@Sharad P. Paul : 我是一个有创造力的人，我的皮肤研究让我意识到皮肤健康与整体健康息息相关，这促使我研究基因组学和微生物组等领域，并开发了基因检测用于健康评估，包括饮食、生活方式和补充剂建议。我的研究重点是使用超声波治疗皮肤癌，以及生物黑客技术优化补充剂，致力于个性化医疗，包括皮肤治疗、药物、生活方式、饮食和补充剂。我的独特贡献是将皮肤健康与整体健康联系起来，专注于健康优化，而非疾病风险评估。生物黑客是指利用表观遗传学原理，通过改变行为来影响基因表达，从而优化健康。基因并非命运，我们可以通过改变环境（饮食、生活方式）来降低患病风险。目前，对表观遗传标记的测序主要在研究领域进行，但一些技术仍有局限性。未来的医疗将通过血液检测早期诊断癌症，并使用免疫疗法进行治疗，减少对手术的需求。即使未来有更先进的血液检测技术，传统的组织学检查方法仍然会存在，并能提高准确性。通过血液检测，可以在肿瘤形成之前检测到其标记物。目前皮肤癌的早期检测主要依靠视觉检查，辅助以人工智能技术提高准确性。德国的研究表明，血液检测可以提前检测到多种肿瘤的标记物，这具有革命性意义。目前，对皮肤癌的基因标记物检测主要用于治疗方案的优化，而非早期预防。偏振光和非偏振光等设备以及人工智能技术提高了皮肤癌诊断的准确性。早期检测的定义取决于癌症类型和发展阶段，对于黑色素瘤，早期检测意味着在癌细胞扩散前将其切除。人工智能驱动的应用程序可以辅助皮肤病变的检测，但不能替代专业医生的诊断。未来皮肤异常检测将结合多种技术，包括血液检测和全身3D成像。研究表明，皮肤微生物组的改变与不同类型的皮肤癌有关。除了饮食和行为习惯外，人们可以通过生活方式来改变基因表达，从而改善健康。 @Richard Jacobs : 提问，例如关于紫外线辐射对飞行员的影响，以及生物黑客技术的具体含义和应用，对早期检测方法的探讨，包括血液检测、表观遗传标记物、微生物组等，以及对未来皮肤癌检测技术发展的展望。
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我是一个有创造力的人。写作、科研，于我而言，都如同编织故事：设定情境、塑造角色、化解冲突。我的皮肤研究之路，让我意识到皮肤健康与整体健康密不可分。这促使我深入基因组学和微生物组等领域，并开发了基因检测技术，用于评估个体健康状况，提供个性化的饮食、生活方式和补充剂建议。
目前，我的研究重点有两个方向：一是利用超声波治疗皮肤癌，通过研究癌细胞与正常组织在振动频率上的差异，实现选择性地消灭癌细胞；二是生物黑客技术在补充剂优化上的应用，旨在根据个体基因差异，制定更有效的补充剂方案。我的目标是实现真正的个性化医疗，涵盖皮肤治疗、药物选择、生活方式调整、饮食规划以及补充剂的个性化推荐。
我的独特之处在于，我将皮肤健康与整体健康紧密联系，并专注于健康优化，而非仅仅评估疾病风险。基因并非命运，这是我的核心信念。我们每个人都继承了父母的基因，但这并不意味着我们注定要患上某些疾病。通过改变生活环境——包括饮食和生活方式——我们可以有效地降低患病风险。这就是我所倡导的生物黑客的精髓：利用表观遗传学原理，通过改变行为来影响基因表达，从而达到优化健康的目的。
关于表观遗传标记的测序，目前主要应用于科研领域。虽然这项技术日新月异，但仍存在一些局限性。然而，我坚信，未来的医疗将发生革命性的变化：通过简单的血液检测，就能在肿瘤形成之前就发现其踪迹，并通过精准的免疫疗法进行早期干预，最大限度地减少对侵入性手术的依赖。
即使未来血液检测技术日益成熟，传统的组织学检查方法也不会完全消失。相反，它将与新的技术手段相结合，进一步提高诊断的准确性。血液检测的优势在于，它能够在肿瘤尚未形成可见病灶之前，就检测到其释放的生物标记物。
目前，皮肤癌的早期检测主要依赖于视觉检查，辅以先进的成像技术和人工智能辅助诊断系统。人工智能技术通过学习大量的正常和异常皮肤图像数据，能够提高医生的诊断准确性，并降低漏诊率。然而，人工智能系统目前还无法完全取代专业医生的判断。
令人振奋的是，来自德国的研究团队已经取得了突破性进展：他们利用血液检测技术，成功地提前检测到多种肿瘤的标记物，这为癌症的早期预防和治疗带来了新的希望。目前，我们对皮肤癌基因标记物的检测主要用于优化治疗方案，而非早期预防。但随着技术的进步，这将很快改变。
为了提高皮肤癌诊断的准确性，我们现在已经广泛使用偏振光和非偏振光等设备，并结合人工智能技术进行辅助诊断。这些技术能够帮助我们更清晰地观察皮肤病变，并更准确地判断其良恶性。
“早期检测”的定义因癌症类型和发展阶段而异。对于恶性程度较高的黑色素瘤，早期检测意味着在癌细胞扩散之前将其完全切除，从而达到治愈的目的。
未来，皮肤异常检测将整合多种技术手段，包括血液检测、全身3D成像以及对皮肤微生物组的分析。研究表明，皮肤微生物组的改变与不同类型的皮肤癌存在关联，这为我们提供了新的研究方向。
除了饮食和行为习惯的调整外，人们还可以通过积极的生活方式来影响基因表达，从而改善健康状况。这需要我们对自身健康有更深入的了解，并积极采取行动，掌控自身的健康命运。
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01:43 我认为我本质上是一个有创造力的人，写作和科学研究有共通之处，我的皮肤研究让我意识到皮肤健康与整体健康息息相关。
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02:28 新西兰高紫外线辐射导致皮肤癌高发，促使我的实验室开发了基因检测用于健康评估，包括饮食、生活方式和补充剂建议。
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04:18 高空飞行员皮肤癌风险高，因为紫外线辐射能够穿透飞机窗户。
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04:44 我的研究重点是使用超声波治疗皮肤癌，以及生物黑客技术优化补充剂。
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07:16 我致力于个性化医疗，包括皮肤治疗、药物、生活方式、饮食和补充剂。
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07:57 我的基因检测服务主要针对健康人群，帮助他们优化饮食、补充剂和生活方式，而非已患皮肤癌的病人。
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09:21 我的独特贡献是将皮肤健康与整体健康联系起来，专注于健康优化，而非疾病风险评估。
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10:55 生物黑客是指利用表观遗传学原理，通过改变行为来影响基因表达，从而优化健康。
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13:21 目前，对表观遗传标记（如组蛋白去乙酰化）的测序主要在研究领域进行，但一些技术仍有局限性。
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14:09 未来的医疗将通过血液检测早期诊断癌症，并使用免疫疗法进行治疗，减少对手术的需求。
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15:07 通过血液检测，可以在肿瘤形成之前检测到其标记物。
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16:14 即使未来有更先进的血液检测技术，传统的组织学检查方法仍然会存在，并能提高准确性。
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17:41 目前皮肤癌的早期检测主要依靠视觉检查，辅助以人工智能技术提高准确性。
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18:09 德国的研究表明，血液检测可以提前检测到多种肿瘤的标记物，这具有革命性意义。
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19:12 目前，对皮肤癌的基因标记物检测主要用于治疗方案的优化，而非早期预防。
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22:53 偏振光和非偏振光等设备以及人工智能技术提高了皮肤癌诊断的准确性。
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24:23 早期检测的定义取决于癌症类型和发展阶段，对于黑色素瘤，早期检测意味着在癌细胞扩散前将其切除。
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26:14 人工智能驱动的应用程序可以辅助皮肤病变的检测，但不能替代专业医生的诊断。
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27:39 未来皮肤异常检测将结合多种技术，包括血液检测和全身3D成像。
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30:00 研究表明，皮肤微生物组的改变与不同类型的皮肤癌有关。
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35:01 除了饮食和行为习惯外，人们可以通过生活方式来改变基因表达，从而改善健康。
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Forget frequently asked questions. Common sense, common knowledge, or Google. How about advice from a real genius? 95% of people in any profession are good enough to be qualified and licensed. 5% go above and beyond. They become very good at what they do, but only 0.1%. 语法解析
00:16
♪♪ 语法解析
00:38
Hello, this is Richard Jacobs with the Finding Genius podcast. Like yesterday, Sherrod Paul is the author of a book called Biohacking Your Genes. So we're going to talk about the book and the ideas he's saying was in it. So Sherrod Paul. 语法解析
00:50
Paul is a doctor and a professor. He's the author of several notable nonfiction books for popular audiences in the field of skin medicine and genomics, such as Skin, a Biography from 2012, The Genetics of Health from 2017. He also writes poetry and literary fiction. Time magazine called him open heart surgeon and New Zealand Medical Association. He's been described as an inspiring, intelligent, compassionate man. So looking forward to speaking to him. Welcome, Sherrod. Thanks for coming. Yeah, thank you so much for having me, Richard. 语法解析
01:19
If you would, tell me a bit about your background. It seems like you have very diverse interests. You know, what's it been like being you? And then we'll talk about your current book. Yeah, I think fundamentally, I think I'm creative. And so, you know, when you write crafting a story, like you mentioned, you always set the context and you develop characters and you resolve conflicts. And, you know, that's a good model for scientific research. So I'm also an academic. 语法解析
