Those of you who have seen the film "Moneyball," or have read the book by Michael Lewis, will be familiar with the story of Billy Beane. Billy was supposed to be a tremendous ballplayer; all the scouts told him so. They told his parents that they predicted that he was going to be a star.
A aqueles de vós que vistes a película <i>Moneyball</i> ou lestes o libro de Michael Lewis soaravos a historia de Billy Beane Billy ía ser un xogador de béisbol xenial, e todos os recrutadores llo dicían Dixéronllo aos seus pais
But what actually happened when he signed the contract -- and by the way, he didn't want to sign that contract, he wanted to go to college -- which is what my mother, who actually does love me, said that I should do too, and I did -- well, he didn't do very well. He struggled mightily. He got traded a couple of times, he ended up in the Minors for most of his career, and he actually ended up in management. He ended up as a General Manager of the Oakland A's.
Predixeron que sería unha estrela. Pero o que realmente sucedeu cando firmou o contrato, que por certo, non quería firmar ese contrato, el quería ir á universidade, é o que a miña nai, que me quere ben, díxome que debería facer tamén e iso fixen. Ben, non lle foi moi aló. Loitou intensamente. Cambiou de equipo en varias ocasións, caeu en ligas menores durante a maior parte da súa carreira e finalmente rematou en administración. Terminou sendo o director xeral dos Athletics de Oakland
Now for many of you in this room, ending up in management, which is also what I've done, is seen as a success. I can assure you that for a kid trying to make it in the Bigs, going into management ain't no success story. It's a failure.
Para moitos de vós nesta sala, acabar en administración, cousa que tamén eu fixen, é un éxito Pódovos asegurar que para un rapaz que trata de chegar ás grandes ligas rematar en administración non é ningún éxito, é un fracaso
And what I want to talk to you about today, and share with you, is that our healthcare system, our medical system, is just as bad at predicting what happens to people in it -- patients, others -- as those scouts were at predicting what would happen to Billy Beane. And yet, every day thousands of people in this country are diagnosed with preconditions.
E hoxe quérovos contar, e compartir con vós que o noso sistema médico é igual de malo para facer predicións do que lles ocorre ás persoas doentes coma os recrutadores dicindo o que lle ía pasar a Billy Beane. Aínda así, cada día a millares de persoas neste país diagnostícanselles enfermidades en estados previos.
We hear about pre-hypertension, we hear about pre-dementia, we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with that in the green room.
Oímos falar de prehipertensión, oímos falar de predemencia oímos falar de preansiedade, e estou case seguro de que me autodiagnostiquei iso nos camerinos. (Risas)
We also refer to subclinical conditions. There's subclinical atherosclerosis, subclinical hardening of the arteries, obviously linked to heart attacks, potentially. One of my favorites is called subclinical acne. If you look up subclinical acne, you may find a website, which I did, which says that this is the easiest type of acne to treat. You don't have the pustules or the redness and inflammation. Maybe that's because you don't actually have acne.
Tamén nos referimos ás afeccións subclínicas Hai aterosclerose subclínica, endurecemento das arterias subclínico, obviamente vinculado a ataques cardíacos, potencialmente. Un dos meus favoritos chámase acne subclínico. Se buscan acne subclínico, se cadra atopen un sitio web, coma min, que di que este é o tipo de acne máis fácil de tratar. (Risas) Non tes as pústulas nin o avermellamento nin a inflamación. Talvez é que en realidade non tes acne. (Risas)
I have a name for all of these conditions, it's another precondition: I call them preposterous. In baseball, the game follows the pre-game. Season follows the pre-season. But with a lot of these conditions, that actually isn't the case, or at least it isn't the case all the time. It's as if there's a rain delay, every single time in many cases.
Téñolle un nome para todas estas afeccións, é outra doenza en estadio previo: chámolle preabsurdeza. (Risas) Ben, en béisbol, o partido vén despois do prepartido A temporada vén despois da pretemporada. Pero isto non ocorre con moitas destas doenzas, ou polo menos non sempre ocorre
We have pre-cancerous lesions, which often don't turn into cancer. And yet, if you take, for example, subclinical osteoporosis, a bone thinning disease, the precondition, otherwise known as osteopenia, you would have to treat 270 women for three years in order to prevent one broken bone. That's an awful lot of women when you multiply by the number of women who were diagnosed with this osteopenia.
