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[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.53,0:00:03.49,Default,,0000,0000,0000,,So let's start with some good news,
Dialogue: 0,0:00:03.49,0:00:05.84,Default,,0000,0000,0000,,and the good news has to do with what do we know
Dialogue: 0,0:00:05.84,0:00:08.11,Default,,0000,0000,0000,,based on biomedical research
Dialogue: 0,0:00:08.11,0:00:11.56,Default,,0000,0000,0000,,that actually has changed the outcomes
Dialogue: 0,0:00:11.56,0:00:14.66,Default,,0000,0000,0000,,for many very serious diseases?
Dialogue: 0,0:00:14.66,0:00:16.91,Default,,0000,0000,0000,,Let's start with leukemia,
Dialogue: 0,0:00:16.91,0:00:19.44,Default,,0000,0000,0000,,acute lymphoblastic leukemia, ALL,
Dialogue: 0,0:00:19.44,0:00:21.87,Default,,0000,0000,0000,,the most common cancer of children.
Dialogue: 0,0:00:21.87,0:00:23.84,Default,,0000,0000,0000,,When I was a student,
Dialogue: 0,0:00:23.84,0:00:27.68,Default,,0000,0000,0000,,the mortality rate was about 95 percent.
Dialogue: 0,0:00:27.68,0:00:30.81,Default,,0000,0000,0000,,Today, some 25, 30 years later, we're talking about
Dialogue: 0,0:00:30.81,0:00:34.44,Default,,0000,0000,0000,,a mortality rate that's reduced by 85 percent.
Dialogue: 0,0:00:34.44,0:00:37.05,Default,,0000,0000,0000,,Six thousand children each year
Dialogue: 0,0:00:37.05,0:00:41.24,Default,,0000,0000,0000,,who would have previously died of this disease are cured.
Dialogue: 0,0:00:41.24,0:00:43.03,Default,,0000,0000,0000,,If you want the really big numbers,
Dialogue: 0,0:00:43.03,0:00:45.86,Default,,0000,0000,0000,,look at these numbers for heart disease.
Dialogue: 0,0:00:45.86,0:00:47.65,Default,,0000,0000,0000,,Heart disease used to be the biggest killer,
Dialogue: 0,0:00:47.65,0:00:49.16,Default,,0000,0000,0000,,particularly for men in their 40s.
Dialogue: 0,0:00:49.16,0:00:52.65,Default,,0000,0000,0000,,Today, we've seen a 63-percent reduction in mortality
Dialogue: 0,0:00:52.65,0:00:54.71,Default,,0000,0000,0000,,from heart disease --
Dialogue: 0,0:00:54.71,0:00:59.60,Default,,0000,0000,0000,,remarkably, 1.1 million deaths averted every year.
Dialogue: 0,0:00:59.60,0:01:02.32,Default,,0000,0000,0000,,AIDS, incredibly, has just been named,
Dialogue: 0,0:01:02.32,0:01:04.60,Default,,0000,0000,0000,,in the past month, a chronic disease,
Dialogue: 0,0:01:04.60,0:01:07.51,Default,,0000,0000,0000,,meaning that a 20-year-old who becomes infected with HIV
Dialogue: 0,0:01:07.51,0:01:11.58,Default,,0000,0000,0000,,is expected not to live weeks, months, or a couple of years,
Dialogue: 0,0:01:11.58,0:01:13.85,Default,,0000,0000,0000,,as we said only a decade ago,
Dialogue: 0,0:01:13.85,0:01:16.24,Default,,0000,0000,0000,,but is thought to live decades,
Dialogue: 0,0:01:16.24,0:01:20.74,Default,,0000,0000,0000,,probably to die in his '60s or '70s from other causes altogether.
Dialogue: 0,0:01:20.74,0:01:23.77,Default,,0000,0000,0000,,These are just remarkable, remarkable changes
Dialogue: 0,0:01:23.77,0:01:26.36,Default,,0000,0000,0000,,in the outlook for some of the biggest killers.
