I'll never forget that day back in the spring of 2006. I was a surgical resident at The Johns Hopkins Hospital, taking emergency call. I got paged by the E.R. around 2 in the morning to come and see a woman with a diabetic ulcer on her foot. I can still remember sort of that smell of rotting flesh as I pulled the curtain back to see her. And everybody there agreed this woman was very sick and she needed to be in the hospital. That wasn't being asked. The question that was being asked of me was a different one, which was, did she also need an amputation?
Nuk do ta harroj kurrë atë ditë të pranverës së 2006-ës. Isha kirurg rezident në Spitalin Johns Hopkins në pranim të thirrjeve te urgjences. Rreth orës 2 të mëngjesit u njoftova nga E.R që të shkoj të shoh një grua me ulcerë diabetike në këmbën e saj. Ende e kujtoj atë lloj ere të gjakut të kalbur, tek po e tërhiqja perden që ta shoh atë. Të gjithë aty mendonim që ajo grua ishte shumë sëmurë dhe kishte nevojë të shtrohej në spital. Kjo nuk vihej në diskutim. Pyetja qe shtroja ishte një tjetër, a kishte ajo nevojë për amputim?
Now, looking back on that night, I'd love so desperately to believe that I treated that woman on that night with the same empathy and compassion I'd shown the 27-year-old newlywed who came to the E.R. three nights earlier with lower back pain that turned out to be advanced pancreatic cancer. In her case, I knew there was nothing I could do that was actually going to save her life. The cancer was too advanced. But I was committed to making sure that I could do anything possible to make her stay more comfortable. I brought her a warm blanket and a cup of a coffee. I brought some for her parents. But more importantly, see, I passed no judgment on her, because obviously she had done nothing to bring this on herself. So why was it that, just a few nights later, as I stood in that same E.R. and determined that my diabetic patient did indeed need an amputation, why did I hold her in such bitter contempt?
Tani, duke kthyer koken pas ne atë natë do të doja dëshperimisht të besoja se e trajtova atë grua, atë natë, me empatinë dhe dhembshurinë e njëjtë që tregova ndaj 27 vjeçares së sapo martuar e cila erdhi në E.R tri ditë perpara me dhimbje mesi e cila doli të jetë kancer pankreatik i avancuar. Në rastin e saj, unë e dija se s'kishte asgjë që mund të bëja që do ti shpëtonte jetën. Kanceri ishte shumë i avancuar. Por isha i përkushtuar të sigurohesha që do bëja gjithçka të mundshme për ta bërë atë të ndihet më rehat. I solla një batanije të ngrohte dhe një filxhan kafe. Solla edhe për prindërit e saj. Por shikoni, më e rëndësishmja eshte qe unë nuk e paragjykova atë, sepse dukej qartë qe ajo s'kishte bërë gjë qe mund t'ia shkaktonte këtë vetes se saj. Atehere, si eshte e mundur qe disa nete me pas, tek qendroja ne te njejten dhome te urgjences dhe i vendosur qe pacientja ime diabetike kish nevoje per amputim, perse ja thashe kete ne nje menyre kaq te hidhur?
You see, unlike the woman the night before, this woman had type 2 diabetes. She was fat. And we all know that's from eating too much and not exercising enough, right? I mean, how hard can it be? As I looked down at her in the bed, I thought to myself, if you just tried caring even a little bit, you wouldn't be in this situation at this moment with some doctor you've never met about to amputate your foot.
Dallimi eshte qe ne ndryshim me gruan e nje nate me pare, kjo grua vuante nga diabeti i tipit 2. Ajo ishte e shendoshe. Dhe te gjithe e dime qe kjo vjen si rezultat i te ngrenit shume dhe mungeses se aktivitetit fizik, apo jo? Dua te them, sa e veshtire mund te jete? Teksa e shihja te shtrire mendoja me vete, sikur shume pak te te interesonte, nuk do te ishe ne kete gjendje tani me nje mjek qe nuk e kishe pare kurre me pare duke u pergatitur per te te prere kemben.
Why did I feel justified in judging her? I'd like to say I don't know. But I actually do. You see, in the hubris of my youth, I thought I had her all figured out. She ate too much. She got unlucky. She got diabetes. Case closed.