é coma se sempre aprazaran o partido por choiva en moitos casos. Existen lesións precanceríxenas, que a miúdo non se transforman en cancro. Aínda así, se poñemos por caso a osteoporose subclínica, un mal que debilita os ósos, cuxa enfermidade previa é coñecida como osteopenia teríamos que tratar a 270 mulleres durante 3 anos para evitar un caso de fractura. Son moitísimas mulleres se multiplicamos polo número das que foron diagnosticadas
And so is it any wonder, given all of the costs and the side effects of the drugs that we're using to treat these preconditions, that every year we're spending more than two trillion dollars on healthcare and yet 100,000 people a year -- and that's a conservative estimate -- are dying not because of the conditions they have, but because of the treatments that we're giving them and the complications of those treatments?
con osteopenia Non resulta sorprendente, tendo en conta os custos e os efectos secundarios das menciñas que se usan para tratar estes males en estado previo, que esteamos a gastar máis de dous billóns de dólares en sanidade, e con todo, 100.000 persoas cada ano, e esa é unha estimación moderada, están a morrer, e non polas afeccións que padecen senón polos tratamentos que estamos a dar e as súas correspondentes complicacións
We've medicalized everything in this country. Women in the audience, I have some pretty bad news that you already know, and that's that every aspect of your life
Medicalizamos todo neste país. Para as mulleres do público, teño unha mala nova, que xa coñecen e é que todos os aspectos das súas vidas se medicalizaron.
has been medicalized. Strike one is when you hit puberty. You now have something that happens to you once a month that has been medicalized. It's a condition; it has to be treated. Strike two is if you get pregnant. That's been medicalized as well. You have to have a high-tech experience of pregnancy, otherwise something might go wrong.
O primeiro <i>strike</i> é cando chegan á puberdade. Agora teñen algo que lles ocorre unha vez ao mes e que está medicalizado É unha doenza; ten que ser tratada. <i>Strike</i> dous é se quedas embarazada. Iso está medicalizado tamén. Tes que usar tecnoloxía punta no embarazo, ou algo pode ir mal.
Strike three is menopause. We all know what happened when millions of women were given hormone replacement therapy for menopausal symptoms for decades until all of a sudden we realized, because a study came out, a big one, NIH-funded. It said, actually, a lot of that hormone replacement therapy may be doing more harm than good for many of those women.
O terceiro <i>strike</i> é a menopausa. Todos sabemos que aconteceu cando se lles deu a milleiros de mulleres unha terapia de substitución hormonal para os síntomas da menopausa durante décadas ata que de repente, decatámonos polos resultados dun gran estudo, financiado polo Instituto Nacional de Saúde (NIH) que dicía que realmente a terapia de substitución hormonal podía estar a facerlles máis mal que ben a moitas destas mulleres.
Just in case, I don't want to leave the men out -- I am one, after all -- I have really bad news for all of you in this room, and for everyone listening and watching elsewhere: You all have a universally fatal condition. So, just take a moment. It's called pre-death. Every single one of you has it, because you have the risk factor for it, which is being alive.
Por se acaso, non quero deixar aos homes fóra Con todo, son un deles. Teño malas novas para todos os que estades nesta sala e para todos os que nos escoitades e vedes noutros lugares: todos tedes unha doenza universal e fatal. Pensade un momento. Chámase premorte. (Risas) Todos vós a padecedes, porque todos vós tedes o factor de risco,
But I have some good news for you, because I'm a journalist, I like to end things in a happy way or a forward-thinking way. And that good news is that if you can survive to the end of my talk, which we'll see if that happens for everyone, you will be a pre-vivor.
