Gautam Gulati:
Fascinating topic. I'm curious. Jamie, if you had a chance to speak with Charles Darwin now, what kind of advice would you give him in terms of rethinking The Origin of Species?
Jamie Metzl:
Well I think he was absolutely right in his analysis. And it's incredible. Darwin and Mendel were contemporaries, but they didn't know each other. And both of them had their philosophies, their theories, for many decades when they didn't become known. Darwin, because he sat on his theories for almost 30 years before he published On the Origin of Species. And Mendel, who published his great paper in this totally obscure journal in Brno where he was living, and it wasn't even discovered until-- really discovered until after his death almost 40 years later.
So Darwin didn't know about genetics. His theories were right, but he didn't fully understand the mechanism of action. And that we have this capacity, it doesn't at all disprove Darwin.
And so I could have titled this book, Ending Darwin. I don't think that we're seeing the end of Darwin. But I just think that we are ourselves going to be in many ways the drivers of evolution in ways that haven't happened.
So that's what I would love to-- I mean, 0 that conversation with Darwin, because I think it would give him, who I think is-- I mean, it's kind of a cliche, but obviously one of the great scientists of all time-- but some additional perspective. And then to help him, just imagine if you're Darwin in the 19th century, can you imagine-- you don't know anything about genetics. Can you imagine precision gene editing? Can you imagine genome sequencing? I mean, that's a big jump.
But from when where we are now, we're not at some kind of terminus of science or technology. We're on this J curve. So what's that jump between Darwin and us? We're going to make that jump within 20 years. What's that jump? And then we'll make a jump of that same size within seven years. And what's that jump?
And that's why I say we all have to think like science fiction writers. Because we are living in an age of science fiction.
Gautam Gulati:
I think in the field of health care, and I'm sure everyone's going to sort of relate to this, there's oftentimes this mismatch between what we think can be done, right, in the future in terms of innovation, and a mismatch with reality. And we oftentimes hear a lot of buzz words around precision medicine, predictive analytics, and artificial intelligence. And oftentimes it just presents itself as false starts, or false promises. So can you sort of hone this into reality a little bit and talk about what is fiction from non-fiction in today's world, and what we perhaps as an organization should be on the lookout from over the next 5 to 10 years in terms of thinking about it in the context of health. health.
Jamie Metzl:
Sure. And So I'll reference something that I said in my remarks. Right now we get a lot of information. We get a lot of genetic information. And most people don't have a way of figuring out what is valid and what's not valid. I use the example of slow twitch muscles. But there's all kinds of-- in the book, I talk about this direct-to-consumer genetics company in Malaysia that is saying to parents, send in your mouth swab. We'll tell you whether your kid is going to be a concert pianist. That's not possible. But there's a new approach, and everyone should know this word, it's called polygenic scoring. And it's basically using an algorithm with big data sets to figure out how different genetic patterns will translate into different outcomes. Because there's so much complexity within our genetics. And the genetic system, as complex as it is, sits within this dynamic interactive systems biology, which sits within and is dynamically interactive with the environment around us. That's why we need these big data sets.
But polygenic scoring is going to allow us to understand, and is already starting to allow us to understand complex genetic diseases, disorders and traits. And so you're going to see, where the rubber is going to hit the road will be in things like pre-implantation genetic diagnosis. Actually there's a company in New Jersey that friends of mine run called Genomic Prediction. And they can really give a lot of directional information about pre-implanted embryos. They're restricting themselves to health information because every time they cross that boundary-- which they did, I mean, they had a product that felt to people like it was predictive IQ-- people, they really get slammed on the head.
So I think that-- polygenic scoring, I think is going to be a driver of change. But we're going to have to think differently. Because the way that we think in our health care system is like you have cancer or you don't have cancer. We don't have a model for you might have cancer, you might have this outcome. And it's going to force us to go back in time in how we do health care.
And you're much better off in a country like Canada where you have a national health system, because there's somebody who's incentivized to think about your lifetime In the United States, the average person switches health plans every 18 months. And so I was talking with someone who was trying to set up a predictive analytics company and they realized that the health insurance companies could have cared less.
They say, hey, this person is high risk for type 2 diabetes. They'd say, essentially, well, is he or she going to get it in the next year and a half? It's like no. I'm sorry. Well, good luck for them.
Gautam Gulati:
So one of the big themes around-- we were at TED, and a few of us were at TED a few weeks ago, and we see in the media about the misuse of data.
Jamie Metzl:
Yes. Yes. Yes.
