Sangeeta Bhatia: This tiny particle could roam your body to find tumors @ TED Talks Live

TED Talks Live were held at The Town Hall Theater in NYC, in November of 2015. I had the pleasure of attending all six nights to hear speakers present impactful Ideas Worth Spreading. This post is an analysis of a talk by Sangeeta Bhatia that explores new and smaller solutions in the fight against cancer.

Watch Sangeeta’s TED Talk. At one level her talk is rather technical, as it involves the latest, most advanced science, but her story allows the audience to see how the concept works by way of analogy, description, and visuals. If you’re trying to convey a complex idea to a public audience, this is a great example of how that can be accomplished.

Transcript

(my notes in red)

In the space that used to house one transistor, we can now fit one billion. That made it so that a computer the size of an entire room now fits in your pocket. You might say the future is small.

One way to open a technology story is by making a statement directly related to your topic, but another technique is to offer an analogy that describes something completely different, but that shares a common feature. In this case, the feature highlighted is ‘small’, and it will remain a theme throughout her talk.

As an engineer, I’m inspired by this miniaturization revolution in computers. As a physician, I wonder whether we could use it to reduce the number of lives lost due to one of the fastest-growing diseases on Earth: cancer. Now when I say that, what most people hear me say is that we’re working on curing cancer. And we are. But it turns out that there’s an incredible opportunity to save lives through the early detection and prevention of cancer.

The focus pivots from computers to cancer, and Sangeeta lets the audience know that she’ll be exploring how miniaturization may play a role in the detection and prevention of cancer. We see that connection in another way, by saying she’s an ‘engineer’ and a ‘physician’.

If you click on the link to her bio, you’ll see that’s true, but in a short story there is rarely the time to go into any greater detail. And that’s something to remember. Two details change how we think about her, and yet it only took seconds to do so. Brief can still have impact.

Worldwide, over two-thirds of deaths due to cancer are fully preventable using methods that we already have in hand today. Things like vaccination, timely screening and of course, stopping smoking. But even with the best tools and technologies that we have today, some tumors can’t be detected until 10 years after they’ve started growing, when they are 50 million cancer cells strong. What if we had better technologies to detect some of these more deadly cancers sooner, when they could be removed, when they were just getting started?

Sangeeta uses two statistics to describe characteristics of tumors that few people outside the field of medicine would know. In this case, they point to the need for early detection. Before 10 years have passed, and before there are 50 million cancer cells. This type of framing applies to a range of scientific topics, as well as social problems. It follows the logic of, ‘the sooner we know, the better’. Consider whether this technique might apply to your story.

Let me tell you about how miniaturization might get us there. This is a microscope in a typical lab that a pathologist would use for looking at a tissue specimen, like a biopsy or a pap smear. This $7,000 microscope would be used by somebody with years of specialized training to spot cancer cells. This is an image from a colleague of mine at Rice University, Rebecca Richards-Kortum. What she and her team have done is miniaturize that whole microscope into this $10 part, and it fits on the end of an optical fiber. Now what that means is instead of taking a sample from a patient and sending it to the microscope, you can bring the microscope to the patient. And then, instead of requiring a specialist to look at the images, you can train the computer to score normal versus cancerous cells.

Sangeeta comes back to the concept of smaller (miniaturization) as a potential solution. And using a story block about someone else – one of her colleagues – she is able to highlight a solution that improves the detection of cancer. The framing of ‘instead of…’ with ‘you can…’ illustrates the notion that an existing process can be improved by implementing a new idea.

Now this is important, because what they found working in rural communities, is that even when they have a mobile screening van that can go out into the community and perform exams and collect samples and send them to the central hospital for analysis, that days later, women get a call with an abnormal test result and they’re asked to come in. Fully half of them don’t turn up because they can’t afford the trip. With the integrated microscope and computer analysis, Rebecca and her colleagues have been able to create a van that has both a diagnostic setup and a treatment setup. And what that means is that they can do a diagnosis and perform therapy on the spot, so no one is lost to follow up.

Once a new technology (or a solution of any sort) has been developed, can your story talk about how it worked? If you don’t have a story block that validates your idea, then it remains theoretical. Which is sometimes the case. Your story’s narrative can take us to the present moment with a desire to take the next step in the future. Probes have been to Mars, but humans haven’t, so your story may end with your vision of the future.

That’s just one example of how miniaturization can save lives. Now as engineers, we think of this as straight-up miniaturization. You took a big thing and you made it little. But what I told you before about computers was that they transformed our lives when they became small enough for us to take them everywhere. So what is the transformational equivalent like that in medicine? Well, what if you had a detector that was so small that it could circulate in your body, find the tumor all by itself and send a signal to the outside world? It sounds a little bit like science fiction. But actually, nanotechnology allows us to do just that. Nanotechnology allows us to shrink the parts that make up the detector from the width of a human hair, which is 100 microns, to a thousand times smaller, which is 100 nanometers. And that has profound implications.

Having taken the ‘smaller’ idea to one level, Sangeeta takes us to place that, as she admits, ‘sounds a bit like science fiction’. In this case, ‘smaller’ is not just some smaller device, but something so small that we can’t even see it. This is common for science related talks, as processes which occur at the the molecular or nano level, can only be imagined, which means the responsibility falls on the storyteller to bring their audience into that world.

It turns out that materials actually change their properties at the nanoscale. You take a common material like gold, and you grind it into dust, into gold nanoparticles, and it changes from looking gold to looking red. If you take a more exotic material like cadmium selenide — forms a big, black crystal — if you make nanocrystals out of this material and you put it in a liquid, and you shine light on it, they glow. And they glow blue, green, yellow, orange, red, depending only on their size. It’s wild! Can you imagine an object like that in the macro world? It would be like all the denim jeans in your closet are all made of cotton, but they are different colors depending only on their size.