Dialogue: 0,0:01:26.36,0:01:28.43,Default,,0000,0000,0000,,And one in particular
Dialogue: 0,0:01:28.43,0:01:30.48,Default,,0000,0000,0000,,that you probably wouldn't know about, stroke,
Dialogue: 0,0:01:30.48,0:01:32.08,Default,,0000,0000,0000,,which has been, along with heart disease,
Dialogue: 0,0:01:32.08,0:01:34.26,Default,,0000,0000,0000,,one of the biggest killers in this country,
Dialogue: 0,0:01:34.26,0:01:36.05,Default,,0000,0000,0000,,is a disease in which now we know
Dialogue: 0,0:01:36.05,0:01:38.98,Default,,0000,0000,0000,,that if you can get people into the emergency room
Dialogue: 0,0:01:38.98,0:01:41.15,Default,,0000,0000,0000,,within three hours of the onset,
Dialogue: 0,0:01:41.15,0:01:43.76,Default,,0000,0000,0000,,some 30 percent of them will be able to leave the hospital
Dialogue: 0,0:01:43.76,0:01:46.88,Default,,0000,0000,0000,,without any disability whatsoever.
Dialogue: 0,0:01:46.88,0:01:49.13,Default,,0000,0000,0000,,Remarkable stories,
Dialogue: 0,0:01:49.13,0:01:51.16,Default,,0000,0000,0000,,good-news stories,
Dialogue: 0,0:01:51.16,0:01:54.23,Default,,0000,0000,0000,,all of which boil down to understanding
Dialogue: 0,0:01:54.23,0:01:57.58,Default,,0000,0000,0000,,something about the diseases that has allowed us
Dialogue: 0,0:01:57.58,0:02:00.90,Default,,0000,0000,0000,,to detect early and intervene early.
Dialogue: 0,0:02:00.90,0:02:03.04,Default,,0000,0000,0000,,Early detection, early intervention,
Dialogue: 0,0:02:03.04,0:02:06.11,Default,,0000,0000,0000,,that's the story for these successes.
Dialogue: 0,0:02:06.11,0:02:08.84,Default,,0000,0000,0000,,Unfortunately, the news is not all good.
Dialogue: 0,0:02:08.84,0:02:11.19,Default,,0000,0000,0000,,Let's talk about one other story
Dialogue: 0,0:02:11.19,0:02:12.88,Default,,0000,0000,0000,,which has to do with suicide.
Dialogue: 0,0:02:12.88,0:02:15.54,Default,,0000,0000,0000,,Now this is, of course, not a disease, per se.
Dialogue: 0,0:02:15.54,0:02:18.62,Default,,0000,0000,0000,,It's a condition, or it's a situation
Dialogue: 0,0:02:18.62,0:02:20.41,Default,,0000,0000,0000,,that leads to mortality.
Dialogue: 0,0:02:20.41,0:02:23.49,Default,,0000,0000,0000,,What you may not realize is just how prevalent it is.
Dialogue: 0,0:02:23.49,0:02:27.70,Default,,0000,0000,0000,,There are 38,000 suicides each year in the United States.
Dialogue: 0,0:02:27.70,0:02:30.46,Default,,0000,0000,0000,,That means one about every 15 minutes.
Dialogue: 0,0:02:30.46,0:02:33.24,Default,,0000,0000,0000,,Third most common cause of death amongst people
Dialogue: 0,0:02:33.24,0:02:36.01,Default,,0000,0000,0000,,between the ages of 15 and 25.
Dialogue: 0,0:02:36.01,0:02:38.26,Default,,0000,0000,0000,,It's kind of an extraordinary story when you realize
Dialogue: 0,0:02:38.26,0:02:40.77,Default,,0000,0000,0000,,that this is twice as common as homicide
Dialogue: 0,0:02:40.77,0:02:43.42,Default,,0000,0000,0000,,and actually more common as a source of death
Dialogue: 0,0:02:43.42,0:02:46.76,Default,,0000,0000,0000,,than traffic fatalities in this country.
Dialogue: 0,0:02:46.76,0:02:49.39,Default,,0000,0000,0000,,Now, when we talk about suicide,
Dialogue: 0,0:02:49.39,0:02:52.50,Default,,0000,0000,0000,,there is also a medical contribution here,
Dialogue: 0,0:02:52.50,0:02:54.93,Default,,0000,0000,0000,,because 90 percent of suicides
Dialogue: 0,0:02:54.93,0:02:56.70,Default,,0000,0000,0000,,are related to a mental illness:
Dialogue: 0,0:02:56.70,0:02:59.75,Default,,0000,0000,0000,,depression, bipolar disorder, schizophrenia,
Dialogue: 0,0:02:59.75,0:03:02.81,Default,,0000,0000,0000,,anorexia, borderline personality. There's a long list
Dialogue: 0,0:03:02.81,0:03:04.92,Default,,0000,0000,0000,,of disorders that contribute,
Dialogue: 0,0:03:04.92,0:03:08.94,Default,,0000,0000,0000,,and as I mentioned before, often early in life.
