIFETIME RISK. AND SO, THE LIFETIME RISK IS A CALCULATION THAT GETS MODIFIED, BASED ON MY ETHNICITY. ALL RIGHT, SO I BROUGHT THIS THING UP ABOUT ETHNICITY A COUPLE TIMES FOR DRUG METABOLISM, AND ALSO FOR DISEASES. CERTAIN POPULATIONS AROUND THE WORLD HAVE MORE OR LESS PROBABILITY OF GETTING A GIVEN KIND OF DISEASE. YOU SEE DISEASES RISING WITH GREATER FREQUENCY. FOR INSTANCE, I WAS JUST IN SAUDI ARABIA NOT LONG AGO, AND IN SAUDI ARABIA, THEY HAVE A HORRIBLE, HORRIBLE PROBLEM WITH METABOLIC DISEASE. AND MORE THAN 40 PERCENT OF THE PEOPLE IN SAUDI ARABIA ARE BECOMING DIABETIC. FORTY PERCENT IN THAT POPULATION! IT'S INCREDIBLE. IT'S NOTHING LIKE THAT HERE. EVEN THOUGH OUR PERCENTAGE IS QUITE HIGH. SO, THIS LOOKS AT MY LIFETIME RISK OF DISEASE, AND YOU CAN SEE THAT CROHN'S DISEASE IS NOT IN THERE, BUT HYPERTENSION IS AT THE TOP OF THE LIST, HEART ATTACK, OBESITY-- AND I WOULD SAY THAT THOSE ARE ALL PRETTY WELL LIKELY FOR ME, AS WELL. SO, THAT'S ME. OTHER FUN STUFF, UM... IT'S NOT JUST ABOUT DISEASE. YOU CAN ACTUALLY USE THE GENETICS TO DETERMINE A LOT OF OTHER INTERESTING THINGS. UM, IN THIS CASE, YOU KNOW, BITTER TASTE PERCEPTION. CAN I TASTE BITTER THINGS? YES. EYE COLOR-- OKAY, SO IF YOU LOOK AT THAT, WHERE IT SAYS "EYE COLOR," IT SAYS I'M MOST LIKELY TO HAVE BROWN EYES-- 60 PERCENT CHANCE OF BROWN EYES. I DO HAVE BROWN EYES. PATTERN BALDNESS DOWN THERE-- 20 PERCENT CHANCE OF DEVELOPING MALE PATTERN BALDNESS BY AGE 40. WELL, THAT HAPPENED. (audience laughing) IT'S NOT FUNNY. (audience laughing) OKAY, JUST A FEW OTHER THINGS OFF THIS LIST THAT I HAVE BEEN TESTED FOR. UM, IRRITABLE BOWEL SYNDROME, DIABETES, RESTLESS LEG, DEMENTIAS, ALZHEIMER'S, TYPE TWO DIABETES-- WOMEN, BREAST CANCER-- PROSTATE CANCER, HEIGHT, A-FIB, YOUR BODY MASS INDEX-- ALL THE STUFF. STROKE... AND PERSONAL ANCESTRY. SO, I KNOW ALL THE WAY BACK TO AFRICA, HOW MY ANCESTORS MIGRATED ACROSS THE GLOBE. ALL RIGHT, SO HOPEFULLY, I'VE SHARED WITH YOU SOME OF THE IMPORTANT THINGS ABOUT GENOMIC MEDICINE, AND YOU CAN UNDERSTAND THAT THIS IS SOMETHING THAT WILL HELP A LOT OF PEOPLE. THERE'S 7 BILLION PEOPLE ON THE PLANET RIGHT NOW. WE JUST PASSED THAT MARK. NOW, HOW THEY FIGURE THIS OUT, I DON'T KNOW. BUT I'M JUST GONNA TAKE IT AS A TACIT ASSUMPTION AND PUT THIS IN THE "FACT" CATEGORY, THAT THERE'S 7 BILLION PEOPLE. HOW IN THE WORLD ARE WE GONNA SEQUENCE 7 BILLION PEOPLE? OR EVEN SOME FRACTION OF 7 BILLION PEOPLE, SO THAT THEY CAN DERIVE THE BENEFITS OF GENOMIC MEDICINE AND GENETIC MEDICINE? THIS IS A MAJOR BUSINESS PROBLEM, AS WELL AS SCIENTIFIC PROBLEM. SO, THERE IS SO MANY OPPORTUNITIES FOR PEOPLE OF YOUR GENERATION TO MOVE INTO THIS, AND SO MANY AREAS THAT ARE NOT EVEN NECESSARILY DIRECTLY WITH THE GENETICS. THEY MAY BE THE BUSINESS PEOPLE BEHIND THIS, BUT THIS IS A PROBLEM THAT NEEDS TO GET SOLVED. SO, ONE OF THE WAYS THAT IT'S GETTING SOLVED IS TO MAKE BIO-BANKS. IN OTHER WORDS, THEY ARE COLLECTING SAMPLES ALL AROUND THE WORLD FROM INDIVIDUALS, AND THEY'RE PUTTING THEM IN A BANK, AND THEY'RE SEQUENCING THEM, AS THEY CAN. NOW, THIS PHOTOGRAPH THAT YOU'RE LOOKING AT-- THIS IS A BIO-BANK THAT IS IN THE BASEMENT OF deCODE GENETICS IN REYKJAVIK, ICELAND. SO, I WANNA DESCRIBE WHAT IT IS THAT YOU'RE SEEING HERE. THESE-- THIS ARMATURE THAT YOU SEE HAS A TRAY IN IT. THIS TRAY IS ACTUALLY ABOUT A METER AND A HALF LONG BY ABOUT 70 CENTIMETERS WIDE. IT'S A PRETTY BIG TRAY, AND IT'S GOT 800 BLOOD TUBES IN IT. THESE ARE TEN MILLILITER BLOOD TUBES, OKAY? SO... WHAT YOU'RE SEEING IS ACTUALLY AT ABOUT MINUS 40 DEGREES CENTIGRADE. AND THIS ENTIRE ROOM IS MINUS 40, AND THESE ROBOTS-- THAT ROBOT ARM THING YOU SEE-- IS AT MINUS 40. AND ON THE WALLS BEHIND IT, WHAT YOU'RE SEEING ARE RACKS AND RACKS AND RACKS OF THESE BLOOD TUBES. THAT, THAT YOU'RE LOOKING AT-- WHICH AMAZES ME-- IS THE BIOLOGICAL SAMPLES FROM THE ENTIRE ADULT POPULATION OF ICELAND. THAT'S AN ENTIRE NATION! YOU'RE LOOKING AT BLOOD FROM A NATION RIGHT HERE. THAT'S COMING TO A COUNTRY NEAR YOU, LIKE THIS ONE. IN FACT, I WOULD BE WILLING TO BET ANY AMOUNT OF MONEY THAT THE VAN ANDEL INSTITUTE HAS EITHER BUILT OR IS BUILDING A BIO-BANK. AND