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.
Pre nekoliko godina, provalio sam u sopstvenu kuću. Upravo sam stigao kući, bilo je oko ponoći usred montrealske zime, bio sam u poseti prijatelju, Džefu, na drugom kraju grada i termometar na tremu je pokazivao minus 40 stepeni - i ne pitajte da li se radi o stepenima Celzijusa ili Farenhajta na minus 40 se skale susreću - bilo je jako hladno. I dok sam stajao na tremu i preturao po džepovima, shvatio sam da nemam ključeve. Zapravo, video sam ih kroz prozor kako stoje na trpezarijskom stolu gde sam ih i ostavio. Brzo sam sve obišao i pokušao da otvorim druga vrata i prozore, i sva su bila zaključana. Palo mi je na pamet da zovem bravara - makar sam imao mobilni, ali u ponoć, moglo je potrajati dok bravar stigne, a bilo je hladno. Nisam mogao da se vratim da prespavam kod Džefa jer je rano ujutru trebalo da letim za Evropu, i morao sam da uzmem pasoš i kofer.
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.
Tako sam, očajan i smrzavajući se pronašao veliki kamen i provalio kroz prozor na podrumu, uklonio komade stakla, provukao se kroz prozor, našao parče kartona i zalepio ga preko otvora, računajući da ću ujutru, na putu do aerodroma, pozvati majstora i zamoliti ga da to popravi. Znao sam da će to biti skupo, ali verovatno ne skuplje nego da bravar dolazi usred noći, tako da sam računao, s obzirom na okolnosti, da sam na istom.
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 obrazovanju sam neurolog i znam ponešto o tome kako mozak funkcioniše pod stresom. Oslobađa kortizol koji ubrzava otkucaje srca, utiče na nivo adrenalina i pomućuje razmišljanje. Sledećeg jutra, kada sam se probudio nakon premalo sna, zabrinut zbog rupe u prozoru i imajući u glavi da moram da zovem majstora, a uz ledene temperature i sastanke koji su me čekali u Evropi i, znate, sa svim tim kortizolom u mozgu, nisam jasno razmišljao. Ali nisam znao da ne razmišljam jasno jer nisam jasno razmišljao.
(Laughter)
(Smeh)
And it wasn't until I got to the airport check-in counter, that I realized I didn't have my passport.
I tek kada sam došao do šaltera za čekiranje na aerodromu, shvatio sam da nisam poneo pasoš.
(Laughter)
(Smeh)
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.
Tako da sam za 40 minuta odjurio kući po snegu i ledu, uzeo pasoš, odjurio nazad na aerodrom, stigao sam tačno na vreme, ali su već dali moje sedište nekom drugom, pa sam zaglavio u zadnjem delu aviona, pored kupatila, u sedištu koje nije moglo da se spusti, na letu od osam sati. Pa, tokom tih osam besanih sati imao sam dosta vremena za razmišljanje.
(Laughter)
(Smeh)
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 zapitao sam se postoji li nešto što mogu da uradim, sistemi koje mogu da postavim, koji će sprečiti da se loše stvari dešavaju? Ili će bar, ako se loše stvari dogode, smanjiti verovatnoću da dođe do potpune katastrofe. Počeo sam da razmišljam o tome, ali su mi se misli iskristalisale tek oko mesec dana kasnije. Večerao sam sa kolegom, Nobelovcem Denijem Kanemanom i pomalo postiđeno mu ispričao kako sam razbio prozor i, znate već, zaboravio pasoš, i Deni mi je otkrio da primenjuje nešto što se zove buduće osvrtanje.
(Laughter)
(Smeh)
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 za šta je čuo od psihologa Gerija Klajna, koji je pisao o tome nekoliko godina ranije, a zove se još i pred-uviđaj. Sad, svi znate šta je uviđaj. Kad god dođe do katastrofe, tim stručnjaka dolazi i pokušava da otkrije šta je pošlo naopako. Pa, u pred-uviđaju, objasnio je Deni, gledate unapred i pokušavate da vidite šta bi sve moglo poći naopako i onda da smislite šta možete da uradite da biste sprečili da se to desi, ili smanjili 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.
Danas hoću da pričam sa vama o nekim vrstama pred-uviđaja koje možemo da primenimo. Neke od njih su očigledne, neke nisu toliko očigledne. Krenuću od onih očiglednih.
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.