Dialogue: 0,0:03:08.94,0:03:12.14,Default,,0000,0000,0000,,But it's not just the mortality from these disorders.
Dialogue: 0,0:03:12.14,0:03:13.79,Default,,0000,0000,0000,,It's also morbidity.
Dialogue: 0,0:03:13.79,0:03:16.05,Default,,0000,0000,0000,,If you look at disability,
Dialogue: 0,0:03:16.05,0:03:18.20,Default,,0000,0000,0000,,as measured by the World Health Organization
Dialogue: 0,0:03:18.20,0:03:21.72,Default,,0000,0000,0000,,with something they call the Disability Adjusted Life Years,
Dialogue: 0,0:03:21.72,0:03:23.82,Default,,0000,0000,0000,,it's kind of a metric that nobody would think of
Dialogue: 0,0:03:23.82,0:03:25.14,Default,,0000,0000,0000,,except an economist,
Dialogue: 0,0:03:25.14,0:03:28.58,Default,,0000,0000,0000,,except it's one way of trying to capture what is lost
Dialogue: 0,0:03:28.58,0:03:31.76,Default,,0000,0000,0000,,in terms of disability from medical causes,
Dialogue: 0,0:03:31.76,0:03:34.65,Default,,0000,0000,0000,,and as you can see, virtually 30 percent
Dialogue: 0,0:03:34.65,0:03:36.92,Default,,0000,0000,0000,,of all disability from all medical causes
Dialogue: 0,0:03:36.92,0:03:39.48,Default,,0000,0000,0000,,can be attributed to mental disorders,
Dialogue: 0,0:03:39.48,0:03:41.86,Default,,0000,0000,0000,,neuropsychiatric syndromes.
Dialogue: 0,0:03:41.86,0:03:44.01,Default,,0000,0000,0000,,You're probably thinking that doesn't make any sense.
Dialogue: 0,0:03:44.01,0:03:46.68,Default,,0000,0000,0000,,I mean, cancer seems far more serious.
Dialogue: 0,0:03:46.68,0:03:49.72,Default,,0000,0000,0000,,Heart disease seems far more serious.
Dialogue: 0,0:03:49.72,0:03:52.76,Default,,0000,0000,0000,,But you can see actually they are further down this list,
Dialogue: 0,0:03:52.76,0:03:55.04,Default,,0000,0000,0000,,and that's because we're talking here about disability.
Dialogue: 0,0:03:55.04,0:03:57.83,Default,,0000,0000,0000,,What drives the disability for these disorders
Dialogue: 0,0:03:57.83,0:04:01.73,Default,,0000,0000,0000,,like schizophrenia and bipolar and depression?
Dialogue: 0,0:04:01.73,0:04:04.71,Default,,0000,0000,0000,,Why are they number one here?
Dialogue: 0,0:04:04.71,0:04:06.22,Default,,0000,0000,0000,,Well, there are probably three reasons.
Dialogue: 0,0:04:06.22,0:04:08.19,Default,,0000,0000,0000,,One is that they're highly prevalent.
Dialogue: 0,0:04:08.19,0:04:11.48,Default,,0000,0000,0000,,About one in five people will suffer from one of these disorders
Dialogue: 0,0:04:11.48,0:04:14.06,Default,,0000,0000,0000,,in the course of their lifetime.
Dialogue: 0,0:04:14.06,0:04:16.38,Default,,0000,0000,0000,,A second, of course, is that, for some people,
Dialogue: 0,0:04:16.38,0:04:17.96,Default,,0000,0000,0000,,these become truly disabling,
Dialogue: 0,0:04:17.96,0:04:21.09,Default,,0000,0000,0000,,and it's about four to five percent, perhaps one in 20.
Dialogue: 0,0:04:21.09,0:04:25.36,Default,,0000,0000,0000,,But what really drives these numbers, this high morbidity,
Dialogue: 0,0:04:25.36,0:04:27.79,Default,,0000,0000,0000,,and to some extent the high mortality,
Dialogue: 0,0:04:27.79,0:04:31.73,Default,,0000,0000,0000,,is the fact that these start very early in life.
Dialogue: 0,0:04:31.73,0:04:34.83,Default,,0000,0000,0000,,Fifty percent will have onset by age 14,
Dialogue: 0,0:04:34.83,0:04:37.95,Default,,0000,0000,0000,,75 percent by age 24,
Dialogue: 0,0:04:37.95,0:04:41.41,Default,,0000,0000,0000,,a picture that is very different than what one would see
Dialogue: 0,0:04:41.41,0:04:43.68,Default,,0000,0000,0000,,if you're talking about cancer or heart disease,
Dialogue: 0,0:04:43.68,0:04:47.08,Default,,0000,0000,0000,,diabetes, hypertension -- most of the major illnesses
Dialogue: 0,0:04:47.08,0:04:51.18,Default,,0000,0000,0000,,that we think about as being sources of morbidity and mortality.
