WEBVTT 00:00:00.000 --> 00:00:02.779 Welcome back to the deep dive. You know, I was 00:00:02.779 --> 00:00:04.759 reading a statistic the other day that completely 00:00:04.759 --> 00:00:07.519 blew my mind. It was about what they call the 00:00:07.519 --> 00:00:10.359 the valley of death in science. Oh, right. I 00:00:10.359 --> 00:00:13.400 know this one. It sounds super dramatic, but 00:00:13.400 --> 00:00:17.600 it's it's actually quite literal in a metaphorical 00:00:17.600 --> 00:00:19.620 sense. Right. Because it's usually used in the 00:00:19.620 --> 00:00:21.239 startup world, like when you run out of cash 00:00:21.239 --> 00:00:22.800 before you can actually launch your product. 00:00:22.859 --> 00:00:26.059 But in medicine, it means something. arguably 00:00:26.059 --> 00:00:29.079 much worse. Yeah, much worse. It is that massive 00:00:29.079 --> 00:00:32.240 gaping void between a breakthrough in a lab, 00:00:32.460 --> 00:00:34.520 you know, some amazing discovery in a test tube, 00:00:34.840 --> 00:00:37.219 and the moment it actually helps a patient in 00:00:37.219 --> 00:00:40.119 a hospital bed. The infamous bench to bedside 00:00:40.119 --> 00:00:43.240 gap. Yeah. It is... Probably the single biggest 00:00:43.240 --> 00:00:45.719 inefficiency in modern science. You have brilliant 00:00:45.719 --> 00:00:48.119 biochemistry happening in one building and brilliant 00:00:48.119 --> 00:00:50.799 patient care happening in another. And they are 00:00:50.799 --> 00:00:52.619 effectively speaking different languages. And 00:00:52.619 --> 00:00:54.479 the stats on this are just depressing. We are 00:00:54.479 --> 00:00:57.000 talking years, sometimes decades, for knowledge 00:00:57.000 --> 00:00:58.859 to cross that valley. And sometimes it never 00:00:58.859 --> 00:01:02.399 makes it. It just dies in a PDF somewhere. Which 00:01:02.399 --> 00:01:04.540 is a tragedy for the patients waiting for those 00:01:04.540 --> 00:01:08.340 treatments. Exactly. So today we are diving into 00:01:08.340 --> 00:01:11.469 the machinery built to fix that. The connective 00:01:11.469 --> 00:01:14.250 tissue, if you will. We are looking at the European 00:01:14.250 --> 00:01:17.549 Society for Clinical Investigation, or ESCI. 00:01:17.670 --> 00:01:19.209 And I know what you're thinking. Society for 00:01:19.209 --> 00:01:21.069 Clinical Investigation sounds like, I don't know, 00:01:21.150 --> 00:01:23.909 a room full of people in tweed jackets quietly 00:01:23.909 --> 00:01:26.109 nodding at each other in a dusty library. It 00:01:26.109 --> 00:01:28.090 really does have a certain dusty textbook ring 00:01:28.090 --> 00:01:30.609 to it. But looking at the research you've pulled 00:01:30.609 --> 00:01:33.090 for us today, this isn't just a social club at 00:01:33.090 --> 00:01:35.609 all. It looks more like the engineering core 00:01:35.609 --> 00:01:38.010 for European medicine. That is a fantastic way 00:01:38.010 --> 00:01:40.790 to frame it. ESCI, which has actually been around 00:01:40.790 --> 00:01:44.689 since February 12, 1967, acts as that connective 00:01:44.689 --> 00:01:47.689 tissue. Their entire mission is to build a really 00:01:47.689 --> 00:01:50.810 rigorous framework that forces fundamental science, 00:01:51.150 --> 00:01:54.150 genetics, physiology, the wet lab stuff, to translate 00:01:54.150 --> 00:01:56.629 directly into applied clinical medicine. So making 00:01:56.629 --> 00:01:58.750 sure the geneticist is actually talking to the 00:01:58.750 --> 00:02:01.549 cardiologist? Precisely. And doing it across 00:02:01.549 --> 00:02:04.049 an entire continent. Which, as you can imagine, 00:02:04.329 --> 00:02:07.840 is a bit like herding cats. But the cats speak 00:02:07.840 --> 00:02:10.939 20 different languages and have entirely different 00:02:10.939 --> 00:02:13.520 funding structures. Let's start with the scope 00:02:13.520 --> 00:02:16.379 here. Because clinical investigation sounds very 00:02:16.379 --> 00:02:18.819 specific. To me, that sounds like a doctor running 00:02:18.819 --> 00:02:21.719 a drug trial on a hospital ward. But the source 00:02:21.719 --> 00:02:25.080 material suggests ESCI views this much, much 00:02:25.080 --> 00:02:27.680 more broadly. They do. And this is the first 00:02:27.680 --> 00:02:30.520 key insight for the listener today. Clinical 00:02:30.520 --> 00:02:32.780 investigation isn't just about testing pills. 