01:43
And I think my original work in skin led me to see that you can't have bad skin and good health. So that's really what opened up me looking more into general health and microbiomes and genomics and what else can we do other than topical stuff on skin. And the second reason for this book where it came 语法解析
02:03
out from is that typically working down under, we've got very high ultraviolet radiation. So most of our work is in cancers and skin cancer. And, you know, when somebody's got tumors, we generally do a genomic analysis to see what kind of medications work best, but we don't do it for wellness. So from that, my lab developed like gene testing for wellness, which used to do with, you know, diet and lifestyles and, you know, what's 语法解析
02:28
if you're taking supplements, what kind of supplements suitable for you and so on and so forth. And so that's what got me here. Okay. Yeah. I have a friend that lives in Adelaide and he says when they go out, like on the news, they'll give the, I don't know, whatever they call the index, but like the reagent index. Yeah. And he said like everyone has to wear or they should wear a sunscreen all the time. Otherwise they'll get burned just walking around, which is crazy to me. You know, in the U.S., 语法解析
02:54
I'm in Texas and the sun's pretty strong here, but they usually talk about UV. So how intense is it in New Zealand and like Australia and stuff? Yeah, look, the closer you go to the poles, the UV is higher. So technically in New Zealand, we have a higher UV than Australia because we're a little bit south. But we don't have, we're more like British climate in some ways. So we haven't got the same sunshine hours as Australia. So overall, 语法解析
03:19
They've got a significant skin cancer problem rivaling us, really because most of the year they've got better weather than us. Adelaide, you mentioned Adelaide is particularly hot. I remember a few years ago, my daughter got into university there and we went there and 语法解析
03:34
In fact, that's what put us off. We walked out and it was 46 degrees, right? It was like being in Death Valley. 46 Celsius? Yes, yeah. So it was just like, Adelaide gets very hot. And we were walking towards the university and I booked a hotel, which was literally like 500 meters. But by the time we reached there, she was like… 语法解析
03:52
And I'm not going here. So that pretty much put us off. So it's very hot. So yeah, our UV is very intense. But I guess the other thing to understand is why the skin cancer thing. You see, the higher you go up as well, the more UV radiation. For example, pilots, for example, have twice the risk of skin cancers and dangerous melanomas. So we also have clear… Pilots even inside an aircraft still? Absolutely. Yeah, yeah, yeah. I have a lot of pilot patients. 语法解析
04:18
That's one of the reasons I often joke about when people are like, let's go to Mars and let's colonize. We weren't even, you know, we weren't designed to fly otherwise with our wings, right? So if you went somewhere like that, you've got to be in an artificial environment and it's not healthy for our species, right? It may be for someone else. But truth be told, yeah, like this is my area of research, you know, cancers, genomics and skin cancers particularly. And literally, I've got a lot of patients and pilot studies. We know that 语法解析
04:44
They have twice the risk of melanoma. And melanomas are quite dangerous, even in America, you know. How can that be if they're inside the plane? It doesn't matter. It just gets in. What kind of radiation would get in? I mean, UV. But it's UVA can go through. So UVB is the one which you typically get 语法解析
05:00
sunburns with, and that's the one which doesn't penetrate clothing as much or those kind of barriers. But UVA is much more intense, so it's actually much more, yeah, it can penetrate all sorts of things, yeah. Wow, that's crazy. I didn't know that. That's amazing. Yeah, yeah. What about for the passengers? I guess people that are frequent flyers are also… Absolutely, but I think, you know, pilots, it's the occupation, so you're daily, right? And I think, you know, for passengers, it's probably, it's a lower risk. But yes, if you're flying, you know… 语法解析
05:29
as close to what a pilot does, yeah, absolutely, you'd have a risk. But I think pilots also, because they're sitting close to where they've got to look out, so they've got a bit more glass area than us, I suppose. Wow. Are the airlines considered using a special tint on the windows? Yeah, we've tried all that, but in spite of all that, yeah, yeah, yeah. So we do have, like, you know, pilots, therefore, here down under, specifically as part of the examination, you know, 语法解析
05:53
the skin is a big focus and I have a lot of pilots as patients as a result. So, yeah. Wow. Yeah, no, that's crazy. So what is, so you do clinical work and you do research? Is that? That's okay. Yeah. So what's the focus of your research right now? My focus of research right now is really to do with all 语法解析
06:11
ultrasound in treating skin cancers, you know, not for diagnosis, but as a therapeutic. Like, you know, at the moment, we're working on looking at the structure of a cell in a cancer is different from normal tissues and therefore they break at different vibrations. So we're trying to optimize it so that 语法解析
06:32