THE VAN ANDEL INSTITUTE IS DIRECTLY CONNECTED TO SPECTRUM HEALTH. THIS WILL BE IMPORTANT FOR ALL OF US. SO, ONCE YOU COLLECT ALL THE BIOLOGICAL SAMPLES AND STORE THEM, WHAT'S THE NEXT STEP? WE HAVE TO SEQUENCE THEM, SO YOU GO INTO SOME SORT OF, LIKE, FACTORY-SCALE SEQUENCING. SO, AMERICA'S BEEN GREAT AT MANUFACTURING. MAYBE THIS IS OUR NEW KIND OF MANUFACTURING. WE'RE GONNA MANUFACTURE GENOME SEQUENCES. THAT'S WHAT MY COMPANY DOES. YOU'RE LOOKING, ACTUALLY, AT THE WORLD'S LARGEST GENOME SEQUENCING FACTORY-- PART OF THE FACTORY. OH, AND YEAH-- I LOVE THIS. (laughing) SO, YOU SAW ALL THE VARIATION IN MY GENOME. YOU SAW ALL THE FACT THAT I HAD DIFFERENT KINDS OF RISK FOR DIFFERENT DISEASES... BEGS THE QUESTION, "WHAT'S THE NORMAL GENOME? "WHAT IS NORMAL?" WELL, THIS IS AN INTERESTING QUESTION THAT WE'RE TRYING TO ANSWER RIGHT NOW. ONE GROUP, IN PARTICULAR, THE SCRIPPS INSTITUTE, OUT IN LA JOLLA, CALIFORNIA... THEY ARE TRYING TO ANSWER THIS, AND THEY'RE DOING IT THROUGH WHAT'S CALLED "THE WELLDERLY STUDY," IN OTHER WORDS, "THE WELL ELDERLY." AND THE THINKING BEHIND THIS IS THAT IF YOU'VE GOTTEN TO BE AN OLD PERSON AND YOU HAVEN'T HAD ANY MAJOR DISEASES YET, THAT PROBABLY, YOUR GENOME, YOUR COPY OF ALL THE GENES, IS, YOU KNOW, CORRECT. THERE AREN'T ANY ERRORS IN THERE. AND SO, THEY'RE TRYING TO FIGURE OUT, "HOW IS THAT DIFFERENT FROM EVERYBODY ELSE?" SO, THEY'VE COLLECTED A COHORT AND THEY'RE NOW UP TO-- CLOSE TO 2,000 SAMPLES OF PEOPLE WHO ARE AT LEAST 84 YEARS OLD AND HAVE NEVER BEEN ON A PRESCRIPTION MEDICATION, HAVEN'T HAD ANY MAJOR HEALTH EPISODES LIKE HEART ATTACK, STROKE, WHATEVER, AND THEY HAVE A WHOLE SET OF PEOPLE IN THIS COHORT THAT ARE SUPER CENTENARIANS, WHO ARE OLDER THAN 110 YEARS OLD, AND THEY'RE STUDYING THESE GENOMES TO FIGURE OUT, "WHY DO THESE GUYS GET TO LIVE SO LONG?" RIGHT? EVERYBODY WANTS TO LIVE A LONG TIME. "THE WELLDERLY STUDY." NOW, THIS BLOWS MY MIND. THIS IS THE OTHER SIDE OF THE SPECTRUM. I CAN STOP LOOKING AT THIS PICTURE. I FOUND THIS PICTURE A COUPLE MONTHS AGO. IT JUST-- IT ABSOLUTELY ASTOUNDS ME. THIS IS-- YOU'RE LOOKING, RIGHT NOW, AT BROOKE GREENBERG. SO, RATHER THAN AGING... BROOKE DOES NOT AGE. BROOKE CAME OUT OF HER MOTHER A NORMAL BABY, AND ABOUT THE AGE OF TWO-ISH-- MAYBE A LITTLE LESS-- SHE STOPPED. SHE DIDN'T GROW. SHE DIDN'T DEVELOP. HER BRAIN DIDN'T DEVELOP, HER BODY DIDN'T DEVELOP, AND WHAT YOU'RE LOOKING AT RIGHT NOW IS BROOKE GREENBERG AT AGE OF 19 YEARS OLD, BEING HELD IN THE ARMS OF HER 17 YEAR OLD YOUNGER SISTER. I THINK THAT'S AMAZING! HOW COME SHE'S NOT AGING? AND IF THERE IS SOME SORT OF TRIGGER THAT PREVENTS PEOPLE FROM AGING, HOW CAN WE HARNESS THAT, SO WE CAN ALL GET LONGER, BETTER LIVES? IT'S JUST INCREDIBLE TO ME. SHE'S JUST AN INFANT-- JUST THIS PERFECT, LITTLE INFANT. SHE'S 19 YEARS OLD! SO... HERE-- THE QUESTION IS, "ARE AGING AND DEVELOPMENT COUPLED? "CAN THEY BE DECOUPLED?" THIS GUY, NICKY FREEMAN... HE POSES ANOTHER QUESTION. SO... NICKY AGES AT 25 PERCENT THE PACE THAT EVERYBODY ELSE DOES. YOU'RE SEEING THIS PHOTOGRAPH OF HIM FROM 2011. NICKY, IN THIS PHOTOGRAPH IS 40-- FOUR, ZERO-- YEARS OLD. THAT IS THE SAME AGE AS ME, ESSENTIALLY. I'M A LITTLE OLDER. FORTY YEARS OLD! BUT HE HAS THE BODY, AND APPARENTLY, THE INTELLECT AND THE TEMPERAMENT OF A TEN YEAR OLD. SO, WHAT PEOPLE ARE ASKING IS IF WE CAN SLOW THIS AGING PROCESS DOWN-- I MEAN, YOU DO THE MATH ON THIS, WHICH I'M SURE IS TOTALLY INCORRECT AND THIS IS OPINION, AND I DON'T THINK IT'S CORRECT-- BUT IF HE LIVED IN NORMAL 70 YEAR LIFE-- YOU KNOW, WE ALL LIVE 70 YEARS-- I MEAN, COULD HE REALLY EXPECT TO LIVE 280 YEARS, IF HE'S AGING AT 25 PERCENT THE RATE THAT WE ARE? AT 280, WOULD HE BE THE SAME PHYSICAL AGE THAT WE ARE AT 70? I MEAN, YOU CAN'T MAKE THIS STUFF UP. IT'S INCREDIBLE! OKAY, SO GONNA SPEED UP A LITTLE BIT THROUGH THIS NEXT SECTION, BECAUSE I'VE BEEN TALKING TOO LONG, I SEE. BUT, UH, EVOLUTION IN GLOBAL GENOGRAPHIC STRUCTURE-- MOVING AWAY FROM GENETIC MEDICINE. OKAY, SO I REALLY LIKE THIS PICTURE HERE, BECAUSE OVER ON THE LEFT SIDE THERE, YOU SEE THAT'S A PICTURE OF CHARLES DARWIN, THE FATHER OF EVOLUTION, AND