@ you clearly don't work in research. One should not throw judgements like that on a field which is not yours. Why isn't there a cure for X? Well because it's a hell hard to find it. And it's not enough that a handful of willing people try shit on themselves, you need to make a controlled test to be sure you won't be hurting anyone with it. That's how it works. Of course if one patient is terminally ill and there's a vague possibility of a cure from something reported by just a few people, and nothing else available, they will let the patient go for it. But the reason it's difficult to cure stuff is that life is a complicated thing and we're no gods. And human bodies don't come with detailed how-to-repair instruction booklets either. I see that it's hard to accept, but it's not like you have a choice, that's how it is. I assure you every single researcher is doing his/her best to find out something useful, it's just a hell harder than simply looking into a microscope and thinking stuff out. I speak from experience. I wish you a good day.
@Heme Review How much healthcare can happen without tech, like without electricity, running water, stable buildings, factories that make drugs, chemicals in laboratories, easily available food, ability to transport patients to doctors and supplies to hospitals in time, etc. Would it even make a difference if people didn't have access to shelter, enough safe food, security, heating? Healthcare is built upon technology, and cannot function without. Saying tech isn't needed or important is extremely narrowsighted, ignorant and factually wrong. Moreover, "technology makes our lives easier" translates to collectively having time and resources to even care about ones health issues instead of being preoccupied finding food, hiding from predators, not freezing to death, etc. Yes, fire and houses are technology. So is AI which saves lives by modelling situations and predicting disasters before they happen. So is everything else. I like your videos a lot, but that does not mean you get away saying nonsense.
If computation capability really gets that advanced, enough to accurately simulate human physiology, I guess it should be capable of simulating human societal activities, we can just run policies in simulations before actually implementing them.
As someone who'll start studying biochemistry at university this fall, I can't express how much I love the content that is produced on Chubbyemu and Heme Review, there is literally no other channel on youtube where I have the bell set to notify me everytime anything happens with either channel. Keep it up!
I didn't major in biochem, only in chemistry in general, but I loved my biochem courses. These videos also hit me in all the right ways (though they sometimes cause my anxiety to flare a bit). Best of luck to you, and I hope you enjoy it!
man i'm doing bio (+ compulsory chem) in secondary school, his content is really interesting and i can sometimes apply my (albeit basic) knowledge to the case studies, which is pretty cool.
I'm going into my third year in biochemistry. Piece of advice: don't mess around when it comes to studying metabolic pathways. They're complicated and require a lot of time and effort compared to most other fields.
Next time someone asks you at a job interview where you see yourself in 5-10 years, "I'll probably have cancer." Probably won't get the job, but it would be interesting to see the look on the interviewers face.
I mean this as the highest compliment from a fellow person of science. "You are such a nerd!" :) Your enthusiasm in your chosen field is an inspiration to me. Thank you.
My mom was held off on treatment for two months while they tried to see if she was stage 3 or 4, and to see what the best treatment would be long term. In the long term looking back, it didn't matter. It was a progressive cancer. But at the time, my mom, sister, most of my family was pissed and blaming the doctors, especially after she died. Would getting treatment sooner made much of a difference? I honestly don't know. Maybe, maybe not. But I can tell you from personal experience, those months felt like years. I don't feel anger at the doctors anymore, but many family members still do. With covid, those family members have little to no trust that the "right" actions will be taken, despite us not knowing either. I miss my mom a lot, but I hope her death meant something to the science community. She had the worst number of leasions on her liver they had ever seen on a non drinker. Over 40, very deep,very scarred leasions. Her death was a combination of her body being too weak to fight infection, internal bleeding, and organs shutting down because her body couldn't fight anymore. Diagnosis to death was 5 months. It was very, very short with almost no time to react, but I'm also greatful. It limited the time she suffered.
Wishing you healing. Your story is a good reminder that sometimes doctors need to prioritize patient relations over hard data (or their quest to get clear on what the data demands), because alienating people can have waves of negative effects that no one could have predicted.
Get gene testing done to see if you’re at risk of the same thing. You can likely prevent it if it’s not too stacked against your favor. At the very least you can delay it. Sorry to hear about that.
I'll never forget my twin brother dying of ALL (leukemia), it was right on the cusp of CAR-T being available, 2014. I remember calling everyone involved in making that treatment happen, and how futile it was trying to get him that treatment. It felt like one of those scenes in Breaking Bad where someone pleads for their life but then gets killed without hesitation, with no emotion, no care at all. They expected us to be ok with him dying, knowing that he was not going to be able to get what was a game changing treatment. It was all about possibly skewing the data of the study, then of course, insurance not wanting to pay for what was likely the best care for him.
Still my favorite UA-cam video of all time. It's extremely underrated and deeply inspirational to me. Instead of thinking "this will be available in the far far future", I'm thinking, "who is starting this work now?" I'm excited to learn more about the research that is being made towards improving the future of medicine, as described here.
I agree that personalised simulation-directed medicine is the natural distant future for the field. It will probably come gradually as personal genomics and epidemiological data gets combined. Similar approaches at the individual tissue level have revolutionised oncology already. There are many practical difficulties though, data at sufficient scale and resolution being one of the more thorny ones: Ideally you would sequence every single human at birth, centralise their medical records throughout life and take every test result, every piece of data from their phones and fitness trackers, every specimen collected from them for analysis and throw every single measurement we can devise at it, then after their death sample all their tissues and collect every piece of data the currently available technology can provide and store it in a huge database. A dataset like that would provide the foundation to the revolution in general medicine that you are talking about and I think it is something we should invest in as a species as a gift to our children. It is almost criminal that autopsy is rare now days, the standard of death care should at the least be robust high resolution imaging of the body before disposal, if not complete sampling and preservation of as much data accumulated by that lifetime experiment of evolution as possible. Of course the ethical, cultural and privacy considerations of collecting that data, the costs to implement it and the discipline to continue to augment it as technology progresses would require cooperation of humans at unprecedented levels, across all scientific and engineering fields and at all levels of government. The benefits seem to justify the costs, on humanist grounds if not actual financial grounds with the eventual reduction in mortality and morbidity and the associated improvement in GDP. Of course many might argue that the technology (or even just ideologies) that would be born from such an endeavor can be subverted into some very dark directions! The other big practical problem is the compute required for finer and finer grained simulation of a complete organism. Moore's Law suggest it will eventually be tractable to do molecular simulation of all biological pathways, of a complete cell and maybe eventually tissue and whole organisms. There is plenty of benefit to be found in more primitive models that are just statistical black-box behavior of cells and tissues with particular mixture of alleles and that can be continuously improved as compute grows and may be the most practical anyway after lower level simulations to establish hierarchical statistical models. Now a lot of rats and people are going to die to produce the verification data for the models. People are already dying so as to my previous point, it seems an enormous waste to not learn everything we can from the artifacts of their lives (one of the biggest being their corpse). I also think this is where tissue engineering and production of fully-human model organs and even complete (but perhaps anencephalic) bodies would be a natural direction too, at least in the medium term for model construction and basic research. Right now complete simulation of a single receptor, a drug candidate and all the jiggling water molecules is just barely practical and nothing like real-time, a fully molecular simulation of a cell is so ridiculously difficult it seems for the foreseeable future that using the universe to do the simulation (i.e. doing molecular scale experiments in vitro rather than in silico) and pushing on the technology to automate shotgun approaches to drug candidate studies using personalised engineered tissue systems would be a good path. There is no reason to do it all in simulated physics if you can do it in real physics, the challenge is assembling the experiment and reading out the results. Fortunately the machinery of life already can mass produce all the components and assemble them for us, all we need is to wrap that in a layer of digital control and measurement. So I guess in summary we are already heading down a path towards something like your hypothetical future and the biggest resistance to progress is going to be human factors around privacy, death rituals and science denial. I agree that social forces associated with a major crisis may change attitudes over short time frames, otherwise gradual attitude changes by careful policy design (in particular education reform) and natural attrition of dissenting individuals will be required.
Moore's law - will it continue? Maybe not but I worked for a microchip company research centre in 1985, pre university. There were limits of miniaturisation because of atomic diffusion in the silicon devices but somehow there have been new designs to keep the density rising and new technologies like flash memory but I note that flash memory SD cards stopped at 1 Terabyte, first shown in 2015, 5 years ago. Doubling has often taken 1.5 to 2 years in capacities: hard disk drives for example from 20Mb to 2Tb since around 1990. That's 46% a year, or x2.15 every 2 years. Fascinating but I think it will stop unless new tech is found, like optical computing, which was in blue sky very basic development even in 1985 but seemed to go nowhere (like nuclear fusion went nowhere, sadly). I really like these kind of videos.
Best comment so far. I personally feel that it is a very distant dream because people will not put the money and resources into accomplishing this anytime soon. The cost is the main barrier. Just getting your genome sequenced is something that most people would never do because of the cost, and its limitations. Compared to other scientific endeavors, I feel that medicine is just now hitting its golden age in the past 50 some years. The amount of knowledge we still lack is staggering, imo
4:43 Interesting fact: to properly blind a study, you want to give the control group an active placebo, one that mimics the side effects of the actual drug. This makes it less likely that the placebo effect kicks in to support a less effective medicine. Antidepressants didn't get this kind of study.
What are you trying to say exactly? Wouldn't this mean Antidepressants are harder to get to market because the placebos they compete with have none of their side effects?
@@justindie7543 I accidentally hit cancel after writing down a huge reply (I feel dead inside now), but basically, the side effects in the drug group enhance placebo effect, thus making the drug look better in the results. Give the control group side effects and this apparent advantage disappears. All the drug trials used to justify psychiatric drugs being pushed on the market have been designed to make the drug look effective, essentially. There's HEAPS of money to be earned by selling a happy or chill pill.
@@centralintelligenceagency9003 I hate it when that happens. Sticking it in a simple text file is good and then copying band pasting. Or on a phone, I write a phone text and send it to myself but I can also look at it later because it's almost impossible to find your own comments later on YT.
@@centralintelligenceagency9003 Placebo control groups do get side effects, and those side effects are usually similar. In some studies, the placebo group gets MORE side effects than in the drug group.
You make a very good point of switching everybody over to the drug trial too quickly. I never thought of giving up that baseline so quick could actually be terrible and problematic.
As a premed student, I can't tell how great this video expanded my understanding. I choose to become a premed student because I love science, more specifically the feeling of understanding the laws of the nature, and I think it's awesome that I can apply those knowledge to help others. But this video warns me the truth of modern medicine, that don't assume we understand thoroughly, we still can't model everything as math or physics. But doctors still need to fulfill their duty, amid the complexity of disease, and the uncertainty of treatment. We can't tell which treatment is best, so the only thing we can do is to try all of them, while dealing with the associated ethic dilemma. No treatments, if followed the rule, is wrong. The only thing regretful is we don't have enough technology to confidently treat it.
I am a premed student that also loves technology and science, and this videos open my eyes and say "gosh, if primitive man knew good or bad food by trying it, and today we know some medicine are good or bad by trying it too by ourself, then we are not that far from primitive man". But i think there is some hope. Today people try to search for a new drugs by doing simulation, today some people try to develop quantum computer, today people read and determine our whole sequence of DNA. It might not be that far from "that" future.