We can use ultrasound selectively to try and kill cancer cells. So rather than using an ultrasound for diagnosis, as is typically done, we're trying to use it for treatment. So that's one I'm working on. The other thing, of course, is largely the topic we're talking about, which is biohacking our genes, which is literally furthering the research in the same topic on optimizing supplements for various infections. 语法解析
06:55
as well as for wellness. Because typically, like I said, in medicine, the focus has been, you know, medicine is an illness model, right? If you're unwell, you go to a doctor, otherwise you don't. So we generally try to look at personalizing medicine, so taking it to the individual level. Personalizing what? So personalizing both. Yeah, yeah, absolutely. Both skin treatments as well as both personalizing 语法解析
07:16
personalizing skin treatments, personalizing medications, personalizing, you know, your lifestyle diet and as well as supplements. Okay. All right. So, I mean, personalization, is that a protocol that you offer to patients that you see in clinic? And is it for, I mean, after they get skin cancer or is it just by profession? Hey, you're a pilot. You're going to need to go on this kind of protocol so you don't have this problem or… 语法解析
07:40
Like when does it come up and when does the need arise according to your patients? Okay, so the two things. If you come to patients who are already coming with skin cancers, then really we don't, this is more for wellness, which is literally like the layperson, like say somebody like yourself, if you wanted to say, you know, 语法解析
07:57
what's the best diet for me or what's the best supplement I should take, right? It's not the same for everybody. Like some people metabolize like say vitamin C or vitamin E differently. So for certain people, they need higher doses or different. Some people like 50% of the population can fast metabolizers of caffeine, for example, to use a common example. So for those people, things like coffee are actually very good. 语法解析
08:22
but if you're a slow metabolizer, it can increase your risk of heart disease and a few things. So this is more at the preventative end, but at the medical end, absolutely, we just use it purely to decide on what drugs may or may not work. Like if you have a dangerous melanoma, then you're really doing gene testing to see whether certain inhibitor medications would work for you or not if you carry those genes. Are 语法解析
08:44
Otherwise, it's mostly, you know, the other stuff, lifestyle advice for skin, I guess, like you said earlier, is pretty much, you know, making sure in high UV things here that you don't get burnt, really. Okay. 语法解析
08:55
Are there any special protocols that you've developed that are effective, you know, for, let's say, skincare specifically or just for whole body wellness? What would you say is your unique contribution to this? I think the unique contribution is really linking, you know, the skin, the health and focusing primarily on wellness. The contribution is there. Whereas most people, if you do a gene test, they're looking at your risk for Alzheimer's or this or that, right? We don't. We 语法解析
09:21
We're fundamentally looking at your body's metabolism and what kind of things overall optimize your health so that you are supercharging your health and therefore thereby reduce your risk. So, yeah. So, in fact, if you simply did biohacking your genes, the title of the book takes you to a site where you can water your own taste. But the kind of difference is this has a skin component as well as a general health component, as well as like a component which advises you on supplements and things. 语法解析
09:50
Before we continue, I've been personally funding the Finding Genius podcast for four and a half years now, which has led to 2,700 plus interviews of clinicians, researchers, scientists, CEOs, and other amazing people who are working to advance science and improve our lives and our world. Even though this podcast gets 100,000 plus downloads a month, we need your help to reach hundreds of thousands more worldwide. Please visit findinggeniuspodcast.com and click on support us. 语法解析
10:16
We have three levels of membership from $10 to $49 a month, including perks such as the ability to see ahead in our interview calendar and ask questions of upcoming guests, transcripts of podcasts you're interested in, the ability to request specific topics or guests, and more. Visit FindingGeniusPodcast.com and click support us today. Now back to the show. 语法解析
10:37
So what does it mean to biohack your genes? Does it mean to you understand epigenetics and you engage in behaviors that will favorably turn on the pathways you need? Or like, what does it mean? Yeah, so that's what it means to me. Like they're two, you know, it's used quite broadly. And I think in my thing is exactly like what you said is, look, genes are a blueprint, but 语法解析
10:55
but they're not destiny, I often like to say. So in other words, look, we inherit genes from our parents and family. So we have certain genes we're born with. So it's always a nature versus nurture, right? So if you take any cancer or any disease, there's always the nature part, which we can't change. There are the genes, there are the cards we're dealt with. But the… 语法解析
11:14
environment, which is the nurture part, we can actually change. That includes our diet, lifestyles specifically. So we can actually therefore reduce our risk significantly of us getting a disease we're predisposed to, right? So that's how my biohacking is exactly an epigenetic. So what we know now is many diets, for example, so there is a diet called Mind, a diet which actually reduces the risk of Alzheimer's like 50%. And for certain people, you know, they're particularly more important to have 语法解析
