 So my name is Darshak Sanghavi. I am a pediatric cardiologist. I still see patients. And I also am a columnist for Slate. I write about health care issues and a variety of other types of work in payment and systems reform delivery, both at the federal level and with other folks in this area. But I wanted to just take a minute and have both Dieter and Rebecca just introduce themselves. Say just briefly a little bit about their backgrounds before we get started. I'm Rebecca Sobel. I am a professor of medicine and obstetrics and gynecology at the Keck School of Medicine of the University of Southern California. And I am the president of the American Society for Reproductive Medicine, which is a large organization of health professionals that are interested in reproduction. Good afternoon. My name is Dieter Egli. I'm an assistant professor at Columbia University. And I'm a senior research fellow at the New York Thames Hall Foundation Research Institute. And my work in my laboratory aims to use human excels to develop new treatments for incurable diseases and to advance new infertility treatments. Terrific. Well, I think that if our panel is charged with trying to understand where babies will come from in the future, that's interesting just to talk a little bit about where babies come from now and what do we actually know about the process of development, and what are the ways in which that can be affected. So I was hoping maybe, Rebecca, you can give us just a little bit of background. This is a clinician. Tell us a little bit about, well, when people currently achieve pregnancy, how often just naturally do problems occur, and what are the ways in which we can currently affect that course? So first of all, I should tell you that I actually am an expert in male reproduction. So we do need to bring the male into this picture. And so I'll start out by saying that approximately one out of every eight couples experience some element of infertility. Of that one out of every eight couples, it's said that 40% is pure male factor infertility, 40% female infertility. And the remainder is what I refer to as additive infertility, which each member of the couple brings some aspect of infertility and makes it much more difficult for them to get pregnant. And if you'll just indulge me for a minute, I have been in the field for quite some time. We don't have to go into exact details. But when I first started out training to be an endocrinologist, certainly IVF was just in its beginning. And I actually was at the University of California at Los Angeles at that time when we had the first pregnancy of an egg donor. This was revolutionary. And up until that time, and when I first started out in this field, it was not uncommon for a couple to come with an evaluation for infertility and have had the wife, which at that time was the usual norm, have gone through perhaps a laparotomy, through surgery in order to see whether or not she had a problem. And the man had never had a semen analysis. So the first thing I can say is we've made great progress in that area. So at least now, one of the absolute beginning evaluations for infertility is having a semen analysis done. And so that's a relatively non-invasive and easy test to do. And so that's where we've come from with regard to the male. As far as the female is concerned, having gone the development through in vitro fertilization has been extraordinary. We then were able to proceed on to have egg donation. Over the years, clinicians and scientists have been very careful about evaluating the efficacy of doing that, the ethics of doing that, and had really refined it into being a very efficient and relatively safe, quite safe approach to trying to help couples become pregnant. As far as the male is concerned, unfortunately, we still don't know very much about the male. We now know we can take sperm out of the testes. We can use that in an in vitro fertilization setting. But in reality, we don't know how to treat the majority of men who have infertility. So that's my overview of where we are now. So it sounds like infertility is quite common. It seems like it concerns both men and women. And we've come a long way in how to treat it. And I think that one of the other things that's worth mentioning, as we had talked about before, is roughly several percent out of 100 individuals who actually achieve a pregnancy, several percent of them, actually today will have a birth defect of some type, leading to major issues or even death. And Dieter, I know that one of the things you've been interested in is how can we help families that might have rare genetic diseases? So normally the egg and sperm get together, the DNA mixes, but that's not all it is. There's other genetic material as well. And I wonder if you could just talk briefly about sort of some of the diseases you work on and the innovative ways that really it takes three people actually to have a baby sometimes. So yes, we have the egg, we have the sperm. And as you know, the question of this panel is where do babies come from? And I think we all know the answer to that question. It's an egg and the sperm. And I think I'm certain that it will remain that way. This is not something as scientists we will change or actually are able to change. So as a scientist it's both important to convey what's gonna be possible, but