Dude man doctor bro your analogy between plague doctors and bloodletting to modern medicine pharmacology is something that I have been trying to explain to people for a long time and to hear it come out of your mouth gives me extreme validity in my beliefs I just hope that I'm around for the next wave of treatment for us because filling our bodies with chemical poisons in the hoping it does what it's supposed is barbaric. On the other hand I freaking love your channel I love your character keep up the wonderful work very informative👏🤘🖤👀😉
They’re still bloodletters lol, I’ve worked in hospitals for 40+ years and they draw soooooo much blood for lab tests it’s unbelievable. That isn’t good for your immune system to constantly have blood drawn when you’re really ill.
Watching these videos, along with the ones on your main channel make me want to go into the medical field ngl. My mom is a cardiac RN, one of the best on her floor.
It’s probably not anyone else’s place to tell you whether you should do it or not but yourself. Be educated on multiple fields so you can actually see what you like, good luck.
So, several thoughts that come to mind while watching this video that I wanted to share with you: 1. If we collated all the information that has been gathered about the current standard of care into a database that is validated by an organization such as the NIH or the NSF, would it be valid to use the information in that database as the control of the clinical trial in order to compare it to the trial drug being tested? I mean, surely, if the database is large enough and diverse enough (which, if we've been running trials using dacarbazine for 40 years, there would likely be enough data to meet that criteria), it'd serve as a good substitute while still retaining the validity of the study, right? 2. Your idea of being able to simulate a hundred thousand humans in real time in order to run clinical trials is an interesting one (even if I can't begin to imagine how much computational power that will take, especially since we can't even begin to simulate an entire brain, only a few thousand neurons at the most in supercomputers), but I think the idea doesn't go far enough. Why stop at just real time? Why not accelerate time within the simulation as well? After all, the higher the time compression factor, the more trials you can run in the same time period. Albeit, this would take even more computational power, but being able to find treatments with high efficacy in a matter of weeks, days, or even hours would likely make a world of difference. 3. Personally, I believe that the production of these tailored medications can just be made at local pharmacies with the right equipment and the right expertise. It'd save people from having to buy the (likely extremely expensive) equipment, and allow those who can't afford it to still have access to the medication they need. The pharmacies would also be able to collect data on drugs that might be similar enough to mass produce with little to no impact on its efficacy, therefore driving down costs.
Thanks for the response! I realize I misspoke when I said real-time. You’re right, it should be done all in parallel, and much faster than real time, when possible. The reality is i think this would look quite a bit different than we think of it today as we’re somewhat limited to imagining technology in a form of how we’ve seen it during our lifetime. And to that, the idea of a pharmacy may be fundamentally different then, than how we have them today! It may serve a different purpose between now and then. Always interesting to think about how it all may turn out! Thanks again!
@@HemeReview I'm not so sure about the idea of a pharmacy being fundamentally from what it is now, truth be told. If you look back at history, you'll find that Apothecaries served more or less the same purpose as pharmacies do now. Albeit in a significantly more primitive capacity due to medicine not being advanced enough. It's essentially been a drug store for centuries. The only reason I can think of the idea of a pharmacy being made different, is if it ends up being obsolete due to nanotechnology advancing enough that it makes most medicine obsolete. After all, what use would Antibiotics, antivirals, anti-fungals, etc. have when you can just have a nanomachine shove a C3 protein into a pathogen or cancer cell, and let the complement system do the rest? Or have nanomachines repair any damage done to the body?
People reminisce that one of the hallmarks of the 20th century was the dawn of the computer age, and that the 21st century will become the "Biotech century." I believe that mind-boggling technologies are on their way... and that developments like CRISPR are just the beginning.
The idea of building a (simulation) model of a human is not so far away, and I don't agree with "not in my lifetime". This is not a binary situation where we either don't have a model or we have a model. Such models have been built, and some are already available. Obviously, they have much poorer predictive power than we wish they had, and they are not as general as we wish, but they are gradually improved. Even machine learning models so prevalent today have some predictive power, and some of them can help answer questions like "how is this new drug likely to behave for a human characterized by such and such properties". So - this is a gradual process and models are getting better and better every day. @David C point 2: Yes, obviously simulation time will not be related to our clock time, so the simulation may be slower or faster depending on its desired accuracy and available computational power. One does not "stop at just real time" or "accelerate time" because simulation time depends on available computational resources and precision. Another possibility (apart from simulation) is to build more accurate and complex in vitro models, and again, they exist and are continuously improved. They at least allow us to test drugs without risking human lives.
Fabulous video, like some of your early philosophical kind of videos such as why you can't be who you want to be, etc. Please keep them coming, absolutely brilliant.
Very interesting video, nicely made. But yeah, that trial? Sure, we need a control, references, a baseline, I get that. But you'd think, that with 40 years of really only one treatment being able, we would have used some, just some of all that time and all those treatments to, you know, figure out that baseline in advance? And if the success rates are so bad you can then just switch over to the new and likely better treatment and still have two sets of data you can properly compare. But instead we consigned all that data... into the void, instead making a control group doing the very same thing we've been doing for decades, to get the very same data again? Why though. I'll take a guess and say that yes, in the future we'll look back at that and call this a totally backwards waste of perfectly fine data in favor of watching a couple more people die.
It’s a double edged sword. Since the medicine in that trial appeared to not have a durable response as a mono therapy in the long term. The second downstream blockade has a longer survival attached to it, but in the metastatic setting, it is still low. I agree. We’re doing things now that will be seen in the future, like how we see blood letting today
@@HemeReview The trial design in specific is a data science problem. One we can, and eventually will figure out I wager, but it's not trivial for sure. Time will tell when we actually get there. A couple decades or half a century I'd assume.
Hi doctor, I'm currently studying Pharmacology and you bring up some good points. I would recommend reading Carl Jung's book Aion. The first chapter, Phenomenology of the self, in particular, is a great standpoint regarding drug efficacy as a necessary evil. As for medicines psychological understanding, Charles dickens - Great expectations - gives a good insight as to why people egotistically think about the future (how it can be misleading) and how it will plan out, without realising the psychological expectations they place on themselves. This ends up a crushing reality to some. I love your videos, please keep up the great work!
Chubbyemu:"Take for example a cancer patient on PD1 checkpoint inhibitor in 2020, what happens if they get COVID-19? While rare, both of these could cause cytokine release syndrome, then what do you do?" Me, having no medical knowledge whatsoever, trying to keep up with the most basic explanations:"Hmm, yes interesting point you are making there, then indeed what do you do?"
You make great videos, I love medicine and pathology. I follow a lot of doctors but you just have a way to tell a story are you a really good speaker you can draw people in and paints a great picture in the listeners head. Just wanted to say I love both of your channels
I’m so torn, I love everything you create, but within the last year of my life this severe, visceral anxious/paranoid sense of impending doom consumes me sometimes when I start watching things describing the inner workings of the body in detail. I was never like that, but now it’s just getting worse and worse, or it’s not there at all. Probably just fear of death setting in differently as I age, though I’m 25, I’m still aging haha
As dumb as this might sound try going to therapy and seeing if you have an underlying anxiety disorder. It may get worse for you and being proactive with these things only helps.
fuzzyfry not dumb at all. honestly, I really appreciate you even taking a moment to suggest that, you could be any old shmuck but you are absolutely right, so I don’t care. Unfortunately I don’t know when I will be able to do something like that again, it’s not really in my cards right now, I loved my psychologist 10 years ago when I was 15, but my mom kind of gas lighted me into thinking it was pointless, because “nothings wrong with her kids”. Now my sisters been dead for a couple years from a drug overdose and anytime I try and vent to my mom about anything she gets all defensive and takes any problem I’m going through as a personal attack and tells me I need to talk to somebody because she doesn’t know what to say. Just makes me feel like I’m a problem. I’m almost 26 and I’m stuck back at home for now, having been back and forth from jobs and apartments instead of doing what’s right for me, out of this deep seated guilt. It’s fucked. Sorry to explode all of this, not even directly connected to what I was saying, it just frustrates me a lot. Therapy was great, and my particular guy back then was so cool, but I literally had to force my way into it and play up my problems to the point that everybody was seriously concerned for a while. Now I’m stuck, and I’m just really tired. Like on a profound level. This quarantine stuff is nothing to me, my life was already a socially distanced, quarantined, fever dream of starvation and sleepless nights. Literally. The last year has been for me, what has been mandatory for everyone else for a couple months, no exaggeration. The difference is now I’m never alone, but the people I live with make me feel absolutely worthless in this passive aggressive way that will make anybody lose their mind. So everything looks “perfect” on the outside, but it’s really bad. The American dream in action. You don’t have to reply to this, random person, but know that I really appreciate you and your time taken to look out for a stranger. You must be a good person.
@@young-stove I try to be decent because I totally get what you are going through. If you want to chat and get a life line you can find me on fb my name is Sadie Fry I live in Oregon. Mental health Master here on UA-cam also has a private discord for those needing support or who want to support others.
