Some of my most wonderful memories of childhood are of spending time with my grandmother, Mamar, in our four-family home in Brooklyn, New York. Her apartment was an oasis. It was a place where I could sneak a cup of coffee, which was really warm milk with just a touch of caffeine. She loved life. And although she worked in a factory, she saved her pennies and she traveled to Europe. And I remember poring over those pictures with her and then dancing with her to her favorite music.
Neke od mojih najlepših uspomena iz detinjstva vezane su za vreme provedeno sa mojom bakom Mamar, u našoj kući sa četiri stana u Bruklinu u Njujorku. Njen stan je bio oaza. Bilo je to mesto gde sam mogla da prošvercujem kafu, što je u stvari bilo toplo mleko sa mrvicom kofeina. Volela je život. Iako je radila u fabrici, prikupljala je sitninu i otputovala u Evropu. Sećam se kako sam razgledala te slike sa njom, a zatim smo igrale uz njenu omiljenu muziku.
And then, when I was eight and she was 60, something changed. She no longer worked or traveled. She no longer danced. There were no more coffee times. My mother missed work and took her to doctors who couldn't make a diagnosis. And my father, who worked at night, would spend every afternoon with her, just to make sure she ate.
Onda, kada sam imala 8 godina, a ona 60, nešto se promenilo. Više nije radila niti je putovala. Više nije plesala. Nije bilo više trenutaka uz kafu. Moja majka je izlazila sa posla i vodila je kod doktora koji nisu mogli da odrede dijagnozu. Moj otac, koji je radio noću, provodio bi svako popodne sa njom, samo da se pobrine da jede.
Her care became all-consuming for our family. And by the time a diagnosis was made, she was in a deep spiral.
Briga o njoj je potpuno obuzela našu porodicu. U trenutku kada je dijagnoza doneta, stanje joj se već dosta pogoršalo.
Now many of you will recognize her symptoms. My grandmother had depression. A deep, life-altering depression, from which she never recovered. And back then, so little was known about depression.
Mnogi među vama ćete prepoznati njene simptome. Moja baka je imala depresiju, duboku depresiju koja menja život, od koje se nikada nije oporavila. U to vreme se tako malo znalo o depresiji.
But even today, 50 years later, there's still so much more to learn. Today, we know that women are 70 percent more likely to experience depression over their lifetimes compared with men. And even with this high prevalence, women are misdiagnosed between 30 and 50 percent of the time.
Čak i danas, 50 godina kasnije, toliko toga još imamo da naučimo. Danas znamo da žene imaju 70 posto veće izglede da dožive depresiju tokom života u poređenju sa muškarcima. Čak i sa tom visokom rasprostranjenošću, žene dobijaju pogrešnu dijagnozu u 30 do 50 odsto slučajeva.
Now we know that women are more likely to experience the symptoms of fatigue, sleep disturbance, pain and anxiety compared with men. And these symptoms are often overlooked as symptoms of depression.
Sada znamo da žene imaju veće šanse da dožive simptome premora, poremećaja sna, bola i anksioznosti u poređenju sa muškarcima. Ovi simptomi se često ne prepoznaju kao simptomi depresije.
And it isn't only depression in which these sex differences occur, but they occur across so many diseases.
Ove polne razlike ne javljaju se samo kod depresije, već i kod mnogih drugih oboljenja.
So it's my grandmother's struggles that have really led me on a lifelong quest. And today, I lead a center in which the mission is to discover why these sex differences occur and to use that knowledge to improve the health of women.
Stoga me je borba moje bake podstakla na životnu potragu. Danas predvodim centar čija je misija da otkrije zašto se te polne razlike javljaju i da upotrebi to znanje da bi se poboljšalo zdravlje žena.
Today, we know that every cell has a sex. Now, that's a term coined by the Institute of Medicine. And what it means is that men and women are different down to the cellular and molecular levels. It means that we're different across all of our organs. From our brains to our hearts, our lungs, our joints.
