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.
Onima koji su vidjeli film "Igra pobjednika" ili su čitali knjigu Michaela Lewisa bit će poznata priča o Billyju Beaneu. Billy je trebao biti veliki igrač baseballa; svi lovci na talente rekli su mu to. Rekli su njegovim roditeljima da predviđaju da će biti zvijezda.
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.
Ali što se zapravo dogodilo kada je potpisao ugovor – usput rečeno, on nije htio potpisati taj ugovor, htio je ići na fakultet – što je moja majka, koja me zapravo voli, rekla da bih ja trebao učiniti, a to sam i učinio – a on nije dobro prošao. Žestoko se trudio. Mijenjali su ga nekoliko puta, bio je u maloj ligi većinu svoje karijere i zapravo na kraju završio u menadžmentu. Završio je kao glavni direktor Oakland A kluba.
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.
Za mnoge od vas završiti kao direktor, kao što sam i ja učinio, zapravo je uspjeh. Uvjeravam vas da za dijete koje pokušava dospjeti do velike lige posao direktora nije uspjeh. To je promašaj.
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.
A ono o čemu vam želim pričati danas i što želim podijeliti s vama jest da je naš zdravstveni sustav, naš sustav medicine jednako loš u predviđanju što će se dogoditi ljudima u njemu – pacijentima, drugima – kao što su bili loši i oni lovci na talente koji su predviđali što će se dogoditi s Billyjem Beaneom. Ali ipak, svaki dan tisućama ljudi u ovoj državi dijagnosticirani su preduvjeti za bolest.
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.
Slušamo o predhipertenziji, slušamo o preddemenciji, slušamo o predanksioznosti i poprilično sam siguran da sam si sam to dijagnosticirao u zelenoj sobi.
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.
Također mislimo i na subklinička stanja. Postoji subklinička arteroskleroza, subkliničko otvrdnjavanje arterija, potencijalno, ali očigledno povezano sa srčanim udarima. Jedno od meni najdražih stanja naziva se subkliničkim aknama. Ako potražite subkliničke akne možete pronaći web stranicu, koju sam ja našao, koja kaže da je ovo najjednostavniji oblik akni za liječenje. Nemate gnoj niti crvenilo ni upalu. Možda zato što zapravo nemate akne.
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.
Imam naziv za sva ova stanja, još jedno predstanje: zovem ih besmislicom. U baseballu igra prati predigru. Sezona prati predsezonu. Ali s mnogima od ovih stanja to nije slučaj ili bar nije uvijek slučaj. To je svaki put poput zakašnjele kiše u mnogim slučajevima.
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.
Imamo predtumorske ozljede koje često ne postanu tumori. Ali, na primjer, ako uzmete subkliničku osteoporozu, bolest omekšanja kostiju, preduvjet za bolest poznatu kao osteopenija, morali biste liječiti 270 žena tri godine kako biste spriječili jednu slomljenu kost. To je jako puno žena, kada se pomnože sa brojem žena kojima je dijagnosticirana osteopenija.
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?
I je li ikakvo čudo, gledajući trošak i sve nuspojave lijekova koje koristimo kako bi tretirali preduvjet za bolest, da svake godine trošimo više od dva bilijuna dolara na zdravstveno osiguranje, a ipak 100,000 ljudi godišnje – i to je blaga procjena – umire ne zbog stanja koje imaju već zbog liječenja koje im je pruženo i komplikacija nastalih tim liječenjem?
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
Sve kategoriziramo kao nešto što treba liječiti u ovoj državi. Žene u publici, imam poprilično loše vijesti koje već znate, a to je da je svaki dio vašeg života
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.
bio kategoriziran kao nešto što se treba liječiti. Počevši od vašeg puberteta. Sada imate nešto što se dogodi jednom mjesečno i kategorizirano je. To je stanje, treba se tretirati. Zatim, ako ste bile trudne. To je također kategorizirano. Tijekom trudnoće sve mora biti modernizirano jer u protivnom nešto može poći po zlu.
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.
Zatim ide menopauza. Svi znamo što se dogodilo kada su milijuni žena dobivali hormonske zamjene za simptome menopauze desetljećima sve dok odjednom nismo shvatili, zato što je napravljeno istraživanje, veliko istraživanje, koje je financirao Nacionalni institut za zdravlje. Otkriveno je da dosta tih terapija hormonskim zamjenama čini više štete nego dobra većini žena.
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.
Za svaki slučaj, ne izostavimo muškarce – na kraju, i ja sam jedan – imam lošu vijest za sve vas u sobi, i za sve koji slušaju i gledaju drugdje. Svi imate univerzalno smrtonosno stanje. Uzmite si trenutak. To se naziva pred-smrt. Svaki od vas ima to stanje zato što svi imate rizični faktor za njega, a to je da ste živi.
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.
Ali imam dobre vijesti za vas, zato što sam novinar i volim završiti stvari sretno ili na optimističan način. A dobra vijest je ta da ako možete preživjeti do kraja mog govora što ćemo vidjeti hoće li se dogoditi svima, svi ćete biti predživitelji.
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.