11:42
more vitamin D. There are all sorts of things like that, which particularly reduce your risk. But on the other hand, there are the other extremes. Some people use biohacking to literally go to the extreme where they're using like CRISPR and that kind of stuff on themselves. I think that's a bit too radical. We haven't, science has not advanced there. That I think is too dangerous. I think the other thing we were talking about, cancer is a minute ago. And 语法解析
12:06
See, if you think about a cancer's immune system, right, it is an immune system at its most hyped, right? So the cancer cells have supercharged immune kind of systems. So in some ways, I guess that teaches us as to how we can deal with it. For example, we know methylation is a big part because we have, you know, carbon-based metabolism in the human bodies. And same with 语法解析
12:29
where we know hypermethylation of tumor suppressors can make tumors progress. So in other words, we understand how methylation can switch a gene on or off and the more groups are added to a gene, like methyl groups, it gets turned off. So that kind of stuff. So we can use in specific people, optimize their folic acid metabolism, you know, restrict methionine production, all that kind of stuff. So I think, yeah, that's where the science is. 语法解析
12:56
Okay. So are we able to, I know we can sequence someone's genome, not all of it, but most of it. Can we sequence epigenetic marks? Can you see like histone deacetylation? Can you see which pathways are turned on and off? Is that capable yet? Or is that available yet? I'm sorry. Yeah, yeah. It's quite a lot. I mean, I guess mostly in research circles, but some of the things are still a bit difficult. Like for example, last year I was giving a keynote in America at a 语法解析
13:21
very major oncology kind of conference and there's a lab from Germany studying methylation of tumor markers in the blood, right? And so they could literally take a blood sample and they can tell you the type of different tumor 语法解析
13:35
tumors you had, for example. The only downside when it comes to skin for us is, for example, they could say, yes, you know, you've got a melanoma, which we know is a dangerous one, but it still means we don't know where it is, right? So I think in the longer term, I think it will change the way medicine is, whereas at the moment, like 语法解析
13:53
It's a little cruder. So, for example, if somebody comes to me, we identify a cancer, we cut it out, right? In the future, I think where this is going is you may have a blood test, you'll figure it out and you'll actually just go on the immune medications which treat it as opposed to, you know, surgery of cutting and scarring. 语法解析
14:09
So I think absolutely, I think that's where it's going. But I think interesting, this guy was very, at this conference, he was actually saying, look, therefore histology, like, you know, us cutting out things is literally dead within a few years. But obviously, you know, industries are slower to adapt because their medicine works on the industry model, right? So their labs and their doctors work pathology. So it's not going to change. It doesn't happen very quickly in guilds like professions, right? So it takes a bit longer. Again, 语法解析
14:35
Again, what is it going to look like? You said there was a comment that histology won't be needed. But I mean, if you have a 3D tumor of whatever size, how are you supposed to sequence and know, okay, we've got this object of 5 billion cells that 语法解析
14:50
That's, you know, eight centimeters thick. How are we supposed to know what sequences are showing up where? How could you ever know that without, like, taking the tissue out and then slicing it? That's the point I'm making is what they were able to see is right from your blood sample before you develop the tumor or 语法解析
15:07
In very, very early stages, you can actually pick what's going to develop, right? So you actually knock it on the head by immune therapy and things like that, which is still being developed. That's not quite ready. But in the future, that's what I see will happen. It may not be in my career, but literally. So you won't reach a stage where you have, like what you're saying, a 3D tumor. You will diagnose it before. Well, what if you can't? Then what do you do? 语法解析
15:29
What is, you know, what does this advanced understanding allow you to do? Not everyone's going to do it. I mean, there's no way. It doesn't matter, like, if you made it, you know, we'll throw you in jail for a thousand years if you don't get early cancer screening. You're still going to get… You will still have the old-fashioned methods for them anyway, because it just means that it 语法解析
15:46
It will also improve your accuracy in current histologies as well. So I think it doesn't actually change, you know, if you, you'd still have the old fashioned approach. But what I mean is if you were asking me to look into the future and what I was saying is that this will be less invasive, less crude. So I guess then it's up to people, right? And interestingly, the cost was much cheaper because it's just a simple blood test. It's actually interesting. It's the industry model, which takes it slower to change, but in actual fact, the 语法解析
16:14
the testing would be much cheaper than having a scan or something like that. So I guess the issue is, like you say, you know, people may not want to be screened. And then, yes, you will still end up with stuff. But that is still even now, right? You know, I see majority of my skin cancers be diagnosed early, but there's some people who are in denial and leave it till it's late, which just means that the prognosis is a little worse because you pick it up later. In this case, they're just picking it up super early before it's even formed. So, I mean, is… Okay, so… 语法解析
