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.
Bir necha yil oldin, o’z uyimga yugurib kirdim. Endi uyga kelgandim, chamasi yarim tunda jonsiz Monreal qishida, shahar narigi chekkasidagi, do’stim Jeffnikiga borardim va old ayvondagi termometr minus 40 darajani ko’rsatayotgan edi -- Selsiy yoki Farangeytdaligini so’rab ovora bo’lmang, minus 40 bu ikki shkala uchrashadigan joy -- juda sovuq edi. Old ayvonda cho’ntagimga qo’limni solib turar ekanman, men kalitim yo’qligini bildim. Aslida, ularni oynadan ko’ra olgan edim, ular qoldirib ketgan ovqat yeydigan xonadagi stol ustida edi. Men tez yugurib, hamma tarafdan eshik va oynalarni tortib ko’rdim, ular mahkam yopilgan edi. Chilangar chaqirishni o’yladim -- telefonim bor edi, lekin yarim tunda, chilangar kelishi ko’p vaqt olar edi, va sovuq edi. Men do’stim Jeffning uyiga tunga bora olmas edim, chunki kelasi tong ertalab Yevropaga uchib ketishim kerak edi, men passport va chamadonimni olishim kerak edi.
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.
Shunday qilib, umidsiz, izg’irin sovuqda, men ulkan tosh topdim va oynani sindirdim, oyna parchalarini tozaladim, sudralib bordim, parcha karta topib, ochilishiga tirab qo’ydim, ertalab aeroportga ketishda uy egasiga qo’ng’iroq qilib mendan tuzatishni so’rashini angladim. Bu qimmatga tushadi, lekin ehtimol yarim tunda chilangar chaqirishdan arzonroqdir, shunda anglab yetdimki, bunday vaziyatdan quruq chiqayotgan ekanman.
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.
Hozir, men amaliyotchi nevrologman va men stress ostida miya qanday ishlashini biroz bilaman. U yurak urishiningizni tezlashtiradigan kortizol ishlab chiqaradi, adrenalin darajangizni o’zgartiradi, fikr- lashingizni qorong’ulashtiradi. Kelasi tong, biroz uxlab turganimda, oynadagi teshik va uy egasiga qo’ng’iroq qilishni o’ylab, izg’irinda temperatura va Yevropada kelayotgan uchrashuvlar haqida qayg’urib, bilasizmi, miyamdagi barcha kortizol bilan fikrlashim qiyin edi, lekin buning qiyinligini bilmasdim, chunki bu haqda o’ylolmasdimam.
(Laughter)
(Kulgi)
And it wasn't until I got to the airport check-in counter, that I realized I didn't have my passport.
Aeroportdagi tekshiruv markaziga bormagunimcha passport yo’qligini bilmadim.
(Laughter)
(Kulgi)
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.
Shunda qor va muzda uyga chopdim, 40 minutda, passportimni oldim, aeroportga yana chopdim, vaqtida bordim, lekin o’rnimni boshqa odamga berib bo’lishgan edi, men samolyot orqasi, hojatxonalar oldida turib qoldim, 8 soatlik yo’lda qimirlamaydigan o’rindiqda. Xo’sh, o’sha 8 soat va uyqusizlikda o’ylashga ko’p vaqtim bor edi.
(Laughter)
(Kulgi)
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.
Va men o’ylanishni boshladim, yomon narsalarni sodir bo’lishini oldin olishga qilishim mumkin bo’lgan qandaydir sistema bormi? Yoki kamida yomon narsa sodir bo’lsa, uning butunlay katastrofa bo’lishining ehtimolligini kamaytiradigan. Shu haqida o’ylashni boshladim, lekin fikrlarim taxminan bir oydan keyingacha tiniqlashmadi. Men kasbdoshim, Nobel mukofoti sovrindori, Danny Kahneman bilan kechki ovqat qilayotgan edim va negadiram uyalib oynamni sindirganimni aytdim, va, bilasizmi, passportimni esdan chiqarganimni, va Danny menga istiqbolli o’tmishga nazar tashlashni mashq qilayotganini aytdi.
