A few years ago, I broke into my own house. I had just driven home, it was around midnight in the dead of Montreal winter, I had been visiting my friend, Jeff, across town, and the thermometer on the front porch read minus 40 degrees -- and don't bother asking if that's Celsius or Fahrenheit, minus 40 is where the two scales meet -- it was very cold. And as I stood on the front porch fumbling in my pockets, I found I didn't have my keys. In fact, I could see them through the window, lying on the dining room table where I had left them. So I quickly ran around and tried all the other doors and windows, and they were locked tight. I thought about calling a locksmith -- at least I had my cellphone, but at midnight, it could take a while for a locksmith to show up, and it was cold. I couldn't go back to my friend Jeff's house for the night because I had an early flight to Europe the next morning, and I needed to get my passport and my suitcase.
Prije nekoliko godina provalio sam u vlastitu kuću. Upravo sam stigao kući, bilo je oko ponoć, a u Montrealu je bila ciča zima. Bio sam kod svog prijatelja Jeffa, u drugom dijelu grada, a termometar pred kućom pokazivao je -40 stupnjeva. Ne pitajte radi li se o Celzijevim ili Fahrenheitovim stupnjevima, na minus 40 te se ljestvice poklapaju. Bilo je jako hladno. Dok sam stajao na trijemu i kopao po džepovima, shvatio sam da nemam ključeve. Zapravo, mogao sam ih vidjeti kroz prozor na stolu u blagovaonici, gdje sam ih ranije ostavio. Zato sam brzo obišao kuću i pokušao otvoriti druga vrata i prozore, ali bili su zaključani. Palo mi je na pamet da nazovem bravara, barem sam imao mobitel, ali bila je ponoć, pa bi mu vjerojatno trebalo neko vrijeme da dođe, a i bilo je hladno. Nisam se mogao vratiti k Jeffu i ondje prespavati jer sam rano ujutro imao let za Europu, a morao sam uzeti putovnicu i putnu torbu.
So, desperate and freezing cold, I found a large rock and I broke through the basement window, cleared out the shards of glass, I crawled through, I found a piece of cardboard and taped it up over the opening, figuring that in the morning, on the way to the airport, I could call my contractor and ask him to fix it. This was going to be expensive, but probably no more expensive than a middle-of-the-night locksmith, so I figured, under the circumstances, I was coming out even.
I tako sam, sav očajan i promrznut, pronašao velik kamen i provalio kroz podrumski prozor, raščistio krhotine stakla, ušao unutra, pronašao komad kartona i zalijepio ga preko otvora za prozor. misleći kako ću ujutro na putu za zračnu luku nazvati svog majstora i reći mu da to popravi. Znao sam da će biti skupo, ali vjerojatno ne skuplje od bravara kojeg bi zvao usred noći, pa sam zaključio da mi ionako dođe na isto.
Now, I'm a neuroscientist by training and I know a little bit about how the brain performs under stress. It releases cortisol that raises your heart rate, it modulates adrenaline levels and it clouds your thinking. So the next morning, when I woke up on too little sleep, worrying about the hole in the window, and a mental note that I had to call my contractor, and the freezing temperatures, and the meetings I had upcoming in Europe, and, you know, with all the cortisol in my brain, my thinking was cloudy, but I didn't know it was cloudy because my thinking was cloudy.
Po zanimanju sam neuroznanstvenik i znam ponešto o tome kako mozak reagira pod stresom. Luči kortizol koji ubrzava rad srca, regulira razinu adrenalina i pomućuje vam razmišljanje. I tako sam se sljedećeg jutra probudio neispavan, zabrinut zbog rupe u prozoru, misleći na to da moram nazvati majstora, da je vani ispod ništice i da me u Europi čekaju sastanci, a zbog kortizola u mom mozgu nisam mogao jasno razmišljati, ali ja to nisam znao jer nisam mogao jasno razmišljati.
(Laughter)
(Smijeh)
And it wasn't until I got to the airport check-in counter, that I realized I didn't have my passport.
Zato sam tek na šalteru za prijavu putnika shvatio da nemam putovnicu.
(Laughter)
(Smijeh)
So I raced home in the snow and ice, 40 minutes, got my passport, raced back to the airport, I made it just in time, but they had given away my seat to someone else, so I got stuck in the back of the plane, next to the bathrooms, in a seat that wouldn't recline, on an eight-hour flight. Well, I had a lot of time to think during those eight hours and no sleep.