Gautam Gulati:
Right? And I think there's no more imperative or critical data set that we have than our own health data, especially our genetic data. And Chris Wylie breaks the news around Cambridge Analytica. And there's this big push back in terms of what are the boundaries between what is usable data and what is not. In order for us to move science, you'd say, well, some of the data has to be-- we should be able to use some of the data for a particular reason. So what's your thought process around that?
Jamie Metzl:
This is a really tough one. Because on an individual basis, I think if I ask people, what's your gut feeling? I think everybody's gut feeling is my private genetic information is my business. I want to control it. I don't want people accessing my genetic information. I don't want them accessing my bank information, and all that. And the problem is, as I mentioned in my remarks, population genomics is the ultimate big data analytics challenge. And so for it to gain the collective benefit you actually need these big and relatively accessible data pools. And so we will all be beneficiaries of that system.
And if you think of kind of these three primary competitive ecosystems in the world, each one has bet, in many ways, the future of their economy on the answer to this question about data privacy. So on one end is the European Union, which I believe has basically opted out of 21st century competitiveness with GDPR, even though it-- which is the European privacy regulations-- even though it feels good for everybody, everyone wants to control that information. So I just think that Europe is kind of finished as an economic power.
That doesn't mean that there'll be a lot of economics, there'll be a lot of other things. But Europe cannot lead the 21st century economy with the privacy protections they have.
On the other side of the spectrum is China, which is basically all in on accessible big data pools. And they're using it for some reasons that kind of makes sense to people, and some that are incredibly threatening to everyone, extremely nefarious. Like getting all the genetic information on the Uighurs in Xinjiang, which is not going to be used to make sure everybody gets colonoscopies in time.
And then there's the United States, where we're kind of struggling. There are these ideas, well, we need to have privacy. But we recognize that we need big data pools. There are some companies like LunaDNA and others that are saying, well, how can we use blockchain models so that people can have some level of privacy and opt in to some big data pools. And I don't know who's going to win. But this question of the privacy of data, and in this case genetic data, is going to be essential to all of our lives and our economies going forward.
Gautam Gulati:
Great. So let's open up the floor to a few questions from you guys and I'll close out with some rapid-- Great.
Jamie Metzl:
What about rapid fire?
Gautam Gulati:
Well we're going to rapid fire at the very--
Jamie Metzl:
I got all excited.
Gautam Gulati:
We'll do that at the very end. We'll reserve a couple minutes.
Jamie Metzl:
I had three coffees this morning waiting for it.
Gautam Gulati:
So, Peter. Oh, we'll start up in a sec. Yeah. Yeah. Yeah. Yeah. Yeah. Yeah.
Speaker 1:
There we go? There we go.
Speaker 1:
So this is brilliant. It's fascinating, it's exciting, but it's terrifying. And throughout your conversation you're talking-- which, my brain started to lead down to racial traits and being able to identify what could be superior traits versus others. So I was wondering, what are your thoughts around the potential negative of people being able to prove a race is superior, versus could this be the end of race because now we just start choosing the best of each and create a new race.
Jamie Metzl:
So it's a great question. And I'll start answering it personally. I mentioned that I'm an Ashkenazi Jew. I'm also the child of a refugee from Nazism. And if you had asked the Nazis, what are you doing, they would have said-- the honest answer they always said is we are implementing Darwinism. That's what Nazism was. That's what they thought that they were doing. And so when we're talking about implementing these kind of genetic philosophies, and even things like, I say if you have 10 pre-implanted embryos, and one of them-- I'll stick with the Ashkenazi Jewish thing-- one of them you know will have Tay-Sachs disease and will die an excruciating, painful death before they're 10 years old. Most people would say, well, I would prefer not to implant that embryo. But that is a judgment. That's a judgment of who has the opportunity to live. And so we need to be extremely thoughtful, and need to be extremely careful.
You used the word, race. Race is-- that the whole term is so imprecise as to be meaningless from a genetic perspective. In that the people who we think of as one group tend to be-- especially when they're these big categories like African-Americans, or whatever-- tend to be extremely diverse.
And the evolutionary history of our species is that most humans stayed in Africa. It was only a small number of our ancestors, not even that long ago, 50,000, 60,000 years ago that left Africa and then procreated and then became everybody else of whose ancestors didn't stay in Africa. And so there's more genetic diversity inside of Africa than there is in the entire rest of the world combined.
And so if we're saying, well, categories, like black people, that doesn't mean anything. But if we use the word, group, then everything changes. Because there are groups that have been isolated for tens of thousands of years. The Tasmanians were that way. I mean there are these groups that have been in certain places and haven't mixed. I mean a lot of groups have mixed. There's a great book on this called Who We Are and Where We Come From by David Reich.