16:43
How would you have early detection right now? Would it have to be, are you relying on like, again, the epigenetic marks? Are you looking at, you know, blood-borne biomarkers from like exosomes? Like what, you know, how are you doing this early detection? Are you talking about a 语法解析
16:57
skin now specifically? No, even skin. Like right now, I would think it has to be visual. What about internal? That's what I'm saying. Right now, it has to be visual. So literally, and this is where AI and things have come in. So in the sense, you know, you have a whole body screening, 3D imaging and things like that. So at the moment, it is visual. So you're essentially looking at a spot which is changing or whatever. And once you 语法解析
17:21
find that and then you biopsy it and then you go down the pathway of if it is advanced enough that you need more than surgery, then you would do the gene analysis and things like that. But what I was saying is in these kind of a blood testing, what they found is they could detect before people were going to get it, like before it's actually forming a tumor somewhere and you can see the changes in your blood. 语法解析
17:41
And that was… That's what you'd want to do. So you don't want to do a visual inspection, right? That's what I'm saying. And that's what will be in the future. But that's what I was saying. Yeah, I think it's a massive advance, but it's not yet. It's quite some time before it's mainstream. Has anyone looked? Has there been any clinical work to look on for correlating biomarkers, you know, not on the skin, but, you know, in the body, in the bloodstream? Yeah, yeah, that's what I was saying. That was what their paper was about. Like they were presenting findings on it and it was literally for all kinds of tumors. It was quite… 语法解析
18:09
mind-blowing really and you know they could literally in the blood you could literally see you have a marker that you're going to you know like whether it's pancreatic or melanoma or whatever well before it was showing up in the pancreas or the skin or somewhere else so it's quite a 语法解析
18:25
amazing. Like it was really a game changing kind of thing I thought. But like I said, it will take time. Yeah, if I have like a melanoma lesion or some kind of lesion on my skin, I would think that the lesion goes all the way through the layers of the skin and it needs a blood supply. So it would release, again, like extracellular vesicles or 语法解析
18:45
other markers into the bloodstream and then they can be picked up. Like what has been observed? What does melanoma do? What do these other things do? So at the moment, we're not that good. Like we know that. But what we do is we only know, you know, certain genetic predispositions or we know that in some type of melanoma cells have a particular kind of markers like the B ref on or off. And then based on that, you can tailor your treatment beyond surgery. 语法解析
19:12
But we don't have, these guys were looking at tumor methylation and things like that much earlier. So they were actually looking at well before it was on your skin. But at the moment, it's much more how it works in medicine. As you first have a tumor or something somewhere, irrespective of the specialty, be it a lung tumor, whatever, then you take a little sample and then you find out what type it is. And then you do the genetic markers to optimize treatments. So it's still more treatment outcome focused as opposed to preventative. 语法解析
19:39
prevented about picking them much earlier. Well, how early on are studies saying that they're able to see markers in the bloodstream? Like I said, this was, you know, this was really a groundbreaking thing where their first, you know, presentation of their findings was like last year. So I think we probably will have much more data within, you know, the next few years. But definitely they were able to show that as a group from Germany that are significant in many of the cases or most of their cases, they 语法解析
20:08
they could now pick these M1s before the tumor formed. Right, but like how early? I guess, you know, they're not going to sit there and let the tumor form. No, that's why it was an hour, as you know. And if you look at, say, melanoma treatment, for example, just use that as an example. If you look at 20 years ago in oncology, you know, something like melanoma had a dismal prognosis. It was basically like pancreatic cancer and melanoma, where perhaps the two real flatline didn't show any progress over decades. 语法解析
20:36
But now the single big advancement has been immune therapy, right? So effectively, you're putting people on immunomodulating medications, which are then tailored and you use different levels of your blocking, different pathways. And what it does is with this, it actually becomes more controllable. So in other words, you can have melanoma, which is spread in your body, but you can live for years by taking regular medications, I guess, in a similar way. 语法解析
21:03
where you would take HIV medication or something, which wasn't possible before. But I think so similarly, that would be, I guess, where this would go. If you were diagnosed with it early, then you would have, you know, immune-modulating medication would just nip it in the bud straight away. And that's where the advance will come. At the moment, we use these medications 语法解析
21:21
as a prolonging life kind of a thing. I think they will reach a stage where these will become where we can actually prevent them forming in the first place. I mean, has this been the case with melanoma? No. 语法解析