Danas znamo da svaka ćelija ima pol. To je termin koji je skovao Institut za medicinu. To znači da su muškarci i žene različiti sve do ćelijskih i molekularnih nivoa. To znači da se svi naši organi razlikuju, od mozga do srca, pluća i zglobova.
Now, it was only 20 years ago that we hardly had any data on women's health beyond our reproductive functions. But then in 1993, the NIH Revitalization Act was signed into law. And what this law did was it mandated that women and minorities be included in clinical trials that were funded by the National Institutes of Health. And in many ways, the law has worked. Women are now routinely included in clinical studies, and we've learned that there are major differences in the ways that women and men experience disease. But remarkably, what we have learned about these differences is often overlooked.
Pre svega 20 godina, jedva da smo imali bilo kakve podatke o zdravlju žena osim reproduktivnih funkcija. Međutim, 1993. godine, stupio je na snagu Akt o revitalizaciji Nacionalnih instituta za zdravlje. Ovaj zakon je nalagao da žene i manjine budu uključeni u kliničkim ispitivanjima koje su finansirali Nacionalni instituti za zdravlje. U mnogo čemu, zakon je delovao. Žene su sada redovno obuhvaćene u kliničkim istraživanjima i saznali smo da postoje velike razlike u tome kako žene i muškarci doživljavaju bolesti. Ipak, što je neobično, saznali smo da se ove razlike često previde.
So, we have to ask ourselves the question: Why leave women's health to chance? And we're leaving it to chance in two ways. The first is that there is so much more to learn and we're not making the investment in fully understanding the extent of these sex differences. And the second is that we aren't taking what we have learned, and routinely applying it in clinical care. We are just not doing enough.
Dakle, moramo postaviti sebi pitanje zašto prepustiti zdravlje žena slučaju, a prepuštamo ga slučaju na dva načina. Prvi je da ima još toliko toga što treba saznati, a ne ulažemo u potpuno razumevanje opsega ovih polnih razlika. Drugi je da ne usvajamo ono što smo saznali i to ne primenjujemo redovno u kliničkoj nezi. Jednostavno ne činimo dovoljno.
So, I'm going to share with you three examples of where sex differences have impacted the health of women, and where we need to do more.
Podeliću sa vama tri primera gde su polne razlike uticale na zdravlje žena i gde je potrebno da učinimo više.
Let's start with heart disease. It's the number one killer of women in the United States today. This is the face of heart disease. Linda is a middle-aged woman, who had a stent placed in one of the arteries going to her heart. When she had recurring symptoms she went back to her doctor. Her doctor did the gold standard test: a cardiac catheterization. It showed no blockages. Linda's symptoms continued. She had to stop working. And that's when she found us. When Linda came to us, we did another cardiac catheterization and this time, we found clues. But we needed another test to make the diagnosis. So we did a test called an intracoronary ultrasound, where you use soundwaves to look at the artery from the inside out.
Počnimo sa bolestima srca. To je ubica žena broj jedan u Sjedinjenim Državama danas. Ovo je lice srčane bolesti. Linda je žena srednjih godina koja je imala stent u jednoj od arterija koje idu ka srcu. Kad je dobila simptome koji se ponavljaju, otišla je ponovo kod doktora. Njen doktor je obavio test „zlatni standard“, kateterizaciju srca. Pokazalo se da nema začepljenja. Lindini simptomi su se nastavili. Morala je da prestane da radi. Tada je pronašla nas. Kada je Linda došla kod nas, sproveli smo još jednu kateterizaciju srca i ovoga puta smo našli naznake. Međutim, bio nam je potreban još jedan test da bismo došli do dijagnoze. Stoga smo obavili test zvani intravaskularni ultrazvuk, gde se koriste zvučni talasi da bi se arterija pregledala iznutra.