(Laughter)
(Kulgi)
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.
U buni bir necha yil oldin psixolog Gary Klein yozganidan olganini aytdi, u o’limdan oldin deb nomlanardi. O’limdan oldin nima ekanligini bilasiz. Qachonki falokat bo’lsa, mutaxassislar kelib nima xato ketganini topishga harakat qilishadi, to’g’rimi? Xo’sh, o’limdan oldingida, Danny tushuntirdi, kelajakka qarab, nima xato ketishi mumkin- ligini topishga harakat qilasiz, keyin bu narsa sodir bo’lishini oldini olish yo zararini kamaytirishga nima qilish mumkin- ligini topishga harakat qilasiz.
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.
Bugun siz bilan gaplashmoqchi bo’lgan narsam o’limdan oldingi shaklda qilish mumkin narsalardir. Ba’zilari aniq, ba’zilari esa unchalik aniq emas. Men aniqlaridan boshlayman.
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.
Uy atrofida, oson yo’qoladigan narsalar uchun joy yasang. Hozir, bu odatiy narsadek eshitilishi mumkin va aslida shunday, fazoviy xotiramiz ishlashiga asoslangan buni qo’llab quvvatlaydigan ko’p fan, ilm mavjud. Miyada gippokamp degan o’n ming yillardan beri shakllanib kelayotgan, muhim narsalarning joylashuvini kuzatib boradigan struktura bor -- quduq qayerda, qayerdan baliq topish mumkinligi, mevali daraxtlarning o’sha shoxi, qayerda do’stona va dushman qabilalarning yashashi. Gippokamp bu Londondagi taksi haydovchilari kengayadigan miyamiz qismidir. Bu olmaxonlarga yong’oqlarni topishga yordam beradigan miya qismi. Hayratga tushayotgan bo’lsangiz, aslida tajriba qilgan, olmaxonlarning hid sezish tizimini olib tashlagan va ular yong’oqlarini hamon topisha olgan. Ular hidni emas, gippokampni ishlatishayotgan edi, bu nozik ravishda miyadagi narsalarni topish qismida rivojlangan. Lekin bu ko’p qimirlamaydigan narsalar uchun juda yaxshi, siljiydigan narsalar uchun uncha yaxshi emas. Shuning uchun mashina kalitlar, ko’zoynak va passportlarimizni yo’qotib qo’yamiz. Shuning uchun uyda, kalitlar uchun joy yasang -- eshik oldida ilgich, balki dekorativ kosa. Passportingiz uchun, ma’lum bir tortma. Ko’zoynaklaringiz uchun, ma’lum bir stol. Agarda joy yasab, ehtiyotkor bo’lsangiz, narsalaringizni qidirayotganingizda yaxshiroq bo’ladi.
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.
Sayohatdachi? Kredit karta, haydovchilik guvohnoma, passportingizni telefonga rasmga oling, cloudda turishi uchun pochtadan o’zingizga yuboring. Bu narsalar yo’qotilsa yoki og’irlansa, siz o’rniga narsani qila olasiz.
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.
Xo’sh bular nisbatan ancha aniq narsalar. Esingizda bo’lsa, stress ostida miyangiz kortizol ishlab chiqaradi. Kortizol zaharli va u fikrlashni qorong’ulashtiradi. O’limdan oldin mashqining bir qismi stress ostida eng yaxshi holatda emas- ligingizni anglashdir va siz sistemalarni o’rniga qo’yishingiz kerak.
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.
Balkim tibbiy qaror qilishga yuzlanishdan ko’ra qiyinroq vaziyat yo’qdir. Qachondir, hammamiz o’sha holatda bo’lamiz, qachonki biz o’z kelajagimizdagi tibbiy holat haqida qaror qilishimiz yoki yaqinlarimizga qaror qilishda yordam berishimiz kerak bo’ladi.
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.
