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What can the Galapagos Teach Us About Cancer, AI, and the Future of Medicine?
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Released: March 25, 2026

John Marshall
John Marshall, MD

         

 
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MedBuzz: What Can the Galapagos Teach Us About Cancer, AI, and the Future of Medicine?

John Marshall, MD: Hey, everybody out there. John Marshall, Oncology Unscripted, having just come back from the trip of a lifetime. Went to the Galapagos with my wife and our friends. Talk about a boat full of science nerds. We did the National Geographic tour, and everybody was a science nerd there to see what was going on in the evolutionary world and to reflect on the past.

I did a little studying in my preparation to go. I’d, of course, read The Origin of Species a long time ago. We all should have read that. But I was also reading some other books about Darwin and his going there in 1835 and the impact of his science. And I was thinking a lot about the past and the science of the past and what they knew, and they basically were having to observe patterns. And the physician was incredibly important in trying to pull out the history from the patient because we didn’t have that much we could do for people except try and make diagnoses based on history. We didn’t have lab tests, and we didn’t do much surgery and certainly didn’t have much in the way of medicines, and we were dependent on our relationship to the earth.

And, by the way, I do want to give you a little shout-out to this book, if you’re looking for a book to read, called Braiding Sweetgrass by Robin Wall Kimmerer. My daughter gave me this book, said, “Dad, you need to read this.” But it’s all about our relationship to the earth and how we nurture one another and how we’ve sort of forgotten that relationship.

And, of course, that fed perfectly into the visit to the Galapagos. But what I was also thinking was on the other side of this coin, and that is the future of medicine. And now we have not only genetics and precision medicine and CAT scanners, we have AI, which is going to cause an evolution going forward, and the importance of needing to hold on to the past, remembering the past, not the made-up history that’s being recreated, but remembering our past in science and in healthcare so that we go forward using our new technologies to our advantage.

There’s been recent papers on this subject around AI, and are physicians just going to go away? Will we still be important, or will the computer modeling replace us completely? You know, radiologists are nervous they’re going to get replaced. Certainly oncologists feel less nervous because we’re so interpersonal. And how could a computer do that? Let’s be honest. A computer probably can do it, and probably do it maybe in some ways better than we do day in and day out.

So where will the physician role be as AI evolves moment by moment, where we’re all using it, right? We’re all logging in to answer a question or even take a test when it’s legal to use your computer to take a test. Many of us are using it. Certainly for patient care we’re using it. Our patients are using it to check on our recommendations. And so we clearly see this rapid evolution in how we are delivering cancer care.

Is evolution slow or fast? We were taught that it takes millions of years to develop a new species. But there was a family that was at the Galapagos. They went for 30 years, and they were able to show that even within 30 years they could see changes within species. You might want to take a look at this explorer in short pants, probably in a bad hat, talk about the speed of evolution and our current impact that it’s having on us.

How quickly could you evolve in this moonscape of a place called the Galapagos Island? We used to say that it took millions and millions of years to evolve, but a family came here and studied over 30 years. They could demonstrate in a very short period of time the actual world of evolution. And this is what we deal with in the world of cancer today.

Very rapid evolution, very rapid selective pressure under the treatments we are giving. The cells that emerge are then resistant and can survive. And so that’s what has happened here in the Galapagos Islands. We need to figure out how to crack that evolution in our clinics tomorrow.

Young people with colon cancer was not in existence 30 years ago, and now it is. So is that evolution? Is that natural selection? Is it unnatural selection that we’re forcing, and what the human role is on all of that?

We need to be reflective back to our relationship to our planet and those around us and our role as stewards, but also as participants in the evolutionary process. So I hope you, too, can reflect back on the past. Take those lessons learned to the future. Yes, use the new technology to its fullest, but don’t forget that human touch that’s going to be so important for us as we move forward in our own personal evolutionary journey.

John Marshall, Oncology Unscripted.

Galapagos videos

John Marshall, MD: John Marshall, Oncology Unscripted. Been thinking a lot about natural selection because guess where I am? I’m in the Galapagos Island. But natural selection is actually kind of a vicious thing. It is survival of the fittest, the ones that make it to the top.