OVER HERE ON THE RIGHT, AS THE STORY GOES, HE WAS IN THE BAR SOME PLACE IN LONDON WITH ONE OF HIS BUDDIES, AND HE WROTE DOWN HIS THEORY OF EVOLUTION, THROUGH THIS GRAPHIC, IN THE BAR, ON THE BAR NAPKIN. THAT'S HOW I GET MY BEST THINKING DONE. SO WHAT HIS THEORY IS, THOUGH, IS THAT, YOU KNOW, AT SOME POINT, YOU SEE THESE BRANCHINGS, THESE BIFURCATIONS-- AT SOME POINT, ONE THING BECOMES TWO-- AND SO, YOU KINDA HAVE TO ASK THIS ABOUT HUMANS. SO, THERE'S GREAT VARIATION, EVEN IF YOU LOOK AMONG THIS AUDIENCE. THERE'S GREAT VARIATION IN THE HUMAN BEING, BUT OSTENSIBLY, WE ARE ALL STILL THE SAME SPECIES. NOW, BETWEEN THE TWO MOST DISTANTLY RELATED HUMAN BEINGS ALIVE TODAY, THERE'S STILL ABOUT 99.7 PERCENT SEQUENCE HOMOLOGY-- SEQUENCE IDENTITY, MEANING THERE'S ONLY-- AND THAT'S BETWEEN THE TWO MOST DISTANT. I MEAN, BETWEEN THE PEOPLE IN THIS ROOM HERE, THERE MAY BE 99.9 PERCENT SEQUENCE IDENTITY. WE'RE SO CLOSELY RELATED TO EACH OTHER, IN TERMS OF OUR GENETIC, IT'S INCREDIBLE. AND YET, IF YOU LOOK AROUND, THERE ARE TALL PEOPLE AND BLOND PEOPLE, AND PEOPLE WITH DARK HAIR, AND MALES AND FEMALES, AND THAT TAKES ALL THAT INTO ACCOUNT. IT'S JUST THESE TINY LITTLE CHANGES THAT PRODUCE THE GREAT VARIATION THAT SPAN THE HUMAN EXPERIENCE. AND SO, I'D LIKE TO THINK OF IT IN TERMS OF ROCK STRATIFICATION. SO, WHAT YOU'RE LOOKING AT RIGHT HERE IS A PICTURE OF SEDIMENTARY ROCK THAT IS LAID DOWN IN LAYERS. IN OTHER WORDS, ONE LAYER IS LAID DOWN-- OF SEDIMENTARY ROCK-- AND MORE DEBRIS IS LAID ON TOP OF THAT, AND MORE DEBRIS IS LAID ON TOP OF THAT... SO THAT THE STRATIFICATION OF THE HUMAN POPULATION WORKS MUCH THE SAME WAY, WHICH, HOPEFULLY, I CAN-- THERE'S GENETIC STRATIFICATION-- MEDICAL STRATIFICATION. HOPEFULLY, I'LL BE ABLE TO RAPIDLY DISCUSS THIS. SO, THIS IS THE MAP OF THE HUMAN GENOGRAPHY. IN OTHER WORDS, IT'S THE GEOGRAPHY OF THE GENOME. AND THIS PARTICULAR STUDY WAS COMMISSIONED BY THE NATIONAL GEOGRAPHIC SOCIETY, AND MANY OF YOU MAY HAVE HEARD ABOUT THE STUDY. BUT WHAT IT SEEKS TO DO IS TO TAKE SAMPLES OF D.N.A. FROM PEOPLE ALL AROUND THE WORLD AND ANALYZE THEM FOR SPECIFIC MARKERS IN THE D.N.A., AND KINDA LIKE TRACE THEM BACK THROUGH THEIR EVOLUTIONARY ROUTES. AND, UM, WHAT I FIND INTERESTING ABOUT THIS IS THAT EVERYBODY, ESSENTIALLY-- IF YOU-- AND I WOULD CONSIDER THIS TO BE FACT-- STARTED OFF IN THE RIFT VALLEY OF AFRICA, RIGHT THERE, THE FIRST ADAM AND EVE. I DON'T KNOW WHY THEY CALL THEM THAT, BUT FIRST HUMANS-- PROTO-HUMANS-- IN THE RIFT VALLEY. AND AFRICA REMAINS THE PART OF THE WORLD THAT HAS THE MOST GENETIC VARIATION IN DIVERSITY... BY FAR. BY FAR. SO, IF WE FIGURE THAT A HUMAN IS ROUGHLY 200,000 YEARS OLD-- THAT'S HOW OLD OUR SPECIES IS. UM, YOU CAN SEE THAT THERE ARE TWO ROUTES, ESSENTIALLY, WHEREBY HUMANS MIGRATED OUT OF AFRICA INTO WHAT IS NOW-- YOU KNOW, THROUGH EGYPT AND SAUDI ARABIA, THAT KIND OF AREA, RIGHT UP THERE. SO, THOSE TWO ROUTES-- THOSE TWO LAND-BRIDGES OUT OF AFRICA-- THE STUDIES HAVE BEEN DONE TO SHOW THAT IN EACH ONE OF THOSE TWO BRIDGES, ONLY 1,000 PEOPLE FROM EACH OF THOSE POINTS EXITED OUT OF AFRICA. AND IT IS THOSE TWO SETS OF 1,000 PEOPLE-- IT IS THAT GENETIC SET-- THAT LIMITED GENETIC SET-- THAT HAS GONE ON TO POPULATE THE REST OF THE PLANET, AND GIVE RISE TO MOST OF US IN THIS ROOM. I FIND THAT TO BE AMAZING. OKAY, SO THIS IS MY OWN GENETIC ATLAS. SO, WHAT YOU'RE LOOKING AT RIGHT HERE IS THE ANALYSIS OF MY GENOME TO SHOW HOW SIMILAR I AM TO INDIVIDUALS IN DIFFERENT PARTS OF THE GLOBE. I AM MOSTLY EUROPEAN-- YOU PROBABLY COULD'VE GUESSED THAT. UH, NEXT, I AM MOST CLOSELY RELATED TO THE ASIANS, AND EAST ASIANS, OCEANIA, WHATEVER. SO, A LITTLE BIT CLOSER LOOK... WHICH I FIND MORE INTERESTING, AND THIS GETS TO THE QUESTION YOU MIGHT WANT TO ASK YOURSELF, AND THAT IS, "HOW WELL DO YOU KNOW YOURSELF?" SO, THE STORY, IN MY FAMILY, IS THAT WE COME FROM CZECHOSLOVAKIA. TURNS OUT, THAT BY MOST CLOSELY RELATED TO THE ICELANDERS. SEE THAT NUMBER ONE UP THERE? ICELANDERS, FOLLOWED VERY CLOSELY BY THE ORKNEYS-- THE ORCADIANS-- IN OTHER WORDS, THAT'S A SET OF ISLANDS OFF THE NORTH COAST OF THE UNITED KINGDOM, FOLLOWED BY