21:32
Has melanoma been caught early enough where it could be treated and the person will be okay? Yeah. Majority of the melanomas, we actually picked them early because of screening. So they're all cured. But for people who have METs now, absolutely, this is the case. So if you look in the last even five years or so, many people for whom melanoma, advanced melanoma would have been a death sentence lived for many years. I mean, in the US, even the famous case, I think Jimmy Carter had melanoma diagnosed, I don't know, 10 years ago or something. But 语法解析
22:00
He was able to be on medications even at his advanced age. So I think now, yes, absolutely. So melanoma is in a large part of it. Even advanced melanoma people can live for a few years, whereas in the past it was like a dead sentence. Well, I've seen people looking at skin with like, I guess, UV light and different light filters to have stuff show up. Is there, I mean, I guess that's not going to be, I don't know if it'll be early detection, but I would guess you use things like that as well, right? 语法解析
22:27
That's a literal staple. It's almost like, I suppose, examining somebody with a stethoscope. It's like a demoscope. So somebody comes to me, you literally have a polarized light, non-polarized light, you use the thing to examine their skin. And then it's all about pattern recognition. And that's where AI is actually coming to some degree where the screening level, as we are getting more and more data of what normal and abnormal looks like. See, in the early part, 语法解析
22:53
Like I was involved with quite a bit of this research in the early days. And the issue was a few years ago, we didn't have enough normal data. You know what I mean? Like, for example, if you take a pathology or even examination, we're only examining your abnormal stuff and then we're only cutting out your abnormal stuff. So but AI needs enough normal stuff to so that it can differentiate to become more accurate. 语法解析
23:16
So AI was a good screen, but it wasn't as accurate because it over-calls things because it's more conservative naturally. But I think now we are realizing how to use it. And so more and more it's getting used, I suppose, in a way like pilots use autopilot. 语法解析
23:32
So more and more in skin diagnosis, yes, there are quite a few of those kind of companies which offer devices and things which actually help the average physician. Like it could be not somebody who deals with skin cancers every day like me, but maybe your family physician, it would help them be much more accurate. But it's still at that kind of diagnostic level. So absolutely, yeah. So it's all about pattern recognition. So before you had to visually inspect skin, 语法解析
23:56
and your accuracy rate wasn't that high. But now with these devices, we find that we're much more accurate in diagnosing tumors and their subtypes as well, including the more non-melanoma skin cancers. And when people say early detection, is that ever on the order of weeks or is it always months or is it years? Like what is considered early? I think early is, it depends on, so if you're talking about melanoma, which are the most dangerous skin cancers, 语法解析
24:23
There are, of course, non-melanoma skin cancers, which are actually more common, which are your basal skin cancers and your squamous. I guess early detection is you're picking it up well before it has a chance to spread anywhere else, right? So I guess early detection in the case would be… So in the case of non-melanoma skin cancers, early detection could be so early that you can simply use topical creams, which can treat them. In case of melanoma, you would detect it early, which means it's well… 语法解析
24:49
under stage one, which means once you cut it out, it's pretty much cured. You don't need any further treatment. So in fact, 99% or more of my patients, we will pick them early because particularly down under, like you mentioned, in Australia and New Zealand, there's much more awareness about it just because the sheer number of skin cancers we deal with. But when I speak internationally, certainly we see some later presentations 语法解析
25:13
partly because they're probably not used to dealing with that on a daily basis. Yeah, like I said, here in the U.S., unless you go to the beach, I don't think anyone thinks about it at all. If you work in the sun all day, yes, but other than that, I don't think anyone thinks about it at all here, you know? Yeah, it is. You're right. But you see, on the other hand, if you look at melanoma, 语法解析
25:32
I don't know when the U.S. kills one American every hour. And you may think, OK, the number is still not that high, but it is quite significant. But absolutely, it's because it's not on your radar, because there is for us down here, this sun is so intense, the UV is so high and it is scorching that you literally comes on your radar because you start developing all these things on your skin. Your radar is melting and you're like, what's going on? 语法解析
25:57
But, you know, like I thought about this. I'm sure you have to. What if you have an app where people can take pictures of stuff on their skin and it references a huge database of skin lesions and then it doesn't diagnose you, but it says go to a skin doctor because it looks concerning or it looks OK. 语法解析
26:14
That's what I was mentioning earlier. Like that's where the AI comes in. There are actually quite a few apps like that already. And so, for example, but like I said, they over call it a bit in the sense like a third of them when I look at it, they're like, no, that's definitely benign. It's partly because, like I said, 语法解析