Dialogue: 0,0:04:51.18,0:04:57.49,Default,,0000,0000,0000,,These are, indeed, the chronic disorders of young people.
Dialogue: 0,0:04:57.49,0:05:00.36,Default,,0000,0000,0000,,Now, I started by telling you that there were some good-news stories.
Dialogue: 0,0:05:00.36,0:05:01.81,Default,,0000,0000,0000,,This is obviously not one of them.
Dialogue: 0,0:05:01.81,0:05:04.68,Default,,0000,0000,0000,,This is the part of it that is perhaps most difficult,
Dialogue: 0,0:05:04.68,0:05:07.27,Default,,0000,0000,0000,,and in a sense this is a kind of confession for me.
Dialogue: 0,0:05:07.27,0:05:12.62,Default,,0000,0000,0000,,My job is to actually make sure that we make progress
Dialogue: 0,0:05:12.62,0:05:14.97,Default,,0000,0000,0000,,on all of these disorders.
Dialogue: 0,0:05:14.97,0:05:16.68,Default,,0000,0000,0000,,I work for the federal government.
Dialogue: 0,0:05:16.68,0:05:18.70,Default,,0000,0000,0000,,Actually, I work for you. You pay my salary.
Dialogue: 0,0:05:18.70,0:05:21.08,Default,,0000,0000,0000,,And maybe at this point, when you know what I do,
Dialogue: 0,0:05:21.08,0:05:23.20,Default,,0000,0000,0000,,or maybe what I've failed to do,
Dialogue: 0,0:05:23.20,0:05:25.41,Default,,0000,0000,0000,,you'll think that I probably ought to be fired,
Dialogue: 0,0:05:25.41,0:05:27.57,Default,,0000,0000,0000,,and I could certainly understand that.
Dialogue: 0,0:05:27.57,0:05:29.90,Default,,0000,0000,0000,,But what I want to suggest, and the reason I'm here
Dialogue: 0,0:05:29.90,0:05:33.16,Default,,0000,0000,0000,,is to tell you that I think we're about to be
Dialogue: 0,0:05:33.16,0:05:37.82,Default,,0000,0000,0000,,in a very different world as we think about these illnesses.
Dialogue: 0,0:05:37.82,0:05:40.92,Default,,0000,0000,0000,,What I've been talking to you about so far is mental disorders,
Dialogue: 0,0:05:40.92,0:05:42.64,Default,,0000,0000,0000,,diseases of the mind.
Dialogue: 0,0:05:42.64,0:05:46.04,Default,,0000,0000,0000,,That's actually becoming a rather unpopular term these days,
Dialogue: 0,0:05:46.04,0:05:48.24,Default,,0000,0000,0000,,and people feel that, for whatever reason,
Dialogue: 0,0:05:48.24,0:05:51.61,Default,,0000,0000,0000,,it's politically better to use the term behavioral disorders
Dialogue: 0,0:05:51.61,0:05:55.52,Default,,0000,0000,0000,,and to talk about these as disorders of behavior.
Dialogue: 0,0:05:55.52,0:05:57.79,Default,,0000,0000,0000,,Fair enough. They are disorders of behavior,
Dialogue: 0,0:05:57.79,0:05:59.79,Default,,0000,0000,0000,,and they are disorders of the mind.
Dialogue: 0,0:05:59.79,0:06:02.20,Default,,0000,0000,0000,,But what I want to suggest to you
Dialogue: 0,0:06:02.20,0:06:03.95,Default,,0000,0000,0000,,is that both of those terms,
Dialogue: 0,0:06:03.95,0:06:06.97,Default,,0000,0000,0000,,which have been in play for a century or more,
Dialogue: 0,0:06:06.97,0:06:09.79,Default,,0000,0000,0000,,are actually now impediments to progress,
Dialogue: 0,0:06:09.79,0:06:14.12,Default,,0000,0000,0000,,that what we need conceptually to make progress here
Dialogue: 0,0:06:14.12,0:06:19.32,Default,,0000,0000,0000,,is to rethink these disorders as brain disorders.