And what we found was that Linda's disease didn't look like the typical male disease. The typical male disease looks like this. There's a discrete blockage or stenosis. Linda's disease, like the disease of so many women, looks like this. The plaque is laid down more evenly, more diffusely along the artery, and it's harder to see. So for Linda, and for so many women, the gold standard test wasn't gold.
Otkrili smo da Lindino oboljenje nije izgledalo kao tipično muško oboljenje. Tipično muško oboljenje izgleda ovako. Postoji izdvojena zapušenost ili stenoza. Lindino oboljenje, kao i oboljenje kod mnogo žena, izgleda ovako. Plak oblaže ravnomernije, difuznije duž arterije i teže ga je uočiti. Zato za Lindu, kao i za mnogo žena, test „zlatni standard“ nije zlatan.
Now, Linda received the right treatment. She went back to her life and, fortunately, today she is doing well. But Linda was lucky. She found us, we found her disease.
Linda je dobila odgovarajuće lečenje. Vratila se svom životu i, srećom, danas joj je dobro. Međutim, Linda je imala sreće. Pronašla je nas, mi smo pronašli njeno oboljenje.
But for too many women, that's not the case. We have the tools. We have the technology to make the diagnosis. But it's all too often that these sex diffferences are overlooked.
To nije slučaj kod isuviše mnogo žena. Imamo sredstva. Imamo tehnologiju za donošenje dijagnoze. Ipak, te polne razlike se prečesto previđaju.
So what about treatment? A landmark study that was published two years ago asked the very important question: What are the most effective treatments for heart disease in women? The authors looked at papers written over a 10-year period, and hundreds had to be thrown out. And what they found out was that of those that were tossed out, 65 percent were excluded because even though women were included in the studies, the analysis didn't differentiate between women and men. What a lost opportunity. The money had been spent and we didn't learn how women fared. And these studies could not contribute one iota to the very, very important question, what are the most effective treatments for heart disease in women?
Šta je sa lečenjem? Značajna studija objavljena pre dve godine postavila je veoma važno pitanje: koji su najdelotvorniji tretmani bolesti srca kod žena? Autori su pregledali papire ispisane tokom perioda od 10 godina i stotine je moralo da bude bačeno. Otkrili su da je, od onih koji su odbačeni, 65 posto izostavljeno jer, iako su žene obuhvaćene studijom, analiza nije pravila razliku između žena i muškaraca. Kakva propuštena prilika. Novac je potrošen, a nismo saznali šta se desilo sa ženama. Ove studije nisu ni mrvicu doprinele vrlo, vrlo važnom pitanju - koji su najdelotvorniji tretmani za bolesti srca kod žena?
I want to introduce you to Hortense, my godmother, Hung Wei, a relative of a colleague, and somebody you may recognize -- Dana, Christopher Reeve's wife. All three women have something very important in common. All three were diagnosed with lung cancer, the number one cancer killer of women in the United States today. All three were nonsmokers. Sadly, Dana and Hung Wei died of their disease. Today, what we know is that women who are nonsmokers are three times more likely to be diagnosed with lung cancer than are men who are nonsmokers. Now interestingly, when women are diagnosed with lung cancer, their survival tends to be better than that of men. Now, here are some clues. Our investigators have found that there are certain genes in the lung tumor cells of both women and men. And these genes are activated mainly by estrogen. And when these genes are over-expressed, it's associated with improved survival only in young women. Now this is a very early finding and we don't yet know whether it has relevance to clinical care. But it's findings like this that may provide hope and may provide an opportunity to save lives of both women and men.