And so if a population has been separated from another for 10,000 or 20,000 years, there will be real differences between those groups. When I talked about no Ashkenazi Jew is ever going to win the hundred meters in the Olympics-- and I hope I'm proven wrong. And I hope I get to be that person. But that is its population genetics.
And so we all, progressive people like I'm sure most of us, we have this desire to say, well, everything is environmental. We're all born the same. And then everything, it's about willpower, and parenting, and opportunity. But it's not true.
And if we tether ourselves to a lie we will have problems down the road. Because the people who don't believe what we believe, who don't believe in equality, equality of opportunity, they're going to say, hey, you guys are lying, and the science is actually supporting us. And if we don't want that, we have to be able to talk about difference. But it's really sensitive.
Speaker 2:
Which is a perfect setup for my question.
Speaker 2:
So, like you, incredibly optimistic about the science. The march of science is unstoppable, and the progress that it's making is unbelievable. So, incredibly optimistic there. I'm much less optimistic about people's ability to deal with complexity. We're living through the unintended side effects of a very small technological change, with social media. Right, and we're all seeing that every day. I think a big part of the reason that issue came up is there was no policy around it. We weren't able to predict what the future was going to be based on our knowledge that we had at the time. So my question for you is, who should-- I'm very interested in this-- who should I be paying attention to from a policy standpoint? Who's doing the interesting policy work on this?
Jamie Metzl:
So it's a really great and really important question. At the end of my talk I'd said that we all need to be educated. We need to have this bottom-up groundswell. But the point of the bottom-up groundswell is to get our governments involved. Because we're talking about is the future of life, and it needs to be regulated. There are some countries that are doing a better job at this regulation than others. In my mind the kind of gold standard relative to everybody else is the United Kingdom, which has a national health service like you have in Canada. They have a very deliberative process of making these kinds of decisions, including through things like national debate forums, votes of Parliament on very technical issues like mitochondrial transfer, and they have a regulatory agency, the Human Fertilisation Embryology Authority that is really the best in the world.
In the United States we have the FDA, which is pretty good. But we have a totally dysfunctional health care So what we need to do is be asking these tough questions to our elected officials. We need to say, this is really important to us, and what are you going to do?
I mean, you can kind of break it down. What are you going to do to facilitate this transition to the world of precision and then predictive medicine in a way that doesn't freak people out? What are you going to do to regulate the kind of information that direct-to-consumer genetic testers can provide so that there's some kind of reliability? How are we going to regulate the whole field of assisted reproduction?
And so I was just in Washington last week. I'm talking to members of Congress who I think are likely to hold hearings based on the topics I raised in the book, fingers crossed. But we need to have more of that kind of thing. But at least in the United States, our leaders are focusing on baloney.
And so we need to-- like with climate change, it was a non-issue and then people organized. And now the Greens just did so well in the European elections, and so the Europeans are going to have to even be more vociferous on issues of climate change. If this stuff is important to us, as it should be, then we need to put that kind of pressure on our elected officials.
And then finally, as I mentioned I'm on this World Health Organization committee. But the UN has been so disempowered that it's hard to imagine the UN kind of doing much of anything. But all of us, individuals and countries, we are stakeholders in having some kind of international authority because we are one species. And so we need a global regulatory infrastructure.
Speaker 3:
Oh. The vision of the future we're facing right now with genetic manipulation and genetic screening is already based, it still has that belief that once you're born your genome is yours, and you are who your genes make you.
Speaker 3:
So all that manipulation is done pre-conception. What if-- and in fact, not what if, since we also have the ability to change our genome at the adult stage. So as opposed to going to mathematical schools because you have the gene for math, you decide that you want to go to math school, and you change your genome to become good at it.
Jamie Metzl:
So great question. So when we talk about gene editing, there are two kinds. One is somatic and one is germline. Germline means heritable. So your germ line cells are your eggs, your sperm, and your embryos, and kind of everything else are your adult cells. So if you change your genome as an adult, and it's not a sex cell, it won't pass on to your children. But the reason why I'm relatively conservative about how far we're going to be able to go in applying gene editing to ourselves is because of this complexity issue. I mean, I do a lot with George Church, who's kind of like the living Charles Darwin. He thinks that within a decade we're going to be making 5,000 single-point mutation changes to people.
I don't think that's the case. Because it's not like we have one gene, a math gene, and you can kind of turn it on or off. Math skills are-- I'm sure there's many thousands of genes, and all those genes are doing a lot of different things. So I think it's going to be very difficult. That's why, now for me when I think of what's the killer application, I think embryo selection and multiplying the number of options, that is where we're really going to be able to push to meet things.
