 Alessandro, how do you navigate in this environment? Well, that's quite a complicated question. So thank you for having me here. Is there someone in the driving seat? I'm complicated to say, I would say not really. So I'll try perhaps to focus on technology, which is my subject here, and on the challenges and the questions that the person who eventually will be in the driver's seat will have to answer. And first, I would like to start by making a quick comparison to assess where technology actually brought us today. So I would like to go back actually to the year 1850. So at that moment, life expectancy was 40 years old. And what does it mean? It means that basically nearly all of us would be statistically dead. And by the way, I also would be dead too, because I would have died in childbirth something like 10 years ago. Oh, and by the way, my child also would be dead because roughly 25% of deaths were children below five. And the three main causes of deaths at that moment were pneumonia, tuberculosis, and diarrhea. And basically at that moment, medicine was largely helpless. You had a few elements like the vaccine for smallpox that was invented on the 18th century. But really, there was nothing much that could be done. And what do we stand now? Today, in the Western world, life expectancy has basically doubled. It is around 80 years old. Death of infants, childbirth is very rare. And the three main causes of death are heart disease, cancer, and stroke. So basically, we have virtually eradicated the three main causes of death of the 19th century. And how did we do that? Well, mainly hygiene, medicine. But in the end, it is science and technology. So between 1850 and now, there has been countless innovations. We've had antibiotics, very efficient drugs, we've had radiotherapy, immunotherapies, advanced surgery. And it's clearly not over, because there are still some innovations that are coming and that will likely change our lives in the year to come, for example, CRISPR-Cas9, or even artificial organs. But of course, when you have such progress, in the same time, you have great challenges and you have a lot of questions. And this basically is a subject that I would like to address today. So I would like to start by the challenge of validating these new innovations. Then I would like to discuss a little bit the place of doctors in all this. And in the end, of course, we need to talk about cost. So let's start by the subject of validation of innovations and more precisely about regulatory validation. So when you want to validate an innovation, you need basically clinical trials, patients, clinicians, regulators. But today, we are in a system that is extremely risk adverse and that requires always more proof of efficacy, more details, and that practically demands that there are no side effects. And it means more preclinical studies, more clinical trials, with more centers and locations, and of course, more money. So it is very easy to say and to see the limitations of such a system. Already today, there is a real competition for people who want to launch an innovation to have access to the well characterized patients for clinical trials. And that's why we see such a big development of biobanks. And the result today is that sometimes, well, COVID is definitely not a good example here, but most of the time you need more than 10 years to put a new drug on the market. And it can cost above $1 billion. And if we go back to the subject of adverse side effects, I guess, well, in my opinion, it is just an illusion to believe that one drug is going to have the same effect on something like 7 billion people and that will have no side effect. For side effect, we see that very well for genetic manipulation. And the direct result in that is that in some therapeutic areas, only 2 or 3% of the drugs in the end reach the market. So there is a real limitation of what we're going to be able to do in only the step of validating the innovation. Well, the good side of it is that, of course, it protects the patients, but the downside is that it's clearly an obstacle. So now, I would like to switch to the role of doctors. And I know that there are doctors among them, so I'm sorry about what I have to say if they don't agree with that. With all the progress that we have seen, the level of required expertise for doctors dramatically increases, even for general practitioners. And in the end, of course, it's not possible. For example, in France today, you need something like 10 years of study to become a general practitioner. But during these 10 years, there is only one hour and a half that is devoted to the theory of mood disorders, mood disorders that include depression, depression that in the end affect 19% of the population during their lifetimes. And of course, this patient, the problem is that in most cases, they go first and only to the general practitioners for the same disease of depression. So we see that here there is a problem and something that needs to be changed. So on the one side, we have doctors that actually need to be experts. But there is another way of seeing things, another implication of progress. And it is that the progress of technology threatens to transform doctors into highly skilled technicians who operate