fuzzyfry aw you are too kind, thank you again, seriously, this has made me feel a bit less alienated. I know very well I’m not alone in my feelings, but sometimes what you feel overrides what you understand. It’s funny that the way other people, people in my life, have suggested therapy to me, but in a way that’s very aggressive and for all the wrong reasons. Like you need medication so you’re too sedated to confront me anymore. I realize some people are in need of some kind of medicinal intervention, even if only temporary, depends on the nature of their struggle and how rooted in reality it is, I know some people go completely off the deep end and the people in their crosshairs genuinely had perfectly healthy relationships with them prior to that, and sometimes everybody except the person with the “problems” just pretends everything’s great. It’s complicated. I’m normally a person everybody else can talk to in depth about these things, but in my current environment I become a monster and I can’t function in any basic way. I’ll be able to move to a much better part of the world with people that are better for me in the next year, hopefully, so I’m clinging to that, but it’s still very hard. I’m deliberately going on and on about this in the hopes that it may be helpful to somebody else that may be feeling something similar, might help them realize something important about their situation in some way. But again, thank you for taking some of your time to respond, I got rid of facebook about 6 years ago, but I’m definitely considering the resources you shared with me. I’ve been having a lot of nice interactions with strangers online lately, it’s been very refreshing. This is the least toxic UA-cam comment thread I’ve ever seen or participated in haha
Yeah I get what you mean man. Kind of makes you depressed to know that life can be destroyed seemingly at random by disease, and there’s so many things that can go wrong with the body that it’s a bit unsettling
Thanks for sharing your thoughts ! Speaking as someone coming from the computer side of things, I'm pretty confident that the kind of simulation that you are describing (billions of patients simulated millions of times) is not going to happen in my lifetime, due to physical limits to how tiny we can make logic, slow rate of scientific progress, and lack of a clear path for immense improvements in either of these areas. On the logic front, we are currently around 70 atoms/transistor and have no clear path for either making transistors smaller than 1 atom at comparable density, stacking lots of them without overheating, or replacing transistors with an immensely superior design. When it comes to scaling horizontally by stacking more computers, avenues for growth are also currently limited by environmental issues, and again we have no idea how to make computer construction and operation immensely easier on the planet at this point in time. Maybe we'll eventually figure out some new physics that allows us to do this, but at this point in time, that's wishful thinking. On the algorithmic front, realistic simulation of human reaction to drug would require medical knowledge that we don't have today and struggle to collect in some cases (think of the actual rate of progress in neurology/psychiatry, once one looks beyond the hype and realizes that the function of basic neurohormones like serotonin is poorly understood and things like figuring out the basic connectivity graph of the central nervous system are still publication-worthy). And once that knowledge is acquired, it would still need to be translated into a form suitable for extremely efficient computer execution, which is also not a trivial endeavour as you need people with broad medical AND programming knowhow to collaborate. While people do shiny things with neural nets, which could be seen as a way to take the programmers out of the equation, these are ultimately just sophisticated math function fitters, which can only fit a set of functions dictated by their topology (which, again, requires human knowhow to design) and their fitting/training costs are so prohibitive that I am very skeptical on our ability to make it scale to billions of simulated patients on any envisionable time horizon. Of course, as you correctly point out in your video, we should not restrict our thought to computers as we know them. Something more analog based on organ cultures would alleviate many of the above problems. But again, making it scale beyond research labs to a universal medical treatment tool would currently require unrealistic amounts of time, space, nutrients, knowhow and machines, and we have no idea how to avoid this. Another consideration that you did not touch is that for computer-aided prescription to be useful, it would need to reach a conclusion on the timescale where drugs are typically prescribed, which currently can go as low to 30min (typical GP appointment in France). I'm not sure if that's currently enough to even input sufficient patient data into the computer system, so the data would somehow need to already be there (and ideally the simulation would be already started) before the patient even thinks of seeing a doctor. Which leads me to the conclusion that on the timescale that I can imagine, I think there's more hope in improving how we collect, process, share and query the medical data that is already there : daily monitoring, medical records, autopsies, etc. From the point where we are today, I could much more readily see a future in which doctors can have much easier access to anonymized records from other patients who have similar symptoms and bodies and have been trying out similar chemicals, with data on what happened to them. This could be used to make more informed decisions on treatment than we can do today, where gut feeling and random trial and error still plays a major role in the daily practice of medicine. Keep up your excellent videos, and take care of yourself :)
For everyone commenting on advancements in math, there are multiple statistical ways that adjust for risk of an on-going trial. One is midpoint safety reviews done by independent statisticians (not the authoring statistician on the RCT, who has already designed the analysis done for the end of the trial), with a higher degree of uncertainty in performing statistical tests due having fewer data points. If you searching "interim monitoring clinical trial" you can read up more on these procedures. This was done in the physicians health longitudinal study where aspirin was shown to have an effect on reducing myocardial infarction. The study was a 15-year long study that wrapped up 6 months earlier than expected due to these safety outcomes. The second is called adaptive randomization where statistical programs separate from the randomizing statistician weigh favorable outcomes, and start dynamically increasing probability to enrollment into the successful group. A group with 50/50 allocation will see death outcomes favor shift towards enrollment into the other group, while a "successful" outcome (survival at 6 months) will see that shift the weight back to the assigned group. If 15% was such a stark difference already known at the time of both cousins' enrollment, then 1) the safety review boards failed to do their job or 2) there was not enough evidence to prove there was a statistically significant difference. The second is influenced by both how far the results are from each other (75 vs. 90 is actually quite far, in terms of statistical testing) or there weren't enough people participating in the trial yet to prove this. I think this episode was interesting, but I wanted to comment on the other aspects of RCTs, and that there are multiple people along the pathway who make these decisions. Some of these techniques have been made possible with advancements in technology, and also increased awareness of their existence. So I think it will be interesting to see what happens in 100 years...
It is unfortunate that throughout history, the data gleaned from patients dying (including those in clinical studies) has been a prerequisite in finding cures and therapies for slew of diseases and related illnesses. Fortunately, with the continuing advancements in genetic engineering and related fields, along with the new "standard of care " outlined in the video, diseases will in the future be cured proactively, without patients risking their lives as "guinea pigs" in clinical trials. Hence, computer simulations will perform in-silico trials, and any unfavorable patient outcomes will relate solely to virtual patients in the computer's memory. Simply modify the software program, recompile, rerun the program, and keep iterating until the efficacy-rate approaches the highest level possible. A medical revolution is on the way.
First time watching this video but I've listened to it many times while at work (welding, funnily enough) and I find it interesting you used a TIG welding clip at the end because of exactly what you're describing. I tell my students quite often that while Stick or MIG welding are still the two more common forms of welding, TIG is taking over simply due to how many different metals, thicknesses, and how it overall has better weld quality and I definitely tell them to pursue it even if it's just as a hobby.
Very interesting mindset you have. Solving medical issues on a person by person case by utilizing models that can repeat various forms of certain medications, eventually calculating the perfect medicine for their exact body.
THIS IS AMAZING! Well-scripted content that induced all sorts of emotions- frustration, shame, hope, encouragement- and drove me to the edge. An inspiring, fascinating and empowering video, to say the least! (perhaps the best you've made thus far) As a young doctor whose mother recently passed away due to multiple poorly-prognostic carcinomas, I have related to Brandon's mother on an emotional level, and can assert the role of genetics in individualistic care- already proving to be paramount. There is huge promise on a conceptual level. This idea you've proposed is mind-boggling YET absolutely conceivable. The ethical dilemma in the realm of clinical trials is multi-fold and unavoidable by current standards; the analogy to 14th Century medical practice is not hard to perceive, when put into this context. However, I have a question: (I understand the process will not be as simplistic as stated, but it's the end-point which is relevant) Consider this model in place. Now, a patient gets diagnosed with cancer and we enter their relevant data in the system. Even if the system were to run through all existing drugs available and find a suitable, individualistic and targeted medicine for the patient, how long would they have to wait for the results (let's say "macro?"results- efficacy, overall survival etc.) of those simulations (considering anti-cancer therapy- so far- is a given on a long-term basis) before being started in the actual patient? OR in an alternative scenario, where perhaps none of the existing drugs seem suitable (based on the patients' genomics, epigenetics, or even an ideal metadata), how long before we find and start the new and optimal therapy in this patient? I guess what I'm getting at is, unless we arrive at a level where we can analyse the real-time effects of the drug and extrapolate that data to Accurately* predict those "macro" results, the simulation-based results will need time to get collected and then implemented ie; this too might cost time and lives. Having said that, the motive is unchanged - we need a better way to do this. Thank you for your insight Dr., the fact that medical practitioners today are moved by such ideas gives me hope and inspires me to continue in this profession. Hope to work unitedly on this radical mission towards improved medicine
The analogy of the tree and the fire took my mind in a different direction. What if instead of the technology being a newer, more effective model of personalized medicine, it's actually technology enabling greater spread of disinformation, anti-intellectualism, and quackery? What if the tree of medicine is burnt down but with nothing better to replace it? Maybe evidence-based medicine will remain as a reduced version of itself, but the losses it has sustained may allow other less effective forms of pseudomedicine to take hold. Your point about technology enabling us to do more while medicine attempts to restore us to the baseline is a good one, and I think the efficacy of technology (without greater understanding of how it works) in additional to the pervasiveness of science fiction and futurism is leading a lot of people to a form of neo-magical thinking where they expect medicine to be at a similar level of advancedness. That provides ripe ground for quackery to take hold. We're already seeing all of this right now, and if technology gets better, that may only get worse.
WOW!!! I admire your dedication to impart knowledge for people like me. I'm not in the medical field but I find all your videos very interesting. Thank you very much for doing these videos. More POWER to you!!! 👏👏👏👏👏 ❤️❤️❤️❤️❤️
I showed this video in my technology class yesterday, and I didn't realize what you meant about clinical trials being hard to explain until I had to summarize everything you said in under a minute haha I'm a huge fan of all your content and you're such an inspiration for me to keep trying as hard as I can (I want to be a neurologist). Please keep going and best of luck in your career! :D
This is some cool thoughts on futurism I think.. and I think your ideas make a lot of sense, who knows what will actually happen though 😂 So many different possibility's, I guess many we are not aware of at all right now. Love your videos btw
For cancer and autoimmune diseases, in the civilization you described, you could run a trial at or even before birth, based on complete genome sequencing. Run a full set of simulations of the entire DNA and predict all upcoming cancers in that person. Then, since cancer often arises later in life, you likely have 20 or more years to run drug simulations and find the best preventive care for that person
Sounds like one tremendously complex simulation, not that it's impossible. Several things would need to be simulated molecules, then cells also collections of billions of cells. I've a feeling your talking about some kind of super computer
Wow, Dr Bernard , Ive been watching your videos for the past week now and there AMAZING!! I like how you explain sophisticated aspects of the human body in simple terminology for a person like me . I'm learning so much more here than I'm learning at School and it's really interesting too. I whish I could meet you in person , and would love you to teach me more . You're very inspiring , thank you . Keep on making awesome content . Hope you're doing well in these times
Another fly in the ointment: the point of doing blind treatments against a control is to remove the possibility of a placebo effect. The outcome of cancer is either dying or recovering. Are researchers worried that the placebo effect might cause patients to recover from cancer???
It seems to me that in order to accurately simulate a person to test a treatment you would not only have to simulate that person but also simulate all or some of the flora and fauna than lives on and in that person. I listened recently to a podcast episode on the Kevin Rose show were a researcher was talking about a treatment for diabetes based on changing the gut microbiome. She seemed like a credible scientist to my ear. There are so many things living inside us that may be helpful or harmful(or neutral) in general and also may affect how drugs work.
It's exciting to imagine such a time. We would be able to diagnose and treat disease at an early stage. I've seen ads for, Forward, and the changes my own medical provider has made and it seems like the beginnings of changes in the system.
You are such a inspiration to me .fun and nerdy equally . Your presentation,dedication and hardwork truely inspires me to the wonderful field of medicine I follow both of your channels and heme review is very informative. keep doing this and your second channel definitely deserves more subs.
Yeah. Strange how the majority of what we know about frostbite came from the Japanese experiments during WW||. It does take pretty insane cruelty to get "good data."
I know this is an old video, but this was very fascinating to me. Both from the prediction side and the iterative medication approach. I am a gear head, and just like medication, the knowledge both of combustion, fuels, and metallurgy have increased in orders of magnitude. General Motors used some form of iterative computer-aided-design on the C7 corvette, with "more than 10 million hours of computational analysis were conducted on the engine program" (Mlive, 2012). Another way to look at it is weather modelling, where we have, with what a casual observer would likely proclaim a fairly good understanding of weather. This understanding has enabled models that can, at a reasonable accuracy, predict weather patterns. The thing I'm curious about, as a non-medical-school educated person, is the "bounds" of the simulated person. Having a genuine interest in medicine (Obviously I wouldn't be here if I wasn't), I'm curious just how far it could go. For example, I've read where the various pathways into which medication is broken down, can greatly be affected by the foods eaten - grapefruit juice seeming to be one of the big offenders, or dairy products like with MAO inhibitors. It also seems to me, an admittedly insufficient-for-serious-medical-discussion education, that gut bacteria seems to be gaining popularity as a cause/treatment for certain disorders. I know that the classical psychological question could perhaps come into play as well, genetics v. environment. I would assume the majority of doctors would lean towards genetics, and I certainly would, but again, I wonder if perhaps this genome-based human-simulator would be riddled with constants that would need to be modified based on diet, environment, and so forth. I look forward to checking back on this and lots of technology when I'm down to my final years. I pray that in my lifetime, I can look back and say something to the effect of "I can't believe for years we were horsing around with serotonin for mental health, and all we really needed to do was xyz". Regarding clinical trials. I have to wonder if all patients electing to go forward with objectively/quantifiable "real" results, should be in clinical trials. For example, many diseases are quantifiable namely, how long one lives post treatment. Therefore, when a patient goes to a doctor for widget cancer, for example, their doctor gives them a list of options. Investigative medications (What we would now consider clinical trial candidates), along with other existing options. The patient makes the decision, and from that point, they become a data point. Yes, it is not a blind in any way study, but in cases which can measure distinct outcomes, I would argue double-blind is not needed. Weight loss (Which is most definitely related to environment/attitude), pain tolerance, mental depression, etc. would in my mind fail to meet this standard, but cancers, and other clear-cut "binary" disorders (either it clearly worked or it didn't) would. Obviously patient privacy would have to be anonymized, but just imagine how much faster trends could be found if "24 and me" type data were to exist in every cohort - not just those with enough disposable income and education/curiosity to actually participate.