que é estar vivos. Pero tamén teño boas novas, porque son xornalista, e gústame rematar as cousas dunha maneira alegre e visionaria. O lado positivo é que, se podedes sobrevivir ata o final da miña charla, que xa veremos se vos sucede a todos,
I made up pre-death. If I used someone else's pre-death, I apologize, I think I made it up. I didn't make up pre-vivor. Pre-vivor is what a particular cancer advocacy group would like everyone who just has a risk factor, but hasn't actually had that cancer, to call themselves. You are a pre-vivor.
seredes "previventes". (Risas) Xa Inventei premorte. Se usei o termo doutra persoa, síntoo, pero creo que o inventei eu. Non inventei "previventes" Previvente é como algún grupo de apoio a persoas con cancro querería que lles chamásemos aos que só teñen o factor de risco pero non tiveron o cancro. Vós sodes previventes.
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the audience, I'd like to suggest a reality TV show called "Pre-vivor." If you develop a disease, you're off the island.
Estivo aquí xente da HBO esta mañá. Pregúntome se Mark Burnett se atopa entre o público. Gustaríame propoñerlle un programa de telerrealidade que se chame "Previvente"
But the problem is, we have a system that is completely -- basically promoted this. We've selected, at every point in this system, to do what we do, and to give everyone a precondition and then eventually a condition, in some cases. Start with the doctor-patient relationship. Doctors, most of them, are in a fee-for-service system. They are basically incentivized to do more -- procedures, tests, prescribe medications.
Se enfermas, estás fóra da illa. (Risas) Pero o problema é que temos un sistema que é completamente... basicamente promoveuisto. Escollemos, en cada momento deste sistema, facer o que facemos, e atribuír a todos unha enfermidade en estado previo e finalmente, nalgúns casos, unha doenza. Comecemos pola relación médico-doente. A maioría dos médicos teñen un sistema de pago por servizo. Principalmente, teñen incentivos para facer máis procedementos, probas, prescribir menciñas.
Patients come to them, they want to do something. We're Americans, we can't just stand there, we have to do something. And so they want a drug. They want a treatment. They want to be told, this is what you have and this is how you treat it. If the doctor doesn't give you that, you go somewhere else. That's not very good for doctors' business. Or even worse, if you are diagnosed with something eventually, and the doctor didn't order that test, you get sued.
Os doentes acoden a eles, queren facer algo. Non podemos quedar mirando. Somos americanos, temos que facer algo. Por iso, queren un medicamento. Queren un tratamento. Queren que lles digan: isto é o que tes e así é como se trata. Se o médico non che dá iso vaste para outra parte. Pero iso non é bo para o negocio dos médicos. Ou aínda peor, se ao final lles diagnostican algo, e o médico non pediu esa proba, demándano.
We have pharmaceutical companies that are constantly trying to expand the indications, expand the number of people who are eligible for a given treatment, because that obviously helps their bottom line. We have advocacy groups, like the one that's come up with pre-vivor, who want to make more and more people feel they are at risk, or might have a condition, so that they can raise more funds and raise visibility, et cetera.
Hai compañías farmacéuticas que tratan constantemente de ampliar as indicacións, ampliar o número de persoas que son aptas para certos tratamentos porque obviamente isto incrementa os seus ingresos Existen grupos de apoio como os que inventaron a palabra previvente, que queren facer que as persoas sintan que están en perigo, ou que pode que padezan unha doenza para así obter máis fondos, e ser máis visibles, etcétera.
But this isn't actually, despite what journalists typically do, this isn't actually about blaming particular players. We are all responsible. I'm responsible. I actually root for the Yankees, I mean talk about rooting for the worst possible offender when it comes to doing everything you can do. Thank you. But everyone is responsible.
Pero non se trata, a pesar de que os xornalistas o fagan normalmente, non se trata de culpar a ninguén en particular. Todos somos responsables, eu son responsable. A verdade é que apoio aos Yankees, é dicir, apoio ao máximo culpable cando se trata de facer todo o que se pode facer Grazas. (Risas) Pero todo o mundo é culpable.
I went to medical school, and I didn't have a course called How to Think Skeptically, or How Not to Order Tests. We have this system where that's what you do. And it actually took being a journalist to understand all these incentives. You know, economists like to say, there are no bad people, there are just bad incentives.