Odredite mesto u kući za stvari koje se lako zagube. Ovo zvuči zdravorazumski, i jeste, ali je utemeljeno na dosta naučnih činjenica, zasnovanih na načinu na koji funkcioniše prostorna memorija. U mozgu postoji struktura koja se zove hipokampus, koja je evoluirala tokom desetina hiljada godina, kako bi vodila računa o lokacijama bitnih stvari - gde je izvor, gde se može naći riba, ono drveće sa voćem, gde žive prijateljska i neprijateljska plemena. Hipokampus je deo mozga koji se uvećava kod londonskih taksista. To je deo mozga zahvaljujući kome veverice pronalaze svoje lešnike. I ako ste se pitali, neko je zaista izveo eksperiment u kome su vevericama blokirali čulo mirisa i one su ipak uspevale da nađu lešnike. Nisu koristile miris, koristile su hipokampus, taj izvanredno razvijeni mehanizam za nalaženje stvari. Ali on dobro funkcioniše sa stvarima koje uglavnom miruju, a slabije sa onima koje se kreću. Zbog toga gubimo ključeve od auta i naočare za čitanje i pasoše. Zato odredite mesto za ključeve u kući - kukicu pored vrata, možda ukrasnu činiju. Odredite posebnu fioku za pasoš. Za naočare za čitanje, određeni sto. Ako odredite jedno mesto i pridržavate se toga, stvari će vam biti tamo kad god ih budete tražili.
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.
A šta je sa putovanjima? Uslikajte telefonom kreditne kartice, vozačku dozvolu, pasoš, pošaljite to sebi mejlom da vam bude dostupno. U slučaju gubitka ili krađe tih stvari, biće lakše da izvadite nove.
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.
To su neke prilično očigledne stvari. Setite se, kada ste pod stresom, mozak oslobađa kortizol. Kortizol je toksičan, i pomućuje misli. Zato je deo pred-uviđaja da shvatite da niste u najboljem izdanju kad ste pod stresom i da bi trebalo da postavite sisteme.
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.
A možda nema stresnije situacije nego kada se suočite sa donošenjem medicinske odluke. I svi ćemo mi u nekom trenutku biti u tom položaju, u kome moramo da donesemo veoma važnu odluku o svom budućem medicinskom lečenju, ili lečenju voljene osobe, da im pomognemo oko odluke.
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.
I o tome želim da pričam. I pričaću o konkretnom medicinskom problemu. Ali on služi da predstavi sve vrste medicinskog odlučivanja, ali i finansijske odluke, kao i društvene odluke - sve odluke koje morate da donesete u kojima bi vam pomogla racionalna procena 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."
Zamislite da odete kod lekara i on kaže: "Dobio sam vaše rezultate iz laboratorije i holesterol vam je malo povišen." Svi znate da je povišen holesterol povezan sa povećanim rizikom od kardiovaskularnih bolesti, od srčanog udara, infarkta. I zato pomišljate kako nije baš dobro imati povišen holesterol, a doktor kaže: "Znate, hteo bih da vam prepišem lek koji će pomoći da vam se snizi holesterol, statin." I verovatno ste čuli za statine, znate da su među najčešće prepisivanim lekovima u svetu danas, verovatno čak poznajete ljude koji ih piju. I zato mislite: "Da! Dajte mi taj 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.
Ali postoji pitanje koje sada treba da postavite, statistika za koju treba da pitate, a o kojoj većina lekara ne voli da govori, a farmaceutske kompanije još manje. To je broj potreban za izlečenje. Dakle, šta je to to, taj BPI? To je broj ljudi koji treba da uzmu lek ili se podvrgu operaciji ili nekoj medicinskoj proceduri da bi se jedna osoba izlečila. I vi mislite, kakva je to suluda statistika? Taj broj treba da bude 1. Moj lekar mi ne bi prepisao nešto ako mi to neće pomoći. Ali zapravo, medicinska praksa ne funkcioniše tako. I za to nisu krivi lekari, ako je iko kriv onda su to naučnici poput mene. Nismo otkrili dovoljno o mehanizmima koji leže u osnovi. Ali kompanija GlaxoSmithCline procenjuje da 90 procenata lekova deluje na samo 30 do 50 procenata ljudi. Zato je broj potreban za izlečenje za statin koji se najčešće prepisuje, šta mislite koji? Koliko ga pacijenata mora uzeti pre nego što pomogne jednom? 300. To su podaci istraživanja koje su sproveli Džerom Grupmen i Pamela Harcbend, a nezavisno potvrdio Bloomberg.com. I sam sam prošao kroz brojeve. Potrebno je da 300 ljudi pije lek godinu dana da bi se sprečio jedan srčani udar ili drugi zdravstveni problem.