00:02:33.360 --> 00:02:36.500 If ESCI limited themselves to just hospital trials, 00:02:36.879 --> 00:02:39.240 they'd miss where all the real innovation is 00:02:39.240 --> 00:02:41.699 happening right now. They define their scope 00:02:41.699 --> 00:02:44.699 as cross -sectional and future -oriented. Future 00:02:44.699 --> 00:02:46.759 -oriented is doing a lot of heavy lifting there. 00:02:46.819 --> 00:02:48.719 What does that actually look like in practice? 00:02:48.840 --> 00:02:51.159 It means they've expanded their mandate to include 00:02:51.159 --> 00:02:53.240 fields that didn't even exist when they were 00:02:53.240 --> 00:02:56.319 founded back in the 60s. We're talking bioinformatics, 00:02:56.759 --> 00:02:59.180 digital health. personalized medicine, and gender 00:02:59.180 --> 00:03:00.840 medicine. That one really jumped out at me in 00:03:00.840 --> 00:03:02.740 the notes. It's a crucial addition. Well, it 00:03:02.740 --> 00:03:04.680 feels like a very necessary correction, doesn't 00:03:04.680 --> 00:03:08.080 it? Because for a long time, medical research 00:03:08.080 --> 00:03:11.099 effectively just meant research on male biology, 00:03:11.099 --> 00:03:13.800 and everyone else was just considered a variation 00:03:13.800 --> 00:03:16.840 of that baseline. Exactly right. By explicitly 00:03:16.840 --> 00:03:20.180 including gender medicine, ESCI is acknowledging 00:03:20.180 --> 00:03:23.020 that you cannot have precision medicine if you 00:03:23.020 --> 00:03:25.580 treat half the global population as a variable 00:03:25.580 --> 00:03:29.129 you can just ignore. Biological differences alter 00:03:29.129 --> 00:03:32.169 how diseases present and how drugs metabolize. 00:03:32.409 --> 00:03:33.930 Right. A heart attack looks different in a woman 00:03:33.930 --> 00:03:36.310 than a man. Completely different. So by adding 00:03:36.310 --> 00:03:38.729 this and adding digital health, they are admitting 00:03:38.729 --> 00:03:41.009 that the bench side of the equation has changed. 00:03:41.330 --> 00:03:43.409 It's not just test tubes and pipettes anymore. 00:03:43.550 --> 00:03:46.789 It's algorithms and huge complex data sets. So 00:03:46.789 --> 00:03:48.969 the raw materials of medicine are changing. It's 00:03:48.969 --> 00:03:51.689 code and data now. And this society is trying 00:03:51.689 --> 00:03:53.830 to update the factory floor to handle all of 00:03:53.830 --> 00:03:56.009 that new material. That's a great analogy. And 00:03:56.009 --> 00:03:58.750 to manage this huge widening scope, they have 00:03:58.750 --> 00:04:01.550 four specific pillars, four core objectives that 00:04:01.550 --> 00:04:03.590 underpin absolutely everything they do. Let's 00:04:03.590 --> 00:04:05.729 break those down because this is really the nuts 00:04:05.729 --> 00:04:08.389 and bolts of the organization. The first one 00:04:08.389 --> 00:04:11.389 is creating a common language. Which goes right 00:04:11.389 --> 00:04:14.229 back to that silo problem we mentioned. If a 00:04:14.229 --> 00:04:16.870 molecular biologist finds a brand new pathway 00:04:16.870 --> 00:04:19.990 for inflammation, but describes it in jargon 00:04:19.990 --> 00:04:22.069 that a clinical rheumatologist cannot parse, 00:04:22.829 --> 00:04:25.589 that knowledge is effectively useless. It stays 00:04:25.589 --> 00:04:28.790 locked in the lab. ESCI wants to standardize 00:04:28.790 --> 00:04:31.370 the lexicon so these completely different fields 00:04:31.370 --> 00:04:33.550 can actually collaborate. It's like trying to 00:04:33.550 --> 00:04:35.810 build a house where the architect speaks French 00:04:35.810 --> 00:04:38.790 and the builder speaks Japanese. You desperately 00:04:38.790 --> 00:04:41.350 need a translator. Or at least a shared set of 00:04:41.350 --> 00:04:44.110 blueprints. Right. Okay. The second pillar is 00:04:44.110 --> 00:04:46.449 promoting the scientific method. Specifically 00:04:46.449 --> 00:04:49.110 apply it to clinical research. Is there a difference 00:04:49.110 --> 00:04:51.889 there? I mean, science is science, right? Hypothesis, 00:04:51.970 --> 00:04:55.560 test, result. In theory, yes. In practice, not 00:04:55.560 --> 00:04:58.040 so much. A bench experiment is highly controlled. 