Dialogue: 0,0:06:19.32,0:06:21.19,Default,,0000,0000,0000,,Now, for some of you, you're going to say,
Dialogue: 0,0:06:21.19,0:06:23.41,Default,,0000,0000,0000,,"Oh my goodness, here we go again.
Dialogue: 0,0:06:23.41,0:06:26.03,Default,,0000,0000,0000,,We're going to hear about a biochemical imbalance
Dialogue: 0,0:06:26.03,0:06:27.77,Default,,0000,0000,0000,,or we're going to hear about drugs
Dialogue: 0,0:06:27.77,0:06:32.60,Default,,0000,0000,0000,,or we're going to hear about some very simplistic notion
Dialogue: 0,0:06:32.60,0:06:35.54,Default,,0000,0000,0000,,that will take our subjective experience
Dialogue: 0,0:06:35.54,0:06:41.61,Default,,0000,0000,0000,,and turn it into molecules, or maybe into some sort of
Dialogue: 0,0:06:41.61,0:06:44.82,Default,,0000,0000,0000,,very flat, unidimensional understanding
Dialogue: 0,0:06:44.82,0:06:48.93,Default,,0000,0000,0000,,of what it is to have depression or schizophrenia.
Dialogue: 0,0:06:48.93,0:06:53.42,Default,,0000,0000,0000,,When we talk about the brain, it is anything but
Dialogue: 0,0:06:53.42,0:06:56.69,Default,,0000,0000,0000,,unidimensional or simplistic or reductionistic.
Dialogue: 0,0:06:56.69,0:06:59.65,Default,,0000,0000,0000,,It depends, of course, on what scale
Dialogue: 0,0:06:59.65,0:07:01.94,Default,,0000,0000,0000,,or what scope you want to think about,
Dialogue: 0,0:07:01.94,0:07:08.22,Default,,0000,0000,0000,,but this is an organ of surreal complexity,
Dialogue: 0,0:07:08.22,0:07:11.69,Default,,0000,0000,0000,,and we are just beginning to understand
Dialogue: 0,0:07:11.69,0:07:13.87,Default,,0000,0000,0000,,how to even study it, whether you're thinking about
Dialogue: 0,0:07:13.87,0:07:16.45,Default,,0000,0000,0000,,the 100 billion neurons that are in the cortex
Dialogue: 0,0:07:16.45,0:07:18.59,Default,,0000,0000,0000,,or the 100 trillion synapses
Dialogue: 0,0:07:18.59,0:07:20.95,Default,,0000,0000,0000,,that make up all the connections.
Dialogue: 0,0:07:20.95,0:07:24.53,Default,,0000,0000,0000,,We have just begun to try to figure out
Dialogue: 0,0:07:24.53,0:07:28.06,Default,,0000,0000,0000,,how do we take this very complex machine
Dialogue: 0,0:07:28.06,0:07:30.80,Default,,0000,0000,0000,,that does extraordinary kinds of information processing
Dialogue: 0,0:07:30.80,0:07:33.52,Default,,0000,0000,0000,,and use our own minds to understand
Dialogue: 0,0:07:33.52,0:07:37.05,Default,,0000,0000,0000,,this very complex brain that supports our own minds.
Dialogue: 0,0:07:37.05,0:07:39.61,Default,,0000,0000,0000,,It's actually a kind of cruel trick of evolution
Dialogue: 0,0:07:39.61,0:07:43.44,Default,,0000,0000,0000,,that we simply don't have a brain
Dialogue: 0,0:07:43.44,0:07:46.34,Default,,0000,0000,0000,,that seems to be wired well enough to understand itself.
Dialogue: 0,0:07:46.34,0:07:48.65,Default,,0000,0000,0000,,In a sense, it actually makes you feel that
Dialogue: 0,0:07:48.65,0:07:51.49,Default,,0000,0000,0000,,when you're in the safe zone of studying behavior or cognition,
Dialogue: 0,0:07:51.49,0:07:52.81,Default,,0000,0000,0000,,something you can observe,
Dialogue: 0,0:07:52.81,0:07:55.82,Default,,0000,0000,0000,,that in a way feels more simplistic and reductionistic
Dialogue: 0,0:07:55.82,0:08:00.78,Default,,0000,0000,0000,,than trying to engage this very complex, mysterious organ
Dialogue: 0,0:08:00.78,0:08:03.21,Default,,0000,0000,0000,,that we're beginning to try to understand.