THE FRENCH, THEN THE TUSCAN, THEN THE ITALIAN. AND WHAT YOU CAN SEE HERE IS WHAT'S CALLED A GENETIC CLINE. IN OTHER WORDS, SIMILARITY DECREASING DOWN THIS PARTICULAR GEOGRAPHIC LINE, THAT SHOWS THE LINE OF MIGRATION OF MY FOREFATHERS. AND SO, JUST TO BRING THIS BACK TO GENOMIC MEDICINE, EACH ONE OF THESE STOPS ALONG THE WAY, THERE ARE A POPULATION OF PEOPLE THAT GET ESTABLISHED IN EACH OF THESE PLACES, AND THEY HAVE THEIR OWN SPECIFIC SET OF GENETIC VARIATION, DUE TO INBREEDING OF THE POPULATION, WHICH GIVES RISE TO VARIOUS KINDS OF SUSCEPTIBILITIES OF DISEASES OR OTHER GENETIC STRENGTHS. OKAY, AND REAL QUICKLY, THIS IS ACTUALLY A MARKER ON MY "Y" CHROMOSOME-- I COME FROM THESE PEOPLE THAT FOLLOWED THIS PARTICULAR LINE, UP THROUGH BRITAIN AND INTO ICELAND. SO-- AND THIS INFORMATION'S AVAILABLE FOR ALL OF YOU, AS WELL. YOU CAN ALL DO THE SAME THING. OH, OKAY, SO... PREDICTIVE VALUE OF THE GENOME. I DON'T KNOW WHY THIS SLIDE IS RIGHT HERE, BUT IT IS RIGHT HERE. SO, THIS IS, AGAIN, MY OWN GENOMICS. YOU CAN SEE THAT THERE'S A 68 PERCENT CHANCE THAT I HAVE BLUE EYES, THERE'S A 93 PERCENT CHANCE THAT I HAVE BLACK HAIR, AND THE ABILITY TO PREDICT PIGMENTATION WAS A BIG DEAL WHEN IT CAME OUT A FEW YEARS AGO-- I THINK 2008, 2007? BUT "NATURE GENETICS" IS THE PREMIER MAGAZINE IN THE SCIENTIFIC COMMUNITY FOR GENETICS. NOW, WE CAN TELL, JUST ON YOUR GENETICS, WHAT YOUR PIGMENTATION'S GONNA LOOK LIKE. SO, FOR THOSE OF YOU-- SO, SOMEBODY WAS IN A... FORENSICS? JUDICIARY? ER, LAW ENFORCEMENT? WHO SAID THAT? YEAH, OKAY, SO THIS IS IMPORTANT FOR YOU, BECAUSE YOU GET A SAMPLE, AT THE SCENE OF THE CRIME, AND THERE'S ALREADY A BUNCH OF STUFF, JUST TODAY-- THIS IS FACT-- THAT YOU CAN TELL ABOUT THE PERSON WHO DEPOSITED THAT SAMPLE YOU TAKE. A SCRAPING OF CELLS FROM A *** SCENE OR WHATEVER-- NOW, YOU KNOW WAS IT A MALE OR FEMALE, WHAT WAS THEIR COLORATION, WHAT WAS THEIR ANCESTRY, SO YOU MAY HAVE SOME CLUE AS TO WHAT THEY LOOK LIKE. WE CAN MAKE ESTIMATES ABOUT WHAT THEIR BODY MASS INDEX SHOULD BE-- ARE THEY GONNA BE FAT OR NOT. AND ALSO, ABOUT THEIR HEIGHT. SO NOW, YOU KNOW WHAT COLOR ARE THEY, WHAT SEX ARE THEY, HOW TALL ARE THEY, WHAT ARE THEY SUPPOSED TO LOOK LIKE? JUST FROM A FEW CELLS. THIS IS FACT, OKAY? THIS IS NOT OPINION-- THIS IS FACT. ALL RIGHT? OKAY, INCIPIENT ROLE OF GENOMICS IN YOUR LIFE. THIS IS THE PART IN THE CONVERSATION WHERE YOU WOULD WANT TO BE ASKING YOURSELF, "DO I WANNA TAKE THE RED PILL OR THE BLUE PILL?" SO, IF YOU DECIDE TO TAKE THE BLUE PILL AND GET UP AND WALK OUT OF HERE RIGHT NOW, THAT'S FINE, I GET THAT, IT'S NO PROBLEM. OKAY, SO WE'RE STILL IN THE REALM OF FACT, RIGHT NOW, BY THE WAY. SO, WE'VE TALKED ABOUT THE ROLE OF GENOMIC MEDICINE IN YOUR LIFE, UM, HOW THIS COULD BE USED TO HELP YOURSELF, UNDERSTANDING OF ETHNICITY, AND THE SCIENCE BEHIND IT. LET'S TALK ABOUT SOME OTHER THINGS. SO, UM... BEAUTIFUL BIO-LUMINESCENT JELLYFISH, RIGHT THERE. A LONG TIME AGO, THEY ISOLATED A PROTEIN, AND SUBSEQUENTLY, THE GENE THAT MAKES THAT JELLYFISH GLOW IN THE DARK. AND VERY CLEVERLY, THEY NAMED IT THE "GREEN FLUORESCENT PROTEIN." IT'S LIKE, "THAT'S ALL THEY COULD COME UP WITH?" SO, THE PROTEIN STRUCTURE FOR THE GREEN FLUORESCENT PROTEIN IS KNOWN. THIS IS THAT PROTEIN STRUCTURE. IT'S VERY FAMOUS. WE USE THE GREEN FLUORESCENT PROTEIN IN MOLECULAR BIOLOGY ALL THE TIME, FOR LABORATORY APPLICATIONS. BUT THERE ARE OTHER APPLICATIONS FOR IT... LIKE ART. SOMEBODY FROM OXFORD, WHO PROBABLY HAD SOMETHING TO DO WITH THE ISOLATION OF THE GREEN FLUORESCENT PROTEIN, MADE THIS SCULPTURE OF THE GREEN FLUORESCENT PROTEIN, WHICH IS NOW ON THEIR CAMPUS, ALL RIGHT, IN OXFORD. BUT THEN, THERE'S THIS GUY, WHO I THINK IS REALLY, REALLY FUNNY... EDUARDO KAC. HE'S FRENCH. EDUARDO IS AN ARTIST, BUT HE'S A SPECIAL KIND OF ARTIST. HE'S A PERFORMANCE ARTIST, ALL RIGHT? SO, EDUARDO... HE WANTED TO HAVE A GOOD TIME AT PARTIES, AND SO, WHAT HE DID WAS HE SAID, "WHAT IF WE TOOK THE GENE FOR GREEN FLUORESCENT PROTEIN "AND WE MADE A TRANSGENIC ANIMAL LIKE, SAY, A DOG"-- WELL, HE COULDN'T AFFORD TO MAKE A DOG... BUT HE DID MAKE A BUNNY. THIS IS FACT, OKAY? SO, THIS IS AN