00:04:58.139 --> 00:04:59.800 You control the room temperature, the cells, 00:04:59.980 --> 00:05:02.040 the reagents. You can run it a hundred times 00:05:02.040 --> 00:05:04.860 and get the exact same result. Clinical research 00:05:04.860 --> 00:05:07.899 involves humans. Humans are messy. We lie about 00:05:07.899 --> 00:05:10.600 what we eat. We skip our medication doses. We 00:05:10.600 --> 00:05:12.439 have genetic variations. We live in different 00:05:12.439 --> 00:05:15.019 environments with different stress levels. Applying 00:05:15.019 --> 00:05:17.480 the rigorous scientific method to all that human 00:05:17.480 --> 00:05:21.170 messiness requires a very specific very strict 00:05:21.170 --> 00:05:23.550 set of standards, which leads us right into the 00:05:23.550 --> 00:05:25.790 third pillar. And this, to me, was the most surprising 00:05:25.790 --> 00:05:28.850 part of their entire charter. They aim to improve 00:05:28.850 --> 00:05:31.810 standards, specifically focusing on three things, 00:05:32.230 --> 00:05:35.490 reproducibility, sustainability. and justice. 00:05:35.829 --> 00:05:37.790 It's a really fascinating combination of words, 00:05:37.970 --> 00:05:40.730 isn't it? Reproducibility, I totally get. We 00:05:40.730 --> 00:05:43.050 are in the middle of a massive replication crisis 00:05:43.050 --> 00:05:45.269 in psychology and medicine. If you can't get 00:05:45.269 --> 00:05:48.009 the same result twice, it's not science. It's 00:05:48.009 --> 00:05:50.670 just an anecdote. Right. If I claim I cured a 00:05:50.670 --> 00:05:52.589 mouse in my lab, you need to be able to cure 00:05:52.589 --> 00:05:54.870 the mouse in your lab using my exact method. 00:05:55.189 --> 00:05:57.629 If you can't, my finding is essentially worthless. 00:05:58.110 --> 00:06:01.149 ESCI is doubling down on that rigor. But sustainability 00:06:01.149 --> 00:06:03.939 and justice take it a step further. When a medical 00:06:03.939 --> 00:06:06.120 society talks about sustainability, are they 00:06:06.120 --> 00:06:08.819 talking about recycling plastic syringes and 00:06:08.819 --> 00:06:11.680 using solar power? While that kind of environmental 00:06:11.680 --> 00:06:14.100 sustainability is important, in this specific 00:06:14.100 --> 00:06:17.100 context, it usually refers to data sustainability. 00:06:18.019 --> 00:06:20.259 Research is incredibly expensive and resource 00:06:20.259 --> 00:06:23.180 intensive. If you run a massive clinical study 00:06:23.180 --> 00:06:25.759 and the data isn't stored properly or it's not 00:06:25.759 --> 00:06:28.139 made accessible to future researchers, that is 00:06:28.139 --> 00:06:31.319 a colossal waste of resources. Oh, I see. Sustainable 00:06:31.319 --> 00:06:33.720 research means building robust data sets that 00:06:33.720 --> 00:06:37.060 can be mined for decades, not just used for one 00:06:37.060 --> 00:06:39.579 single paper and then thrown away on an old hard 00:06:39.579 --> 00:06:41.779 drive. OK, that makes perfect sense. But justice, 00:06:42.160 --> 00:06:44.500 that feels like a really heavy word for a scientific 00:06:44.500 --> 00:06:47.540 charter. It is a heavy word. And seeing it explicitly 00:06:47.540 --> 00:06:50.480 mentioned signals a massive shift in how these 00:06:50.480 --> 00:06:53.819 organizations view their role in society. Justice 00:06:53.819 --> 00:06:55.939 here implies that research has a fundamental 00:06:55.939 --> 00:06:58.779 obligation to be equitable in its structure. 00:06:59.079 --> 00:07:01.639 Equitable in what way, exactly? In who gets to 00:07:01.639 --> 00:07:03.620 be included in the studies and who actually gets 00:07:03.620 --> 00:07:06.660 to benefit from them. Historically, clinical 00:07:06.660 --> 00:07:09.339 trials have been overwhelmingly focused on very 00:07:09.339 --> 00:07:13.480 specific demographics, often white, Western male 00:07:13.480 --> 00:07:16.339 populations. If you only ever test a drug on 00:07:16.339 --> 00:07:18.839 that one demographic, you technically don't know 00:07:18.839 --> 00:07:21.050 if it works safely for everyone else. Right. 00:07:21.050 --> 00:07:24.829 It's a huge blind spot. Exactly. ESEI explicitly 00:07:24.829 --> 00:07:26.569 mentioning justice suggests they are pushing 00:07:26.569 --> 00:07:29.529 hard for inclusivity in trials. It's a quality 00:07:29.529 --> 00:07:32.170 control issue as much as a moral one. If your 00:07:32.170 --> 00:07:34.769 data doesn't represent the population, your data 00:07:34.769 --> 00:07:37.170 is simply bad. That moves them from being just 00:07:37.170 --> 00:07:39.810 scientists to being almost guardians of the data's 00:07:39.810 --> 00:07:41.850 integrity across the whole population. Which 00:07:41.850 --> 00:07:44.209 is exactly what the fourth pillar is all about. 00:07:44.889 --> 00:07:48.069 Networking. You cannot uphold standards of justice 00:07:48.069 --> 00:07:50.550 or reproducibility completely alone. You need 00:07:50.550 --> 00:07:53.430 a solid web of mutual support. You need the cardiologists 00:07:53.430 --> 00:07:55.490 in Berlin to be able to back up the geneticists 00:07:55.490 --> 00:07:57.829 in Lisbon. Okay, so we have the mission mapped 00:07:57.829 --> 00:08:00.889 out. Connect the lab to the patient, modernize 00:08:00.889 --> 00:08:02.829 the science, and do it all with extreme rigor. 