also what the limitations are because this removes certain fears that might be present. Because as we start to do things to those cells, we kind of feel that we are touching something that we haven't touched yet. And the egg is a very special cell that we know each of us kind of feel if we do something to that cell, we're doing something very basic to human identity and who we are as a human species. What we are able to do is not affect that we come from an egg and the sperm, but the ways we can do that. And so IVF is the prime example and this has led to a remarkable revolution in infertility treatments. And so what my lab does is we can manipulate human eggs. I do that myself in the laboratory. We can manipulate human eggs and we can take out the genome, the nuclear genome from one egg and put it into another egg. So these are now, egg donation was mentioned as a keyword here. A woman has an inheritable disease and that inheritable disease is transmitted through the egg. And so by doing such an exchange, transferring the genome from one egg to the other, we should be able to prevent the transmission of that disease. And so these diseases are caused by mutations in a part of the cell which is called the mitochondria. These convey energy that we have. You know, you just had lunch so you're now using your mitochondria to generate cellular energy. That's what we need to walk around. And if these mitochondria are affected, then you maybe have a very severe disease. It's usually lethal. These are not very common, but it cannot possibly also affect in more subtle ways all of us. And so that treatment that we intend to do, it's not a clinical reality yet, but it's developing from these emerging technologies in IVF is to transfer the genome from one egg that has these abnormal mitochondria into the egg of someone else who has normal mitochondria. And then that woman would be able to have a genetically related child, but without the disease. And for some people that's important to have a child who has their inherited material in them and they would prefer to have a child like that. So it sounds like what you're talking about is that to avoid disease, you can take the nucleus of an egg from the biological mother who plans to carry the child, use the cytoplasm of the rest of the egg from somebody else and then add a sperm to it. So that's the three part. But one of the things I've been interested in is we can now, we now know many things about a fetus's genetic material. In the past, to find out if your child had a genetic disease, maybe a mitochondrial disease possibly, it might be more difficult, Down syndrome or others, the way it was done is by getting a sample of DNA from the fetus through either CVS where they take a little piece of that or through amniocentesis. These are pretty invasive ways of getting that. Today, we can get genetic material from a woman carrying a fetus by doing a blood test and soon we'll be able to potentially even do a full genome analysis of that. Do you think this is a good thing? Is this information helpful in today's day and age and do you expect that this will be helpful in the future or do you think that this kind of information leads us down a path of increasing confusion? I'll take it two different steps. First of all, I think that it's a step forward. If you don't have to perhaps traumatize the fetus by having an amniocentesis or a biopsy, then I can't imagine why anybody would be opposed to that. And so it makes it, it's preferable because it's less invasive and it can be done earlier if a person wants to make a decision based on those results. And we're still really looking for single deletion diseases. We're looking for chromosomal abnormalities. And as time goes on, maybe we'll be identifying more types of major defects that a baby might have. The question on whether or not we should be doing the whole genome analysis and what we're going to do with that information, I certainly don't have the answer to that. It's a very controversial issue. What are you gonna do with the information? And what are you gonna tell your child when your child is born about that information and how are you going to intervene? Now I can say that a lot of geneticists who are interested in this field will say that this is giving you an opportunity to know exactly what kind of genetic abnormalities might occur. You have a decision as an individual whether or not you want to carry that pregnancy to term. But if you know that and you have the knowledge and you want to prepare for having such a child, this is very valuable information because it alerts the pediatrician. You already know what kind of interventions this child might have to have and it can only benefit the child's life. So, and the other obviously is that you're manipulating life and nobody should do any of those things which is at the other extreme. One of the things that also parents sometimes want is that feeling as Liza was talking about of having a child who sort of resembles them in some way while they're physically or culturally or share some traits. And the other thing that many parents want is a child that's healthy. That's sort of what drives a lot of this kind of work especially the work deed or you're doing. The thing about health is that it's very hard to predict as we talked about a large number of