Perse u ndjeva i justifikuar qe gjykoja ndaj saj? Do desha te thoja qe nuk e di. Por ja qe nuk eshte e vertete. Me kryelartesine e rinise sime, mendova se e kisha psikologjisur ate. Ajo ka ngrene shume. Ajo ka qene pa fat. U semur me diabet. Kaq qe puna.
Ironically, at that time in my life, I was also doing cancer research, immune-based therapies for melanoma, to be specific, and in that world I was actually taught to question everything, to challenge all assumptions and hold them to the highest possible scientific standards. Yet when it came to a disease like diabetes that kills Americans eight times more frequently than melanoma, I never once questioned the conventional wisdom. I actually just assumed the pathologic sequence of events was settled science.
Cuditerisht, ne ate kohe, po hulumtoja rreth kancerit, terapite e sistemit imunitar per kancer te lekures, per te qene me ekzakt, nga kisha mesuar se duhej te kisha dyshime per gjithcka, te mos merrja te mireqene gje dhe ti masja me standardet me te larta shkencore. Nderkohe, kur vjen fjala tek diabeti i cili vret 8 here me shume amerikane se melanoma, nuk e vura kurre ne prove dijen e deri atehershme. Pranova te mireqene, cdo hallke te zinxhirit te shkaqeve patologjike qe te conte ne te.
Three years later, I found out how wrong I was. But this time, I was the patient. Despite exercising three or four hours every single day, and following the food pyramid to the letter, I'd gained a lot of weight and developed something called metabolic syndrome. Some of you may have heard of this. I had become insulin-resistant.
Tre vite me pas, zbulova se isha shume gabim. Por kete here, isha pacienti. Edhe pse beja ushtrime fizike 3-4 ore ne dite, dhe zbatimin i piramides ushqimore me perpikmeri, kisha shtuar shume ne peshe dhe kisha zhvilluar dicka te ashtuquajtur sindroma e metabolizmit. Disa nga ju mund edhe te kene degjuar per te. Isha bere imun ndaj insulines.
You can think of insulin as this master hormone that controls what our body does with the foods we eat, whether we burn it or store it. This is called fuel partitioning in the lingo. Now failure to produce enough insulin is incompatible with life. And insulin resistance, as its name suggests, is when your cells get increasingly resistant to the effect of insulin trying to do its job. Once you're insulin-resistant, you're on your way to getting diabetes, which is what happens when your pancreas can't keep up with the resistance and make enough insulin. Now your blood sugar levels start to rise, and an entire cascade of pathologic events sort of spirals out of control that can lead to heart disease, cancer, even Alzheimer's disease, and amputations, just like that woman a few years earlier.
Mund ta mendoni insulinen si ky hormon i gjithepushtetshem qe kontrollon se cfare ben trupi yne me ushqimet qe hame, nese i ruajme ose i djegim. Ne gjuhen mjekesore kjo quhet "ndarje e energjise". Mos prodhimi i mjaftueshem i insulines nuk pajtohet me jeten. Dhe rezistence ndaj insulines, sikunder sugjeron dhe emri, ndodh atehere kur qelizat behen gjithnje e me rezistente nga efektet e insulines qe perpiqet te beje punen e saj. Kur behesh rezistent ndaj insulines, kthehesh ne diabetik, c'ka ndodh kur pankreasi nuk mund te perballoje rezistencen dhe te prodhoje mjaftueshem insuline. FIllon ngritja e sasise se sheqerit ne gjak, dhe nje ujvare problemesh patologjike dalin jashte kontrolli, c'ka mund te cojne ne probleme me zemren, kancer, ose edhe Alzaimer, dhe amputim, pikerisht si ajo grua disa vite me pare.
With that scare, I got busy changing my diet radically, adding and subtracting things most of you would find almost assuredly shocking. I did this and lost 40 pounds, weirdly while exercising less. I, as you can see, I guess I'm not overweight anymore. More importantly, I don't have insulin resistance.
Me kete problem, nisa te ndryshoj dieten time ne menyre drastike, duke hequr e shtuar gjera qe ju do ti gjenit padyshim shokuese. Bera keshtu dhe humba 20 kg, ndonese beja me pak ushtrime fizike. Sikunder mund te shihni, nuk jam me mbipeshe. Cka eshte me e rendesishme eshte qe nuk kam me rezistence ndaj insulines.