Dialogue: 0,0:08:03.21,0:08:06.87,Default,,0000,0000,0000,,Now, already in the case of the brain disorders
Dialogue: 0,0:08:06.87,0:08:08.60,Default,,0000,0000,0000,,that I've been talking to you about,
Dialogue: 0,0:08:08.60,0:08:10.87,Default,,0000,0000,0000,,depression, obsessive compulsive disorder,
Dialogue: 0,0:08:10.87,0:08:13.03,Default,,0000,0000,0000,,post-traumatic stress disorder,
Dialogue: 0,0:08:13.03,0:08:15.97,Default,,0000,0000,0000,,while we don't have an in-depth understanding
Dialogue: 0,0:08:15.97,0:08:19.70,Default,,0000,0000,0000,,of how they are abnormally processed
Dialogue: 0,0:08:19.70,0:08:21.80,Default,,0000,0000,0000,,or what the brain is doing in these illnesses,
Dialogue: 0,0:08:21.80,0:08:24.86,Default,,0000,0000,0000,,we have been able to already identify
Dialogue: 0,0:08:24.86,0:08:27.44,Default,,0000,0000,0000,,some of the connectional differences, or some of the ways
Dialogue: 0,0:08:27.44,0:08:29.94,Default,,0000,0000,0000,,in which the circuitry is different
Dialogue: 0,0:08:29.94,0:08:31.76,Default,,0000,0000,0000,,for people who have these disorders.
Dialogue: 0,0:08:31.76,0:08:33.51,Default,,0000,0000,0000,,We call this the human connectome,
Dialogue: 0,0:08:33.51,0:08:35.90,Default,,0000,0000,0000,,and you can think about the connectome
Dialogue: 0,0:08:35.90,0:08:37.77,Default,,0000,0000,0000,,sort of as the wiring diagram of the brain.
Dialogue: 0,0:08:37.77,0:08:39.87,Default,,0000,0000,0000,,You'll hear more about this in a few minutes.
Dialogue: 0,0:08:39.87,0:08:42.82,Default,,0000,0000,0000,,The important piece here is that as you begin to look
Dialogue: 0,0:08:42.82,0:08:46.80,Default,,0000,0000,0000,,at people who have these disorders, the one in five of us
Dialogue: 0,0:08:46.80,0:08:48.63,Default,,0000,0000,0000,,who struggle in some way,
Dialogue: 0,0:08:48.63,0:08:50.92,Default,,0000,0000,0000,,you find that there's a lot of variation
Dialogue: 0,0:08:50.92,0:08:54.13,Default,,0000,0000,0000,,in the way that the brain is wired,
Dialogue: 0,0:08:54.13,0:08:56.73,Default,,0000,0000,0000,,but there are some predictable patterns, and those patterns
Dialogue: 0,0:08:56.73,0:09:00.55,Default,,0000,0000,0000,,are risk factors for developing one of these disorders.
Dialogue: 0,0:09:00.55,0:09:03.54,Default,,0000,0000,0000,,It's a little different than the way we think about brain disorders
Dialogue: 0,0:09:03.54,0:09:06.31,Default,,0000,0000,0000,,like Huntington's or Parkinson's or Alzheimer's disease
Dialogue: 0,0:09:06.31,0:09:08.70,Default,,0000,0000,0000,,where you have a bombed-out part of your cortex.
Dialogue: 0,0:09:08.70,0:09:11.96,Default,,0000,0000,0000,,Here we're talking about traffic jams, or sometimes detours,
Dialogue: 0,0:09:11.96,0:09:14.71,Default,,0000,0000,0000,,or sometimes problems with just the way that things are connected
Dialogue: 0,0:09:14.71,0:09:15.95,Default,,0000,0000,0000,,and the way that the brain functions.
Dialogue: 0,0:09:15.95,0:09:19.12,Default,,0000,0000,0000,,You could, if you want, compare this to,
Dialogue: 0,0:09:19.12,0:09:22.17,Default,,0000,0000,0000,,on the one hand, a myocardial infarction, a heart attack,
Dialogue: 0,0:09:22.17,0:09:23.100,Default,,0000,0000,0000,,where you have dead tissue in the heart,
Dialogue: 0,0:09:23.100,0:09:27.59,Default,,0000,0000,0000,,versus an arrhythmia, where the organ simply isn't functioning
Dialogue: 0,0:09:27.59,0:09:29.84,Default,,0000,0000,0000,,because of the communication problems within it.
Dialogue: 0,0:09:29.84,0:09:31.81,Default,,0000,0000,0000,,Either one would kill you; in only one of them
Dialogue: 0,0:09:31.81,0:09:34.41,Default,,0000,0000,0000,,will you find a major lesion.