00:08:02.990 --> 00:08:05.110 But how do they actually move the information 00:08:05.110 --> 00:08:07.050 around? You can't just beam it into doctors' 00:08:07.149 --> 00:08:10.310 heads. No, you can't. Like any major academic 00:08:10.310 --> 00:08:13.610 society, their primary engine for moving knowledge 00:08:13.610 --> 00:08:16.720 is their journal. The European Journal of Clinical 00:08:16.720 --> 00:08:19.720 Investigation or the EJCI. Now, for the listener 00:08:19.720 --> 00:08:22.000 who isn't deep in the weeds of academic publishing, 00:08:22.339 --> 00:08:24.579 there are thousands of journals out there. I 00:08:24.579 --> 00:08:26.519 feel like I see a new one pop up every single 00:08:26.519 --> 00:08:28.920 day. Some are super prestigious. Some are essentially 00:08:28.920 --> 00:08:33.039 just academic spam. Where does the EJCI actually 00:08:33.039 --> 00:08:36.399 sit in that hierarchy? It is a very solid high 00:08:36.399 --> 00:08:39.139 -tier publication. It's a monthly peer -reviewed 00:08:39.139 --> 00:08:42.019 journal. As of 2024, it has an impact factor 00:08:42.019 --> 00:08:45.740 of 3 .6. Contextualize 3 .6 for us, is that Nobel 00:08:45.740 --> 00:08:48.679 Prize level or is that local university newsletter 00:08:48.679 --> 00:08:50.940 level? It's in the messy middle, but very much 00:08:50.940 --> 00:08:53.320 on the high end for general medicine. In the 00:08:53.320 --> 00:08:55.519 world of specialized academic metrics, it ranks 00:08:55.519 --> 00:08:59.679 as Q1. That means it is in the top 25 % in the 00:08:59.679 --> 00:09:02.259 general and internal medicine category. OK, that's 00:09:02.259 --> 00:09:04.580 impressive. And it's Q2 in research and experimental 00:09:04.580 --> 00:09:06.679 medicine. So if you are a researcher, getting 00:09:06.679 --> 00:09:08.320 your paper published here is a very good day. 00:09:08.399 --> 00:09:10.659 It means your peers genuinely respect the work. 00:09:10.830 --> 00:09:13.629 Exactly. It signals strong credibility. But what 00:09:13.629 --> 00:09:16.610 I actually like most about the EJCI isn't just 00:09:16.610 --> 00:09:19.129 their ranking. It's the format of the content 00:09:19.129 --> 00:09:21.710 they accept. They don't just publish original 00:09:21.710 --> 00:09:24.070 research, which is usually just raw data and 00:09:24.070 --> 00:09:26.450 direct results. They publish a huge variety of 00:09:26.450 --> 00:09:28.909 things, research letters, systematic reviews, 00:09:29.190 --> 00:09:32.090 meta -analyses, narrative reviews, editorials, 00:09:32.309 --> 00:09:34.470 and commentaries. Why does that distinction matter 00:09:34.470 --> 00:09:36.710 so much? Why do we need commentaries in a scientific 00:09:36.710 --> 00:09:39.059 journal? because of that valley of death we talked 00:09:39.059 --> 00:09:41.820 about at the start. If you only ever publish 00:09:41.820 --> 00:09:45.220 raw data, you are just adding to the noise. There 00:09:45.220 --> 00:09:47.320 are millions of papers published every single 00:09:47.320 --> 00:09:50.580 year. No doctor on earth can read them all. So 00:09:50.580 --> 00:09:52.879 the reviews are basically the filter. They are 00:09:52.879 --> 00:09:55.379 the synthesis. A systematic review takes, say, 00:09:55.500 --> 00:09:58.019 15 distinct studies on one very specific topic 00:09:58.019 --> 00:10:00.940 and boils them down to say, OK, what do we actually 00:10:00.940 --> 00:10:04.480 know is true across all this data? By prioritizing 00:10:04.480 --> 00:10:06.620 these types of articles, the EJCI isn't just 00:10:06.620 --> 00:10:09.159 a static repository. It's an active participant 00:10:09.159 --> 00:10:11.320 in translating that raw science for the reader. 00:10:12.139 --> 00:10:14.639 It turns data into usable knowledge. It's the 00:10:14.639 --> 00:10:17.059 difference between giving someone a massive pile 00:10:17.059 --> 00:10:19.620 of bricks and giving them a blueprint. Perfect 00:10:19.620 --> 00:10:22.000 analogy. And looking at the content, you really 00:10:22.000 --> 00:10:24.639 see that variety in action. It allows for a much 00:10:24.639 --> 00:10:27.139 broader conversation. It allows experts to take 00:10:27.139 --> 00:10:29.240 a step back and say, wait a minute, these three 00:10:29.240 --> 00:10:31.279 studies completely contradict each other. Let's 00:10:31.279 --> 00:10:35.090 figure out why. That ongoing dialogue is what 00:10:35.090 --> 00:10:38.090 actually moves science forward, not just a raw 00:10:38.090 --> 00:10:41.549 data dump. So the journal is the vehicle for 00:10:41.549 --> 00:10:44.490 the knowledge. But we humans are simple creatures. 