Želim da vam predstavim Hortens, moju kumu, Hung Vej, rođaku jednog kolege, i nekog koga možda prepoznajete, Dejnu, ženu Kristofera Riva. Ove tri žene imaju nešto zajedničko što je veoma važno. Sve tri su dobile dijagnozu raka pluća, ubice žena broj jedan među vrstama raka u Sjedinjenim Državama danas. Sve tri su bile nepušači. Nažalost, Dejna i Hung Vej su preminule zbog svoje bolesti. Danas znamo da žene nepušači imaju tri puta veću šansu da dobiju dijagnozu raka pluća nego muškarci koji su nepušači. Zanimljivo je da, kada je ženama dijagnostikovan rak pluća, njihovo preživljavanje obično bude bolje nego kod muškaraca. Evo nekih nagoveštaja. Naši istraživači su otkrili da postoje izvesni geni u ćelijama tumora na plućima kod žena i kod muškaraca. Te gene aktivira uglavnom estrogen. Kada su ti geni previše izraženi, to je u vezi sa poboljšanim preživljavanjem samo kod mladih žena. Ovo je skorašnji nalaz i još ne znamo da li je od značaja za kliničku negu. Ipak, nalazi poput ovoga mogu pružiti nadu i mogućnost za spasavanje života i žena i muškaraca.
Now, let me share with you an example of when we do consider sex differences, it can drive the science. Several years ago a new lung cancer drug was being evaluated, and when the authors looked at whose tumors shrank, they found that 82 percent were women. This led them to ask the question: Well, why? And what they found was that the genetic mutations that the drug targeted were far more common in women. And what this has led to is a more personalized approach to the treatment of lung cancer that also includes sex.
Dopustite da podelim sa vama jedan primer kako, kada uzmemo u obzir polne razlike, to može da pokrene nauku. Pre nekoliko godina, novi lek protiv raka pluća prolazio je kroz evaluaciju, a kada su autori razmotrili čiji su se tumori smanjili, otkrili su da su 82 procenta činile žene. To ih je navelo da se zapitaju zašto je to tako. Otkrili su da je genetska mutacija na koju je gen usmeren daleko češća kod žena. Ovo je dovelo do personalizovanijeg pristupa u lečenju raka pluća koje podrazumeva i pol.
This is what we can accomplish when we don't leave women's health to chance. We know that when you invest in research, you get results. Take a look at the death rate from breast cancer over time. And now take a look at the death rates from lung cancer in women over time. Now let's look at the dollars invested in breast cancer -- these are the dollars invested per death -- and the dollars invested in lung cancer. Now, it's clear that our investment in breast cancer has produced results. They may not be fast enough, but it has produced results. We can do the same for lung cancer and for every other disease.
To je ono što možemo postići kada ne prepustimo zdravlje žena slučaju. Znamo da, kada uložite u istraživanje, dobijate rezultate. Pogledajte stopu smrtnosti od raka dojke tokom vremena. Sada pogledajte stopu smrtnosti od raka pluća kod žena tokom vremena. Hajde da sada pogledamo iznos u dolarima koji je uložen u rak dojke - to su dolari uloženi po smrti - i dolare uložene u rak pluća. Jasno je da je naše ulaganje u rak dojke proizvelo rezultate. Možda nisu dovoljno brzi, ali je dovelo do rezultata. Možemo isto postići kod raka pluća i svake druge bolesti.
So let's go back to depression. Depression is the number one cause of disability in women in the world today. Our investigators have found that there are differences in the brains of women and men in the areas that are connected with mood. And when you put men and women in a functional MRI scanner -- that's the kind of scanner that shows how the brain is functioning when it's activated -- so you put them in the scanner and you expose them to stress. You can actually see the difference. And it's findings like this that we believe hold some of the clues for why we see these very significant sex differences in depression.
Vratimo se na depresiju. Depresija je uzrok broj jedan za invaliditet žena u svetu danas. Naši istraživači su otkrili da postoje razlike u mozgu žena i muškaraca u oblastima koje su povezane sa raspoloženjem. Kada stavite muškarce i žene pod skener funkcionalne MRT - to je vrsta skenera koja pokazuje kako mozak funkcioniše kada se aktivira - dakle, stavite ih u skener i izložite ih stresu. Možete zaista videti razliku. Smatramo da nalazi kao što je ovaj daju neke nagoveštaje o tome zašto vidimo vrlo značajne polne razlike kod depresije.
