The Medicine for Tomorrow: Memories of the Future: Aris Lācis and Andrejs Ērglis at TEDxRiga

Good morning, ladies and gentlemen. We should do something to keep up
to the introduction we have received. We were just standing backstage with prof. Aris Lacis, discussing how we could be as uplifting
and cheerful as the previous presentation. We decided that
we will not be able to do that. What we will do is tell you
what we work with. – The same as in the movie “Diamond Hand” – Yes, but we will try to present
what we do every day, and maybe have a look
at the notion of health in a different light. So maybe I will try and ask prof.
Aris Lacis, and he will comment. Aris Lacis has worked in medicine
for a very long time, and now he has engaged in some brand new projects,
so he constantly continues. If we talk about medicine,
and look at what happens with health, we can note that healthcare is a broader concept
than just giving a pill to a patient, or a syringe. Maybe you could comment on it
and on the picture we see on the screen. Health is not merely how you are feeling today,
not only a sore throat. Health is mental, spiritual and physical well-being of ourselves,
as well as our families and nations. Would you agree
that it is more than giving a shot? – Yes. I think that it is an obligation
to ensure that everyone, the whole country is provided with support and treatment Our challenge with Andrejs is to find a way to provide it
when the orthodox methods prove to fail. Or when it is too late to apply traditional medicine,
we have to run other forms of activity. – I would say that some time ago
we acted similar to these paintings. We approached the patient, looked into their eyes,
talked, and then tried to diagnose. Can we say that something has changed
since these Flemish paintings were created? It think you must have experienced
a huge leap in development of medicine, since you started with children’s cardiac surgery in the sixties,
when it was looked upon with extreme mistrust. You probably have a story that you were rebuked,
criticized for practicing surgery on infants. – It was the case. However, let’s not look to much at the past
I try to distance myself from that, so you shouldn’t remind me of it.
I enjoy where I am today. I have practiced medicine for fifty years,
and forty-five of them in children’s cardiac surgery. On the attitudes towards the patient
and patients’ relationships with doctors, I think the situation has changed indeed.
It used to be the case, when you and I were still studying… – When I studied, you were teaching. – So we were taught
that talking with patients is important, and the crucial part of it was to find out, comprehend,
if the patient is truthful about themself… The accent has shifted away from it. Today doctors can run tens of different tests
before having a conversation. Some of my colleagues might
be offended by these words. We can find proof of it in medical history logs, too. – You can see the ten different tests
that can be run, on the screen. – But a doctor has to be wise and find clues
before falling for myriads of such tests. In a word, all of these tools should not replace
the doctor’s ability to draw conclusions. – We should look for the balance, because today
we are also talking about development of technology. TEDx in a way is also
a huge medication technology. By sharing our knowledge about medicine, basically we treat
the society’s health, and we receive a feedback flow, too. So perhaps this is why
we compare memories with the future. Looking at the past, we need to understand
how exactly we develop medical technology for the future. – I would like to say that we need to fundamentally change
our mentality and the attitude towards the optimization of how
medical science is applied. We should be looking for easier ways
for scientific discoveries to be applied in practice. We will show you an illustration later on. We need to think how to shorten this process,
make it less bureaucratic, with less red tape, which sometimes sets a whole lot of obstacles
that usually prevent the doctor from doing a good job. – Did you mean this illustration?
– Of course. – And you are not afraid that your blood vessels
are somewhat similar to a pie? – I don’t eat them.
I could say that I am more of a honey person. – What I want to ask you is this.
Do you think that sometimes we treat risks as a decease? And that actually,
I don’t have a slide with it but still, one Chinese doctor once said
long time before Hippocrates, that best doctors treat a decease long before
it manifests itself, before the patient is sick. – It is hard to agree on this in my case. A large portion of my patients
are children that are not yet born. So I couldn’t accuse them of not going to see me earlier,
before the decease had progressed. – I am not talking about accusations. My point is that we have to start working at a much earlier stage,
so that risks do not turn into deceases. – Of course. – Perhaps people do not take it seriously,
but let’s have a look at the ages on this graph. I always mention it to my students.
The Bible says that when we are born, we die. This is a normal evolution,
and Proust described it in detail. We ought not to live eternally. And we need
to understand that right after we are born, some deceases, which are not actually deceases
but merely aging-related processes do come to pass. And we should do everything
to prevent them from happening, both ourselves, and this is why
I am grateful for this conference, TEDx or any TV show I can participate in,
for the reason that it educates the society. – By pointing out what should be prohibited? – Those are not prohibitions.
Those are attempts to foster knowledge. Prohibitions and bans do not work. – Harmful habits, unhealthy food. – We started talking about coffee today.