Hello! I'm actually working on a research team from Texas A&M that's focusing on some of the same topics you discuss in this video! I've been watching you since your first diagnostician video, and would love to get your input and thoughts on my team's research, if you're up to it!
Outstanding talk. Hopefully as Artificial Intelligence and rapid DNA sequencing technologies mature, they will join to facilitate the fantastical advances in personalized medicine you discussed. Modern medicine has a short history, but as data is amassed on current treatments, it seems the additional data points gathered from a control group would be less significant.
Well there is something we can do in some cases at least: take samples of the patient's cells, grow them to model the disease (typically done from stem cells) and test the drug on them. The reliability of that is of course unknown for now, but we should do it for two reasons: for now, to "have a hint" on the efficacy of a treatment, and for the future, to have data to know whether it actually works as a prediction method.
One of the advance that we should make it happen, but hasn't yet, is the ability to digitise case data from millions of patients being treated every year, worldwide, plus the data that is on paper and ink, locked up somewhere in a dusty basement, in a unified, accessible, yet somehow also totally private and confidential, way. There is a lot of talk about AI and what not but those talks never address the real hurdle of not having enough data to begin with. We have so much data of just not what went right but also what went wrong. This should increases the n number of clinical studies to much better numbers than the hundreds or thousands per trial we have right now. If there is one thing I want a national service to be used around, would be to provide some rudimentary health education (which will be useful to everyone anyway), and get young people to sit down and digitise the data that is on paper.
Great insights! I really appreciate your genuine love for medicine and the patients. It is clear that you put a lot of thought into how medicine is done today. You are talking about improving medicine by utilizing technology to reach precision medicine. I am sure a lot of other people and doctors like you have thought about ways to provide precision medicine. Somehow, I believe technology is a must to reach this! There are limits to the human mind that a computer or algorithm can do for us ( meaning do something faster and feed on much more material than we ever could). Very clever and well-thought video.
I was bingeing all the videos on your other channel and the thought came to mind: why don't doctors have an online international database, so that even "rare" cases as documented and a doctor could look up symptoms and know what to do
Some people have been sort of doing this for certain rare and genetic illnesses, creating a network of docs sharing info on their patients, this has helped some people get diagnosed with rare diseases that otherwise would have been missed or misdiagnosed. As much as I feel social media is a bane on society, it has helped make inroads into this
22:00 i think, by the time were accurately able to model this, were also accurately able to predict and create new forms of treatments the same way, without having to manually input what were wanting to administer to the real patient
I was reading a paper other day, how with this medicine system it was not possible to fix even a AM/FM radio (it was a paper on neurology). You really need to have systemic understanding of the things. For example, for an engineer, there's a top-down model of knowing how to construct things. On human medicine, the models they use are pathetic, in terms of simplicity, they are just too simple, to linear, and its like trying to create an radio without the laws of electromagnetism pinned down, you will never be able to come up with an radio by randomly trying shit, not unless you're willing to way billions of years. How much computing power would that be? immense computing power. At least in biology studies they study chemical path-ways, everything comes from chemical path-ways, so there's that, the basis of biology is physics, but that's bottom-up. Even thou I don't believe a top-down approach would truly be possible with any biological system, as there are no designer (obviously, if there were, it would be so much easier to reverse engineer the human body), its still possible to do systems modelling. There must be a computational way to simulate it from the basics. Or perhaps just simulate the universe itself, as its kind of easier. You plug 1024 qubits, and there you are, you can simulate matter.
Something that's disturbed me about clinical trials is how my now husband's experience was participating in phase 1 trials. We were dating at the time, and he got paid very well for participating. However, this compensation came at a cost, and thus the trials tended to invite desperate people. Some people, like him, were just college kids with time on their hands in the summer and wanted some extra cash. A lot of them, though, were the homeless and other desperately poor people. The more serious the drug and the longer the trial, the more they would be compensated and the more they risked their health. My husband didn't do the more risky trials, but he did test one sleep drug that made every single person in the trial have unimaginable night terrors. The participants would be locked in the facility together for days or weeks at a time and couldn't take anything in with them other than the clothes on their backs and a cell phone. My husband couldn't even bring in his chap stick. I'm also not saying that I have a magic way to get rid of this system, but there is an ugly underbelly that we could work to eliminate.
I enjoy your videos, I appreciate the way you illustrate points and poise questions that I can understand without having medical training. Thank you. Which French artists created those works btw.
Generic is the name of the substance for example the generic name is alprazolam but the brand name is xanax, it is the same thing! Just different producers/companies that manufacture it.
Not always. Different additives, etc. That's why drs have the option to daw on scripts. If the dr writes that, it means that med be given and not a generic. Some patients cannot tolerate any change in compound, additives etc
I know that with some time release medications, for example bupropion, the release rate can sometimes be less consistent depending on the manufacturer.
10:03 we got war planes, 10:06 We got that, we got the little robot that slides around the floor and cleans it. 10:10 Drones delivering mail, 10:15 And we got some scientist right now talking about using computers to boost the human brain. That artist wasn't too far off, I give it a 10/10 and can confirm the artist can see the future.
its so disturbing that medicine even today is as advanced as math was in the first millenia. trial and error, no predicting, no big and stable framework to represent the chemical reactions of drugs and viruses in the body, complexity and chaos rules. lifetime doctors can barely predict effects of drugs administered and are sometimes surprised by adversities. i understand how complexity makes the simplest of considerations become unfathomable. why dont medicine, higiene and public policies focus on prevention instead of therapy... and then we enter politics...
Maths is very simple in that it is a process. Medicine has an unknown number of variables and the fact that it deals with people rather than static variables. That's why it's hard for medicine fo advance.
Shooting blindly! Big profesor, and awards winning doctors, they only seem like fraud. Milions and milions, spent on worthless research. I'm disgusted, how some of them , pretend they are more then regular humans, when actually, are just playing a part ,in a falsely theatre play. :( :( Disappointing!
I totally agree with you on the "prevention over therapy" framework. But keep in mind that trial and error is the underlying mechanism of prediction, so it naturally just has to get better and better. What does that mean or imply? The fact that we can't talk about knowing something perfectly, with an 100% accuracy rate. That would be nonsense from a statistical point of view. But every single detail that medicine (or science in general, for that matter) researches will be 'measured' by using confidence intervals. Yeah, the 95% has 5% error rate, but that can really help us getting over some Type II statistical errors (let's say that we have a 99% confidence interval, and only 1% error rate, that actually implies that some of those 99% people that NEED treatment will NOT get it, and here is where it's getting dangerous). That's why RCTs exist, to account for false postivies and false negatives. But, at the end of the day, prediction is not about perfection, it actually is about getting closer and closer to a consensus!
Thats a beautiful vision of the futore Doc, and I really hope we can get there. I really hope this video is a self fulfilling prophecy. And good on you for dreaming.
The patients should be able to decide, and the data should speak for itself, a new method should emerge as superior both in patient preference and outcome
You had a throw away comment about health plan administrators not knowing the difference between generic and name brand medication. Can you please expand on that.
In the USA insurances sometimes require an authorization for a medication. if you use the generic name in the script they sometimes deny the authorization, not realizing that it's a medicine on their formulary that's on their list by brand name instead. it can take several days and multiple phone calls to get this corrected
no, it's the same in reverse sometimes with a prior auth. the rx will have the brand name and they only know generics on their formulary. but still, because an admin couldn't be bothered to look up a medicine's name, they lock a patient out of medicine for several days and force nurses and doctors to keep calling back?
Heme Review Hey. Former “health plan administrator” here. At least with the company I worked at, agents designated for authorizations and referrals are the same as the agents who answer the phones to tell insurance members what their ID numbers are. There was a very large lack of training done to handle these calls. Not only that, there was a very large negative workplace view of providers. There’s no deals going on, just lots of incompetence in both the agents and the people who trained them.
English subtitles avaIlable ✅
@ you clearly don't work in research. One should not throw judgements like that on a field which is not yours. Why isn't there a cure for X? Well because it's a hell hard to find it. And it's not enough that a handful of willing people try shit on themselves, you need to make a controlled test to be sure you won't be hurting anyone with it. That's how it works. Of course if one patient is terminally ill and there's a vague possibility of a cure from something reported by just a few people, and nothing else available, they will let the patient go for it.
But the reason it's difficult to cure stuff is that life is a complicated thing and we're no gods. And human bodies don't come with detailed how-to-repair instruction booklets either. I see that it's hard to accept, but it's not like you have a choice, that's how it is. I assure you every single researcher is doing his/her best to find out something useful, it's just a hell harder than simply looking into a microscope and thinking stuff out. I speak from experience.
I wish you a good day.
@Heme Review How much healthcare can happen without tech, like without electricity,
running water, stable buildings, factories that make drugs, chemicals in
laboratories, easily available food, ability to transport patients to
doctors and supplies to hospitals in time, etc.
Would it even make a difference if people didn't have access to shelter,
enough safe food, security, heating?
Healthcare is built upon technology, and cannot function without. Saying
tech isn't needed or important is extremely narrowsighted, ignorant and
factually wrong.
Moreover, "technology makes our lives easier" translates to collectively
having time and resources to even care about ones health issues instead
of being preoccupied finding food, hiding from predators, not freezing
to death, etc. Yes, fire and houses are technology. So is AI which saves
lives by modelling situations and predicting disasters before they
happen. So is everything else.
I like your videos a lot, but that does not mean you get away saying nonsense.
If computation capability really gets that advanced, enough to accurately simulate human physiology, I guess it should be capable of simulating human societal activities, we can just run policies in simulations before actually implementing them.
That's why hela cells are what's up. Plus they have a sad book about the woman who got a horrible virulent cancer.
3:27 anybody noticed that lonely adenine.
That hair be going to places
He do be going for the anime protagonist doctor look doe
SIGSEGV Am I a joke to you?
@@SIGSEGV1337 He's working on his Black Jack Cosplay.
I love the hair! It makes a statement. 😄😄👍👍❤
Wait I know you from discord, from which server were you?
Hearing a medically informed person rant about the future of the medicinal meta is some content I never knew I needed.
As someone who'll start studying biochemistry at university this fall, I can't express how much I love the content that is produced on Chubbyemu and Heme Review, there is literally no other channel on youtube where I have the bell set to notify me everytime anything happens with either channel. Keep it up!
Heyyy congrats!!! I graduated undergrad with biochemistry a couple years ago. It was a wild ride but so worth it. Good luck, young Padawan!