00:10:44.750 --> 00:10:46.789 We also really like shiny things and we like 00:10:46.789 --> 00:10:49.149 money. Let's talk about the awards they give 00:10:49.149 --> 00:10:52.769 out. Incentives drive behavior. ESCI knows this 00:10:52.769 --> 00:10:55.309 very well. They give out two major awards annually 00:10:55.309 --> 00:10:58.070 and the structure of these awards is very telling 00:10:58.070 --> 00:11:00.169 about their priorities. They seem to mirror that 00:11:00.169 --> 00:11:02.330 bridge concept we keep coming back to. They really 00:11:02.330 --> 00:11:04.750 do. They have one award for the best basic research 00:11:04.750 --> 00:11:06.529 article and one for the best clinical research 00:11:06.529 --> 00:11:09.070 article. They're deliberately balancing the scales 00:11:09.070 --> 00:11:11.649 there. They're saying we value the discovery 00:11:11.649 --> 00:11:14.309 of the molecule just as much as we value the 00:11:14.309 --> 00:11:16.389 trial of the drug. And there is a geographic 00:11:16.389 --> 00:11:18.730 constraint tied to the money too, right? Yes. 00:11:19.120 --> 00:11:21.220 A significant part of the research has to have 00:11:21.220 --> 00:11:23.519 been performed in Europe. Which makes a lot of 00:11:23.519 --> 00:11:26.440 sense given the name. It's about building European 00:11:26.440 --> 00:11:28.919 sovereignty in science. You don't want all your 00:11:28.919 --> 00:11:31.399 best researchers thinking they absolutely have 00:11:31.399 --> 00:11:34.379 to move to Boston or San Francisco to get recognized 00:11:34.379 --> 00:11:37.639 and funded. Exactly. It strengthens the local 00:11:37.639 --> 00:11:40.629 ecosystem. And the winners don't just get a check 00:11:40.629 --> 00:11:43.590 and a plaque. They are required to deliver a 00:11:43.590 --> 00:11:45.990 plenary lecture at the annual scientific meeting. 00:11:46.190 --> 00:11:48.649 Which forces them to communicate their work all 00:11:48.649 --> 00:11:51.049 over again. It forces that common language pillar 00:11:51.049 --> 00:11:53.190 into action. You have to stand up in front of 00:11:53.190 --> 00:11:55.629 the entire society, the clinicians, the basic 00:11:55.629 --> 00:11:58.370 scientists, the students, and explain why your 00:11:58.370 --> 00:12:00.990 work actually matters. If you can't explain it 00:12:00.990 --> 00:12:02.850 to that diverse room, you haven't really won. 00:12:03.019 --> 00:12:05.080 I was looking at the list of past winners in 00:12:05.080 --> 00:12:07.100 the source material, and even as a lay person, 00:12:07.379 --> 00:12:09.019 some of these names really popped out. It is 00:12:09.019 --> 00:12:12.059 a serious roster of scientists. It is an absolute 00:12:12.059 --> 00:12:14.960 roll call of heavy hitters. You have recent winners, 00:12:15.320 --> 00:12:18.059 like in 2020 Fabrizio Montecuco, one for clinical 00:12:18.059 --> 00:12:21.259 and Guadalupe Sabio, one for basic. But if you 00:12:21.259 --> 00:12:23.860 look further back, you really see the long term 00:12:23.860 --> 00:12:26.240 impact of this society. One name in particular 00:12:26.240 --> 00:12:30.059 caught my eye from 2007, Jean -Pierre Ioannidis. 00:12:30.409 --> 00:12:33.350 The fact that they awarded Ioandis is endlessly 00:12:33.350 --> 00:12:35.370 fascinating to me. For the listener who doesn't 00:12:35.370 --> 00:12:37.409 know him, he's sort of the meta research guy, 00:12:37.490 --> 00:12:39.950 right? He wrote the incredibly famous paper called 00:12:39.950 --> 00:12:42.549 Why Most Published Research Findings Are False. 00:12:42.870 --> 00:12:45.409 That's him. He is effectively the auditor -in 00:12:45.409 --> 00:12:48.230 -chief of modern science. He points out exactly 00:12:48.230 --> 00:12:50.809 where research is sloppy, where it's biased, 00:12:51.070 --> 00:12:53.230 or where it's statistically weak. So by giving 00:12:53.230 --> 00:12:56.279 him a major award... ESEI was basically high 00:12:56.279 --> 00:12:58.639 -fiving the guy who aggressively criticizes their 00:12:58.639 --> 00:13:00.940 own industry. Which shows immense maturity on 00:13:00.940 --> 00:13:03.100 their part. It shows they are dead serious about 00:13:03.100 --> 00:13:05.399 that reproducibility standard we discussed earlier. 