Fun á facultade de medicina, e non tiven unha clase de "Como pensar con escepticismo" ou "Como non pedir análises". Temos este sistema onde iso é o que se fai. Tiven que ser xornalista para entender estes incentivos. Sabedes, os economistas adoitan dicir que non hai xente mala, só malos incentivos.
And that's actually true. Because what we've created is a sort of Field of Dreams, when it comes to medical technology. So when you put another MRI in every corner, you put a robot in every hospital saying that everyone has to have robotic surgery. Well, we've created a system where if you build it, they will come. But you can actually perversely tell people to come, convince them that they have to come.
E de feito, iso é certo. Porque creamos unha especie de "Campo de Soños" no ámbito da tecnoloxía médica. Poñemos máquinas de resonancia magnética por todas partes, non queda un hospital sen unha máquina que di que todos necesitamos cirurxía robótica Creamos un sistema de "se o constrúes, eles virán". Pero pódese convencer de maneira perversa á xente sa de que teñen que vir.
It was when I became a journalist that I really realized how I was part of this problem, and how we all are part of this problem. I was medicalizing every risk factor, I was writing stories, commissioning stories, every day, that were trying to, not necessarily make people worried, although that was what often happened.
Pero, cando me fixen xornalista foi cando me dei conta de como eu era parte do problema e de como todos somos parte do problema. Medicalizaba todos os factores de risco, escribía historias, encargaba artigos, que non trataban de preocupar á xente, pero iso era o que ocorría con frecuencia.
But, you know, there are ways out. I saw my own internist last week, and he said to me, "You know," and he told me something that everyone in this audience could have told me for free, but I paid him for the privilege, which is that I need to lose some weight. Well, he's right. I've had honest-to-goodness high blood pressure for a dozen years now, same age my father got it, and it's a real disease. It's not pre-hypertension, it's actual hypertension, high blood pressure.
Pero sabedes, hai saída. Vin ao meu internista a semana pasada e díxome "Xa sabes", e informoume de algo que calquera dos que estades aquí podería dicirme gratuitamente, pero eu pagueille pola exclusiva: Teño que perder peso. Ben, ten razón. Son hipertenso dende hai doce anos xa, á mesma idade que empezou a selo meu pai, Non se trata de prehipertensión, é hipertensión de verdade, presión arterial alta.
Well, he's right, but he didn't say to me, well, you have pre-obesity or you have pre-diabetes, or anything like that. He didn't say, better start taking this Statin, you need to lower your cholesterol. No, he said, "Go out and lose some weight. Come back and see me in a bit, or just give me a call and let me know how you're doing."
Ben, ten razón, pero non me dixo tes preobesidade, ou prediabetes, ou algo así Non me dixo que empezara a tomar estatinas para baixar o colesterol. Non, díxome: vai perder peso e volve verme nun tempiño ou chámame e dime que tal vas.
So that's, to me, a way forward. Billy Beane, by the way, learned the same thing. He learned, from watching this kid who he eventually hired, who was really successful for him, that it wasn't swinging for the fences, it wasn't swinging at every pitch like the sluggers do, which is what all the expensive teams like the Yankees like to -- they like to pick up those guys. This kid told him, you know, you gotta watch the guys, and you gotta go out and find the guys who like to walk, because getting on base by a walk is just as good, and in our healthcare system we need to figure out, is that really a good pitch or should we let it go by and not swing at everything? Thanks.
Iso é para min o camiño para seguir. Billy Beane, por certo, aprendeu o mesmo. Decatouse, observando este rapaz, a quen ao final contratou, e tivo moito éxito, que non se trataba de batear a pelota fóra do campo, ou de batear todos os lanzamentos, como fan os mellores, que é o que lles gusta a todos os equipos con cartos, coma os Yankees, que escollen esa clase de xogadores. Este rapaz díxolle: tes que observar aos mozos, tes que saír buscar aos que lles guste camiñar, porque chegar a unha base camiñando é igual de válido, e no noso sistema de saúde temos que reflexionar: é iso un bo lanzamento, ou temos que deixalo pasar e non tratar de batealo todo? Grazas. (Aplausos)