@@EsspressoStresso hello fellow in medicine industry, intellect is a luxury in a society
I didn't major in biochem, only in chemistry in general, but I loved my biochem courses. These videos also hit me in all the right ways (though they sometimes cause my anxiety to flare a bit). Best of luck to you, and I hope you enjoy it!
man i'm doing bio (+ compulsory chem) in secondary school, his content is really interesting and i can sometimes apply my (albeit basic) knowledge to the case studies, which is pretty cool.
I'm going into my third year in biochemistry. Piece of advice: don't mess around when it comes to studying metabolic pathways. They're complicated and require a lot of time and effort compared to most other fields.
"Where do you see yourself in 10-20 years?"
Me, a cancer survivor who now has a higher risk of other cancers: "Having cancer again, probably."
😢 don’t think that way. It will become a self fulfilling prophecy. I’m glad you beat it. Stay positive :)
@@Polylowshoes A self fulfilling prophecy means I would have to intentionally give myself cancer though lmao
@@mayanightstar Have you heard about the sugar bomb treatment? It seems like a safer alternative to chemotherapy.
@@blakops000007 Dude I thought you were nuts but this actually kinda looks legit.
Next time someone asks you at a job interview where you see yourself in 5-10 years, "I'll probably have cancer."
Probably won't get the job, but it would be interesting to see the look on the interviewers face.
I mean this as the highest compliment from a fellow person of science. "You are such a nerd!" :) Your enthusiasm in your chosen field is an inspiration to me. Thank you.
99% comments are memes
The remaining 1%: also memes
lets get this to 69
You do not understand the definition of 'meme' if that is what you think.
My mom was held off on treatment for two months while they tried to see if she was stage 3 or 4, and to see what the best treatment would be long term. In the long term looking back, it didn't matter. It was a progressive cancer. But at the time, my mom, sister, most of my family was pissed and blaming the doctors, especially after she died. Would getting treatment sooner made much of a difference? I honestly don't know. Maybe, maybe not. But I can tell you from personal experience, those months felt like years. I don't feel anger at the doctors anymore, but many family members still do. With covid, those family members have little to no trust that the "right" actions will be taken, despite us not knowing either. I miss my mom a lot, but I hope her death meant something to the science community. She had the worst number of leasions on her liver they had ever seen on a non drinker. Over 40, very deep,very scarred leasions. Her death was a combination of her body being too weak to fight infection, internal bleeding, and organs shutting down because her body couldn't fight anymore. Diagnosis to death was 5 months. It was very, very short with almost no time to react, but I'm also greatful. It limited the time she suffered.
Sorry for your loss
So sorry your family went through this 💕💕💕
Wishing you healing. Your story is a good reminder that sometimes doctors need to prioritize patient relations over hard data (or their quest to get clear on what the data demands), because alienating people can have waves of negative effects that no one could have predicted.
Get gene testing done to see if you’re at risk of the same thing. You can likely prevent it if it’s not too stacked against your favor. At the very least you can delay it. Sorry to hear about that.
I'll never forget my twin brother dying of ALL (leukemia), it was right on the cusp of CAR-T being available, 2014. I remember calling everyone involved in making that treatment happen, and how futile it was trying to get him that treatment. It felt like one of those scenes in Breaking Bad where someone pleads for their life but then gets killed without hesitation, with no emotion, no care at all. They expected us to be ok with him dying, knowing that he was not going to be able to get what was a game changing treatment. It was all about possibly skewing the data of the study, then of course, insurance not wanting to pay for what was likely the best care for him.
Yep - your experience seemed to mirror the video exactly. Condolences to your brother.
Sorry to hear.
That's vile. It's exactly what this video is talking about
Chubbyemu videos = what keeps me going
Still my favorite UA-cam video of all time. It's extremely underrated and deeply inspirational to me. Instead of thinking "this will be available in the far far future", I'm thinking, "who is starting this work now?" I'm excited to learn more about the research that is being made towards improving the future of medicine, as described here.
I agree that personalised simulation-directed medicine is the natural distant future for the field. It will probably come gradually as personal genomics and epidemiological data gets combined. Similar approaches at the individual tissue level have revolutionised oncology already. There are many practical difficulties though, data at sufficient scale and resolution being one of the more thorny ones: Ideally you would sequence every single human at birth, centralise their medical records throughout life and take every test result, every piece of data from their phones and fitness trackers, every specimen collected from them for analysis and throw every single measurement we can devise at it, then after their death sample all their tissues and collect every piece of data the currently available technology can provide and store it in a huge database. A dataset like that would provide the foundation to the revolution in general medicine that you are talking about and I think it is something we should invest in as a species as a gift to our children. It is almost criminal that autopsy is rare now days, the standard of death care should at the least be robust high resolution imaging of the body before disposal, if not complete sampling and preservation of as much data accumulated by that lifetime experiment of evolution as possible.
Of course the ethical, cultural and privacy considerations of collecting that data, the costs to implement it and the discipline to continue to augment it as technology progresses would require cooperation of humans at unprecedented levels, across all scientific and engineering fields and at all levels of government. The benefits seem to justify the costs, on humanist grounds if not actual financial grounds with the eventual reduction in mortality and morbidity and the associated improvement in GDP. Of course many might argue that the technology (or even just ideologies) that would be born from such an endeavor can be subverted into some very dark directions!
The other big practical problem is the compute required for finer and finer grained simulation of a complete organism. Moore's Law suggest it will eventually be tractable to do molecular simulation of all biological pathways, of a complete cell and maybe eventually tissue and whole organisms. There is plenty of benefit to be found in more primitive models that are just statistical black-box behavior of cells and tissues with particular mixture of alleles and that can be continuously improved as compute grows and may be the most practical anyway after lower level simulations to establish hierarchical statistical models. Now a lot of rats and people are going to die to produce the verification data for the models. People are already dying so as to my previous point, it seems an enormous waste to not learn everything we can from the artifacts of their lives (one of the biggest being their corpse). I also think this is where tissue engineering and production of fully-human model organs and even complete (but perhaps anencephalic) bodies would be a natural direction too, at least in the medium term for model construction and basic research. Right now complete simulation of a single receptor, a drug candidate and all the jiggling water molecules is just barely practical and nothing like real-time, a fully molecular simulation of a cell is so ridiculously difficult it seems for the foreseeable future that using the universe to do the simulation (i.e. doing molecular scale experiments in vitro rather than in silico) and pushing on the technology to automate shotgun approaches to drug candidate studies using personalised engineered tissue systems would be a good path. There is no reason to do it all in simulated physics if you can do it in real physics, the challenge is assembling the experiment and reading out the results. Fortunately the machinery of life already can mass produce all the components and assemble them for us, all we need is to wrap that in a layer of digital control and measurement.
So I guess in summary we are already heading down a path towards something like your hypothetical future and the biggest resistance to progress is going to be human factors around privacy, death rituals and science denial. I agree that social forces associated with a major crisis may change attitudes over short time frames, otherwise gradual attitude changes by careful policy design (in particular education reform) and natural attrition of dissenting individuals will be required.
Moore's law - will it continue? Maybe not but I worked for a microchip company research centre in 1985, pre university. There were limits of miniaturisation because of atomic diffusion in the silicon devices but somehow there have been new designs to keep the density rising and new technologies like flash memory but I note that flash memory SD cards stopped at 1 Terabyte, first shown in 2015, 5 years ago. Doubling has often taken 1.5 to 2 years in capacities: hard disk drives for example from 20Mb to 2Tb since around 1990. That's 46% a year, or x2.15 every 2 years. Fascinating but I think it will stop unless new tech is found, like optical computing, which was in blue sky very basic development even in 1985 but seemed to go nowhere (like nuclear fusion went nowhere, sadly). I really like these kind of videos.
Hey man how much you'll charge to write my papers?
Sounds like the medical version of the short story of Ray Bradbury's "There will come soft rains". You should read, you'd enjoy. ☺️
Thanks for your perspective. I appreciate it a lot
Best comment so far. I personally feel that it is a very distant dream because people will not put the money and resources into accomplishing this anytime soon. The cost is the main barrier. Just getting your genome sequenced is something that most people would never do because of the cost, and its limitations. Compared to other scientific endeavors, I feel that medicine is just now hitting its golden age in the past 50 some years. The amount of knowledge we still lack is staggering, imo
I... was REALLY not expecting that phone background 😂
4:43
Interesting fact: to properly blind a study, you want to give the control group an active placebo, one that mimics the side effects of the actual drug. This makes it less likely that the placebo effect kicks in to support a less effective medicine. Antidepressants didn't get this kind of study.
What are you trying to say exactly? Wouldn't this mean Antidepressants are harder to get to market because the placebos they compete with have none of their side effects?
@@justindie7543 I accidentally hit cancel after writing down a huge reply (I feel dead inside now), but basically, the side effects in the drug group enhance placebo effect, thus making the drug look better in the results. Give the control group side effects and this apparent advantage disappears.
All the drug trials used to justify psychiatric drugs being pushed on the market have been designed to make the drug look effective, essentially. There's HEAPS of money to be earned by selling a happy or chill pill.
@@centralintelligenceagency9003 I hate it when that happens. Sticking it in a simple text file is good and then copying band pasting. Or on a phone, I write a phone text and send it to myself but I can also look at it later because it's almost impossible to find your own comments later on YT.
@@davebellamy4867 I always think of that once an accident has happened. Hindsight is 20/20, I guess.
@@centralintelligenceagency9003 Placebo control groups do get side effects, and those side effects are usually similar. In some studies, the placebo group gets MORE side effects than in the drug group.
You make a very good point of switching everybody over to the drug trial too quickly. I never thought of giving up that baseline so quick could actually be terrible and problematic.
I’ve recently discovered both the main channel and this one. Really like the way you present information.
As a premed student, I can't tell how great this video expanded my understanding. I choose to become a premed student because I love science, more specifically the feeling of understanding the laws of the nature, and I think it's awesome that I can apply those knowledge to help others. But this video warns me the truth of modern medicine, that don't assume we understand thoroughly, we still can't model everything as math or physics. But doctors still need to fulfill their duty, amid the complexity of disease, and the uncertainty of treatment. We can't tell which treatment is best, so the only thing we can do is to try all of them, while dealing with the associated ethic dilemma. No treatments, if followed the rule, is wrong. The only thing regretful is we don't have enough technology to confidently treat it.
I am a premed student that also loves technology and science, and this videos open my eyes and say "gosh, if primitive man knew good or bad food by trying it, and today we know some medicine are good or bad by trying it too by ourself, then we are not that far from primitive man".
But i think there is some hope. Today people try to search for a new drugs by doing simulation, today some people try to develop quantum computer, today people read and determine our whole sequence of DNA. It might not be that far from "that" future.
In some ways, we are still cavemen. Modernity and the access to educations are not a sign of intelligence.
"We're basically cavemen' is another variation of 'people are dumb', which most truly reflects on those holding the opinion.
Dude man doctor bro your analogy between plague doctors and bloodletting to modern medicine pharmacology is something that I have been trying to explain to people for a long time and to hear it come out of your mouth gives me extreme validity in my beliefs I just hope that I'm around for the next wave of treatment for us because filling our bodies with chemical poisons in the hoping it does what it's supposed is barbaric. On the other hand I freaking love your channel I love your character keep up the wonderful work very informative👏🤘🖤👀😉
They’re still bloodletters lol, I’ve worked in hospitals for 40+ years and they draw soooooo much blood for lab tests it’s unbelievable. That isn’t good for your immune system to constantly have blood drawn when you’re really ill.