Men o’sha haqida gapirmoqchiman. Men ma’lum bir tibbiy holat haqida gapirmoqchiman. Lekin bu har qanday tibbiy qaror qilish uchub model sifatida xizmat qiladi, va albatta moliyaviy qaror qilish, ijtimoiy qaror qilish jarayonlarida ham -- har qanday faktlarning to’g’ri baholashdan foyda keltiradigan qarorda.
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."
Tasavvur qiling siz shifokorga bordingiz va shifokor aytdi: “Labaratoriyadan natijalaringizni oldim, xolestrin darajangiz ozgina yuqori ekan”. Xo’sh, hammangiz bilasiz, yuqori xolestrin kardiologik kasalliklar, yuruk xuruji, falajning ehtimolligini ko’taradi. O’ylayotgan bo’lishingiz yuqori xolestrin bo’lishi yaxshi narsa emas, va shifokor aytadi: “Sizga xolesterinningizni kamaytiradigan dori - statin bermoqchiman”. Ehtimol siz statin haqida eshitgansiz, bilasizki bugungi kunda ko’p yozib berilayotgan dorilar orasida, balki siz buni olayotgan insonlarni ham bilasiz. Siz o’ylayapsiz, “Ha! Menga statin bering”.
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.
Lekin shu vaqtda siz savol berishingiz kerak, ko’pchilik shifokorlar gapirishni yaxshi ko’rmaydigan va farmastevtik kompaniyalar undan kam gapirishni istaydigan statistikani. so’rashingiz kerak. Bu davolash uchun ketadigan son. Hop, DUKS, nima bu? Bu son bir insonga yordam berilishidan oldin dori ichish, jarrohligi qilinadigan yoki qandaydir tibbiy muolaja oladigan insonlardir. O’ylashingiz mumkin, bu qanday axmoqona statistika? Son 1 bo’lishi kerak edi. Shifokorim menga yordam bermaydigan narsani yozib bermaydi. Lekin aslida, tibbiy jarayon bunday ishlamaydi. Bu shifokor aybi emas, kimning aybi bo’lsa ham, bu menga o’xshash olimlarning aybi. Buning ostida mexanizmlarni hali to’liq o’rganib chiqmadik. Lekin GlaxoSmithKline baholashicha, 90% dorilar faqat 30%dan 50% gacha odamlarga ta’sir qiladi. Xo’sh davolanish uchun ketgan son keng yozib beriladigan statin uchun necha deb o’ylaysiz? Bittaga yordam berishidan oldin nechta odam olishi kerak? 300. Bu Bloomberg.com tomonidan mustaqil ravishda tasdiqlangan amaliyotchi izlanuvchilar jerome Groopman va Pamela Hartzbandning izlanishlariga ko’ra. Men buni o’zim ko’rib chiqdim. Yiliga 300 ta odam bitta yurak xuruji, falaj yoki boshqa o’xshash falokatni oldini olishi uchun ichishi kerak.
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.
Hozir o’ylashingiz mumkin: “Hop, xolestrinni kamaytirish ehtimolligi 300dan bir. Nima qilibdi? Menga beravering shifokor”. Lekin shu vaqtda yana bir statistikani so’rashingiz kerak, va u: “Undan keyingi alomatlarini ayting”. To’g’rimi? Xo’sh bu ma’lum dorida alomatlar besh foiz bemorlarda kuzatilar ekan. Bunga qo’rqinchli narsalar kiradi - muskullarni zaiflashtirish va bo’g’im og’rig’i, ichak stressi -- lekin o’ylayotgan bo’lishingiz mumkin, “Besh foiz, dori ichsam men bilan sodir bo’lish ehtimoli kam”. To’xtab turing. Esingizda tursin stressda aniq fikrlamayapsiz. O’sha vaqtning o’zida mulohaza yuritmaslik uchun oldindan nima qilishning ustida ishlab boring. 300 ta odam dori ichdi, to’g’rimi? Bittasiga yordam beradi, 300 taning 5%ida alomatlar kuzatiladi, bu 15 ta odam. Siz doridan zarar topishingiz ehtimolligi yordam olishingizdan 15 marta balandroq.
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.