For example our ancestors, I mean they took these wild chickens laying one egg a month and we turned them into domestic chickens laying one egg a day, knowing nothing about genetics. So this kind of informed embryo selection, it could take us a very long way.
Gautam Gulati:
So I'm going to squeeze in my rapid fire questions here as we close out, so we'll go through these pretty quickly. And we ask this of all of authors so we can sort of track the patterns over time. So one piece of technology you can't live without.
Jamie Metzl:
I'm going to give you two. One is my bidet. Americans are disgusting in their bathroom habits. I'm sure you Canadians with your French roots are better. And the book. People forget what a revolutionary technology the book is. And I still believe in books.
Gautam Gulati:
And a quick follow up to that one, the one piece of technology you wish never existed.
Jamie Metzl:
8-track player. Does nothing for me.
Gautam Gulati:
All right. Next question. First word that comes to mind when you think of health.
Jamie Metzl:
Invisible. Like I want it just to happen. I don't want to experience it.
Gautam Gulati:
A piece of advice you have most frequently shared with others.
Jamie Metzl:
This I have to get a little personal. Because last week I was in my apartment, and my girlfriend screamed. And there was actually a woman-- we're in New York-- who was on the fire escape across the street. And she was literally about to jump. And then these people had just run there, and they were yelling what people yell, which is the dumbest thing, don't jump. It's like, well, why am I there in the first place? And so I went there and I ran down the thing and I said to this woman, I said, please trust me. Life has ups and downs. And when you're down it's hard to see that you're going to go up. And when you're up, the down is going to come. And that's just life. Get through this moment, I promise you it's going to get better.
And anyway, and there were other-- the police then came. And anyway, the woman was fine. But I think that's my thing. I think we get so caught up in this perspective of the moment that when we're high, it's like, oh this is forever. And when we're low, this is forever. I mean, you talked about your story of these tough experiences you had last year, and it's so easy to get caught. But we just have to remember that you ride the downs, and we'll get to ups. And when you're up, the down-- when you're up the down is coming.
Gautam Gulati:
Finish the following sentence. I'm most curious about--
Gautam Gulati:
What's a book that's transformed your life? Why and how?
Jamie Metzl:
I think it's Ficciones by Borges. And just because it's this way-- I think that our biggest challenge is connected to this point about perspective, is just looking, kind of seeing the world, seeing reality around us in different ways. And he's just, it's so brilliant and it's so concise how he just kind of challenges reality in ways that makes, it makes me and I think people think.
Gautam Gulati:
Dead or alive, who would you invite to your dinner table and what would you talk about?
Jamie Metzl:
Probably one of the Greek philosophers, like Aristotle. I mean we have at least in Western society, we kind of have all of this inheritance. And our brains work a certain way, just because it's like we don't even recognize our thought patterns. But the kind of early thinkers who were starting without this background, I'd love to learn more about how they arrived where they did.
Gautam Gulati:
I thought for sure you would have said Darwin.
Jamie Metzl:
Well, I already said that.
Gautam Gulati:
What important truth do very few people agree with you on?
Jamie Metzl:
Again, this is going to be totally irrelevant. But that I don't understand dogs as pets. I was telling somebody last night, dogs are like these slaves. If Martians came down to Earth, and then some of us were more adventurous, like hey, I wonder what these Martians are doing, and then they took some of us and then they bred us, and then they made us really small and they carried us around in their purse, and then we had this-- our sole survival strategy, because they they'd taken away our ability to hunt, our sole survival strategy was kissing the ass of these Martians. And the Martians come and these little us, it's like, oh, goody, the Martians are home, the Martians are home.
Like we would think, God, that's really humiliating. But that's what we've done to dogs. But if you tell that to people, people think you're a monster.
Gautam Gulati:
And last question for you. What is the one question you wish someone would ask but never has?
Jamie Metzl:
Maybe a few people have asked it. But the question is, what's the limit of our humanity? Like, we have all of this technology. There are all these things that we're going to do. We're going to bring technology inside of us. We're just going to change life. Is there a line which is the outer limit of our humanness? Or is this entire construct just this blurry thing that's set within our culture? I don't know it, but I think we're going to have to face that.
Gautam Gulati:
So that wraps up all the questions.
Jamie Metzl:
Yeah, but let me-- hold on, before you do--
Jamie Metzl:
I have a big favor to ask of everybody. As I said, my mission is to engage people in this dialogue. Everybody here, you are a hub of something, of some community, whether it's your family, or your book club, or your faith community, or work. And I really implore you to be amplifiers of this conversation. You have the information you need. But I hope you'll join me in spreading the conversation. Because there's really, in my view, not much more important that we could be talking about.
Gautam Gulati:
So join me again in thanking Jamie.