Izmislio sam pred-smrt. Ako sam koristio tuđu pred-smrt, ispričavam se, mislim da sam ju izmislio. Nisam izmislio predživitelje. Predživitelj je ime koje bi određene grupe zagovornika tumora voljele upotrijebiti za sve koji imaju rizični faktor, ali nemaju zapravo tumor. Vi ste predživitelj.
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.
Gledali smo HBO ovdje ujutro. Pitam se je li Mark Burnett negdje u publici jer bih htio predložiti reality show koji se zove “Predživitelji”. Ako se razvije bolest, odlazite s otoka.
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.
Problem je taj što imamo sustav koji se potpuno temelji na tome. Odabrali smo kao svaku točku ovog sustava raditi što radimo i svima dati preduvjet za bolest, a zatim i stanje u nekim slučajevima. Počnimo s odnosom liječnika i pacijenta. Liječnici, većina njih, u naplatnom su sustavu. Oni su zapravo potaknuti da čine više – zahvata, pretraga, propisivanja lijekova.
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.
Pacijenti dolaze k njima, oni žele nešto učiniti. Mi smo Amerikanci, ne možemo samo mirno stajati, moramo učiniti nešto. I zato žele lijekove. Žele liječenje. Žele da im se kaže: Ovo je to što imate i ovako se to liječi. Ako liječnik to ne učini, vi odlazite negdje drugdje. To nije dobro za liječnički posao. Ili još gore, ako ste na kraju dobili svoju dijagnozu, možete tužiti liječnika koji je propustio učiniti taj test.
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.
Imamo farmaceutske tvrtke koje neprestano žele proširiti pokazatelje, proširiti broj ljudi koji su prikladni za određenu terapiju, jer to očigledno pomaže zaradi. Imamo grupe zagovornika, poput one koja je izmislila predživiteljski status, koje žele učiniti da sve više i više ljudi osjeća kao da su ugroženi ili bolesni, kako bi mogli sakupiti više novca i povećati vidokrug, itd.
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.
Ali ovdje nije riječ o - bez obzira što novinari obično rade - okrivljavanju određenih igrača. Svi smo odgovorni. Ja sam odgovoran. Ja zapravo navijam za Yankeese. Dakle, govorim o navijanju za najgoreg mogućeg prekršitelja što se tiče svega što se može učiniti. Hvala vam. Ali svi su odgovorni.
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.
Pohađao sam medicinsku školu i nisam imao predmete koji su se zvali "Kako razmišljati skeptično" ili "Kako ne naručiti pretragu". Imamo sustav u kojem je to ono što radiš. I zapravo tek nakon što sam postao novinar shvatio sam sve te poticaje. Znate, ekonomisti vole reći da ne postoje loši ljudi, već samo loši poticaji.
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.
I to je zapravo istina. Ono što smo stvorili nekakvo je polje snova kada se radi o medicinskoj tehnologiji. Zato kada stavite još jedan MRI uređaj u svaki kut, stavljate robota u svaku bolnicu govoreći da svi moraju imati robotske operacije. Stvorili smo sustav gdje ako ga izgradiš, oni će doći. I zapravo možete izopačeno reći ljudima da dođu, uvjeriti ih da moraju doći.
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.
Nakon što sam postao novinar shvatio sam da sam ja dio ovog problema i kako smo svi dio ovog problema. Kategorizirao sam svaki rizični faktor, pisao sam priče, odobravao priče, svaki dan, koje su ne nužno pokušavale zabrinuti ljude, iako se to često događalo.
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.
Ali, znate, postoje načini za izlazak iz ove situacije. Posjetio sam svog internista prošli tjedan i rekao mi je: "Znate", i rekao mi je nešto što bi mi svi u publici mogli reći besplatno, ali ja sam platio za tu povlasticu, a to je da trebam smršaviti. I u pravu je. Istina je da imam visok krvni tlak već dvanaestak godina, ista dob u kojoj je i moj otac dobio visok tlak i to je prava bolest. Nije predhipertenzija, to je prava hipertenzija, visoki krvni tlak.
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."
Pa, u pravu je, ali nije mi rekao: "Znate, imate predpretilost ili imate preddijabetes ili nešto poput toga." Nije rekao da je bolje da počnem uzimati ovaj Statin, da trebam smanjiti kolesterol. Ne, rekao je: "Idi i izgubi na težini. Vrati se i posjeti me uskoro ili me samo nazovi i reci kako se osjećaš."
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.
I to je za mene plan za budućnost. Billy Beane je, usput, naučio isto to. Naučio je iz promatranja djeteta koje je zaposlio i koje je postalo uspješno, da nije dobro udarati prema ogradi, nije dobro udarati sve kao razbijač, što skupi timovi poput Yankeesa vole raditi – vole uzimati takve likove. Dijete mu je reklo: "Znate, morate promatrati dečke, morate izaći i pronaći dečke koji vole hodati zato što doći na bazu hodajući je isto tako dobro, a u našem zdravstvenom sustavu moramo otkriti je li to doista dobro bacanje ili ga trebamo propustiti i ne zamahnuti palicom na sve. Hvala.