Men sizga statinni olish yoki olmaslikni aytmyapman. Shunchaki shifokor bilan maslahatlashingiz kerakligini aytyapman. Tibbiy etika buni talab etadi, xabardor rozilik prinsipi bir qismidir. Sizning bunday ma’lumot olishga, tavakkal qilishni xohlashingiz yoki yo’qligi haqidagi suhbatni boshlashga haqqingiz bor.
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.
Hozir siz hayratga solish uchun bu sonni osmondan oldim deb o’ylashingiz mumkin, lekin aslida bu juda odatiy, bu davolanishi kerak bo’lgan son. 50 yoshdan katta erkak kishilarga qilinadigan eng keng jarrohliklik saraton uchun prostatani olib tashlashga davolanish uchun kerak bo’lgan son 49. To’g’ri, bitta odamga yordam berilishiga 49 ta jarrohlik amalga oshiriilishi kerak. Alomatlar bemorlarning 50%ida kuzatiladi. Bu o’z ichiga holsizlik, bo’g’imlarning ishdan chiqishi, tutib turolmaslik, rektal terlash, najas tutib turolmaslikni oladi. Agar omadli bo’lsangiz va bular borlarning 50% idan biri bo’lsangiz, ular uzog’i bir yoki ikki yil bo’ladi.
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.
O’limdan oldinning asosiy g’oyasi suhbatni rivojlantiradigan so’rashingiz mumkin bo’lgan savollarni vaqtdan oldin o’ylashdir. Siz hammasini o’z vaqtida o’ylashni xohlamaysiz. Shuningdek, hayot sifati kabi narsalar haqida ham o’ylashni xohlaysiz. Chunki ba’zida sizda tanlov bo’ladi, siz kamroq lekin og’riqsiz hayotni xohlaysizmi, yoki uzunroq lekin oxiriga kelib juda og’riqli hayotnimi? Bular oila, yaqinlaringiz bilan hozir gaplashish, o’ylashingiz kerak bo’lgan narsalar. Ayni qaynoq damda fikringizni o’zgartirishingiz mumkin, lekin kamida bunday fikrlash bilan mashq qilgansiz.
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.
Esingizda bo’lsa, miyamiz stress ostida kortizol ishlab chiqaradi va bu paytda sodir bo’ladigan narsalardan biri bir necha sistemalarning o’chishidir. Bunga evolutsion sabab bor. Yirtqich bilan yuzma-yuz paytda, sizga hazm qilish sistema yoki libido yoki immun sistemangiz kerak bo’lmaydi, chunki tanangiz bu narsalarga metobolizm kengaytirsa va tezda javob bermasangiz, sherning tushligiga aylanishingiz mumkin, va bularning hech qaysinisi kerak bo’lmaydi. Afsuski, bunday stress vaqtlarida butunlay ishdan chiqadigan narsalardan Danny Kahneman va kasbdoshlari ko’rsatganidek, to’g’ri va mantiqiy fikrlashdir. Demak biz bunday vaziyatlarga oldindan fikrlashga o’rganishimiz kerak.
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.
O’ylashimcha, bu yerda hammamizning nuq- sonliligimizni bilish muhim. Hammamiz hozir yoki keyin yiqilamiz. Bu yerdagu asosiy g’oya oldindan bu mag’lubiyatlarni o’ylash, ularning zararini kamaytirishga sistemalar qo’yish yoki bu yomon voqealarni birinchi o’rinda sodir bo’lishidan saqlash.
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.
Qorli Montrealdagi tunga qaytsak, sayohatdan qaytganimdan so’ng, Shartnomamchi menga kombinatsiyali qulfni eshik oldiga o’rnatib berdi, oldingi eshikka qulf bilan, oson esda qoladigan kombinatsiya. Tan olishim kerak, Mening hali ham ko’plab saralab chiqmagan pochtalarim va ko’rib chiqmagan ko’plab pochtalarim bor. Men butunlay tartibli emasman, tartiblilik asta-sekinlik bilan erishiladi deb bilaman, va men u tomon boryapman.
Thank you very much.
Rahmat kattakon.
(Applause)
(Olqishlar)