individuals that have diseases which aren't even genetic. I'm a pediatric cardiologist. Turns out most heart defects, you can do all the gene tests you want. We're not gonna be able to tell you if that child's gonna have a heart defect. And that's the most common major congenital defect. So my question is do we think that genetic manipulation in some way is really going to be where we stop or at some point do you think that we will now move on our research to not only look at genetic material but to sort of make changes to a fetus when they're in the womb for other reasons, the way they develop? Or is that something we should pursue? So hard question but I think this is sort of where we're going. We've started to change genes. What about adding other physical characteristic capabilities that are not genetic? So that genetic question is of course a very sensitive one. And one that needs to be considered very carefully. There's also very considerable reservations in the public in general to do anything to the genes. Because again, if we modify genes off the germ line, in particular, we don't know how this will affect our species and how it really touches a nerve. And so it needs to be an important, it is very important to have a discussion like this one I think. At the same time, we just talked about the genes in those mitochondrial disease. One thing that needs to be pointed out is that human reproduction works with combining genes together. That's inherent nature of human reproduction. So this fear of genes is an irrational one. We have two parents, we have four grandparents and so on, eight great grandparents. We are new combinations of these genes. And essentially what IVF does when we combine a sperm and an egg is we combine genes. So there are genetic changes that go on. And this technique that I just referred to, the mitochondrial treatment, to prevent that disease combines those genes that are here that some of us carry within us. And so this is very, very different from what we can today do in animals for research. We can modify the genome of a mouse in a very precise way, modify a property so the mouse has a certain gene is mutated. Usually it's one that we want to study relevant for human disease. And also you all are familiar with the genetically modified plants. Whether whole foods should sell these or not, whether they should be labeled or not. This is not what we are talking about. Very clearly, though some may tell you, despite better knowledge, that what you're doing is genetic manipulation, this is not the case. What reproduction does is combine genes that are existing in the human population and this is exactly being done what we can do today. And that's a very separate discussion whether we should be modifying the genome in any type of way. Now, as adults, we have something called gene therapy. So if somebody has a disease, like cystic fibrosis or an immune system disorders, because a certain gene is missing, we have the technology to put that gene into those cells in the adult body and potentially cure that disease or at least improve the condition. These cells as we, when we pass away, these cells will go away too. So this is not passed on to the next generation. So it's called somatic gene therapy. There is no consensus or no agreement that any of those technologies should be used on the germline today. And it's my personal opinion that it shouldn't. Let me push on that a little bit. So we can tell you today based on genetic analysis if your child, and suppose you had a child who had cystic fibrosis previously who passed away, sickle cell anemia, a variety of other genetic diseases. Through a technology pre-implantation genetic diagnosis, you can take one of the cells of an embryo and see whether that embryo is affected. Why would you not wanna fix that gene? Because the only technology we have today is either not to implant that embryo at all or potentially check for those defects when a woman is 17 to 20 weeks pregnant and recommend termination. If I may just add to that, you may want to add more to it, but I, you know, the techniques we have- I'm sorry to recommend, but at least offer. Offer, sorry. The techniques we have to do these genetic changes by extracting DNA manipulating in the laboratory are not perfect. So when we take, or when we manipulate those genes in an embryo is a low chance, but the chance is there that we may modify something else that we don't know about. So this is not the case for the mitochondrial therapy that I just talked about, but this is the case if we use these, they're called crispers. They can cut the genome and then you can insert a new piece of DNA in there. Theoretically it is possible to do such modifications. I don't think the technique is mature enough to apply that to something that's potentially being transmitted to the next generation, but I think the technique is mature enough to do it on the soma, the body that will not be passed on to the next generation. One of the things I know is that parents, I have two kids, we tend to really wanna do everything we can to ensure the health and safety of our children. As a pediatric cardiologist, I'm aware of that because only 50 years ago when children had major heart defects, the way the first surgeries were done, which bothers my mind to this day, was people had not invented