sophisticated machines and computers and prescribe paracetamol. Already today, artificial intelligence is sometimes more efficient than trained doctors in detecting cancers in radiographies. So my point here is that as technology advances, as it has such a big impact on the healthcare, there is probably a real reflection to be had on the role of doctors and how it should evolve and adapt to the progress of science and technology. So another subject, of course, is cost in healthcare and innovation. The USA today spent something like 17% of their GDP in health and it keeps increasing. Yet the quality of care in the US is often criticized. So where is the problem? Does it mean that we're not spending enough? Or does it mean that we're not spending well? Difficult to say, but obviously there is a limit to the amount of money that can be spent even for health. So the question that can be asked, well, the first one is what do we expect from innovation? And the second, which innovations should we fund? If we want to simplify, there are two categories of innovations. So first category corresponds to the innovations that increase efficiency, meaning the ones that allow to do at least as well as what is already available on the market, but for lower cost. For this one, I would say it's a no-brainer. It's better for cheaper, so it will be adopted. For the second category, it's more complicated. And the second category is basically the innovations that bring something new, that you're a new disease or something equivalent. So how do we evaluate the worst of such an innovation? The answer is we give a price to human life. And the concept is simple. We give a worse to one year of a life of a patient and it depends on the country and of the age of the patient. So if we consider innovations that will save one year of life for this patient, if the cost of this innovation is below the worst of one year, then it's economically viable. If it's not, then adoption of this innovation will be compromised or impossible. A very good example is that the cost of one dose to cure and save infants with spinal muscular atrophy is over two million dollars. And this figure, it is already giving an idea of how much a baby is worth. So this is one way of seeing the problem of cost, but there is another one. And it concerns R&D and investment. When should we invest and for what? Here, the problem is that money is not enough. R&D is about searching and it's not necessarily about finding. Concernings of vaccine for COVID-19 that has been discussed a lot previously today, I've heard a lot of people say around me, oh, it's noble that they found so quickly. The governments gave tons of money. Well, I guess we would know if it was that simple. Because for example, the Bill and Melinda get foundations as massively invested for malaria. And what is the conclusion of their research? Use mosquito nets impregnated with insecticide. So it's not really a revolution here. So if we want to wrap up on technology and cost, perhaps a key takeaway would be, in the end, there is no choice. Technology will have to allow for a global reduction of cost, because only at this condition will the system be sustainable. So progress. Where will it all lead us? I would like to do here a little analogy with financial bubbles and financial crisis. In a financial bubble, everything is accelerating, especially profit. And people tend to think that it will never end, which leads in the end to the crisis. In health care, these last years and decades has been quite the same thing. Progress has always been quicker and more spectacular. And we tend to think that it will never end. And my opinion is that these beliefs that progress is everlasting affects our position as a society towards tests. Deep inside us, a lot of people believe that technology will find a solution to everything, to AIDS, to cancer, to Alzheimer, to everything. And the consequence is that today, most deaths are unacceptable. Dying during a surgery of a random disease, unacceptable. Childbirth, let's not even talk about that. For example, even dying of COVID-19 when you are 90 years old is not accepted. Today, you're allowed to die in a car crash of cancer of all the age the rest will not do. But as it is the case with financial bubble, technology in health care will one day or another reach its limits. And the question are, will we understand when we reach that point? Will we see it? And how will we react? And to conclude, I would like to go back to the other theme of this session, which is ethics. And I would like to ask one question. Is innovation necessarily the synonym of progress? I would say no. Let's take, for example, human cloning and genetic manipulation on human embryos. And notably, these are big innovations. But most countries agree that they are also very unethical. So the immediate question is, where is a red line? Where should science and technology stop? And at what point must we decide that we need to stop trying to cure and that we need to stop trying to save? And I guess that this is going to be a huge challenge for anyone who in the end will find itself in the driver position. Thank you very much. Thank you, Alessandra, for very lively and at least still provoking, if not simply provoking, presentation.