26:29
They're a good screen, but as a basic level, so they cut down our workload. They were not saying things unnecessarily. And they're useful for the family physician, I suppose. But sometimes, as time goes, they'll get better and better. And because it's just more and more now we're realizing the importance of imaging all over the body. So the AI will have a lot of normal skin to compare with. Same with pathology will get better because at the moment, we only cut out stuff which is abnormal. So 语法解析
26:55
as we start analyzing the sides of the tumor, which are normal more and more. I think the AI is learning and there's a lot more, a lot of research in this area. And you're absolutely, that's actually a big growth field. There have been quite a few of these competing in the last few years. Is it abnormal growth field? That's a terrible joke, sorry. So what is… 语法解析
27:13
What do you think is going to be the future of, you know, skin abnormality detection? I guess it'd be a combination of all these things. But what what do you think is going to be a game changer in terms of early, early detection? Just like a, you know, you'll get this, you'll get the blood work done every year from the time you're a certain age. Just that's it. And that'll be enough to kind of catch nip any problem in the bud or they will be an ideal protocol protocol in your mind to protect people. 语法解析
27:39
Yeah, I think there are two things. I think the blood thing I'm talking about is not specific for skin, so it literally will be a marker for any kind of tumor, right? But if you're talking about skin at the moment, we're already… 语法解析
27:49
In certain centers, like particularly in research centers, we have 3D, like body imaging, like it's almost like a non-invasive scanner. You go into it, it images your whole body so that it can then screen you again and pick up any minor change and it can then analyze it to see whether it's significant or not, or we help analyze it. So I think in places with high risk, like, you know, Australia, New Zealand, perhaps in the Sun Belt of the U.S., you know, California, Florida, 语法解析
28:14
I guess these things are becoming common and eventually there will be early detection because they will pick changes much earlier than we can with the naked eye but I 语法解析
28:24
I guess what I was talking about, the blood was more at the other end of the spectrum, whereas at the moment, a few people still don't come for their checks, like you said, or many people don't think about it at all until it's too late. But for those people at the moment, even after you've diagnosed, yes, for melanoma, we've made a lot of progress, but for many other things, we haven't made as much progress. But even in melanoma, some people, it's just too late. So I think for those people, I guess, you know, if this screening may become like, you know, as part of 语法解析
28:52
I don't know whether you do go annually and have a routine blood test with your doctor. I don't know. If people do that, then I think that may include all these kind of stuff as well. I don't know if people regularly go in the U.S. every year and have… Some do. You know, I meant there's people that hate the doctor and never go and they're for 50 years. And then there's people that go every year and then there's people that, you 语法解析
29:13
you know yeah you get all kinds yeah so i think they'll all therefore there will always be a combination of physical kind of treatments which is where we're doing now you know examining and cutting out and then treating and then the real cutting edge where you're picking it up so early and that may be for people who are a little more proactive with their health but i guess that's where the science is going what about microbiome is anyone looking to see if there's a 语法解析
29:37
microbiome changes that could signal melanoma or other types of cancers or problems with skin. Very good. You have good questions, Richard. Actually, funnily enough, I just peer-reviewed a research article literally two weeks ago on this topic where they looked at microbiome on skin cancer subtypes, and they did actually identify different bacteria in the microbiome of different 语法解析
30:00
types. And of course, it's very early. I think one of the first papers. So there's still, you know, it's again early days. But that's a huge thing to see, including like one, my interest in skin is broad because it goes into health and genomics. So the other thing, of course, is the skin, you know, brain access and the skin gut access. So yeah, microbiome is a big part for not just skin for many, you know, diseases and tumors. But increasingly now, we are seeing that microbiome 语法解析
30:26
you know, like people with certain skin cancers have particular bacteria, more implicated kind of stuff. It was very recent. I literally only just 语法解析
30:34
peer reviews a couple of weeks ago. So these are very new areas, but you're absolutely right. I think it's definitely going in that direction. Yeah, it's weird to me that, as I read about some people, I think it was Staphylococcus aureus, they had a different version on their skin that, you know, if you had an open wound and it got in there, it would cause you tremendous trouble. But the fact that the skin has a microbiome at all is just amazing to me because 语法解析
30:58
the cells there have to be so hardy. The bacteria, they're exposed to the environment and everything. One side is the surface of the skin, but everything outside is, again, super harsh environment. Dry, hot, cold, they get ablated, all kinds of stuff. It's just 语法解析