Dialogue: 0,0:09:34.41,0:09:37.24,Default,,0000,0000,0000,,As we think about this, probably it's better to actually go
Dialogue: 0,0:09:37.24,0:09:40.47,Default,,0000,0000,0000,,a little deeper into one particular disorder, and that would be schizophrenia,
Dialogue: 0,0:09:40.47,0:09:42.60,Default,,0000,0000,0000,,because I think that's a good case
Dialogue: 0,0:09:42.60,0:09:46.13,Default,,0000,0000,0000,,for helping to understand why thinking of this as a brain disorder matters.
Dialogue: 0,0:09:46.13,0:09:50.01,Default,,0000,0000,0000,,These are scans from Judy Rapoport and her colleagues
Dialogue: 0,0:09:50.01,0:09:52.18,Default,,0000,0000,0000,,at the National Institute of Mental Health
Dialogue: 0,0:09:52.18,0:09:55.89,Default,,0000,0000,0000,,in which they studied children with very early onset schizophrenia,
Dialogue: 0,0:09:55.89,0:09:57.36,Default,,0000,0000,0000,,and you can see already in the top
Dialogue: 0,0:09:57.36,0:09:59.90,Default,,0000,0000,0000,,there's areas that are red or orange, yellow,
Dialogue: 0,0:09:59.90,0:10:02.04,Default,,0000,0000,0000,,are places where there's less gray matter,
Dialogue: 0,0:10:02.04,0:10:03.58,Default,,0000,0000,0000,,and as they followed them over five years,
Dialogue: 0,0:10:03.58,0:10:05.82,Default,,0000,0000,0000,,comparing them to age match controls,
Dialogue: 0,0:10:05.82,0:10:07.64,Default,,0000,0000,0000,,you can see that, particularly in areas like
Dialogue: 0,0:10:07.64,0:10:09.95,Default,,0000,0000,0000,,the dorsolateral prefrontal cortex
Dialogue: 0,0:10:09.95,0:10:14.28,Default,,0000,0000,0000,,or the superior temporal gyrus, there's a profound loss of gray matter.
Dialogue: 0,0:10:14.28,0:10:15.83,Default,,0000,0000,0000,,And it's important, if you try to model this,
Dialogue: 0,0:10:15.83,0:10:17.78,Default,,0000,0000,0000,,you can think about normal development
Dialogue: 0,0:10:17.78,0:10:21.04,Default,,0000,0000,0000,,as a loss of cortical mass, loss of cortical gray matter,
Dialogue: 0,0:10:21.04,0:10:24.70,Default,,0000,0000,0000,,and what's happening in schizophrenia is that you overshoot that mark,
Dialogue: 0,0:10:24.70,0:10:26.27,Default,,0000,0000,0000,,and at some point, when you overshoot,
Dialogue: 0,0:10:26.27,0:10:29.26,Default,,0000,0000,0000,,you cross a threshold, and it's that threshold
Dialogue: 0,0:10:29.26,0:10:32.84,Default,,0000,0000,0000,,where we say, this is a person who has this disease,
Dialogue: 0,0:10:32.84,0:10:35.12,Default,,0000,0000,0000,,because they have the behavioral symptoms
Dialogue: 0,0:10:35.12,0:10:37.24,Default,,0000,0000,0000,,of hallucinations and delusions.
Dialogue: 0,0:10:37.24,0:10:38.72,Default,,0000,0000,0000,,That's something we can observe.
Dialogue: 0,0:10:38.72,0:10:44.36,Default,,0000,0000,0000,,But look at this closely and you can see that actually they've crossed a different threshold.
Dialogue: 0,0:10:44.36,0:10:47.36,Default,,0000,0000,0000,,They've crossed a brain threshold much earlier,
Dialogue: 0,0:10:47.36,0:10:50.50,Default,,0000,0000,0000,,that perhaps not at age 22 or 20,
Dialogue: 0,0:10:50.50,0:10:53.27,Default,,0000,0000,0000,,but even by age 15 or 16 you can begin to see
Dialogue: 0,0:10:53.27,0:10:55.63,Default,,0000,0000,0000,,the trajectory for development is quite different
Dialogue: 0,0:10:55.63,0:10:59.14,Default,,0000,0000,0000,,at the level of the brain, not at the level of behavior.
Dialogue: 0,0:10:59.14,0:11:01.24,Default,,0000,0000,0000,,Why does this matter? Well first because,
Dialogue: 0,0:11:01.24,0:11:04.38,Default,,0000,0000,0000,,for brain disorders, behavior is the last thing to change.