And the way Sangeeta does that, is to compare a property that exists at such a small scale to something that everyone can relate to – their denim jeans – different size equals different color. While jeans are completely different than nanoparticles, we still get the picture.

So as a physician, what’s just as interesting to me is that it’s not just the color of materials that changes at the nanoscale; the way they travel in your body also changes. And this is the kind of observation that we’re going to use to make a better cancer detector.

So let me show you what I mean. This is a blood vessel in the body. Surrounding the blood vessel is a tumor. We’re going to inject nanoparticles into the blood vessel and watch how they travel from the bloodstream into the tumor. Now it turns out that the blood vessels of many tumors are leaky, and so nanoparticles can leak out from the bloodstream into the tumor. Whether they leak out depends on their size. So in this image, the smaller, hundred-nanometer, blue nanoparticles are leaking out, and the larger, 500-nanometer, red nanoparticles are stuck in the bloodstream. So that means as an engineer, depending on how big or small I make a material, I can change where it goes in your body.

In my lab, we recently made a cancer nano detector that is so small that it could travel into the tumor body and look for tumors. We designed it to listen for tumor invasion: the orchestra of chemical signals that tumors need to make to spread. For a tumor to break out of the tissue that it’s born in, it has to make chemicals called enzymes to chew through the scaffolding of tissues. We designed these nanoparticles to be activated by these enzymes. One enzyme can activate a thousand of these chemical reactions in an hour. Now in engineering, we call that one-to-a-thousand ratio a form of amplification, and it makes something ultrasensitive. So we’ve made an ultrasensitive cancer detector.

Once again, we have an example of how the idea becomes real, and we also come back to more of Sangeeta’s personal story, of what is happening in her laboratory. Instead of an ultra-technical description of what the tumor’s enzymes actually do, she uses a visual metaphor of how they ‘chew through’ the ’tissues’. They don’t have teeth, of course, but listeners make the connection and realize that the enzyme has a way to get through, and that’s all the audience needs to understand in order for Sangeeta to continue with the narrative.

OK, but how do I get this activated signal to the outside world, where I can act on it? For this, we’re going to use one more piece of nanoscale biology, and that has to do with the kidney. The kidney is a filter. Its job is to filter out the blood and put waste into the urine. It turns out that what the kidney filters is also dependent on size. So in this image, what you can see is that everything smaller than five nanometers is going from the blood, through the kidney, into the urine, and everything else that’s bigger is retained. OK, so if I make a 100-nanometer cancer detector, I inject it in the bloodstream, it can leak into the tumor where it’s activated by tumor enzymes to release a small signal that is small enough to be filtered out of the kidney and put into the urine, I have a signal in the outside world that I can detect.

The use of visual images is critical here, as they show, in graphic terms, what is happening. If the audience had to figure that out on their own, most of them would be lost. One of the most important uses of static or motion images is to say more than the speaker is saying.

OK, but there’s one more problem. This is a tiny little signal, so how do I detect it? Well, the signal is just a molecule. They’re molecules that we designed as engineers. They’re completely synthetic, and we can design them so they are compatible with our tool of choice. If we want to use a really sensitive, fancy instrument called a mass spectrometer, then we make a molecule with a unique mass. Or maybe we want make something that’s more inexpensive and portable. Then we make molecules that we can trap on paper, like a pregnancy test. In fact, there’s a whole world of paper tests that are becoming available in a field called paper diagnostics.

Alright, where are we going with this? What I’m going to tell you next, as a lifelong researcher, represents a dream of mine. I can’t say that’s it’s a promise; it’s a dream. But I think we all have to have dreams to keep us pushing forward, even — and maybe especially — cancer researchers.

I’m going to tell you what I hope will happen with my technology, that my team and I will put our hearts and souls into making a reality. OK, here goes. I dream that one day, instead of going into an expensive screening facility to get a colonoscopy, or a mammogram, or a pap smear, that you could get a shot, wait an hour, and do a urine test on a paper strip. I imagine that this could even happen without the need for steady electricity, or a medical professional in the room. Maybe they could be far away and connected only by the image on a smartphone.

Now I know this sounds like a dream, but in the lab we already have this working in mice, where it works better than existing methods for the detection of lung, colon and ovarian cancer. And I hope that what this means is that one day we can detect tumors in patients sooner than 10 years after they’ve started growing, in all walks of life, all around the globe, and that this would lead to earlier treatments, and that we could save more lives than we can today, with early detection.

Related to the previous comment about people going to Mars, Sangeeta takes the narrative beyond the laboratory and tells us her ‘what if’ story, which is a type of ‘better future’ story block. Anyone proposing a solution to a problem is, in effect, saying, ‘what if we implemented my solution? if we did, the world could be better for the following reasons’.

Many times speakers will conclude their story with an emphatic statement, along the lines of, ‘the world will be better’. You have to decide whether to frame your statement as a ‘could’ or a ‘will’. Just know that the audience may have their own opinion on the topic.

By using words such as ‘dream’ and ‘hope’, Sangeeta is clear on this point.

Thank you.

[Note: all comments inserted into this transcript are my opinions, not those of the speaker, the TED organization, nor anyone else on the planet. In my view, each story is unique, as is every interpretation of that story. The sole purpose of these analytical posts is to inspire a storyteller to become a storylistener, and in doing so, make their stories more impactful.]

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