And why did we talk about it? Would you agree that today’s medicine
is a medicine that is based on proof? We cannot compare it to what used to take place. When we studied, whatever
the professor told you, you had to do. Was it always the right thing?
Huh… – Well, in our team we always say that an obedient fool
is the worst employee you can imagine. And if one’s energy stronger than the ability
to do their work properly, a problem appears. – So, I put up this slide because all the time
I am approached with a question whether coffee is harmful. And since the medicine practiced today is proof-based medicine,
these are findings of major research on coffee. So you see in red that consuming more
than four cups of coffee daily is harmful. And on the other side there are findings
from research as major as the first one, saying that more than four cups
of coffee daily is not harmful. This is what becomes of proof-based medicine
if you look for patterns in too large samples of patients. And now I would like to roll back to
prof. Lacis’ area of expertise, and my own, too. Let’s look at this Voltaire’s citation. He said that doctors issue drugs
that they know little about, to treat deceases they know even less about, to the people they do not know anything about. So maybe it is time to shift back from
proof-based medicine, which we cannot neglect, for the same reason that you mentioned the obedient fool,
and go back to the medicine that is personalized. What do you think? – While you were talking there,
I thought that actually in this whole process. – But wait. I am keeping track of time,
so it means that I am not talking too much. But I was convinced you would at some point
refer to something I’d said earlier. – Not this time. I wanted to say that first of all the doctor should be
thinking about not harming their patient by what their treatment. In addition, there is a Benjamin Franklin’s
citation that time is money. If applied in our area, it could be rephrased to
“Time is life”. You are on a tight schedule. So, extensive research or personalized medicine aside,
sometimes you reach the point when the laws have to be bent. You are in a hurry, there is risk, whether something should be done
is actually not a question of ethics, rather a professional question. Do you belong to your profession or not? Are you capable of making
a decision based on your skills? I’d like to stress how good it is
to present together at this conference, TEDx, the letters that stand for technology,
environment and design. Design is also applied in our field – research is designed. Everything within us is designed, too. If you look at these pictures,
and I don’t know how good you can see them, this is our genetic map, or a DNA map.
And this is a totally new approach. If in the past we had the doctor works
together with the scientist doing research, today we see more and more often that doctors work directly with
the patient, in the hospital, to provide personalized treatment. And for that reason,
medicine is changing so rapidly. So quite often, especially in Latvia, when we talk about medicine,
we fail to look ahead at what is coming. In fact, we fail to look at today. We merely draw conclusions from something
that took place in the past. And this is our biggest mistake. I think it will be interesting to designers
and technology people, too…. If you could comment on the following slide.
I will stop talking soon. I know that we agreed that
you would be talking about this, not me. – We both have the same flaw. – Yes.
That’s why we were invited here. – What I wanted to say was that we apply quite a lot
of mathematics in medicine today, and a lot of physics. The same principles that are applied
in Formula I or in cart racing. What you see here is called the dynamics of fluids. And for the next slide.
This actually is today. The same people who created
Jurassic Park made this depiction. The idea is that we can measure
everything that goes on in a heart. If you are looking at these pictures today,
this is one of our patients. The measurements were made in Riga.
The visualization was made in the Silicon Valley. So the question to you is, considering that you are in fact
a very up-to-date person, and it is proved just by looking at you… – Especially at my clothes… – Well, you can afford to dress like that.
As for me, I still have to build the image. – Lacquered shoes compared to mine…
We are not exactly compatible. – Yes, they should write about us in papers. – So perhaps you wanted me to comment on the slide? The only way to prevent you from talking
is to continue what you were saying. It really is of crucial importance. In everything we do, and
in everything we will mention today, this provides proof that you did a good job
treating the patient, first of all, proof to yourself, but also to convince others,
show them how it looks. Such visual explanation was necessary
when we made the first stem cell transfer. A journalist approached me asking me “So how is it?”
So I didn’t know what to say. If I reply “Bad” or “Good”, I will look rather foolish.
How good exactly? I had no idea how to respond, so I pulled the X-ray log
that I hadn’t even seen before. I pulled out two shots and was able to show that the heart that
had been shaped like a ball was now in normal configuration. But not always we have such opportunity. That’s why we need such technology to be able to show visually and to convince the patient and
their family, and yourself, too, that you have done a good job. – Would you agree that these math models will help us
in the future to comprehend how it looks? – But of course. This technology has to be
drawn closer to the clinical application. This is the problem that I mentioned earlier. – That’s what we do.
We apply it with regenerative medicine in Latvia. – Perhaps that was the reason… – Why we were invited here. We work in different fields
of regenerative medicine. Probably the emotional story
would be about prof. Aris calling me at night and telling how he has just saved
a child’s life, and it was successful. Maybe you can tell this story. – I think you are used to such situations,
others might find it peculiar… – That you call me at night?