Odjurio sam kući po snijegu i ledu, trebalo mi je 40 minuta, uzeo putovnicu i požurio natrag na aerodrom. Stigao sam u zadnji čas, ali moje su mjesto već dali nekom drugom, pa sam završio na kraju aviona, pokraj zahoda, na zakočenom sjedalu, a čekalo me 8 sati putovanja. Imao sam puno vremena za razmišljanje u tih osam sati bez sna.
(Laughter)
(Smijeh)
And I started wondering, are there things that I can do, systems that I can put into place, that will prevent bad things from happening? Or at least if bad things happen, will minimize the likelihood of it being a total catastrophe. So I started thinking about that, but my thoughts didn't crystallize until about a month later. I was having dinner with my colleague, Danny Kahneman, the Nobel Prize winner, and I somewhat embarrassedly told him about having broken my window, and, you know, forgotten my passport, and Danny shared with me that he'd been practicing something called prospective hindsight.
I počeo sam se pitati mogu li nešto učiniti, sustavi koje bih mogao upregnuti, koji bi spriječili da se dogode loše stvari? Ili barem, ako se loše stvari i dogode, oni bi umanjili vjerojatnost da to bude potpuna katastrofa. Pa sam počeo razmišljati o tome, no misli mi se nisu iskristalizirale sve do mjesec dana kasnije. Večerao sam sa svojim kolegom nobelovcem, Dannyjem Kahnemanom, i pomalo posramljeno ispričao mu o tome kako sam razbio prozor, i zaboravio svoju putovnicu, a Danny mi se povjerio kako vježba nešto što se zove vjerojatna neopreznost.
(Laughter)
(Smijeh)
It's something that he had gotten from the psychologist Gary Klein, who had written about it a few years before, also called the pre-mortem. Now, you all know what the postmortem is. Whenever there's a disaster, a team of experts come in and they try to figure out what went wrong, right? Well, in the pre-mortem, Danny explained, you look ahead and you try to figure out all the things that could go wrong, and then you try to figure out what you can do to prevent those things from happening, or to minimize the damage.
To je nešto što je čuo od psihologa Garyja Kleina, koji je pisao o tome prije par godina, također poznato kao pre-mortem. Svi znate što je postmortem (obdukcija). Kada se dogodi katastrofa, tim stručnjaka dođe i pokuša odgonetnuti što je pošlo po zlu, zar ne? E pa, u pre-mortemu, kaže Danny, gledate unaprijed i pokušavate odgonetnuti sve što bi moglo poći po krivu, a onda pokušate shvatiti što možete učiniti kako biste sprječili da se to dogodi ili da umanjite štetu.
So what I want to talk to you about today are some of the things we can do in the form of a pre-mortem. Some of them are obvious, some of them are not so obvious. I'll start with the obvious ones.
Ono o čemu vam ja danas želim pričati je nekoliko primjera koje možemo slijediti u obliku obdukcije. Neki od njih su očiti, neki baš i nisu. Počet ću s očitima.
Around the home, designate a place for things that are easily lost. Now, this sounds like common sense, and it is, but there's a lot of science to back this up, based on the way our spatial memory works. There's a structure in the brain called the hippocampus, that evolved over tens of thousands of years, to keep track of the locations of important things -- where the well is, where fish can be found, that stand of fruit trees, where the friendly and enemy tribes live. The hippocampus is the part of the brain that in London taxicab drivers becomes enlarged. It's the part of the brain that allows squirrels to find their nuts. And if you're wondering, somebody actually did the experiment where they cut off the olfactory sense of the squirrels, and they could still find their nuts. They weren't using smell, they were using the hippocampus, this exquisitely evolved mechanism in the brain for finding things. But it's really good for things that don't move around much, not so good for things that move around. So this is why we lose car keys and reading glasses and passports. So in the home, designate a spot for your keys -- a hook by the door, maybe a decorative bowl. For your passport, a particular drawer. For your reading glasses, a particular table. If you designate a spot and you're scrupulous about it, your things will always be there when you look for them.