But most important, I was left with these three burning questions that wouldn't go away: How did this happen to me if I was supposedly doing everything right? If the conventional wisdom about nutrition had failed me, was it possible it was failing someone else? And underlying these questions, I became almost maniacally obsessed in trying to understand the real relationship between obesity and insulin resistance.
Por edhe me e rendesishme, jane keto tre pyetjet qe me kane mbetur dhe te cilat nuk duan te me hiqen: Si me ngjau kjo gje kur une mendohej se po beja gjithcka si duhej? Nese shkenca rreth te ushqyerit te shendetshem ka qene e rreme, a thua e tille ishte dhe per te tjere? Dhe ne analizimin e ketyre pyetjeve u bera pothuajse i fiksuar ne te perpjekurit per te kuptuar lidhjen e vertete midis obezitetit dhe rezistences se insulines.
Now, most researchers believe obesity is the cause of insulin resistance. Logically, then, if you want to treat insulin resistance, you get people to lose weight, right? You treat the obesity. But what if we have it backwards? What if obesity isn't the cause of insulin resistance at all? In fact, what if it's a symptom of a much deeper problem, the tip of a proverbial iceberg? I know it sounds crazy because we're obviously in the midst of an obesity epidemic, but hear me out. What if obesity is a coping mechanism for a far more sinister problem going on underneath the cell? I'm not suggesting that obesity is benign, but what I am suggesting is it may be the lesser of two metabolic evils.
Tanime, shume hulumtues besojne se obeziteti eshte si rrjedhoje e resistences ndaj insulines. Logjikisht, kur do te trajtosh rezistencen ndaj insulines, i detyron njerezit te bien ne peshe, apo jo? Trajton obezitetin. Po sikur te jete pikerisht e kunderta? Po sikur obeziteti te mos jete shkaku i rezistences ndaj insulines? Ne fakt, po sikur te jete sintoma e nje problemi shume me te madh, maja e nje ajsbergu? E di qe tingellon pak e cuditshme, pasi jemi ne mesin e nje epidemie obeziteti, por me degjoni pak. Po sikur obeziteti te jete nje kamuflazh i nje problemi shume me te rende qe i ka rrenjet ne qelize? Nuk jam duke sugjeruar ketu qe obeziteti eshte beninj, por ate qe po sugjeroj eshte qe mund te jete e keqja me e vogel e dy te keqijave te metabolizmit.
You can think of insulin resistance as the reduced capacity of our cells to partition fuel, as I alluded to a moment ago, taking those calories that we take in and burning some appropriately and storing some appropriately. When we become insulin-resistant, the homeostasis in that balance deviates from this state. So now, when insulin says to a cell, I want you to burn more energy than the cell considers safe, the cell, in effect, says, "No thanks, I'd actually rather store this energy." And because fat cells are actually missing most of the complex cellular machinery found in other cells, it's probably the safest place to store it. So for many of us, about 75 million Americans, the appropriate response to insulin resistance may actually be to store it as fat, not the reverse, getting insulin resistance in response to getting fat.
Mund ta mendoni rezistencen ndaj insulines si aftesia e limituar e vetes per te shperndare karburantin, sikunder iu referova para nje minute, te marresh kalorite qe sigurojme me ushqimin dhe ne menyre proporcionale te djegim nje pjese e te ruajme tjetren. Kur behemi rezistent ndaj insulines, homeostaza ne kete lloj ballancimi prishet. Pra tanime, kur insulina i thote qelizes, dua te djegesh me shume energji sesa qeliza e konsideron te sigurt, ne te vertete ajo pergjigjet, "Jo faleminderit, do ta ruaj kete energji." Dhe duke qene se ne qelizat e dhjamit nuk i gjen ato makineri komplekse qelizore qe gjendet ne qeliza te tjera, eshte vendi me i mire per ti ruajtur. Shume prej nesh, rreth 75 milion Amerikane, pergjigja e rezistences ndaj insulines mund te jete qe ta ruaj ne formen e dhjamit e jo e kunderta, te kesh rezistence insuline ne pergjigje te dhjamosjes.