Now, the reason they figured it all out here at the Galapagos is it’s a very challenging environment, and creatures from other places got here and had to evolve quickly, very quickly, in order to survive here in these waters and on this land. But now there is not much in the way of natural predators because the ones that made it, in fact, are the ones that can survive. There are very few predators out here. So they’re very trusting, and I think about what we do in the world of cancer care day in and day out.

And isn’t that also natural selection? Cells get mutations. Those mutations cause those cells to be able to survive better than the cells around them, actually spread from one place to another and grow over there and survive, ultimately killing the host if left unchecked. And our whole job is to try and kill just the right ones, leaving the other ones safe and sound to survive to another day.

And we’re influencing this by trying to influence natural selection. But that’s what they’re doing here. That island right there has the land iguana on it, that it actually died out because people had come here, but then some smart people figured out, some naturalists figured out, how to grow ’em, and then put ’em back on the isle.

And then we went and saw them this morning. They’re beautiful, golden, almost orange iguanas, land iguanas. Beautiful. Not beautiful. They’re really cool, though, that’s for sure. So we are influencing things. And so what’s natural selection, meaning that’s what the world’s supposed to do, and then what’s human-influenced natural selection, stuff we’re trying to change or alter natural selection?

Isn’t that what you and I try to do day in and day out when we’re treating our patients, is trying to undo something that was actually driving what may be natural selection? I realize this is a sticky subject.

What’s natural, what’s not? What are we trying to influence? What are we trying to alter? Certainly we don’t want our patients to die. Certainly we want to interfere with cancer as best we can. That’s our mission. That’s what we do. But there are times that I also think the naturalists here are doing very much the same thing that we’re trying to do, is reset, get it back the way it was before we messed it all up.

Somewhere along the way, more to come from the Galapagos and maybe some more on natural selection. John Marshall, Oncology Unscripted.

 

John Marshall, MD: John Marshall, Oncology Unscripted. What Darwin saw when he came here for the first time was that creatures could evolve from one to the next. There’s a beautiful little yellow warbler that was evolved. You see the giant tortoise there in front. That’s not the original version. That’s the version that evolved over time. And Darwin was the first one in 1835, was only here for five weeks, to see that this phenomenon of science was happening. He had no idea why. He had no idea about DNA. It took 150 years for anyone to figure out about DNA and the mechanics of evolution.

The principle of scientific evolution was controversial, right? Because you had creation on one side, and on the other side you had this new science of evolution, of natural selection for the reason that we were here. And even Darwin himself had to wait 20 to 30 years to publish his book in order to have the confidence to overcome the current belief that evolution did not exist. That creation was the only way forward. And we are in a similar place today in our world where we’re seeing new science, and yet the public is against science at the moment, and we have to be careful not to repeat ourselves the same way with Darwin. So more to come from Oncology Unscripted.

John Marshall, MD: Hey, everybody. John Marshall for Oncology Unscripted. I am right here on the Galapagos Island, and I want to interview yet one more famous scientist. This is a guy named Charles Darwin, and he came here and he observed something for the first time. It came to him. It was sort of an epiphany, and I want to ask him about it, but he’s feeling a little flat today.

John Marshall, MD: Hey, everybody out there in internet land. John Marshall for Oncology Unscripted. I’m here in the central island of the Galapagos, and if you can’t tell, there is one of the little beautiful creatures that lives here, a giant tortoise. Now the question is, how did it get here? One side of science for a long time believed that God put it here, these are very young islands, and that God placed it here. Another side of science said this beautiful creature was floating in the ocean for 500, 600 miles and landed on this island and evolved from that original trip through the water. And there was a contentious debate about how this creature got here.

So you know what? We do interviews on this program. So let’s ask it how it got here. Mr. Giant Tortoise, can you remember back how your people originally got here onto this beautiful island?

Mr. Tortoise: Well, yes.

John Marshall, MD: Well, can you tell us a little bit more? Was it God plunked you here, or did, in fact, you float up from somewhere else?

Mr. Tortoise: Well, some of it’s kind of a blur to me.

John Marshall, MD: Do you remember back when man first came here, when people first came here? What was that like?

Mr. Tortoise: Well, as a matter of fact, I knew Charles Darwin. Charles Darwin was a friend of mine, and you, doctor, you’re no Chuck Darwin.

John Marshall, MD: Well, that is no question. That is true, that I am no Charles Darwin. From the Galapagos, Oncology Unscripted.

This transcript has been generated by AI and edited for clarity.