U cijelom domu, odredite mjesto za stvari koje se lako gube. Znam da ovo zvuči zdravorazumski, i jest, ali i znanost to podupire, temeljeno na načinu na koji funkcionira naša spacijalna memorija. Postoji struktura u mozgu koja se zove hipokampus, koja evoluirala tijekom desetaka tisuća godina, kako bi se pamtila lokacije važnih stvari -- gdje je izvor, gdje se može naći riba, gdje su stabla voćki, gdje žive prijateljska i neprijateljska plemena. Hipokampus je dio mozga koji se londonskim vozačima taksija s vremenom povećava. To je dio mozga zahvaljujući kojem vjeverice nađu lješnjake. I ako se pitate, netko je zapravo proveo eksperiment u kojem su vjevericama odstranili osjetilo mirisa, a one su i dalje mogle naći lješnjake. Nisu koristile njuh, već hipokampus, taj izvrsno razvijen mehanizam u mozgu za pronalaženje stvari. No, odličan je za stvari koje se puno ne miču, ne tako dobar za one koje se miču. To je razlog zašto gubimo ključeve auta, naočale za čitanje i putovnice. Stoga u svome domu odredite mjesto za svoje ključeve -- kukica kraj vrata, možda dekorativna zdjela. Za putovnicu odredite posebnu ladicu. Za naočale poseban stol. Ako odredite mjesto i budete savjesni po tom pitanju, vaše stvari će uvijek biti ondje kad ih tražite.
What about travel? Take a cell phone picture of your credit cards, your driver's license, your passport, mail it to yourself so it's in the cloud. If these things are lost or stolen, you can facilitate replacement.
Što je s putovanjima? Mobitelom slikajte kreditne kartice, vozačku dozvolu, putovnicu, pošaljite to sebi, da bude na online disku. Ako se te stvari izgube ili ukradu, možete si olakšati njihovu zamjenu.
Now these are some rather obvious things. Remember, when you're under stress, the brain releases cortisol. Cortisol is toxic, and it causes cloudy thinking. So part of the practice of the pre-mortem is to recognize that under stress you're not going to be at your best, and you should put systems in place.
Dakle, ovo su neki od očitih primjera. Sjetite se, kada ste pod stresom, mozak luči kortizol. Kortizol je toksičan i uzrokuje pomućeno razmišljanje. Stoga je dio prakse u pre-mortemu prepoznati da pod stresom nećete biti u najboljem izdanju, i da morate upregnuti neke sustave.
And there's perhaps no more stressful a situation than when you're confronted with a medical decision to make. And at some point, all of us are going to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision.
Vjerojatno ne postoji stresnija situacija od one kada ste suočeni s donošenjem medicinske odluke. U nekom trenutku, svi mi ćemo se naći u toj poziciji, gdje moramo donijeti vrlo važnu odluku o budućoj medicinskoj brizi o nama ili našim voljenima, kako bismo im pomogli s odlukom.
And so I want to talk about that. And I'm going to talk about a very particular medical condition. But this stands as a proxy for all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making -- any kind of decision you have to make that would benefit from a rational assessment of the facts.
To je ono o čemu želim pričati. Pričat ću o vrlo specifičnom medicinskom stanju. Ali to je primjer za sve vrste donošenja medicinskih odluka i uistinu, za donošenje financijskih i socijalnih odluka -- bilo kakvih odluka koje morate donijeti kojima bi koristilo racionalno prosuđivanje činjenica.
So suppose you go to your doctor and the doctor says, "I just got your lab work back, your cholesterol's a little high." Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke. And so you're thinking having high cholesterol isn't the best thing, and so the doctor says, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin." And you've probably heard of statins, you know that they're among the most widely prescribed drugs in the world today, you probably even know people who take them. And so you're thinking, "Yeah! Give me the statin."
Pretpostavimo da idete kod liječnika i on kaže, "Upravo su stigli laboratorijski nalazi, kolesterol Vam je malo povišen." Svi znate da je povišeni kolesterol povezan s povećanim rizikom od kardiovaskularnih bolesti, srčanim udarom, kapi. Pa mislite, imati povišen kolesterol nije baš najbolje, a liječnik kaže, "Znate, dao bih Vam lijek koji će Vam pomoći sniziti kolesterol, statin." Vjerojatno ste čuli za statine, znate da su danas među najčešće propisanim lijekovima na svijetu, vjerojatno poznate i ljude koji ih uzimaju. Pa mislite, "Da! Dajte mi statin."
But there's a question you should ask at this point, a statistic you should ask for that most doctors don't like talking about, and pharmaceutical companies like talking about even less. It's for the number needed to treat. Now, what is this, the NNT? It's the number of people that need to take a drug or undergo a surgery or any medical procedure before one person is helped. And you're thinking, what kind of crazy statistic is that? The number should be one. My doctor wouldn't prescribe something to me if it's not going to help. But actually, medical practice doesn't work that way. And it's not the doctor's fault, if it's anybody's fault, it's the fault of scientists like me. We haven't figured out the underlying mechanisms well enough. But GlaxoSmithKline estimates that 90 percent of the drugs work in only 30 to 50 percent of the people. So the number needed to treat for the most widely prescribed statin, what do you suppose it is? How many people have to take it before one person is helped? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by Bloomberg.com. I ran through the numbers myself. 300 people have to take the drug for a year before one heart attack, stroke or other adverse event is prevented.