This is a really subtle distinction, but the implication could be profound. Consider the following analogy: Think of the bruise you get on your shin when you inadvertently bang your leg into the coffee table. Sure, the bruise hurts like hell, and you almost certainly don't like the discolored look, but we all know the bruise per Se is not the problem. In fact, it's the opposite. It's a healthy response to the trauma, all of those immune cells rushing to the site of the injury to salvage cellular debris and prevent the spread of infection to elsewhere in the body. Now, imagine we thought bruises were the problem, and we evolved a giant medical establishment and a culture around treating bruises: masking creams, painkillers, you name it, all the while ignoring the fact that people are still banging their shins into coffee tables. How much better would we be if we treated the cause -- telling people to pay attention when they walk through the living room -- rather than the effect? Getting the cause and the effect right makes all the difference in the world. Getting it wrong, and the pharmaceutical industry can still do very well for its shareholders but nothing improves for the people with bruised shins. Cause and effect.
Kjo eshte ne te vertete nje ndryshim i vogel, por me pasoja te renda. Konsideroni analogjine e meposhtme: Mendoni per gerricjet qe pesoni ne lekure kur ne menyre rastesore perplasni gjurin ne tavolinen e kafes. Padyshim qe plaga dhemb shume dhe ju nuk e pelqeni faktin qe eshte nxire, por te gjithe e dime qe plaga ne vetvete nuk eshte problemi. Ne fakt, eshte e kunderta, eshte nje pergjigje e shendetshme ndaj nje traume, jane qelizat imunitare qe vrapojne aty ku ndodhi demtimi qe te ndihmojne qelizat e atyshme dhe te ndalojne perhapjen e infeksionit ne pjese te tjera te trupit. Tani, imagjinoni sikur ne te mendonim se plaga eshte faktikisht problemi, dhe zhvillojme cdo kerkim dhe kulture mjeksore rreth trajtimit te plageve: krem maskimi, ilace kunder dhimbjes, e shume te tjere, duke injoruar teresisht faktin qe njerezit jane ende duke perplasur kercirin ne tavolina kafeje. Sa me mire do te ish po te trajtonim shkaqet-- duke i thene njerezve te jene me te kujdesshem teksa ecin neper sallon-- ne vend te efektit qe krijohet? Te kuptosh shkakun dhe efektin, ben te gjithe diferencen e mundshme. Ta kesh gabim, industria farmaceutike mund te vazhdoje te jete fitimprurese per investuestit e saj por per njerezit me kerci te vrare nuk permiresohet asgje. Shkaku dhe efekti.
So what I'm suggesting is maybe we have the cause and effect wrong on obesity and insulin resistance. Maybe we should be asking ourselves, is it possible that insulin resistance causes weight gain and the diseases associated with obesity, at least in most people? What if being obese is just a metabolic response to something much more threatening, an underlying epidemic, the one we ought to be worried about?
Ajo c'ka jam duke sugjeruar eshte se ndoshta kemi shkakun dhe efektin e gabuar kur falsim per obezitet dhe rezistence ndaj insulines. Ndoshta duhet ta pyesim veten, a eshte e mundur qe rezistenca ndaj insulines shkakon rritje ne peshe dhe semundje qe lidhen me obezitetin, te pakten ne shumicen e njerezve? Po sikur te qenit obez eshte thjesht nje pergjigje e metabolizmit ndaj dickaje shume me teper kercenuese, nje epidemi e fshehur, ajo per cka duhet te shqetesohemi me shume?
Let's look at some suggestive facts. We know that 30 million obese Americans in the United States don't have insulin resistance. And by the way, they don't appear to be at any greater risk of disease than lean people. Conversely, we know that six million lean people in the United States are insulin-resistant, and by the way, they appear to be at even greater risk for those metabolic diseases I mentioned a moment ago than their obese counterparts. Now I don't know why, but it might be because, in their case, their cells haven't actually figured out the right thing to do with that excess energy. So if you can be obese and not have insulin resistance, and you can be lean and have it, this suggests that obesity may just be a proxy for what's going on.
Le ti hedhim nje sy fakteve. E dime qe 30 milion amerikane obeze ne USA nuk vuajne nga rezistenca e insulines. Dhe meqenese ra fjala, ato nuk duket te jene ne ndonje rrezik me te madh per semundje se njerezit e dobet. Nderkohe, dime qe 6 milione njerez te dobet ne USA jane rezistent ndaj insulines, dhe meqenese ra fjala, ata mendohet te jene ne rrezik me te madh per ato semundje metabolike qe permenda me siper, ne dallim nga grupi i obezeve. Une nuk e di pse, por ndoshta kjo vjen si rezultat i faktit qe ne rastin e tyre, qelizat nuk e kane kuptuar ende se c'duhet te bejne me tepricen e energjise. Pra nqse nje njeri mund te jete obez dhe mund te mos kete rezistence ndaj insulines, ose mund te jete i dobet e ta kete, kjo tregon se obeziteti mund te jete nje kamuflazh per ate qe po ndodh.