But even though we know that these differences occur, 66 percent of the brain research that begins in animals is done in either male animals or animals in whom the sex is not identified.
Međutim, iako znamo da se ove razlike javljaju, 66 posto istraživanja mozga koja započinju na životinjama sprovodi se ili na mužjacima ili na životinjama čiji pol nije ustanovljen.
So, I think we have to ask again the question: Why leave women's health to chance? And this is a question that haunts those of us in science and medicine who believe that we are on the verge of being able to dramatically improve the health of women. We know that every cell has a sex. We know that these differences are often overlooked. And therefore we know that women are not getting the full benefit of modern science and medicine today. We have the tools but we lack the collective will and momentum.
Dakle, mislim da ponovo treba da postavimo pitanje zašto da prepuštamo zdravlje žena slučaju. To je pitanje koje proganja nas u oblasti nauke i medicine koji smatramo da smo nadomak mogućnosti da drastično poboljšamo zdravlje žena. Znamo da svaka ćelija ima pol. Znamo da se te razlike često previđaju. Prema tome, znamo da žene danas ne koriste u potpunosti savremenu nauku i medicinu. Imamo sredstva, ali nam nedostaje kolektivne volje i poleta.
Women's health is an equal rights issue as important as equal pay. And it's an issue of the quality and the integrity of science and medicine. (Applause) So imagine the momentum we could achieve in advancing the health of women if we considered whether these sex differences were present at the very beginning of designing research. Or if we analyzed our data by sex.
Žensko zdravlje je problem jednakih prava podjednako važan kao i jednaka zarada. To je pitanje kvaliteta i integriteta nauke i medicine. (Aplauz) Zamislite zamah koji bismo postigli u unapređivanju zdravlja žena ako bismo uzeli u obzir da li postoje ove polne razlike na samom početku osmišljavanja istraživanja, ili kada bismo analizirali podatke prema polu.
So, people often ask me: What can I do? And here's what I suggest: First, I suggest that you think about women's health in the same way that you think and care about other causes that are important to you. And second, and equally as important, that as a woman, you have to ask your doctor and the doctors who are caring for those who you love: Is this disease or treatment different in women? Now, this is a profound question because the answer is likely yes, but your doctor may not know the answer, at least not yet. But if you ask the question, your doctor will very likely go looking for the answer. And this is so important, not only for ourselves, but for all of those whom we love. Whether it be a mother, a daughter, a sister, a friend or a grandmother.
Ljudi me često pitaju: „Šta mogu da učinim?“ Evo šta predlažem. Najpre, predlažem da razmišljate o zdravlju žena na isti način na koji razmišljate i brinete o drugim ciljevima koji su vam važni. Drugo, jednako važno, jeste da kao žena morate pitati svog doktora i doktore koji brinu o onima koje volite: „Da li su ova bolest ili njeno lečenje drugačiji kod žena?“ Ovo je obuhvatno pitanje jer je odgovor verovatno potvrdan, ali vaš doktor možda još ne zna odgovor, bar ne za sada. Ipak, ako postavite pitanje, vaš doktor će verovatno potražiti odgovor. Ovo je toliko važno, ne samo za nas same, već i za sve one koje volimo, bilo da je to majka, ćerka, sestra,
It was my grandmother's suffering that inspired my work to improve the health of women. That's her legacy. Our legacy can be to improve the health of women for this generation and for generations to come.
prijatelj ili baka. Patnja moje bake je inspirisala moj rad na poboljšanju zdravlja žena. To je njeno zaveštanje. Naše zaveštanje može biti da poboljšamo zdravlje žena ove generacije
Thank you.
i budućih generacija.
(Applause)
Hvala. (Aplauz)