00:13:06.019 --> 00:13:07.799 They aren't just looking for cheerleaders for 00:13:07.799 --> 00:13:10.039 European science. They are looking for the truth. 00:13:10.659 --> 00:13:13.259 They rewarded the guy who tells them how to do 00:13:13.259 --> 00:13:15.240 better science. And going even further back in 00:13:15.240 --> 00:13:18.419 the archives. You have actual Nobel laureates 00:13:18.419 --> 00:13:21.539 like Rolf M. Zinkernagel who won the ESCI award 00:13:21.539 --> 00:13:24.960 in 1985. You have Jean -Francois Bach all the 00:13:24.960 --> 00:13:28.539 way back in 1976. These are the people who literally 00:13:28.539 --> 00:13:32.299 shaped modern immunology. This award is definitely 00:13:32.299 --> 00:13:34.720 not a participation trophy. And I noticed that 00:13:34.720 --> 00:13:36.980 balance you mentioned, the clinical versus basic 00:13:36.980 --> 00:13:39.379 winners, remains really consistent. Like, looking 00:13:39.379 --> 00:13:43.000 at 2018, you had Victoria Catalan for clinical 00:13:43.000 --> 00:13:46.379 and Miguel Lopez for basic. They really do strictly 00:13:46.379 --> 00:13:49.159 stick to that dual focus year after year. They 00:13:49.159 --> 00:13:51.759 absolutely have to. If they let one side dominate 00:13:51.759 --> 00:13:53.960 the awards or the journal, the bridge collapses. 00:13:54.559 --> 00:13:56.720 If it becomes just a clinical society, they lose 00:13:56.720 --> 00:13:59.039 the raw innovation. If it becomes just a basic 00:13:59.039 --> 00:14:01.139 science society, they lose the connection to 00:14:01.139 --> 00:14:03.000 the patient. So we have the journal publishing 00:14:03.000 --> 00:14:05.059 the work, we have the prestige of the awards. 00:14:05.419 --> 00:14:07.240 But eventually you have to get these people in 00:14:07.240 --> 00:14:09.779 a room together. You cannot build a robust network 00:14:09.779 --> 00:14:12.840 just on paper or over email. No, you need the 00:14:12.840 --> 00:14:14.580 physical collision of ideas. That is the whole 00:14:14.580 --> 00:14:16.899 point of the annual scientific meeting. And they 00:14:16.899 --> 00:14:18.820 really move this thing around. It's a proper 00:14:18.820 --> 00:14:21.899 European tour every year. It is. Looking at recent 00:14:21.899 --> 00:14:24.340 years, they've been to Bari in Italy in 2020, 00:14:25.080 --> 00:14:28.820 Coimbra in Portugal in 2019. Barcelona in 2018, 00:14:29.299 --> 00:14:31.580 plus places like Utrecht, Paris, and Athens. 00:14:31.879 --> 00:14:33.740 It's not just about picking cities with nice 00:14:33.740 --> 00:14:35.340 food and good weather, though. Although I am 00:14:35.340 --> 00:14:37.500 sure that helps attendance quite a bit. No, it's 00:14:37.500 --> 00:14:40.460 really about decentralization. If you always 00:14:40.460 --> 00:14:42.700 held the meeting in London or Berlin, you would 00:14:42.700 --> 00:14:44.679 unintentionally signal that those are the only 00:14:44.679 --> 00:14:47.340 places where real science happens. By moving 00:14:47.340 --> 00:14:50.740 it to places like Bari or Coimbra, they are validating 00:14:50.740 --> 00:14:53.139 and elevating the research happening in every 00:14:53.139 --> 00:14:55.360 corner of the continent. It's a powerful pan 00:14:55.360 --> 00:14:57.820 -European statement. There is also a specific 00:14:57.820 --> 00:14:59.720 financial detail regarding these meetings that 00:14:59.720 --> 00:15:02.379 I thought was absolutely crucial. They explicitly 00:15:02.379 --> 00:15:05.200 offer travel grants for young scientists. This 00:15:05.200 --> 00:15:07.559 is vital. We talked about sustainability earlier 00:15:07.559 --> 00:15:10.220 in terms of data. Well, this is human sustainability 00:15:10.220 --> 00:15:13.100 because academic conferences are notoriously 00:15:13.100 --> 00:15:15.960 expensive. You have flights, hotels, massive 00:15:15.960 --> 00:15:18.759 registration fees. If you were a 24 year old 00:15:18.759 --> 00:15:21.740 PhD student or a junior postdoc, you usually 00:15:21.740 --> 00:15:23.980 do not have the budget for that. If the society 00:15:23.980 --> 00:15:26.100 doesn't step in and pay for you to come, you 00:15:26.100 --> 00:15:28.120 simply don't come. And then the meeting just 00:15:28.120 --> 00:15:30.039 becomes a room full of 60 -year -old tenured 00:15:30.039 --> 00:15:32.159 professors talking to each other. Exactly. It 00:15:32.159 --> 00:15:35.200 becomes a stagnant echo chamber. By funding the 00:15:35.200 --> 00:15:37.919 youth, ESEI ensures that the next generation 00:15:37.919 --> 00:15:40.500 gets plugged into the network early. They are 00:15:40.500 --> 00:15:44.100 literally buying the future of the society. They 00:15:44.100 --> 00:15:46.799 are paying to ensure that the 25 -year -old researcher 00:15:46.799 --> 00:15:49.539 sitting in a lab in Utrecht gets to meet the 00:15:49.539 --> 00:15:52.240 60 -year -old expert from Athens. It really does 00:15:52.240 --> 00:15:54.980 seem like a remarkably well -oiled machine. You 00:15:54.980 --> 00:15:56.820 have the journal circulating the blood, which 00:15:56.820 --> 00:15:59.179 is the information. You have the meeting acting 00:15:59.179 --> 00:16:01.419 as the heart, pumping energy into the system. 