ACTUAL PHOTOGRAPH OF THAT BUNNY IN HIS ARMS, ILLUMINATED BY ULTRAVIOLET LIGHT. IT'S FLUORESCENT GREEN-- HE MADE A TRANSGENIC ANIMAL, A GREEN FLUORESCENT BUNNY. HA HA. SO, HIS IDEA, OF COURSE, WITH THIS WHOLE THING, WHICH I THINK IS PRETTY FUNNY, IS THAT HE WANTED TO HAVE BIG PARTIES AT HIS HOUSE AND HE WANTED TO HAVE A GREEN FLUORESCENT DOG, SO THAT THE DOG COULD WALK AROUND IN THE ULTRA-VIOLET LIGHT AND INTERACT WITH THE PEOPLE AT THE PARTY... AND BE GREEN. CLEVER. SO... NOT TO BELABOR THIS POINT, BUT ACTUALLY, HE DID A SMART THING, TOO, AND IT'S KIND OF THE HOPE OF TRANSLATIONAL MEDICINE TO BE ABLE TO DO THIS-- THIS GENE THERAPY WORK. I MEAN, WHAT IF, INSTEAD OF A GREEN FLUORESCENT PROTEIN, UH, INSULIN. SO, IF YOU HAD GENETIC DEFECT TO MAKE INSULIN, IT MIGHT BE NICE TO KNOCK IN A GOOD COPY OF INSULIN INTO YOUR GENOME, SOMEHOW. SO, INSTEAD OF MAKING A GREEN FLUORESCENT BUNNY, YOU MAKE A PERSON, PERHAPS CURING THEIR DIABETES BY KNOCKING IN A NEW COPY. SO, SCIENTISTS-- AND THIS IS THE NOT-QUITE-FACTUAL-YET PART-- PEOPLE HAVE BEEN TRYING TO DO THIS A LOT, ALL OVER THE WORLD. THE RESULTS HAVE NOT BEEN THAT GOOD YET. I MEAN, IT'S A LOT OF PROMISE, BUT HOPEFULLY, THAT WILL HAPPEN. JUST SO WE DON'T GET TOO FAR AWAY FROM THE DOG BIT, IT TURNS OUT THAT THE KOREANS THOUGHT IT WAS SUCH A GOOD IDEA, THAT THEY WENT AHEAD AND MADE A TRANSGENIC DOG WITH A RED FLUORESCENT PROTEIN FROM A SEA ANEMONE. THIS IS RUPPY, THE RED FLUORESCENT PUPPY. YEAH, THAT'S TRUE. THAT'S IN THE FACT DEPARTMENT. SO, IT BEGINS TO BEG THE QUESTION, "IF WE'RE ABLE TO DO THIS WITH COMPLEX ANIMALS LIKE DOGS, "WE COULD CERTAINLY DO THE SAME THING WITH HUMAN." AND WHEN WE THINK BACK TO DARWIN AND EVOLUTION, WHEN ONE THING BECOMES TWO, WHEN WE BEGIN TO INTERACT WITH OUR OWN PLAN AND CHANGE THE COURSE OF OUR OWN DEVELOPMENT AND DIRECTION, YOU KNOW, WHAT ARE WE REALLY DOING THERE? UH, WHAT SORT OF DIRECTED EVOLUTION IS THAT? IS THIS A GOOD IDEA OR NOT? THAT'S A QUESTION. SO, THERE'S BIG MOVEMENT THAT SURROUNDS THIS-- IT'S CALLED "TRANSHUMANISM," AND THERE'S ACTUALLY A "JOURNAL OF TRANSHUMANISM." I'M NOT REALLY INTO IT, BUT IT'S THERE. OKAY, VIDEO CLIP. (music) >> I WAS CONCEIVED IN THE RIVIERA... NOT THE FRENCH RIVIERA, THE DETROIT VARIETY. THEY USED TO SAY THAT A CHILD CONCEIVED IN LOVE HAS A GREATER CHANCE OF HAPPINESS... THEY DON'T SAY THAT ANYMORE. I'LL NEVER UNDERSTAND WHAT POSSESSED MY MOTHER TO PUT HER FAITH IN GOD'S HANDS RATHER THAN THOSE OF HER LOCAL GENETICIST. (baby crying) TEN FINGERS, TEN TOES, THAT'S ALL THAT USED TO MATTER. NOT NOW. NOW, ONLY SECONDS OLD, THE EXACT TIME AND CAUSE OF MY DEATH WAS ALREADY KNOWN. (baby crying) >> NEUROLOGICAL CONDITION, 60 PERCENT PROBABILITY. MANIC DEPRESSION, 42 PERCENT PROBABILITY. ATTENTION DEFICIT DISORDER, 89 PERCENT PROBABILITY. HEART DISORDER... 99 PERCENT PROBABILITY. EARLY FATAL POTENTIAL. LIFE EXPECTANCY, 30.2 YEARS. >> THIRTY YEARS... >> THE NAME FOR THE CERTIFICATE? >> ANTON. >> NO! UM, VINCENT ANTON. YEAH... IT'S A GOOD NAME. >> OKAY, SO THAT... IS A LOT CLOSER THAN YOU MIGHT BELIEVE. LET'S TALK ABOUT HOW CLOSE THAT ACTUALLY IS. ALL RIGHT, SO IN IN VITRO FERTILIZATION-- I DON'T KNOW IF ANY OF YOU HAVE GONE THROUGH I.V.F. OR KNOW PEOPLE THAT HAVE-- THE PROCESS, BASICALLY, WORKS AS FOLLOWING-- YOU TAKE A FEMALE, YOU STIMULATE THE PRODUCTION OF EGGS FROM THE FEMALE, YOU TAKE A MALE, YOU STIMULATE THE PRODUCTION OF *** FROM MALE, AND THEN, YOU MIX THE TWO OF THESE THINGS TOGETHER IN A PETRI DISH, AND VOILA! THROUGH MAGIC, YOU GET EMBRYOS THAT BEGIN TO GROW, IN VITRO-- IN OTHER WORDS, UNDER GLASS IN A PETRI DISH. BUT HERE'S THE THING, RIGHT? SO, YOU DON'T JUST GET ONE. YOU GET LOTS OF EMBRYOS THAT GROW IN THIS PETRI DISH, RIGHT? SO, THEN YOU'RE FACED WITH-- AND THIS IS ALL SCIENCE FACT. THIS IS ALL-- HAPPENS EVERY DAY, ALL AROUND THE WORLD, RIGHT? SO, THEN YOU'RE FACED WITH THE QUESTION, "OKAY, WHICH ONE OF THESE PARTICULAR EMBRYOS "DO I WANNA TAKE OUT OF THE PETRI DISH AND PUT INTO THE WOMAN, "WHERE THEY ARE SUPPOSED TO GO, IN ORDER TO MAKE A BABY?" SO, RIGHT NOW, THE WAY IT WORKS IS... SOME SMART EMBRYOLOGIST TAKES A LIGHT