Međutim, tada se treba nešto zapitati, statistika koju želite saznati o kojoj većina liječnika ne voli pričati, a farmaceutske firme još manje. To je broj koji se treba liječiti. Što je to NNT? To je broj ljudi koji treba uzeti lijek ili biti podvrgnut operaciji ili nekom medicinskom postupku prije nego što se pomogne jednoj osobi. I mislite se, kakva je to luda statistika? Broj bi trebao biti jedan. Moj liječnik mi ne bi prepisao nešto ako mi neće pomoći. Ali zapravo, u medicinskoj praksi nije uvijek tako. I nije liječnikova krivica, ako je ičija krivica, onda je to krivica znanstvenika poput mene. Nismo baš potpuno dokučili osnovne mehanizme. No, GlaxoSmithKline procjenjuje da 90% lijekova funkcionira u samo 30% do 50% ljudi. Pa, što mislite koji bi bio broj ljudi koji treba liječiti za najčešće propisani statin? Koliko ljudi ga mora uzimati prije nego što se pomogne jednoj osobi? 300. Ovo se temelji na istraživanju liječnika istraživača Jeromea Groopmana i Pamele Hartzband, nezavisno potvrđenog od strane Bloomberg.com. Osobno sam prošao kroz brojke. 300 ljudi mora godinu dana uzimati lijek prije nego što se spriječi 1 srčani udar, kap ili drugi štetni događaj.
Now you're probably thinking, "Well, OK, one in 300 chance of lowering my cholesterol. Why not, doc? Give me the prescription anyway." But you should ask at this point for another statistic, and that is, "Tell me about the side effects." Right? So for this particular drug, the side effects occur in five percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress -- but now you're thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug." But wait a minute. Remember under stress you're not thinking clearly. So think about how you're going to work through this ahead of time, so you don't have to manufacture the chain of reasoning on the spot. 300 people take the drug, right? One person's helped, five percent of those 300 have side effects, that's 15 people. You're 15 times more likely to be harmed by the drug than you are to be helped by the drug.
Sad vjerojatno mislite, "Pa, u redu, jedna od 300 šansi da snizim kolesterol. Zašto ne, doktore? Svejedno mi dajte recept." Sada biste trebali zatražiti drugu statistiku, a to je "Recite mi koje su nuspojave." Zar ne? Za ovaj lijek, konkretno, do nuspojava dolazi kod 5% pacijenata. A one uključuju strahote -- bol u oslabljenim mišićima i zglobovima, gastrointestinalni bolovi ali sad mislite, "Pet posto, nije baš vjerojatno da će se dogoditi meni, ipak ću uzeti lijek." Ali samo malo. Sjetite se da pod stresom ne razmišljate jasno. Pa razmislite kako to premostiti prije vremena, kako ne biste trebali proizvesti lanac rasuđivanja na licu mjesta. 300 ljudi uzima lijek, zar ne? Jednoj osobi se pomogne, pet posto od onih 300 imaju nuspojave, to je 15 ljudi. 15 puta više vjerojatnosti ima da vam se lijekom naudi nego da vam se njime pomogne.
Now, I'm not saying whether you should take the statin or not. I'm just saying you should have this conversation with your doctor. Medical ethics requires it, it's part of the principle of informed consent. You have the right to have access to this kind of information to begin the conversation about whether you want to take the risks or not.
Ne poručujem vam da biste trebali uzimati lijek ili ne. Samo kažem da biste trebali povesti ovakav razgovor sa svojim liječnikom. Liječnička etika to zahtijeva, to je dio principa o informiranoj suglasnosti. Imate pravo na pristup ovakvoj vrsti informacija, da započnete razgovor o tome želite li riskirati ili ne.
Now you might be thinking I've pulled this number out of the air for shock value, but in fact it's rather typical, this number needed to treat. For the most widely performed surgery on men over the age of 50, removal of the prostate for cancer, the number needed to treat is 49. That's right, 49 surgeries are done for every one person who's helped. And the side effects in that case occur in 50 percent of the patients. They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you're lucky, and you're one of the 50 percent who has these, they'll only last for a year or two.