bypass machines. So a father or mother would typically volunteer to be a human bypass machine. So we would dissect out arteries and veins from the parent connected to the child, anesthetize the child while you were living bypass circuit. High risk, you can only imagine. Walt Lillaha, who did some of the first surgery, said it was one of the only procedures where the mortality could be 200%. You would not only lose a healthy child, potentially a healthy one. So I say that because that seems inconceivable to some people, but many parents say, yeah, I see where those parents are coming from. I would do anything for my child. So what I wanted to talk about or maybe touch on here is that once these technologies are available, should we be restricting them in some way until society is ready? As you said, you're concerned about germline changes, but many parents would feel that they're ready to try that now. Or do you feel that we should let sort of a thousand flowers bloom, so to speak? Well, first of all, I would wanna come back a little bit to the fact that we're talking about a very small portion number of babies that are being born or would be born in the population. So that's the first thing. I mean, we're only talking about doing PGD in general for looking for specific diseases that we already know are running in those families, and those families really would not like to have their children have that disease because they had a brother or sister who suffered from that disease and felt that that was what they wanted to do. In those particular cases, if the technique were advanced enough that it would not be, as Dieter said, a possibility of having a more abnormal child than with your intervention, I mean, you might wanna offer that to somebody like that, but so that we have to remember the average person in the future is still gonna be having in general for the majority of the population intercourse to have their baby. And so that means until we have been able to develop a technique to be, without having to do an invasive procedure like IVF in order to be able to do these therapeutic interventions for hair and eye color and everything else everybody is worried about, that means you have to do something quite invasive. And so I think it's not something that I don't think that's the future of reproduction, but that is my personal opinion. Did you want to say something? Yeah, of course, yes. Rebecca is on the Ethics Committee of ASRM as well. And so these organizations that advance new treatments, they all have ethical reviews. And so we have people from the FDA here. We have all the necessary bodies to discuss these things. And I consider this one also an important one. And so there is a process of advancing such new treatments, which is a good thing. There needs to be some form of guidance. We are in the city of lawmakers, so I think that there probably should be also some laws, but they should be done very carefully. And I think in the past very often what we have done is to be afraid of the research. And it has affected me personally because I've made my career in stem cell research and when I was in Massachusetts in 2005 to 2008, we tried to do some of these experiments, but we simply couldn't because there was this innate fear of working with human eggs. And of course, this is a very special cell, the human egg, and deserves all respect when working with such precious material. But there needs to be one of the most understudied types of cells despite being so important. And it is because we have to overcome that fear of doing the research and advancing new treatments. And I think that's an important point and there have been laws that have inhibited that and some of them are still in place today and I wish they wouldn't be there. So because we couldn't do these experiments at Harvard University in Massachusetts that actually moved to New York in 2008, so I could do work on human excels. And I think it was an important lesson that research should be allowed because since then we have, I would say, done quite remarkable progress. Can I say something? You know, in to follow up with Dieter just said, I always tell my medical students and my fellows that in resonance that I'm teaching that they need to read a book about Semmelweis who was a Hungarian physician in Austria who did what was considered to be outrageous suggestion that you should wash your hands between the time you do the autopsy and the time you deliver babies. And that that was the primary cause for postpartum death. He was so maligned and was basically driven out of town, ended up dying in an insane asylum because he went, as they say, mad at the time. And so it's important to remember, along with what you're saying, is you can't be afraid of things that are suggested which might be appropriate medical interventions in the future because you don't know what might be happening in the future. I think it's important to remain open-minded and I think Semmelweis is the absolute perfect example of when you decide to close your mind and you're to the detriment of the population that you're taking care of. So to that term, one of the things I'm sort of struck by is how do we talk about these technologies and even this forum, you know, we bring up, like I think there's a panel about Gatica, like where babies are sort of manipulated