MICROSCOPE OUT AND HE LOOKS THAT THESE EMBRYOS UNDER A LIGHT MICROSCOPE, ABLE TO TELL ABSOLUTELY NOTHING ABOUT THEM, OTHER THAN WHAT THEY LOOK LIKE-- IN OTHER WORDS, HE DOES THINGS LIKE, SAY HOW MANY CELLS ARE IN THIS PARTICULAR EMBRYO THAT'S FORMING. THEY'RE SUPPOSED TO HAVE EIGHT, OKAY? IS THERE EIGHT CELLS? WHAT DO THE CELLS LOOK LIKE? YOU KNOW, GROSS MORPHOLOGICAL PROBLEMS-- ARE THERE TEARS IN THE PELLUCIDA? SO, SOME OF THESE ARE NOT GONNA BE VIABLE, RIGHT OFF THE BAT. THEN, YOU'RE LEFT WITH THE PROBLEM OF, "OKAY, WE'VE ELIMINATED SOME, "BUT THERE'S STILL A WHOLE BUNCH OF THESE EMBRYOS "THAT NEED TO GET IMPLANTED, "AND WE DON'T KNOW WHICH ONE'S GONNA WORK." AND SO, TYPICALLY, WHAT HAPPENS IS THEY TAKE A BUNCH OF THESE EMBRYOS-- FIVE, TEN, SOME LARGE NUMBER-- AND PLANT THEM IN THE WOMAN, AND THEY SEE WHICH ONE TAKES. AND THEN... THEY DO SELECTIVE ABORTION AFTER-- IF THERE ARE SEVERAL THAT GROW-- THEY DO SELECTIVE ABORTION, LEAVING ONE OR TWO TO COME TO TERM AND BE DELIVERED. SO, THIS IS WHERE YOU GET SITUATIONS LIKE THE OCTOMOM, WHO HAD A WHOLE BUNCH OF, YOU KNOW, EMBRYOS IMPLANTED, AND SHE'S LIKE, "I CAN'T DO IT. "I CAN'T GET RID OF THESE BABIES. "THEY'RE MINE-- I DON'T CARE IF THERE'S EIGHT OF THEM. "I JUST CAN'T DO IT." SO, SHE MADE EIGHT BABIES, ALL RIGHT? THAT'S HOW THAT HAPPENS. SO, UM, AND THEN, WITH THE REMAINDER-- WHAT DO YOU DO WITH THOSE? STICK 'EM IN THE FREEZER. IT'S TRUE. MIGHT WANT TO USE 'EM LATER. THIS IS A LIGHT MICROGRAPH OF WHAT THOSE EMBRYOS ACTUALLY LOOK LIKE-- THOSE ARE HUMAN EMBRYOS. BUT THERE IS A BETTER WAY-- (chuckling) MAYBE-- A BETTER WAY TO DO THIS, AND THIS IS TECHNOLOGY THAT I DEVELOPED AND IS NOW IN USE ALL AROUND THE WORLD. YOU TAKE A SINGLE EMBRYO... FROM THAT EMBRYO, YOU DO A MICROSCOPIC BIOPSY AND YOU REMOVE ONE OF THE EIGHT CELLS, LEAVING THE REMAINING SEVEN CELLS TO BE IMPLANTED, TO MAKE A HUMAN. AT THIS STAGE OF DEVELOPMENT, THE CELLS ARE PLURIPOTENT, AND IT'S NO PROBLEM. THEN, YOU CRACK THAT CELL OPEN, YOU TAKE OUT THE D.N.A., YOU FRAGMENT THE D.N.A., AND YOU DO SOME FANCY TESTING, AND THEN SOME FANCY ANALYSIS, AND FROM DOING ALL THAT, YOU ARE ABLE TO GET THE EXACT KIND OF GENETIC DIAGNOSIS FOR THAT EMBRYO THAT I SHOWED YOU FOR ME. SAME THING CAN BE DONE. SO, IN OTHER WORDS, YOU TAKE EITHER, IN THIS CASE, AN EMBRYO-- THAT'S A SCANNING ELECTRON MICROGRAPH FALSE COLOR IMAGE OF A HUMAN EMBRYO-- OR, WELL, AN EMBRYO THAT'S ACTUALLY GROWING, AND YOU APPLY GENETICS TOOLS TO IT, TO GET THIS. SO, YOU CAN KNOW A LOT, EVEN BEFORE PREGNANCY OCCURS. THIS IS A PRETTY POWERFUL THING. THIS IS GONNA CHANGE OUR SOCIOLOGY AND HOW WE APPROACH CHILDBIRTH. SO, THIS WHAT'S DOWNSTREAM. THAT WAS ALL FACT, BY THE WAY. >> LIKE MOST OTHER PARENTS OF THEIR DAY, THEY WERE DETERMINED THAT THEIR NEXT CHILD WOULD BE BROUGHT INTO THE WORLD IN WHAT HAS BECOME "THE NATURAL" WAY. >> YOUR EXTRACTED EGGS, MARIE, HAVE BEEN FERTILIZED WITH ANTONIO'S ***. AFTER SCREENING, WE ARE LEFT, AS YOU SEE, WITH TWO HEALTHY BOYS AND TWO VERY HEALTHY GIRLS. NATURALLY, NO CRITICAL PREDISPOSITIONS TO ANY OF THE MAJOR INHERITABLE DISEASES. ALL THAT REMAINS IS TO SELECT THE MOST COMPATIBLE CANDIDATE. FIRST, WE MAY AS WELL DECIDE ON GENDER. HAVE YOU GIVEN IT ANY THOUGHT? >> WE WOULD WANT VINCENT TO HAVE A BROTHER. YOU KNOW, TO PLAY WITH. >> OF COURSE YOU WOULD. HELLO, VINCENT. >> HI. >> YOU HAVE SPECIFIED HAZEL EYES, DARK HAIR, AND FAIR SKIN. I'VE TAKEN THE LIBERTY OF ERADICATING ANY POTENTIAL PREJUDICIAL CONDITIONS-- UH, PREMATURE BALDNESS, MIOPIA, ALCOHOLISM AND ADDICTIVE SUSCEPTIBILITY, PROPENSITY FOR VIOLENCE, OBESITY, ETCETERA-- >> WE DIDN'T WANT-- I MEAN, DISEASES, YES, BUT-- >> RIGHT. WE WERE JUST WONDERING IF IT'S GOOD TO JUST LEAVE A FEW THINGS TO CHANCE. >> YOU WANT TO GIVE YOUR CHILD THE BEST POSSIBLE START. BELIEVE ME, WE HAVE ENOUGH IMPERFECTION BUILT IN ALREADY. YOUR CHILD DOESN'T NEED ANY ADDITIONAL BURDENS. NOW, KEEP IN MIND, THIS CHILD IS STILL YOU... SIMPLY THE BEST OF YOU. YOU COULD CONCEIVE NATURALLY A THOUSAND TIMES AND NEVER GET SUCH A RESULT. (music) >> THAT'S HOW MY BROTHER, ANTON, CAME INTO THE WORLD. A SON MY FATHER CONSIDERED