31:14
It's amazing there could be one. Has anyone looked at like the surface skin microbiome of a melanoma spot or other lesions on skin? Absolutely. But at the moment, look, it is, it's not as specific as like when we were talking about the microbiome internally, just 语法解析
31:28
minute ago. That's funnily enough showing quite clear differences. But see, skin is, let's look at it another way. Skin is our largest organ in our body and it's our only universal organ if you take it animal forms. There are creatures without hearts like starfish and then you have 语法解析
31:46
creatures without brains like sea squirts, but everyone's got skin, right? Even bacteria, you know, like I sell, well. And I guess the thing is, so skin is a barrier to the environment, but it also reflects what's going on inside. So what we find in tumors or infection is an alteration in the homeostasis, in other words, alteration of the normal bacteria. So we actually, you mentioned Staph aureus, all of us have Staph aureus on our skin, right? But the colonies are at a control level, so they're at a particular optimal level. 语法解析
32:14
And then sometimes for some reason you have a breach on skin or you're immune separation or you're under stress for whatever reason or exposed to radiation. All these kind of things then breach the barrier. So therefore what happens is you develop so much bacteria or an overgrowth that your body can no longer cope. So it's interesting. So when I used to teach medical students, one of the things I used to point out is, like for example, if you go and somebody… 语法解析
32:40
checks your urine and they say you've got a urine infection, they'll normally say, oh, you know, E. coli and you've grown, you know, more than 10 to the power of six bacteria. Look, everybody's got E. coli in the urine, right? But it just means it's, so it doesn't mean you don't have bacteria. It just means you haven't got the degree of overgrowth and that happens for some reason. So at the moment, when we look at physical tumors on skin, obviously because there's a breach 语法解析
33:03
there's a little bit of an alteration, but it's not specific because what colonizes skin we know is what colonizes skin. But with the microbiome in the gut, it's very interesting because there are actually significant potential variations. And that's why, you know, even recently they've started, you know, for certain people with irritable bowel and various things, they've tried like 语法解析
33:22
fecal transplants and things like that where somebody else's microbiome into yours and it gives you relief because those people have different kind of bacteria which actually make your system function much more better than 语法解析
33:34
the bacteria you have. And so it's interesting. And not only are the genetic variations, but it could have been your lifestyle and all these things we're still learning. And this is, again, newer areas, which will be probably, if you ask me, this in 10 years, we have much more advanced. But absolutely, this is all heading in the direction of 语法解析
33:52
linking them all up. Excellent. So where can people go to find out more about your work and see, you know, maybe interesting images and again, learn what you're doing? Yeah, I think if they just, just put my name, you know, sharadpal.com and they can then go and have a look at blogs and just read about me. If you did, if you were specifically interested in personalized wellness and 语法解析
34:12
genomics and supplementing, you know, what you need to do individually to personalize your wellness and healthcare, then you can just go to just biohackingyourgenes.com and then it'll point you in the right direction. Yeah, last question. In terms of biohacking your genes as an individual person without, you know, without having a medical degree or access to a pharmacy or just stuff to take, do 语法解析
34:34
Beyond diet, where, you know, I guess behavior, lifestyle is the way that people can biohack their genes, you know. Don't be in the sun, be in the sun, wear sunscreen. And also the diet, you know, for major diseases like the biohacking is skin is only one part of it. Like I said, there's a big part for, you know, general health and preventative medicine. And for that, literally anybody can do it. You don't have to take supplements. There's a significant number of those ingredients you can obtain from your food. 语法解析
35:01
It's just that it points out that in some people, you will have a faulty gene, which means that you just don't absorb it well. Like, for example, vitamins you're saying. Those people, there may be an argument to take a supplement, but a lot of these vitamins are still inexpensive and things like that and don't have to, you know. And so I think 语法解析
35:18
It depends on how far you want to take it. If you just want to know what's your type and what's the best diet and exercises for you, you can just do that. If you then want to go to the next level and say, what kind of skin works best for me or what kind of supplement should I be taking or should I be taking magnesium or vitamin D or whatever, then I guess you can take it to the next level. 语法解析
35:38
Okay. Well, very good. Well, Shirad, thank you for coming on the podcast and kind of from so far away. I really appreciate you being here and taking the time to explain all this carefully. Thank you, Richard. Thank you very much for your questions. They were very interesting and all the best. If you like this podcast, please click the link in the description to subscribe and review us on iTunes. You've been listening to the Finding Genius Podcast with Richard Jacobs. 语法解析
Edit:2025.04.04