and it sort of has this sinister undercurrent, oh, we're manipulating these. But there's a whole other way to look at it as well which is we're helping individuals live healthy lives and actually helping families live, achieve healthy pregnancies as well. What I wanted to maybe just touch on now is is there a way that we need to change how we talk about this in some way where we don't focus on these sort of very unusual and sort of sinister ways of using technology and instead talk about sort of the everyday benefits that maybe they could offer. I'd love to hear sort of both your thoughts on this as well. So I think one thing as a scientist we convey what we can do and what will be possible and all these amazing technologies and the title where babies will come from implies that they will come suddenly from somewhere else and they come today. But yes, there are very important developments that will help people. I'm convinced of that. But there are some fundamental limitations nature has put in place. And I just need to reassure you of those limitations. As a scientist, we're not just suddenly gonna turn the world upside down and people will look very different. Just recently I received the question on Twitter, will this change our identity as human beings what you're doing? That was addressed to me. And so the answer is no. Fundamentally what we do, we will enable new treatments. There are exciting developments but I also need to point to the limitations of these developments. So for that mitochondrial therapy is we will be able to prevent mitochondrial disease in those families but we will not be able to predict exactly how that baby will look like. No more than we can today by natural reproduction. And so this inherent uncertainty of human reproduction will still be there. There are things we will not be able to predict. And also as Rebecca pointed out, most of human reproduction will remain the way it has always been. And I think most all hospitals has ethics committees. Certainly the American Society for Reproduction has an ethics committee. The American College of Obstructions and Gynecology. I think every single major academic organization has ethics committees. I am indeed, as because I'm the president of the organization, I am on the ethics committee for part of my tenure. And these committees are very thoughtful and they are made up of people from all walks. In our particular ethics committee, there are attorneys, there's ethicists, there's REIs, there's male reproduction specialists. There are many different areas of expertise that are brought and they're very thoughtfully discussed and the documents that are produced are read over by the, are actually given to the entire organization in our situation to make comments about before it goes back out. And I think that's true for probably every academic or medical organization around. So it's not like, you know, scientists like are out there in their, you know, wild men and women doing things totally unregulated. So I think that will be okay because people are concerned and the conversation should continue so that people are on the alert that there's oversight. I think that to touch on that though, there will always be a tension between freedom and regulation. For example, in India, it is my understanding is it's illegal to do an ultrasound to determine the sex of a baby, which here is a normal expectation. Many people want to know the sex of a baby and the reason is that there, there's a strong preference for a certain sex child and they're worried that this could lead to termination and obviously there's an entire black market industry of individuals who will do ultrasounds on children there. So we may look at that in the US and say, you know, that's pretty, that's really kind of different, I don't get that. But you can look over here even and say, well, how do we feel about that? We permit that, right? You could in the United States today determine the sex of a child and choose not to have that child. So there is this sort of, we accept that freedom or that ability to make a choice, but because it gives the opportunity to potentially take advantage of these technologies as well and it'll always be a little bit of a balance. Do you sort of see that balance though, understanding their ethics committees and things like that, tipping though a little bit towards sort of creating a system where some things people do still make us feel a little uncomfortable? I mean, I've been on ethics committees, you know, you feel like, people talk a lot, but sometimes you don't really get at these kinds of issues. I think there will always be issues that people feel uncomfortable about and I don't think it's only about reproduction. I think it's about the way you behave, the way you conduct your life. So I would hope there would always be that tension because if there's not a tension and people become complacent about how life is going on, then I think it's then that it's much more likely that things that might be done, that should not be done or being done. So I would hope that there would always be such a tension. Yes. Do we have, I wasn't sure if we are supposed to have a little time for questions now, so I wanted to make sure that we left that for the group here too. Should I be in charge of picking people or do you wanna? Oh, no, I