Thanks!
thank you!
Watching these videos, along with the ones on your main channel make me want to go into the medical field ngl. My mom is a cardiac RN, one of the best on her floor.
Do it! I’m going to be a nurse. Schooling is hard work but if you like what you are doing , it is fun. I can’t wait to do a job I enjoy.
It’s probably not anyone else’s place to tell you whether you should do it or not but yourself. Be educated on multiple fields so you can actually see what you like, good luck.
Heme Review>Meme Review
CHUBBYEMU>Everyone else
ChubbyMememu
@@DragonLaggin chubbymemu
Last time I was this early Chubbyemu had short hair
So, several thoughts that come to mind while watching this video that I wanted to share with you:
1. If we collated all the information that has been gathered about the current standard of care into a database that is validated by an organization such as the NIH or the NSF, would it be valid to use the information in that database as the control of the clinical trial in order to compare it to the trial drug being tested? I mean, surely, if the database is large enough and diverse enough (which, if we've been running trials using dacarbazine for 40 years, there would likely be enough data to meet that criteria), it'd serve as a good substitute while still retaining the validity of the study, right?
2. Your idea of being able to simulate a hundred thousand humans in real time in order to run clinical trials is an interesting one (even if I can't begin to imagine how much computational power that will take, especially since we can't even begin to simulate an entire brain, only a few thousand neurons at the most in supercomputers), but I think the idea doesn't go far enough. Why stop at just real time? Why not accelerate time within the simulation as well? After all, the higher the time compression factor, the more trials you can run in the same time period. Albeit, this would take even more computational power, but being able to find treatments with high efficacy in a matter of weeks, days, or even hours would likely make a world of difference.
3. Personally, I believe that the production of these tailored medications can just be made at local pharmacies with the right equipment and the right expertise. It'd save people from having to buy the (likely extremely expensive) equipment, and allow those who can't afford it to still have access to the medication they need. The pharmacies would also be able to collect data on drugs that might be similar enough to mass produce with little to no impact on its efficacy, therefore driving down costs.
Thanks for the response! I realize I misspoke when I said real-time. You’re right, it should be done all in parallel, and much faster than real time, when possible. The reality is i think this would look quite a bit different than we think of it today as we’re somewhat limited to imagining technology in a form of how we’ve seen it during our lifetime. And to that, the idea of a pharmacy may be fundamentally different then, than how we have them today! It may serve a different purpose between now and then. Always interesting to think about how it all may turn out! Thanks again!
@@HemeReview I'm not so sure about the idea of a pharmacy being fundamentally from what it is now, truth be told. If you look back at history, you'll find that Apothecaries served more or less the same purpose as pharmacies do now. Albeit in a significantly more primitive capacity due to medicine not being advanced enough. It's essentially been a drug store for centuries.
The only reason I can think of the idea of a pharmacy being made different, is if it ends up being obsolete due to nanotechnology advancing enough that it makes most medicine obsolete. After all, what use would Antibiotics, antivirals, anti-fungals, etc. have when you can just have a nanomachine shove a C3 protein into a pathogen or cancer cell, and let the complement system do the rest? Or have nanomachines repair any damage done to the body?
People reminisce that one of the hallmarks of the 20th century was the dawn of the computer age, and that the 21st century will become the "Biotech century." I believe that mind-boggling technologies are on their way... and that developments like CRISPR are just the beginning.
The idea of building a (simulation) model of a human is not so far away, and I don't agree with "not in my lifetime". This is not a binary situation where we either don't have a model or we have a model. Such models have been built, and some are already available. Obviously, they have much poorer predictive power than we wish they had, and they are not as general as we wish, but they are gradually improved. Even machine learning models so prevalent today have some predictive power, and some of them can help answer questions like "how is this new drug likely to behave for a human characterized by such and such properties". So - this is a gradual process and models are getting better and better every day.
@David C point 2: Yes, obviously simulation time will not be related to our clock time, so the simulation may be slower or faster depending on its desired accuracy and available computational power. One does not "stop at just real time" or "accelerate time" because simulation time depends on available computational resources and precision.
Another possibility (apart from simulation) is to build more accurate and complex in vitro models, and again, they exist and are continuously improved. They at least allow us to test drugs without risking human lives.
When the "Reminder: this is absolutely not possible today" text came up 😂
What if we are just in-silico simulations the real humans are using to test out effects of medication?
Fabulous video, like some of your early philosophical kind of videos such as why you can't be who you want to be, etc. Please keep them coming, absolutely brilliant.
Very interesting video, nicely made.
But yeah, that trial? Sure, we need a control, references, a baseline, I get that.
But you'd think, that with 40 years of really only one treatment being able, we would have used some, just some of all that time and all those treatments to, you know, figure out that baseline in advance? And if the success rates are so bad you can then just switch over to the new and likely better treatment and still have two sets of data you can properly compare.
But instead we consigned all that data... into the void, instead making a control group doing the very same thing we've been doing for decades, to get the very same data again? Why though. I'll take a guess and say that yes, in the future we'll look back at that and call this a totally backwards waste of perfectly fine data in favor of watching a couple more people die.
It’s a double edged sword. Since the medicine in that trial appeared to not have a durable response as a mono therapy in the long term. The second downstream blockade has a longer survival attached to it, but in the metastatic setting, it is still low. I agree. We’re doing things now that will be seen in the future, like how we see blood letting today
@@HemeReview The trial design in specific is a data science problem. One we can, and eventually will figure out I wager, but it's not trivial for sure.
Time will tell when we actually get there. A couple decades or half a century I'd assume.
Hi doctor, I'm currently studying Pharmacology and you bring up some good points. I would recommend reading Carl Jung's book Aion. The first chapter, Phenomenology of the self, in particular, is a great standpoint regarding drug efficacy as a necessary evil. As for medicines psychological understanding, Charles dickens - Great expectations - gives a good insight as to why people egotistically think about the future (how it can be misleading) and how it will plan out, without realising the psychological expectations they place on themselves. This ends up a crushing reality to some.
I love your videos, please keep up the great work!
Im stunned at this mans ability to speak on these topics so well.
This video deserves far more views you have incredibly informative yet interesting content. 👍
Chubbyemu:"Take for example a cancer patient on PD1 checkpoint inhibitor in 2020, what happens if they get COVID-19? While rare, both of these could cause cytokine release syndrome, then what do you do?"
Me, having no medical knowledge whatsoever, trying to keep up with the most basic explanations:"Hmm, yes interesting point you are making there, then indeed what do you do?"
This is an incredibly underrated video. I'm definitely going to share this!
You make great videos, I love medicine and pathology. I follow a lot of doctors but you just have a way to tell a story are you a really good speaker you can draw people in and paints a great picture in the listeners head. Just wanted to say I love both of your channels
I’m so torn, I love everything you create, but within the last year of my life this severe, visceral anxious/paranoid sense of impending doom consumes me sometimes when I start watching things describing the inner workings of the body in detail. I was never like that, but now it’s just getting worse and worse, or it’s not there at all. Probably just fear of death setting in differently as I age, though I’m 25, I’m still aging haha
As dumb as this might sound try going to therapy and seeing if you have an underlying anxiety disorder. It may get worse for you and being proactive with these things only helps.
fuzzyfry not dumb at all. honestly, I really appreciate you even taking a moment to suggest that, you could be any old shmuck but you are absolutely right, so I don’t care. Unfortunately I don’t know when I will be able to do something like that again, it’s not really in my cards right now, I loved my psychologist 10 years ago when I was 15, but my mom kind of gas lighted me into thinking it was pointless, because “nothings wrong with her kids”. Now my sisters been dead for a couple years from a drug overdose and anytime I try and vent to my mom about anything she gets all defensive and takes any problem I’m going through as a personal attack and tells me I need to talk to somebody because she doesn’t know what to say. Just makes me feel like I’m a problem. I’m almost 26 and I’m stuck back at home for now, having been back and forth from jobs and apartments instead of doing what’s right for me, out of this deep seated guilt. It’s fucked. Sorry to explode all of this, not even directly connected to what I was saying, it just frustrates me a lot. Therapy was great, and my particular guy back then was so cool, but I literally had to force my way into it and play up my problems to the point that everybody was seriously concerned for a while. Now I’m stuck, and I’m just really tired. Like on a profound level. This quarantine stuff is nothing to me, my life was already a socially distanced, quarantined, fever dream of starvation and sleepless nights. Literally. The last year has been for me, what has been mandatory for everyone else for a couple months, no exaggeration. The difference is now I’m never alone, but the people I live with make me feel absolutely worthless in this passive aggressive way that will make anybody lose their mind. So everything looks “perfect” on the outside, but it’s really bad. The American dream in action. You don’t have to reply to this, random person, but know that I really appreciate you and your time taken to look out for a stranger. You must be a good person.
@@young-stove I try to be decent because I totally get what you are going through. If you want to chat and get a life line you can find me on fb my name is Sadie Fry I live in Oregon. Mental health Master here on UA-cam also has a private discord for those needing support or who want to support others.
fuzzyfry aw you are too kind, thank you again, seriously, this has made me feel a bit less alienated. I know very well I’m not alone in my feelings, but sometimes what you feel overrides what you understand. It’s funny that the way other people, people in my life, have suggested therapy to me, but in a way that’s very aggressive and for all the wrong reasons. Like you need medication so you’re too sedated to confront me anymore. I realize some people are in need of some kind of medicinal intervention, even if only temporary, depends on the nature of their struggle and how rooted in reality it is, I know some people go completely off the deep end and the people in their crosshairs genuinely had perfectly healthy relationships with them prior to that, and sometimes everybody except the person with the “problems” just pretends everything’s great. It’s complicated. I’m normally a person everybody else can talk to in depth about these things, but in my current environment I become a monster and I can’t function in any basic way. I’ll be able to move to a much better part of the world with people that are better for me in the next year, hopefully, so I’m clinging to that, but it’s still very hard. I’m deliberately going on and on about this in the hopes that it may be helpful to somebody else that may be feeling something similar, might help them realize something important about their situation in some way. But again, thank you for taking some of your time to respond, I got rid of facebook about 6 years ago, but I’m definitely considering the resources you shared with me. I’ve been having a lot of nice interactions with strangers online lately, it’s been very refreshing. This is the least toxic UA-cam comment thread I’ve ever seen or participated in haha
Yeah I get what you mean man. Kind of makes you depressed to know that life can be destroyed seemingly at random by disease, and there’s so many things that can go wrong with the body that it’s a bit unsettling
Great topic, awesome presentation, thought-provoking. Thank you for thinking this out!
I’m a researcher in neuroscience and I love your channel!!! Thank you for all the content!!! :)
I work in phase 1 cancer clinical trials. This was an interesting watch!
Thanks for sharing your thoughts !
Speaking as someone coming from the computer side of things, I'm pretty confident that the kind of simulation that you are describing (billions of patients simulated millions of times) is not going to happen in my lifetime, due to physical limits to how tiny we can make logic, slow rate of scientific progress, and lack of a clear path for immense improvements in either of these areas.
On the logic front, we are currently around 70 atoms/transistor and have no clear path for either making transistors smaller than 1 atom at comparable density, stacking lots of them without overheating, or replacing transistors with an immensely superior design. When it comes to scaling horizontally by stacking more computers, avenues for growth are also currently limited by environmental issues, and again we have no idea how to make computer construction and operation immensely easier on the planet at this point in time. Maybe we'll eventually figure out some new physics that allows us to do this, but at this point in time, that's wishful thinking.