00:16:01.500 --> 00:16:04.039 And you have the awards and the grants serving 00:16:04.039 --> 00:16:06.139 as the nutrients. And guiding the whole ship, 00:16:06.139 --> 00:16:08.759 you have a rotating presidency. Right, the leadership 00:16:08.759 --> 00:16:11.129 structure. I notice in the notes that it changes 00:16:11.129 --> 00:16:14.230 quite frequently. It rotates again to reflect 00:16:14.230 --> 00:16:17.929 that international makeup. Since 2019, the president 00:16:17.929 --> 00:16:21.669 has been Paul Oliveira from Coimbra, Portugal. 00:16:21.909 --> 00:16:23.870 But looking at the past presidents, you see that 00:16:23.870 --> 00:16:27.090 geographic rotation really clearly. You do. Just 00:16:27.090 --> 00:16:29.070 before Oliveira, you had Hendrik Natho from the 00:16:29.070 --> 00:16:31.929 Netherlands. Before him, Piero Portincasa from 00:16:31.929 --> 00:16:34.750 Italy and George P. Cruzos from Greece. It's 00:16:34.750 --> 00:16:36.970 like a United Nations of clinical investigation. 00:16:37.149 --> 00:16:40.009 It has to be. Disease doesn't respect international 00:16:40.009 --> 00:16:42.590 borders. A virus doesn't stop at the Alps or 00:16:42.590 --> 00:16:44.909 the Pyrenees. So the research infrastructure 00:16:44.909 --> 00:16:47.629 can't stop there either. You need a leader who 00:16:47.629 --> 00:16:50.950 deeply understands the specific challenges of 00:16:50.950 --> 00:16:53.389 their region and then passes the baton to someone 00:16:53.389 --> 00:16:55.649 else who brings a totally new perspective. So 00:16:55.649 --> 00:16:57.029 let's zoom out for a second. We've looked at 00:16:57.029 --> 00:16:59.009 the gears and the pulleys of this organization, 00:16:59.009 --> 00:17:00.549 but I want to bring this back to the listener. 00:17:00.750 --> 00:17:02.870 If you are driving to work right now and you 00:17:02.870 --> 00:17:05.789 are not a biochemist and you are not a cardiologist, 00:17:06.109 --> 00:17:09.220 why should you care about the... You should care 00:17:09.220 --> 00:17:11.579 because this is the invisible infrastructure 00:17:11.579 --> 00:17:14.259 that keeps you safe. That is a pretty bold claim. 00:17:14.299 --> 00:17:16.359 Unpack that for us. Think about it this way. 00:17:16.720 --> 00:17:18.559 When you go to the doctor and they prescribe 00:17:18.559 --> 00:17:21.460 a treatment for you, you are relying on an immense 00:17:21.460 --> 00:17:25.099 chain of trust. You trust the doctor. The doctor 00:17:25.099 --> 00:17:27.019 trusts the medical guidelines. The guidelines 00:17:27.019 --> 00:17:29.599 are based on clinical trials. The trials are 00:17:29.599 --> 00:17:32.819 based on basic fundamental research. And if any 00:17:32.819 --> 00:17:36.259 single link in that chain is weak, the treatment 00:17:36.259 --> 00:17:40.339 fails. or it's unsafe, or it simply doesn't work 00:17:40.339 --> 00:17:44.170 at all. ESCI is the organization tightening the 00:17:44.170 --> 00:17:47.029 bolts on every single one of those links. They 00:17:47.029 --> 00:17:49.450 are the ones standing there demanding, is this 00:17:49.450 --> 00:17:51.730 reproducible? Is this just? Did we translate 00:17:51.730 --> 00:17:53.829 this correctly from the mouse model to the human 00:17:53.829 --> 00:17:57.009 being? So without organizations doing this background 00:17:57.009 --> 00:17:59.150 work, the Valley of Death isn't just some clever 00:17:59.150 --> 00:18:02.230 metaphor for failed scientific startups. It's 00:18:02.230 --> 00:18:04.809 actual danger for patients. Exactly. Without 00:18:04.809 --> 00:18:07.210 them, medicine becomes fragmented, it gets slower, 00:18:07.210 --> 00:18:09.890 and it becomes much more prone to error. They 00:18:09.890 --> 00:18:11.720 are essentially the quality control department 00:18:11.720 --> 00:18:13.440 for the knowledge that eventually saves your 00:18:13.440 --> 00:18:15.200 life. There is one thing that's still nagging 