Dialogue: 0,0:11:04.38,0:11:07.29,Default,,0000,0000,0000,,We know that for Alzheimer's, for Parkinson's, for Huntington's.
Dialogue: 0,0:11:07.29,0:11:09.72,Default,,0000,0000,0000,,There are changes in the brain a decade or more
Dialogue: 0,0:11:09.72,0:11:14.76,Default,,0000,0000,0000,,before you see the first signs of a behavioral change.
Dialogue: 0,0:11:14.76,0:11:17.71,Default,,0000,0000,0000,,The tools that we have now allow us to detect
Dialogue: 0,0:11:17.71,0:11:22.00,Default,,0000,0000,0000,,these brain changes much earlier, long before the symptoms emerge.
Dialogue: 0,0:11:22.00,0:11:25.40,Default,,0000,0000,0000,,But most important, go back to where we started.
Dialogue: 0,0:11:25.40,0:11:28.62,Default,,0000,0000,0000,,The good-news stories in medicine
Dialogue: 0,0:11:28.62,0:11:31.56,Default,,0000,0000,0000,,are early detection, early intervention.
Dialogue: 0,0:11:31.56,0:11:35.23,Default,,0000,0000,0000,,If we waited until the heart attack,
Dialogue: 0,0:11:35.23,0:11:39.20,Default,,0000,0000,0000,,we would be sacrificing 1.1 million lives
Dialogue: 0,0:11:39.20,0:11:41.61,Default,,0000,0000,0000,,every year in this country to heart disease.
Dialogue: 0,0:11:41.61,0:11:44.02,Default,,0000,0000,0000,,That is precisely what we do today
Dialogue: 0,0:11:44.02,0:11:48.53,Default,,0000,0000,0000,,when we decide that everybody with one of these brain disorders,
Dialogue: 0,0:11:48.53,0:11:51.73,Default,,0000,0000,0000,,brain circuit disorders, has a behavioral disorder.
Dialogue: 0,0:11:51.73,0:11:54.96,Default,,0000,0000,0000,,We wait until the behavior becomes manifest.
Dialogue: 0,0:11:54.96,0:11:59.52,Default,,0000,0000,0000,,That's not early detection. That's not early intervention.
Dialogue: 0,0:11:59.52,0:12:01.32,Default,,0000,0000,0000,,Now to be clear, we're not quite ready to do this.
Dialogue: 0,0:12:01.32,0:12:04.48,Default,,0000,0000,0000,,We don't have all the facts. We don't actually even know
Dialogue: 0,0:12:04.48,0:12:07.02,Default,,0000,0000,0000,,what the tools will be,
Dialogue: 0,0:12:07.02,0:12:11.28,Default,,0000,0000,0000,,nor what to precisely look for in every case to be able
Dialogue: 0,0:12:11.28,0:12:15.49,Default,,0000,0000,0000,,to get there before the behavior emerges as different.
Dialogue: 0,0:12:15.49,0:12:18.42,Default,,0000,0000,0000,,But this tells us how we need to think about it,
Dialogue: 0,0:12:18.42,0:12:19.91,Default,,0000,0000,0000,,and where we need to go.
Dialogue: 0,0:12:19.91,0:12:21.12,Default,,0000,0000,0000,,Are we going to be there soon?
Dialogue: 0,0:12:21.12,0:12:23.79,Default,,0000,0000,0000,,I think that this is something that will happen
Dialogue: 0,0:12:23.79,0:12:26.62,Default,,0000,0000,0000,,over the course of the next few years, but I'd like to finish
Dialogue: 0,0:12:26.62,0:12:29.16,Default,,0000,0000,0000,,with a quote about trying to predict how this will happen
Dialogue: 0,0:12:29.16,0:12:31.52,Default,,0000,0000,0000,,by somebody who's thought a lot about changes
Dialogue: 0,0:12:31.52,0:12:33.85,Default,,0000,0000,0000,,in concepts and changes in technology.
Dialogue: 0,0:12:33.85,0:12:36.11,Default,,0000,0000,0000,,"We always overestimate the change that will occur
Dialogue: 0,0:12:36.11,0:12:38.34,Default,,0000,0000,0000,,in the next two years and underestimate
Dialogue: 0,0:12:38.34,0:12:42.21,Default,,0000,0000,0000,,the change that will occur in the next 10." -- Bill Gates.
Dialogue: 0,0:12:42.21,0:12:43.58,Default,,0000,0000,0000,,Thanks very much.
Dialogue: 0,0:12:43.58,0:12:46.26,Default,,0000,0000,0000,,(Applause)