just, sorry. Why don't we start there and then next we'll go to you in the front here. Yeah, I just had a question for Dr. Egley. You mentioned at the beginning of your comments that the way we reproduce, it's a sperm and an egg cell and there's nothing that scientists will do to change that, but there is a method that could be used to change that somatic cell nuclear transfer. Take a somatic cell, the nucleus and transfer it to an egg. There's no sperm involved. You end up with an embryo that is genetically related to one person or maybe a second person with the mitochondrial DNA. Of course, I think you have done a little bit of research on this yourself with the human egg cells and somatic cell nuclear transfer creating these embryos. Do you really think that this is something that could never be used to produce children or is there no reproductive implications of creating these embryos or how do you respond to this? Great question, thank you. Glad I get the chance to talk about this. So yes, this is one of my major research focus in my laboratory. So again, we exchange the genome of one egg and here we don't exchange it with the genome of another egg, we exchange it with the somatic cell of a patient. As I've done that for a type I diabetes patient. And so we made those stem cells after that transfer. The egg is just such a remarkable cell because it can make all cells of the body and it made all of us. So I mean it's amazing. And when we do that transfer, that egg cell restores that developmental ability to that somatic genome of that patient. So our bodies as we get older cannot do everything anymore. And for a body of a type I diabetic, they don't have those insulin producing beta cells. So this offers is a remarkable opportunity to make these cells again and they're essentially the patient's own cell. So these kind of manipulations will allow to make matched cells for a person. These will allow treatments for a patient with a specific disease, very personalized. I understand this is gonna be still far into the future but I think this is what people want. If you had a disease, what would you want to be treated with? Would you want the drug that maybe keeps you dependent for a lifetime? Or would you choose your own cells for treatment? You probably would choose your own cells. So let's make it possible. And I think this is one of the things that Washington can help with and we need that. And people want it, so let's do it. Regarding reproductive use of those cells is nothing I ever would consider nor I think it would be appropriate. And again I think here the FDA and perhaps other agencies play an important role. It has to do with the considerations of safety and medical safety. And so we found that if you look at those stem cells they have some defects in genes that are have to do with imprinting. And imprinting is a certain way genes are expressed whether they come from the father or the mother. And if this is misregulated it can lead to severe birth defects. And we know that this is happening when animals are cloned. So the answer, the FDA, Dr. Schneider will talk later today. The answer they will give us is no. So it's good we have those bodies. I think they are important and necessary. And as the researchers, of course responsible conduct is requested not to step outside of those boundaries. But in my opinion and in my view is that we do, we do that. With your mitochondrial therapy does the child essentially have three parents? Again a wonderful question. Thank you for that opportunity. So I don't have children but some of the men here do. And I assume you do. And you probably consider yourself a father of your child but you don't contribute to mitochondrial DNA. Do you consider yourself less of a father because you didn't contribute to mitochondrial DNA? Probably not. There may be other reasons why somebody considers himself less of a parent. Maybe, I mean the woman certainly contributed a lot to the birth of that child. From the pregnancy to many other things. But as a father, you contribute your nuclear genome and very often the child may resemble you. Perhaps even more than people might say wow this child is just like that. And so there is no, as a society we don't make a difference whether we contribute to mitochondrial DNA or not. We assume equal responsibility for that child. And so there's so many other layers from the nuclear genome to feeling empathy to that person or feeling part of the family that essentially I think don't think there is room for somebody that the contribution of the mitochondrial genome is neither necessary nor sufficient to claim parenthood. So there's still just two parents. My name is Roberta Stanley. I work in K-12 public education and I really appreciate the conversation day all the way I have to say scientifically it's out of my league and that's where I bring my question forth. This is a high brow thoughtful discussion. How do we communicate this information as we move to the future so that the general public and even the Congress and our leaders understand it because people tend to jump to conclusions and off the path and so to speak. How would you develop a communication strategy to spread the word? I think we touched on this to some extent but let's get into it a little bit more. Maybe my feeling is that I think that people also instinct will