On the algorithmic front, realistic simulation of human reaction to drug would require medical knowledge that we don't have today and struggle to collect in some cases (think of the actual rate of progress in neurology/psychiatry, once one looks beyond the hype and realizes that the function of basic neurohormones like serotonin is poorly understood and things like figuring out the basic connectivity graph of the central nervous system are still publication-worthy). And once that knowledge is acquired, it would still need to be translated into a form suitable for extremely efficient computer execution, which is also not a trivial endeavour as you need people with broad medical AND programming knowhow to collaborate. While people do shiny things with neural nets, which could be seen as a way to take the programmers out of the equation, these are ultimately just sophisticated math function fitters, which can only fit a set of functions dictated by their topology (which, again, requires human knowhow to design) and their fitting/training costs are so prohibitive that I am very skeptical on our ability to make it scale to billions of simulated patients on any envisionable time horizon.
Of course, as you correctly point out in your video, we should not restrict our thought to computers as we know them. Something more analog based on organ cultures would alleviate many of the above problems. But again, making it scale beyond research labs to a universal medical treatment tool would currently require unrealistic amounts of time, space, nutrients, knowhow and machines, and we have no idea how to avoid this.
Another consideration that you did not touch is that for computer-aided prescription to be useful, it would need to reach a conclusion on the timescale where drugs are typically prescribed, which currently can go as low to 30min (typical GP appointment in France). I'm not sure if that's currently enough to even input sufficient patient data into the computer system, so the data would somehow need to already be there (and ideally the simulation would be already started) before the patient even thinks of seeing a doctor.
Which leads me to the conclusion that on the timescale that I can imagine, I think there's more hope in improving how we collect, process, share and query the medical data that is already there : daily monitoring, medical records, autopsies, etc. From the point where we are today, I could much more readily see a future in which doctors can have much easier access to anonymized records from other patients who have similar symptoms and bodies and have been trying out similar chemicals, with data on what happened to them. This could be used to make more informed decisions on treatment than we can do today, where gut feeling and random trial and error still plays a major role in the daily practice of medicine.
Keep up your excellent videos, and take care of yourself :)
For everyone commenting on advancements in math, there are multiple statistical ways that adjust for risk of an on-going trial.
One is midpoint safety reviews done by independent statisticians (not the authoring statistician on the RCT, who has already designed the analysis done for the end of the trial), with a higher degree of uncertainty in performing statistical tests due having fewer data points. If you searching "interim monitoring clinical trial" you can read up more on these procedures. This was done in the physicians health longitudinal study where aspirin was shown to have an effect on reducing myocardial infarction. The study was a 15-year long study that wrapped up 6 months earlier than expected due to these safety outcomes.
The second is called adaptive randomization where statistical programs separate from the randomizing statistician weigh favorable outcomes, and start dynamically increasing probability to enrollment into the successful group. A group with 50/50 allocation will see death outcomes favor shift towards enrollment into the other group, while a "successful" outcome (survival at 6 months) will see that shift the weight back to the assigned group.
If 15% was such a stark difference already known at the time of both cousins' enrollment, then 1) the safety review boards failed to do their job or 2) there was not enough evidence to prove there was a statistically significant difference. The second is influenced by both how far the results are from each other (75 vs. 90 is actually quite far, in terms of statistical testing) or there weren't enough people participating in the trial yet to prove this.
I think this episode was interesting, but I wanted to comment on the other aspects of RCTs, and that there are multiple people along the pathway who make these decisions. Some of these techniques have been made possible with advancements in technology, and also increased awareness of their existence. So I think it will be interesting to see what happens in 100 years...
It is unfortunate that throughout history, the data gleaned from patients dying (including those in clinical studies) has been a prerequisite in finding cures and therapies for slew of diseases and related illnesses. Fortunately, with the continuing advancements in genetic engineering and related fields, along with the new "standard of care " outlined in the video, diseases will in the future be cured proactively, without patients risking their lives as "guinea pigs" in clinical trials. Hence, computer simulations will perform in-silico trials, and any unfavorable patient outcomes will relate solely to virtual patients in the computer's memory. Simply modify the software program, recompile, rerun the program, and keep iterating until the efficacy-rate approaches the highest level possible. A medical revolution is on the way.
Prenursing student here! Absolutely love these videos especially when I’m lifting and need something to listen to!
channel break it’s called sophomore year of college finishing pre reqs you dunce.
First time watching this video but I've listened to it many times while at work (welding, funnily enough) and I find it interesting you used a TIG welding clip at the end because of exactly what you're describing.
I tell my students quite often that while Stick or MIG welding are still the two more common forms of welding, TIG is taking over simply due to how many different metals, thicknesses, and how it overall has better weld quality and I definitely tell them to pursue it even if it's just as a hobby.
Very interesting mindset you have. Solving medical issues on a person by person case by utilizing models that can repeat various forms of certain medications, eventually calculating the perfect medicine for their exact body.
I thought this was called meme review until just now
I absolutely love your content and your vision for the future
I really appreciate your passion towards compassion
THIS IS AMAZING! Well-scripted content that induced all sorts of emotions- frustration, shame, hope, encouragement- and drove me to the edge. An inspiring, fascinating and empowering video, to say the least! (perhaps the best you've made thus far) As a young doctor whose mother recently passed away due to multiple poorly-prognostic carcinomas, I have related to Brandon's mother on an emotional level, and can assert the role of genetics in individualistic care- already proving to be paramount. There is huge promise on a conceptual level. This idea you've proposed is mind-boggling YET absolutely conceivable. The ethical dilemma in the realm of clinical trials is multi-fold and unavoidable by current standards; the analogy to 14th Century medical practice is not hard to perceive, when put into this context.
However, I have a question: (I understand the process will not be as simplistic as stated, but it's the end-point which is relevant)
Consider this model in place. Now, a patient gets diagnosed with cancer and we enter their relevant data in the system. Even if the system were to run through all existing drugs available and find a suitable, individualistic and targeted medicine for the patient, how long would they have to wait for the results (let's say "macro?"results- efficacy, overall survival etc.) of those simulations (considering anti-cancer therapy- so far- is a given on a long-term basis) before being started in the actual patient?
OR in an alternative scenario, where perhaps none of the existing drugs seem suitable (based on the patients' genomics, epigenetics, or even an ideal metadata), how long before we find and start the new and optimal therapy in this patient?
I guess what I'm getting at is, unless we arrive at a level where we can analyse the real-time effects of the drug and extrapolate that data to Accurately* predict those "macro" results, the simulation-based results will need time to get collected and then implemented ie; this too might cost time and lives.
Having said that, the motive is unchanged - we need a better way to do this.
Thank you for your insight Dr., the fact that medical practitioners today are moved by such ideas gives me hope and inspires me to continue in this profession. Hope to work unitedly on this radical mission towards improved medicine
The analogy of the tree and the fire took my mind in a different direction. What if instead of the technology being a newer, more effective model of personalized medicine, it's actually technology enabling greater spread of disinformation, anti-intellectualism, and quackery? What if the tree of medicine is burnt down but with nothing better to replace it? Maybe evidence-based medicine will remain as a reduced version of itself, but the losses it has sustained may allow other less effective forms of pseudomedicine to take hold. Your point about technology enabling us to do more while medicine attempts to restore us to the baseline is a good one, and I think the efficacy of technology (without greater understanding of how it works) in additional to the pervasiveness of science fiction and futurism is leading a lot of people to a form of neo-magical thinking where they expect medicine to be at a similar level of advancedness. That provides ripe ground for quackery to take hold. We're already seeing all of this right now, and if technology gets better, that may only get worse.
This may be my favourite UA-cam channel.
My Dad died form a melanoma that metastasized. This shit hits home. Thanks for the content my guy, not gonna lie, made me tear up a bit.
WOW!!! I admire your dedication to impart knowledge for people like me. I'm not in the medical field but I find all your videos very interesting. Thank you very much for doing these videos. More POWER to you!!!
👏👏👏👏👏
❤️❤️❤️❤️❤️
I showed this video in my technology class yesterday, and I didn't realize what you meant about clinical trials being hard to explain until I had to summarize everything you said in under a minute haha
I'm a huge fan of all your content and you're such an inspiration for me to keep trying as hard as I can (I want to be a neurologist). Please keep going and best of luck in your career! :D
This is some cool thoughts on futurism I think.. and I think your ideas make a lot of sense, who knows what will actually happen though 😂 So many different possibility's, I guess many we are not aware of at all right now. Love your videos btw
For cancer and autoimmune diseases, in the civilization you described, you could run a trial at or even before birth, based on complete genome sequencing.
Run a full set of simulations of the entire DNA and predict all upcoming cancers in that person. Then, since cancer often arises later in life, you likely have 20 or more years to run drug simulations and find the best preventive care for that person
Sounds like one tremendously complex simulation, not that it's impossible. Several things would need to be simulated molecules, then cells also collections of billions of cells. I've a feeling your talking about some kind of super computer
It's quite rare when doctors today sees themselves as blood-letters from the future. Good first step in my opinion.
Came to see the progress of your anime hair, stayed for an exceptionally made video about the future of trials. Thanks!
Wow, Dr Bernard , Ive been watching your videos for the past week now and there AMAZING!! I like how you explain sophisticated aspects of the human body in simple terminology for a person like me . I'm learning so much more here than I'm learning at School and it's really interesting too. I whish I could meet you in person , and would love you to teach me more . You're very inspiring , thank you . Keep on making awesome content . Hope you're doing well in these times
This is a very important video.
Another fly in the ointment: the point of doing blind treatments against a control is to remove the possibility of a placebo effect. The outcome of cancer is either dying or recovering. Are researchers worried that the placebo effect might cause patients to recover from cancer???
If a placebo effect can treat patients of cancer with any regularity, it is good medicine and should be used in treatment, placebo or not.
as a bioinformatician, i love your insight into this as a medical professional!
It seems to me that in order to accurately simulate a person to test a treatment you would not only have to simulate that person but also simulate all or some of the flora and fauna than lives on and in that person. I listened recently to a podcast episode on the Kevin Rose show were a researcher was talking about a treatment for diabetes based on changing the gut microbiome. She seemed like a credible scientist to my ear. There are so many things living inside us that may be helpful or harmful(or neutral) in general and also may affect how drugs work.
I freaking love this as a nursing student this makes me even more excited learning my subjects!! Thank you!!
i see medicine the same way and i'm happy a lot of other people do too... i feel like some doctors really don't
It's exciting to imagine such a time. We would be able to diagnose and treat disease at an early stage. I've seen ads for, Forward, and the changes my own medical provider has made and it seems like the beginnings of changes in the system.
Very cool to see Bernard talking about pbpk! Nice one
Matrioska brains, chubbyemu of the future is gonna love them.
You are such a inspiration to me .fun and nerdy equally . Your presentation,dedication and hardwork truely inspires me to the wonderful field of medicine I follow both of your channels and heme review is very informative. keep doing this and your second channel definitely deserves more subs.
I recommend your videos to everyone. keep up the good work my dude
3:30 causes frameshift mutations in the amino acids causing there to be segments that aren’t triplet codons
Yeah. Strange how the majority of what we know about frostbite came from the Japanese experiments during WW||. It does take pretty insane cruelty to get "good data."