00:18:15.200 --> 00:18:18.380 at me though as we wrap this up. We talked earlier 00:18:18.380 --> 00:18:22.670 about their shift into digital health and personalized 00:18:22.670 --> 00:18:26.809 medicine, using AI and genetics to tailor treatments 00:18:26.809 --> 00:18:29.630 to the individual. Yes, the absolute frontier 00:18:29.630 --> 00:18:32.609 of modern medicine. Right. But we also talked 00:18:32.609 --> 00:18:35.730 extensively about their pillar of justice. And 00:18:35.730 --> 00:18:38.309 I feel like there is a massive potential friction 00:18:38.309 --> 00:18:41.099 there. You are spotting the tension. biggest 00:18:41.099 --> 00:18:43.519 challenge they face. Because personalized medicine 00:18:43.519 --> 00:18:47.039 is incredibly expensive right now. AI tools are 00:18:47.039 --> 00:18:51.400 notoriously trained on very specific, often biased 00:18:51.400 --> 00:18:55.700 datasets. If ESCI is pushing hard for these high 00:18:55.700 --> 00:18:58.220 -tech solutions, how do they square that with 00:18:58.220 --> 00:19:00.880 their foundational goal of justice? That is the 00:19:00.880 --> 00:19:03.279 defining question for their next 50 years. It's 00:19:03.279 --> 00:19:05.299 very easy to put the word justice in a charter. 00:19:05.460 --> 00:19:07.680 It is incredibly hard to enforce it when the 00:19:07.680 --> 00:19:10.059 technology itself tends to start out very expensive 00:19:10.059 --> 00:19:12.799 and exclusive. Right. If bench -to -bedside only 00:19:12.799 --> 00:19:15.660 applies to the bedside of the top 1 % or only 00:19:15.660 --> 00:19:17.759 applies to patients living in major cities with 00:19:17.759 --> 00:19:20.339 high -tech research hospitals, have they really 00:19:20.339 --> 00:19:23.569 succeeded in their mission? Precisely. If they 00:19:23.569 --> 00:19:26.349 help develop a perfect, personalized cancer treatment 00:19:26.349 --> 00:19:28.950 that relies on a genetic sequence only found 00:19:28.950 --> 00:19:31.670 in European ancestry, or a treatment that cost 00:19:31.670 --> 00:19:34.170 half a million dollars a dose, scientifically 00:19:34.170 --> 00:19:36.230 they have succeeded. But according to their own 00:19:36.230 --> 00:19:40.569 charter, they might have completely failed. So 00:19:40.569 --> 00:19:43.470 the challenge for ESCI moving forward isn't just 00:19:43.470 --> 00:19:46.089 can we discover it, it's can we distribute it 00:19:46.089 --> 00:19:49.130 fairly. And can we ensure the data we feed into 00:19:49.130 --> 00:19:52.470 these new AI models represents Absolutely everyone. 00:19:52.970 --> 00:19:55.490 That is the new battleground for clinical investigation. 00:19:56.009 --> 00:19:57.910 It's not just about the molecule anymore. It's 00:19:57.910 --> 00:20:00.359 about the algorithm and the access. As they move 00:20:00.359 --> 00:20:02.539 deeper into digital health, they have to ensure 00:20:02.539 --> 00:20:05.539 they aren't just digitizing and amplifying existing 00:20:05.539 --> 00:20:07.859 systemic biases. It's a fascinating pivot for 00:20:07.859 --> 00:20:10.039 them. They started in the 60s just trying to 00:20:10.039 --> 00:20:11.940 get biochemists to talk to doctors. Now they 00:20:11.940 --> 00:20:14.180 have to get data scientists to talk to ethicists. 00:20:14.359 --> 00:20:15.900 The bridge just got a whole lot longer and a 00:20:15.900 --> 00:20:18.039 whole lot more complicated. Well, it certainly 00:20:18.039 --> 00:20:19.579 gives you something to think about the next time 00:20:19.579 --> 00:20:22.380 you read a flashy headline about a medical breakthrough. 00:20:23.420 --> 00:20:26.180 It's really worth asking, who is actually building 00:20:26.180 --> 00:20:28.880 the bridge to get that breakthrough to me? And 00:20:28.880 --> 00:20:31.259 is it a bridge built for everyone? It is the 00:20:31.259 --> 00:20:33.319 most important question we can ask as consumers 00:20:33.319 --> 00:20:35.400 of healthcare. Thank you for walking us through 00:20:35.400 --> 00:20:37.920 the machinery today. It's genuinely fascinating 00:20:37.920 --> 00:20:39.980 to see what happens behind the curtain of modern 00:20:39.980 --> 00:20:42.480 medicine. My pleasure entirely. It's always good 00:20:42.480 --> 00:20:45.140 to check the foundations of the house. And to 00:20:45.140 --> 00:20:46.980 you, the listener, thanks for taking this deep 00:20:46.980 --> 00:20:49.480 dive with us today. Keep asking those hard questions 00:20:49.480 --> 00:20:52.160 about access and justice and science, and we'll 00:20:52.160 --> 00:20:53.019 catch you on the next one.