– Yes. You being a man and all… – Very contemporary. This here is what we started to do with
heart attacks about three years ago. Actually more like four years,
the time is running so fast… When we talk about cells,
usually there is a mix up. People think that we refer to embryo cells,
but that is not the case. We do not work with such cells.
We would have enormous problems if we did. What we work with in Latvia are patients’
own stem cells. They simply are cleansed. They are not even modified. Yet.. We do it with children, and in
cases of myocardial infarction. We have started catheterizing also in cases of diabetes.
I remember these slides back when I was still your student. Back at the time I was also
learning to catheterize the heart. But these pictures are in fact not of a heart
but of a pancreatic artery. We can go very deep
into the artery with a catheter. – Once you were approached in a market
with a question about that.. – Yes, right. So look, this is about children.
Maybe you can tell this story. – Yes, children. What you see here is
stem cell injection into the heart muscle. So far we are the only ones in the world,
the first in the world to do that. What others work with is
injecting stem cells into the coronary artery. Of course, injecting a two, three, four or five month old infant,
entering their coronary artery is extremely risky. It is dangerous and technically it is very difficult to accomplish.
It is much easier to inject into the heart muscle. This method is gentle, it is not dangerous,
but it is professional. And it is in no way harmful,
and it follows the Hippocrates principle, it cannot harm the patient because
the stem cells are the child’s bone marrow cells. – Of course we were not so definite in the beginning.
We were also afraid, and I think, you especially, weren’t you? – You don’t know me, but those who work with me know
that I am not an adventurist, I do only things that I know. And since I have worked in cardiac surgery for 45 years, I know in what place, professionally,
accurately it must be done. So I do not have to be afraid. – But you have always lived with a risk.
You cannot conduct surgery without a risk. – The risk has to be reasonable, but you have to be
equipped with knowledge and experience. You shouldn’t let family physician conduct this procedure. – This is what we see in this picture.
This is the injection. – The place where the injection is made, you see,
is the ventricle wall, given the patient’s myopathy, we are talking about children
with unclear centrology myopathy. More than 50% of them do not
live to one year’s age. In 40% of cases treatment
proves ineffective. They face heart transplantation, which is
conducted very scarcely across the world. So this method is of critical practical importance. The first girl, Sofia. The surgery
was made in a preagonal state. The girl has lived 3,5 years since,
and she is fine. She is seven now. – Dear scientist, you are exaggerating.
This was made in May 2009. So it was three years ago. – Yes, but she was of
a certain age then. Were you good at maths? – Yes, I graduated high school in the city. – Well, I went to school in a small town,
I could never compete with you. – Why will we continue giving preference
to cell therapy also in the future? – Because for patients in such state
this is in principle the only option. The only option. And without claiming full recovery,
let’s say, everyone gets better, but not everyone gets better similarly.
It depends on many factors. Were the cells chosen properly? Or the method. There is a possibility to stimulate these cells. – I am afraid we have to conclude.
I knew we would take more than 20 minutes. I just want to show you what is happening in Latvia.
Latvian audience will find it interesting. This is made by a local physicist,
Andrejs Cebers. We call it an ant. I am sorry for the quality of the pictures,
but we can get quite many cells from bone marrow. And this is what the story is about. Because of these ants
we are able to transport these cells to a specific organ. And in fact this is not future. This is what I call the memories of future,
because it is happening today. This is what is peculiar about Latvia.
It is both the pro and the con. We can complain about it,
but in Latvia we are allowed to practice it. We ourselves do not complain. – Only in front of the whole audience. – Of course.
This is what you wanted – to mention the straw hat. – Yes. He was participating in a parade of Nobel
prize laureates, on some special day. Everyone was wearing mantels,
he was the only one in a straw hat. The photo is publicly available,
if you are interested you can find it. – You want to stress this issue with my suit probably. And then the last picture.
Regenerative medicine dates back to antique times. This is Prometheus.
When he brought fire to humans, he was chained to a cliff. And each day birds
fed of his flesh. I will not say those were eagles
(prof. Erglis’ surname means “Eagle” in Latvian). – Correct way to act. – So the birds rove his liver,
and his liver was renewed every day. This is what we call
regenerative therapy. And speaking of Aris Lacis,
this might be interesting. I have just met prof. Ochkurin in Paris who, together with DeBakey conducted
surgery on president Yeltsin. And he was asking how you are doing,
and how Okhlakov is. He said that when these two guys would
walk down a hallway, he always got terrified. Thank you. – Well, very sincerely.

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