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.
Sada verovatno mislite: "Dobro, verovatnoća da snizim holesterol je 1 prema 300. Što da ne, doktore? Ipak mi dajte recept." Ali sada treba da pitate za još jedan statistički podatak, a to su neželjena dejstva. Zar ne? Kod ovog konkretnog leka, neželjena dejstva se javljaju kod pet posto pacijenata. I ona mogu biti užasna - iznurujući bol u mišićima i zglobovima, gastrointestinalne tegobe - ali sada vi mislite: "Pet posto, mala je verovatnoća da se to meni desi, ipak ću uzeti lek." Ali čekajte malo. Setite se da pod stresom ne razmišljate jasno. Zato razmislite unapred kako ćete ovo rešiti, kako ne biste na licu mesta morali da osmislite lanac zaključaka. Lek uzima 300 osoba, je li tako? Jednoj pomogne, 5 posto od tih 300 oseća neželjena dejstva, to je njih 15. Verovatnoća da će vam lek naškoditi je 15 puta veća nego da će vam pomoći.
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 kažem da li bi trebalo da uzmete statin ili ne. Samo kažem da treba da razgovarate o ovome sa svojim lekarom. To zahteva lekarska etika, to je deo principa o informisanoj saglasnosti. Imate pravo da pristupite ovakvim informacijama da biste započeli razgovor o tome želite li da prihvatite rizike 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.
Sada možda mislite da sam ovaj broj izvukao niotkuda da bih vas zapanjio, ali je taj broj potreban za izlečenje zapravo prilično uobičajen. Za najčešću operaciju među muškarcima starijim od 50 godina, uklanjanje prostate zbog raka, broj potreban za izlečenje je 49. Tako je, izvrši se 49 operacija, da bi se izlečila jedna osoba. U tom slučaju se neželjene posledice javljaju kod 50 posto pacijenata. Među njima su impotencija, erektilna disfunkcija, urinarna inkontinencija, analne fisure, fekalna inkontinencija. I ako imate sreće, a jedan ste od onih 50 posto kojima se ovo dogodi, potrajaće samo godinu ili dve.
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.
Zato je ideja pred-uviđaja da mislite unapred o pitanjima koja ćete moći da postavite i tako podstaknete razgovor. Ne morate sve ovo da smislite na licu mesta. I još treba da razmislite o pitanjima poput kvaliteta života. Jer često imate izbor, želite li kraći život bez bola, ili duži život koji će pred kraj možda biti izuzetno bolan? O tome treba pričati i razmišljati sada, sa porodicom i voljenim osobama. Možda ćete se predomisliti u žaru trenutka, ali makar ćete uvežbati da razmišljate na ovaj način.
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.
Setite se, mozak oslobađa kortizol kada je pod stresom i jedna od stvari koje se tada dese je isključivanje gomile sistema. Postoji evolutivni razlog za to. Kad se suočite sa predatorom, ne treba vam sistem za varenje, niti libido, niti imuni sistem, jer ako vaše telo troši metabolizam na sve to i ako ne reagujete brzo, možete postati ručak za lava, a onda ništa od svega toga nije bitno. Nažalost, jedna od stvari koje nestaju tokom tih stresnih trenutaka je racionalno, logičko mišljenje, kao što su pokazali Deni Kaneman i njegove kolege. Zato moramo da se naviknemo da mislimo unapred o takvim 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 ovde važno da shvatimo da svi mi imamo mane. S vremena na vreme, svi pogrešimo. Ideja je da unapred mislimo o tome koje bismo greške mogli napraviti, da postavimo sisteme koji će pomoći da se umanji šteta, ili sprečiti da se loše stvari uopšte 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 snežnu noć u Montrealu, kada sam se vratio sa putovanja, majstor mi je ugradio bravu sa šifrom pored vrata, koja otključava ulazna vrata, sa kombinacijom koja se lako pamti. I moram da priznam, još uvek imam gomilu pošte koju nisam sredio i gomilu mejlova koje nisam pročitao. Dakle, nisam sasvim organizovan, ali organizaciju posmatram kao postepeni proces i bližim se cilju.
Thank you very much.
Hvala vam mnogo.
(Applause)
(Aplauz)