Sad možda mislite da sam izvukao bezveze neki broj radi izazivanja šoka, ali zapravo je jako tipično, broj koji se treba liječiti. Za većinu obavljenih operacija na muškarcima starijim od 50 godina, odstranjivanje prostate zbog raka, broj koji je potrebno liječiti je 49. Točno tako, 49 operacija mora se izvršiti za svaku osobu kojoj se pomaže. Nuspojave u tom slučaju pojavljuju se kod 50% pacijenata. One uključuju impotenciju, erektilnu disfunkciju, urinarnu inkontinenciju, pucanje rektuma, fekalnu inkontinenciju. A ako imate sreće i jedan ste od 50% koji ovo imaju, nuspojave će trajati samo godinu dana ili dvije.
So the idea of the pre-mortem is to think ahead of time to the questions that you might be able to ask that will push the conversation forward. You don't want to have to manufacture all of this on the spot. And you also want to think about things like quality of life. Because you have a choice oftentimes, do you I want a shorter life that's pain-free, or a longer life that might have a great deal of pain towards the end? These are things to talk about and think about now, with your family and your loved ones. You might change your mind in the heat of the moment, but at least you're practiced with this kind of thinking.
Ideja pre-mortema je razmišljati unaprijed o pitanjima koja biste mogli postaviti koja će pogurnuti razgovor. Ne želite da se dogodi da to sve morate proizvesti na licu mjesta. A morate i razmišljati o nečemu kao što je kvaliteta života. Zato što često imate izbor, želite li kraći život, bez boli ili duži život u kojem ćete pred kraj možda iskusiti jaku bol? To je nešto o čemu treba sada razmisliti i pričati sa svojom obitelji i bližnjima. Možda se u trenutku predomislite, ali barem ste vježbali ovakav način razmišljanja.
Remember, our brain under stress releases cortisol, and one of the things that happens at that moment is a whole bunch on systems shut down. There's an evolutionary reason for this. Face-to-face with a predator, you don't need your digestive system, or your libido, or your immune system, because if you're body is expending metabolism on those things and you don't react quickly, you might become the lion's lunch, and then none of those things matter. Unfortunately, one of the things that goes out the window during those times of stress is rational, logical thinking, as Danny Kahneman and his colleagues have shown. So we need to train ourselves to think ahead to these kinds of situations.
Zapamtite, naš mozak pod stresom luči kortizol, a nešto što se tada dogodi jest da cijeli niz sustava zakaže. Za to postoji evolucijski razlog. Licem u lice s predatorom, ne treba vam probavni sustav, ni libido niti imunološki sustav, jer ako vaše tijelo troši metabolizam na takve stvari, a vi ne reagirate brzo, možete lavu postati obrok, a tada ništa od ovoga nije bitno. Nažalost, ono što u takvim stresnim trenucima više ne postoji je racionalno, logično razmišljanje, kao što su pokazali Danny Kahneman i njegovi kolege. Zato se moramo istrenirati da razmišljamo unaprijed o ovakvim situacijama.
I think the important point here is recognizing that all of us are flawed. We all are going to fail now and then. The idea is to think ahead to what those failures might be, to put systems in place that will help minimize the damage, or to prevent the bad things from happening in the first place.
Mislim da je bitna stavka ovdje prepoznati da svi imamo mane. Svi ćemo tu i tamo pogriješiti. Bit je unaprijed razmišljati o tim greškama, uspostaviti sustave koji će umanjiti štetu ili spriječiti da se loše stvari uopće i dogode.
Getting back to that snowy night in Montreal, when I got back from my trip, I had my contractor install a combination lock next to the door, with a key to the front door in it, an easy to remember combination. And I have to admit, I still have piles of mail that haven't been sorted, and piles of emails that I haven't gone through. So I'm not completely organized, but I see organization as a gradual process, and I'm getting there.
Da se vratimo na onu snježnu noć u Montrealu kad sam se vratio s puta, majstor mi je instalirao kombinacijsku bravu kraj vrata u kojoj je ključ za prednja vrata, kombinacija je lako pamtljiva. I moram priznati, još uvijek imam hrpe pošte koja nije svrstana i hrpe e-mailova koje još nisam niti pogledao. Tako da nisam potpuno organiziran, ali na organizaciju gledam kao postupni proces i napredujem prema tome.
Thank you very much.
Hvala puno.
(Applause)
(Pljesak)