WORTHY OF HIS NAME. (music) >> WHAT DID I TELL YOU? SEE HOW MUCH HE'S GROWN? >> RIGHT, SO THAT'S HEAVY-DUTY. BUT THAT'S WHERE WE'RE HEADED. IT'S CLOSE TO THAT, AND I THINK THAT THIS IS THE KIND OF QUESTION THAT WE NEED TO ADDRESS AS A SOCIETY, "DO WE WANT TO DO THIS? "WHAT ARE THE LIMITATIONS TO THIS? "WHAT'S OKAY? "HOW'S THIS GOING TO BE REGULATED? "WHO IS GONNA REGULATE IT?" THESE ARE ALL VERY, VERY DIFFICULT, PERSONAL QUESTIONS. I MEAN, IS THIS SOMETHING THAT SHOULD HAPPEN ON THE LEVEL OF A RELIGION OR THE GOVERNMENT OR WHATEVER? OR SHOULD IT BE UNREGULATED? BUT I HAVE THIS QUESTION, AND THAT IS, "WHAT'S GONNA HAPPEN ALL THE ARTISTS "WHEN ALL THE PEOPLE WHO ARE CRAZY ARE NOT ALLOWED TO BE, YOU KNOW, BORN?" RIGHT? I MEAN, LET'S THINK ABOUT THIS. SO, HERE'S A GUY-- VINCENT VAN GOGH-- HAD A BAD DAY, ONE DAY. I MEAN, HE JUST HAD A BAD DAY, AND SO, HIS RESPONSE IT WAS, "I'M GONNA CUT MY EAR OFF AND GIVE IT TO A ***," WHICH HE DID, AND THEN, HE PAINTED THIS PICTURE OF HIMSELF, AND NOW, THIS REMAINS AS AN IMPORTANT PIECE OF ART THAT AFFECTS MILLIONS OF PEOPLE AROUND THE WORLD AND IS A GIFT TO US ALL. WHAT HAPPENS WHEN THERE ARE NO MORE KURT COBAIN, BECAUSE THEY GET ELIMINATED TOO EARLY. THIS IS A QUESTION THAT I DON'T HAVE AN ANSWER TO. WELL, HERE'S ANOTHER QUESTION-- WHAT YOU'RE LOOKING AT IS THE COVER SHEET OF A REPORT THAT WAS COMMISSIONED BY THE DEPARTMENT OF DEFENSE, AND IT WAS IN 2010, AND IT IS THE ROLE OF, ESSENTIALLY, GENOMICS IN OUR NATIONAL SECURITY. SO, UH... THIS WAS DELIVERED ON DECEMBER 15th OF 2010-- $100 GENOME. REMEMBER, I WAS TALKING ABOUT WHY THE PRICE IS IMPORTANT? THE PRICE IS IMPORTANT. THE FACT THAT THE COST HAS COME DOWN ALL THESE YEARS, MEANS THAT IT'S GONNA BE AVAILABLE FOR USE, BROADLY, IN THE POPULATION. IT IS UP TO US TO DETERMINE HOW IT GETS USED. SO, THE MILITARY-- THIS IS FROM THE PENTAGON-- YOU DON'T GET HIGHER IN THE GOVERNMENT THAN THE PENTAGON-- COMMISSIONED THIS REPORT. AND THE GOAL OF THE REPORT, AMONG A LOT OF OTHER THINGS, IS ASSESSMENT OF PERSONNEL. IN OTHER WORDS, ASSESSMENT OF PERSONNEL FOR DUTY. WHO ARE WE GOING TO ALLOW TO DO WHAT IN THIS COUNTRY? HERE'S A QUESTION FOR YOU-- ANYBODY KNOW WHAT THE MOST EXPENSIVE DISEASE TO TREAT IS IN THE ENTIRE COUNTRY? ANY GUESS? NO GUESS? NOBODY? >> CANCER? >> THAT IS A GREAT GUESS. I'M GLAD YOU SAID THAT. BUT YOU'RE DEAD WRONG. SO, THE MOST EXPENSIVE DISEASE IS SCHIZOPHRENIA. SCHIZOPHRENIA, IN FACT, COSTS MORE TO TREAT THAN ALL CANCERS COMBINED. WHY? BECAUSE IT DOESN'T KILL YOU. IT REQUIRES MEDICATION, IT REQUIRES SUPERVISION, IT REQUIRES STRUCTURE-- THERE IS OFTEN POLICE INVOLVED. THE COST OF THIS IS ACTUALLY ASTRONOMICAL, AND THE MILITARY, AT LEAST-- I DON'T KNOW-- I'M NOT A PSYCHIATRIST, I'M NOT A PSYCHOLOGIST-- I DON'T KNOW ABOUT SCHIZOPHRENIA, I JUST KNOW ABOUT GENETICS-- BUT THE MILITARY, AT LEAST, BELIEVES THAT SCHIZOPHRENIA IS A TWO-PART DEAL. IN OTHER WORDS, ONE PART OF IT IS SOME SORT OF GENETIC SUSCEPTIBILITY AND THE OTHER PART OF IT IS A THRESHOLD EVENT THAT PUSHES YOU OVER FROM SOME SORT OF NORMAL STATE-- YOU HAVE A SCHISM, A BREAK FROM REALITY-- AND YOU BECOME SCHIZOPHRENIC, AND THAT'S WHAT IT'S LIKE FOR THE REST OF YOUR LIFE. SO, MOST PEOPLE GET SCHIZOPHRENIA WHEN THEY'RE, YOU KNOW, 18, 19, 20, I SUPPOSE. ABOUT THE SAME AGE THAT THEY GO INTO THE MILITARY. SO, THE MILITARY WANTS TO FIND BIOLOGICAL MARKERS THAT WILL TELL THEM WHO IS AT RISK FOR DEVELOPING SCHIZOPHRENIA, AND THEY'RE GONNA KEEP THOSE PEOPLE OUT OF CERTAIN KINDS OF SERVICE, SO THAT THEY DON'T HAVE SOME SORT OF STRESSFUL EVENT, FOR WHICH THE MILITARY WILL BE ON THE HOOK FOR PAYING FOR FOR THE REST OF THEIR LIVES. IT'S VERY EXPENSIVE. THIS IS GONNA HAPPEN IN A LOT OF DIFFERENT WAYS. YOU NEED TO WATCH OUT FOR IT. SO, WHAT IS THIS THING THAT WE'RE TALKING ABOUT HERE? I MEAN, THIS IS ACTUALLY NOT A NEW CONCEPT AT ALL. I MEAN, THIS RESEMBLES EUGENICS, YOU KNOW, AND THAT IS THE SELF-DIRECTION OF HUMAN EVOLUTION. THIS IS A POSTER FROM, LIKE, THE SECOND ANNUAL EUGENICS CONFERENCE, BACK IN 1921. SO, THE EUGENICS MOVEMENT, YOU KNOW, IS, I THINK, FROM THE LATE 1800s-- I'M NOT AN EXPERT IN THE