Very thought-provoking video! Thanks for giving me some homework to do
i love your channel. You respect your audience. I have told many of your channel.
I know this is an old video, but this was very fascinating to me. Both from the prediction side and the iterative medication approach. I am a gear head, and just like medication, the knowledge both of combustion, fuels, and metallurgy have increased in orders of magnitude. General Motors used some form of iterative computer-aided-design on the C7 corvette, with "more than 10 million hours of computational analysis were conducted on the engine program" (Mlive, 2012). Another way to look at it is weather modelling, where we have, with what a casual observer would likely proclaim a fairly good understanding of weather. This understanding has enabled models that can, at a reasonable accuracy, predict weather patterns.
The thing I'm curious about, as a non-medical-school educated person, is the "bounds" of the simulated person. Having a genuine interest in medicine (Obviously I wouldn't be here if I wasn't), I'm curious just how far it could go. For example, I've read where the various pathways into which medication is broken down, can greatly be affected by the foods eaten - grapefruit juice seeming to be one of the big offenders, or dairy products like with MAO inhibitors. It also seems to me, an admittedly insufficient-for-serious-medical-discussion education, that gut bacteria seems to be gaining popularity as a cause/treatment for certain disorders.
I know that the classical psychological question could perhaps come into play as well, genetics v. environment. I would assume the majority of doctors would lean towards genetics, and I certainly would, but again, I wonder if perhaps this genome-based human-simulator would be riddled with constants that would need to be modified based on diet, environment, and so forth.
I look forward to checking back on this and lots of technology when I'm down to my final years. I pray that in my lifetime, I can look back and say something to the effect of "I can't believe for years we were horsing around with serotonin for mental health, and all we really needed to do was xyz".
Regarding clinical trials. I have to wonder if all patients electing to go forward with objectively/quantifiable "real" results, should be in clinical trials. For example, many diseases are quantifiable namely, how long one lives post treatment. Therefore, when a patient goes to a doctor for widget cancer, for example, their doctor gives them a list of options. Investigative medications (What we would now consider clinical trial candidates), along with other existing options. The patient makes the decision, and from that point, they become a data point. Yes, it is not a blind in any way study, but in cases which can measure distinct outcomes, I would argue double-blind is not needed. Weight loss (Which is most definitely related to environment/attitude), pain tolerance, mental depression, etc. would in my mind fail to meet this standard, but cancers, and other clear-cut "binary" disorders (either it clearly worked or it didn't) would. Obviously patient privacy would have to be anonymized, but just imagine how much faster trends could be found if "24 and me" type data were to exist in every cohort - not just those with enough disposable income and education/curiosity to actually participate.
I love this idea, what a creative vision of the future.
Hello! I'm actually working on a research team from Texas A&M that's focusing on some of the same topics you discuss in this video! I've been watching you since your first diagnostician video, and would love to get your input and thoughts on my team's research, if you're up to it!
Outstanding talk. Hopefully as Artificial Intelligence and rapid DNA sequencing technologies mature, they will join to facilitate the fantastical advances in personalized medicine you discussed. Modern medicine has a short history, but as data is amassed on current treatments, it seems the additional data points gathered from a control group would be less significant.
Well there is something we can do in some cases at least: take samples of the patient's cells, grow them to model the disease (typically done from stem cells) and test the drug on them. The reliability of that is of course unknown for now, but we should do it for two reasons: for now, to "have a hint" on the efficacy of a treatment, and for the future, to have data to know whether it actually works as a prediction method.
One of the advance that we should make it happen, but hasn't yet, is the ability to digitise case data from millions of patients being treated every year, worldwide, plus the data that is on paper and ink, locked up somewhere in a dusty basement, in a unified, accessible, yet somehow also totally private and confidential, way. There is a lot of talk about AI and what not but those talks never address the real hurdle of not having enough data to begin with. We have so much data of just not what went right but also what went wrong. This should increases the n number of clinical studies to much better numbers than the hundreds or thousands per trial we have right now.
If there is one thing I want a national service to be used around, would be to provide some rudimentary health education (which will be useful to everyone anyway), and get young people to sit down and digitise the data that is on paper.
Love your content and way of explaining each case
amazing ideas!
I admire the thought process!
Great insights! I really appreciate your genuine love for medicine and the patients. It is clear that you put a lot of thought into how medicine is done today.
You are talking about improving medicine by utilizing technology to reach precision medicine. I am sure a lot of other people and doctors like you have thought about ways to provide precision medicine. Somehow, I believe technology is a must to reach this! There are limits to the human mind that a computer or algorithm can do for us ( meaning do something faster and feed on much more material than we ever could). Very clever and well-thought video.
I was bingeing all the videos on your other channel and the thought came to mind: why don't doctors have an online international database, so that even "rare" cases as documented and a doctor could look up symptoms and know what to do
Some people have been sort of doing this for certain rare and genetic illnesses, creating a network of docs sharing info on their patients, this has helped some people get diagnosed with rare diseases that otherwise would have been missed or misdiagnosed. As much as I feel social media is a bane on society, it has helped make inroads into this
Absolutely brilliant 👏
22:00 i think, by the time were accurately able to model this, were also accurately able to predict and create new forms of treatments the same way, without having to manually input what were wanting to administer to the real patient
Aaand he addressed that right after, cool
I was reading a paper other day, how with this medicine system it was not possible to fix even a AM/FM radio (it was a paper on neurology). You really need to have systemic understanding of the things. For example, for an engineer, there's a top-down model of knowing how to construct things. On human medicine, the models they use are pathetic, in terms of simplicity, they are just too simple, to linear, and its like trying to create an radio without the laws of electromagnetism pinned down, you will never be able to come up with an radio by randomly trying shit, not unless you're willing to way billions of years. How much computing power would that be? immense computing power.
At least in biology studies they study chemical path-ways, everything comes from chemical path-ways, so there's that, the basis of biology is physics, but that's bottom-up.
Even thou I don't believe a top-down approach would truly be possible with any biological system, as there are no designer (obviously, if there were, it would be so much easier to reverse engineer the human body), its still possible to do systems modelling.
There must be a computational way to simulate it from the basics.
Or perhaps just simulate the universe itself, as its kind of easier. You plug 1024 qubits, and there you are, you can simulate matter.
Something that's disturbed me about clinical trials is how my now husband's experience was participating in phase 1 trials. We were dating at the time, and he got paid very well for participating. However, this compensation came at a cost, and thus the trials tended to invite desperate people. Some people, like him, were just college kids with time on their hands in the summer and wanted some extra cash. A lot of them, though, were the homeless and other desperately poor people. The more serious the drug and the longer the trial, the more they would be compensated and the more they risked their health. My husband didn't do the more risky trials, but he did test one sleep drug that made every single person in the trial have unimaginable night terrors. The participants would be locked in the facility together for days or weeks at a time and couldn't take anything in with them other than the clothes on their backs and a cell phone. My husband couldn't even bring in his chap stick.
I'm also not saying that I have a magic way to get rid of this system, but there is an ugly underbelly that we could work to eliminate.
Grear job i really enjoyed every one of your videos never got disappointed so informative and simplified keep it up 🤩
Another excellent video! Hope the future is better!
I enjoy your videos, I appreciate the way you illustrate points and poise questions that I can understand without having medical training. Thank you. Which French artists created those works btw.
Can you explain the difference between generic and brand medication? I've always been told that they're interchangeable
Generic is the name of the substance for example the generic name is alprazolam but the brand name is xanax, it is the same thing! Just different producers/companies that manufacture it.
Not always. Different additives, etc. That's why drs have the option to daw on scripts. If the dr writes that, it means that med be given and not a generic. Some patients cannot tolerate any change in compound, additives etc
same Active Pharmaceutical Ingredient (API). the excipients may differ
I know that with some time release medications, for example bupropion, the release rate can sometimes be less consistent depending on the manufacturer.
There are some drugs that don't share an equivalent to the brand. Such as Coumadin and warfarin
19:33 that's why I study computing science, there must be a way to simulate those effects.
I hope you succeed in computer science and help end diseases.
10:03 we got war planes, 10:06 We got that, we got the little robot that slides around the floor and cleans it. 10:10 Drones delivering mail, 10:15 And we got some scientist right now talking about using computers to boost the human brain. That artist wasn't too far off, I give it a 10/10 and can confirm the artist can see the future.
its so disturbing that medicine even today is as advanced as math was in the first millenia. trial and error, no predicting, no big and stable framework to represent the chemical reactions of drugs and viruses in the body, complexity and chaos rules. lifetime doctors can barely predict effects of drugs administered and are sometimes surprised by adversities. i understand how complexity makes the simplest of considerations become unfathomable. why dont medicine, higiene and public policies focus on prevention instead of therapy... and then we enter politics...
Maths is very simple in that it is a process. Medicine has an unknown number of variables and the fact that it deals with people rather than static variables. That's why it's hard for medicine fo advance.
Shooting blindly! Big profesor, and awards winning doctors, they only seem like fraud. Milions and milions, spent on worthless research. I'm disgusted, how some of them , pretend they are more then regular humans, when actually, are just playing a part ,in a falsely theatre play. :( :( Disappointing!
Because prevention is full of just as much trial and error as therapy. Think how much nutritional recommendations have changed over the years.
I totally agree with you on the "prevention over therapy" framework. But keep in mind that trial and error is the underlying mechanism of prediction, so it naturally just has to get better and better. What does that mean or imply? The fact that we can't talk about knowing something perfectly, with an 100% accuracy rate. That would be nonsense from a statistical point of view. But every single detail that medicine (or science in general, for that matter) researches will be 'measured' by using confidence intervals. Yeah, the 95% has 5% error rate, but that can really help us getting over some Type II statistical errors (let's say that we have a 99% confidence interval, and only 1% error rate, that actually implies that some of those 99% people that NEED treatment will NOT get it, and here is where it's getting dangerous). That's why RCTs exist, to account for false postivies and false negatives. But, at the end of the day, prediction is not about perfection, it actually is about getting closer and closer to a consensus!
yayy thank you for another vidd
Thats a beautiful vision of the futore Doc, and I really hope we can get there. I really hope this video is a self fulfilling prophecy.
And good on you for dreaming.
It's so depressing to here "alive after 1 year, alive after 3 years".
I absolutely want this as soon as possible
Fascinating! Ethical decisions need to be incorporated.
The patients should be able to decide, and the data should speak for itself, a new method should emerge as superior both in patient preference and outcome
You had a throw away comment about health plan administrators not knowing the difference between generic and name brand medication. Can you please expand on that.
In the USA insurances sometimes require an authorization for a medication. if you use the generic name in the script they sometimes deny the authorization, not realizing that it's a medicine on their formulary that's on their list by brand name instead. it can take several days and multiple phone calls to get this corrected
no, it's the same in reverse sometimes with a prior auth. the rx will have the brand name and they only know generics on their formulary. but still, because an admin couldn't be bothered to look up a medicine's name, they lock a patient out of medicine for several days and force nurses and doctors to keep calling back?
Heme Review Hey. Former “health plan administrator” here. At least with the company I worked at, agents designated for authorizations and referrals are the same as the agents who answer the phones to tell insurance members what their ID numbers are. There was a very large lack of training done to handle these calls. Not only that, there was a very large negative workplace view of providers. There’s no deals going on, just lots of incompetence in both the agents and the people who trained them.