require even from the term like a communication strategy about somebody. So I think part of maybe what I would do is for us to think about how do we tell the stories of people who benefit from this type of technology in ways that resonate with everyday experience. And I think that's a complicated question. I'd love to hear sort of maybe, I don't know if this is getting at what you're saying but how do we do that? Like how do we sort of take the conversation away from these sort of very rare, unusual, highly charged cases? You know, I love the question. When I was, on my sabbatical, I went and got a master's in public health in health communication. And I think there's a big movement forward now to try to go into the school systems and to educate the teachers and the students about this kind of science and bring it to that level. And I think that's the way it has to be done. I think that physicians and scientists have to train how to communicate to people who are other than just scientists. And I know that there are many medical schools now which have set up health communication programs for their residents so that when they're, I went on one with their patients. I mean, goes up and beyond the school. I mean, patients can sit down with their physician and walk out and have not a clue what that physician was trying to tell them. So I think it actually behooves our centers who are training scientists and who are training physicians that they should be able to communicate with their patients. They should volunteer to go into the schools to teach about this. And I think that educators should also have the opportunity to be, you know, you guys go have, you have training, teacher training sessions, right? Don't you, workshops and things like that? I don't want to step outside of my bounds here, but yes. Because it was really, it's surprising, the level of ignorance throughout the country by people who we know are smarter than that, like the governor of New York. And interestingly in New York, there's the Allen Alde Center for Communication up at SUNY New York. And that center is really a pioneering center in sending, going to medical schools, training people and public policy people how to communicate issues such as Ebola. So hopefully there's a movement in that direction. I'm sure it's gonna take a while for it to have an impact. But at least I know for a fact the medical schools are definitely thinking about how to do that. Although I have to say, as somebody who's writing in the case you first late, there is nothing better than a headline that says in the future we're all gonna have three parents. But you're right, that there is always gonna be this temptation to sensationalize, particularly in the day and age where we live today, given how difficult this get information out. Next question, sort of in the back. Yes, hello. I was wondering how you do think about the second woman involved, the egg donor. How do I think about in the mitochondrial? Oh, okay. Maybe I could just declare, when you say how do you think about her, talk about what you're getting at a little bit more. So far we know that there is a second woman involved from whom eggs are being extracted in a relatively intrusive procedure. And we know she's not a parent. I was just wondering what she is. So we already have that. We have, as Rebecca alluded to, maybe 20, 30 years ago, when were the first egg donations being done? 19, oh, we have to say this, 1983. 1983. We have all forms of parenthood where not everybody is equally related to the child. In this case, we have adoption and yet we know that people can feel like they are the parents. They are not genetically the parents, but they are the parents. Then we have egg donation, where one woman donates her eggs and the woman carrying the baby is not genetically related to that child at all. It's from the husband's partner sperm and the egg of that other woman. And so that's a much bigger difference than what we are talking about right here with the mitochondria. And then we have other forms of where we have the genes of other people within us, like organ transplantation. And so these are well-accepted technologies. I think what this is a lot about is when I first started working on this, I had to overcome my own fears, my own concerns about touching a cell like the human egg. It's one of the most important cells in the body. And these fears are there with stem cell research as well. Big reservations, should we be doing this? Should we be doing anything to those cells? But I think these are somehow within us and have been there in the past for other things like in the middle ages, it wasn't possible to dissect the diseased body, but now we know that this has enabled many treatments that we now enjoy. And I see stem cell research very much in the same way today. It will be transformed many aspects of medicine, what we are doing with those cells. And I think we will enjoy those treatments in the future. We have just about a minute or so left. So any final thoughts you'd like to leave the audience with before we- I think that the audience needs to be open-minded to taking in what is being done and to think deeply about the impact of what is being done in the science field and remain open-minded about how it may well be a revolutionary treatment in the future. Thank you very much.