EUGENICS MOVEMENT. BUT ESSENTIALLY, WHAT THEY WANT TO DO IS WEED OUT PARTS OF HUMANITY THAT DON'T FIT A CERTAIN CRITERIA. THEY WANT TO GET RID OF HANDICAPS, YOU KNOW, BALD PEOPLE, PEOPLE THAT TALK TOO LONG-- STUFF LIKE THAT. UH, SO, 1921-- I'M GONNA-- SHORT ON TIME. SO, IN 1932, BASED ON EUGENICS, GERMANY PASSED THIS LAW FOR THE PREVENTION OF HEREDITARILY DISEASED OFFSPRING. WELL, WHO GETS TO DECIDE WHAT A DISEASE IS? RIGHT? IS DEPRESSION A DISEASE? WELL, HERE'S WHAT THEY SAID-- THEIR GOVERNMENT-- THEY SAID "CONGENITAL MENTAL DEFICIENCY." NUMBER ONE, SCHIZOPHRENIA, MANIC-DEPRESSIVE INSANITY, EPILEPSY, YOU KNOW, HUNTINGTON'S CHOREA, BLINDNESS, DEAFNESS, ALL THESE KIND OF THINGS. THEY DIDN'T WANT PEOPLE TO HAVE THIS, AND SO, THEY WERE STERILIZING THEM. AND YOU CAN SEE UP THERE IN THE RED, IT SAYS, YOU KNOW, "FORCED STERILIZATION," ALL THAT KIND OF THING. AND IF YOU LOOK AT THE POSTER THAT PROMOTES THIS LAW, RIGHT ACROSS THE TOP OF IT-- I CAN'T READ GERMAN, BUT THAT SAYS-- "WE DO NOT STAND ALONE." AND IF YOU'LL SEE, OUR FLAG IS RIGHT THERE AMONG THE OTHER FLAGS OF MAJOR NATIONS. WE'RE NO BETTER. BRITAIN, JAPAN, UNITED STATES, NORWAY-- MAJOR NATIONS WERE ALL INVOLVED WITH THIS. SO, ONE YEAR LATER, THIS BECAME THE FLAG OF GERMANY, WHO PASSED THAT LAW. I THINK WE CAN ALL AGREE THAT THIS WAS A BAD DEAL. AND IT'S SOMETHING THAT WE NEED TO WATCH OUT FOR. THESE TECHNOLOGIES ARE AMAZING. THEY HAVE THE ABILITY TO TRANSFORM OUR LIVES AND MAKE OUR LIVES MUCH BETTER, BUT THEY MUST BE CAREFULLY WATCHED BY US, AS INDIVIDUAL CITIZENS. OKAY, SO HERE'S A FEW QUESTIONS-- I'M DONE NOW. HERE'S A FEW QUESTIONS THAT I WANTED TO POSE TO ALL OF YOU, JUST FOR YOUR OWN THOUGHT AND, UM... JUST 'CAUSE I THINK THEY'RE GOOD QUESTIONS I DON'T HAVE ANSWERS TO ANY OF THESE QUESTIONS. "SHOULD WE TELL A PERSON HOW THEY'RE LIKELY TO DIE AND WHEN?" THERE ARE ACTUARIALS-- IN OTHER WORDS, THE PEOPLE THAT WORK FOR INSURANCE COMPANIES TO TRY TO MAKE SURE THEY DON'T LOSE MONEY, WHO WORK ON THIS KIND OF PROBLEM. YOU KNOW, "WHEN'S A PERSON GONNA DIE? "HOW MUCH CAN WE INSURE THEM FOR?" AND THEY COME UP WITH STATISTICS THAT ARE PRETTY CLOSE. WE SHOULD GET CLOSE ON THIS. SHOULD WE TELL A PERSON WHEN THEIR DADDY AIN'T THEIR DADDY? YOU'D BE SURPRISED AT HOW OFTEN THIS HAPPENS. I WAS INVOLVED WITH A RESEARCH PROJECT ON THE EAST COAST-- 4,000 PEOPLE. WE HAD TO THROW AWAY 19 PERCENT OF THE SAMPLES, BECAUSE THE PERSON IN THE SAMPLE-- THEIR PARENT WASN'T ACTUALLY THEIR PARENT, AND WE COULDN'T USE THEM IN THE STUDY. IT'S SOMETHING LIKE TEN PERCENT OF THE PEOPLE IN THE GENERAL POPULATION IN THE UNITED STATES-- THERE'S TEN PERCENT OF US, OUR DADDY'S NOT OUR DADDY. SO, I DON'T KNOW HOW MANY PEOPLE ARE HERE-- IF THERE'S 100 PEOPLE HERE, TEN OF US, WE DON'T KNOW THAT OUR DADDY'S NOT OUR DADDY. RIGHT? THAT'S TRUE. AND WHEN WE BEGIN TO IMPLEMENT GENOMIC HEALTH, THIS IS GOING TO COME OUT, BECAUSE WHEN YOU SEQUENCE YOURSELF, YOU'RE ALSO GETTING INFORMATION ABOUT THE PEOPLE AROUND YOU-- YOUR BROTHERS, YOUR SISTERS, YOUR PARENTS, YOUR AUNTS, YOUR UNCLES, BECAUSE THE MATERIAL THAT MAKES YOU, MAKES THEM, TOO. AND IT'LL BE VERY OBVIOUS IF YOUR DAD ISN'T YOUR DAD. HOW ARE WE GONNA HANDLE THAT, AS A SOCIETY? WHAT DO WE DO WITH UNUSED EMBRYOS-- THE ONES THAT ARE IN THE FREEZER? WHAT HAPPENS TO THOSE THINGS? AND IF THERE'S A BUNCH OF EMBRYOS IN THE FREEZER, AND MOM AND DAD GET A DIVORCE, WHO GETS THE EMBRYOS? ARE THEY PROPERTY? AND WHAT IS A "NORMAL" GENOME? WHAT'S A "NORMAL" BABY? THESE ARE KIND OF QUESTIONS WE NEED TO ANSWER. AND LASTLY, IS IT WRONG TO KNOWINGLY GIVE BIRTH TO A HANDICAPPED BABY? SO, I WILL LEAVE YOU WITH THIS-- AND IT MAY NOT SEEM TOTALLY RELATED, BUT I WILL ASK YOU TO THINK UPON THIS-- "ALL TRUTH PASSES THROUGH THREE PHASES. "FIRST, IT IS RIDICULED. "SECOND, IT IS VIOLENTLY OPPOSED. "AND THIRD, IT IS ACCEPTED AS SELF-EVIDENT." NOW, THAT'S SCHOPENHAUER, RIGHT THERE, WHO'S AN OLD PHILOSOPHER, AND HE CAME UP WITH THIS DURING HIS LIFETIME. AND I FIND THIS TO BE TRUE. I FIND THAT WE ARE IN THE MIDDLE OF THIS RIGHT NOW. SO, THAT'S IT. THAT'S WHAT I HAVE TO SAY. THANK YOU VERY MUCH FOR YOUR ATTENTION.