So what if we're fighting the wrong war, fighting obesity rather than insulin resistance? Even worse, what if blaming the obese means we're blaming the victims? What if some of our fundamental ideas about obesity are just wrong?
Pra, po sikur te jemi duke luftuar nje lufte te gabuar, te luftojme obezitetin ne vend te rezistences ndaj insulines? Edhe me keq, po sikur fajesimi i obezeve do te thote qe po fajesojme viktimat? Po sikur disa nga idete tona thelbesore mbi obezitetin jane gabim?
Personally, I can't afford the luxury of arrogance anymore, let alone the luxury of certainty. I have my own ideas about what could be at the heart of this, but I'm wide open to others. Now, my hypothesis, because everybody always asks me, is this. If you ask yourself, what's a cell trying to protect itself from when it becomes insulin resistant, the answer probably isn't too much food. It's more likely too much glucose: blood sugar. Now, we know that refined grains and starches elevate your blood sugar in the short run, and there's even reason to believe that sugar may lead to insulin resistance directly. So if you put these physiological processes to work, I'd hypothesize that it might be our increased intake of refined grains, sugars and starches that's driving this epidemic of obesity and diabetes, but through insulin resistance, you see, and not necessarily through just overeating and under-exercising.
Personalisht, nuk mund ta kem me luksin e arrogances mos flasim pastaj per luksin e sigurise se plote. Kam idete e mia te asaj c'ka mund te jete problemi, por jam e hapur per sugjerime. Hipoteza ime, sepse te gjithe me pyesin, eshte kjo. Nese e pyesni veten, se nga se perpiqet te mbrohet qeliza kur behet rezistente ndaj insulines, pergjigja ndoshta nuk eshte, teprice ushqimore. Por me gjasa, teprice glukoze: sheqeri ne gjak. E dime qe dritherat e perpunuara e ngrene nivelin e sheqerit ne gjak ne nje kohe afatshkurter, dhe ka edhe arsye per te besuar se sheqeri mund te coje direkt ne rezistence ndaj insulines. Nqse keto procese psikologjike vihen ne pune, hedh hipotezen qe mund te jete shkaku i marrjes se drithrave te perpunuara, sheqerit ne mase, ajo cka sjell epidemine e obezitetit dhe diabetit, por nepermjet rezistences ndaj insulines, dhe jo si efekt i mbingopjes ose mos berjes ushtrime fizike.
When I lost my 40 pounds a few years ago, I did it simply by restricting those things, which admittedly suggests I have a bias based on my personal experience. But that doesn't mean my bias is wrong, and most important, all of this can be tested scientifically. But step one is accepting the possibility that our current beliefs about obesity, diabetes and insulin resistance could be wrong and therefore must be tested. I'm betting my career on this. Today, I devote all of my time to working on this problem, and I'll go wherever the science takes me. I've decided that what I can't and won't do anymore is pretend I have the answers when I don't. I've been humbled enough by all I don't know.
Kur humba 20 kg disa vite me pare, e bera thjesht duke kufizuar keto gjera, cka sugjeron qe kam nje anesi bazuar ne eksperiencen time personale. Por kjo nuk do te thote qe anesia ime eshte e gabuar, dhe me e rendesishmja, te gjitha keto mund te provohen shkencerisht. Por, shkalla e pare eshte te pranosh mundesine se besimi yne rreth obezitetit, diabetit dhe rezistences ndaj insulines mund te jene te gabuara dhe si rrjedhoje duhen testuar. Ve bast karrieren time ne kete gje. Sot, ja dedikoj te gjithe kohen time punes mbi kete problem, dhe do te shkoj kudo te me coje shkenca. Kam vendosur qe ajo c'ka nuk mundem dhe nuk do te bej me eshte te pretendoj qe i kam pergjigjet kur nuk i kam ato. Kam qene i perulur per gjithcka nuk njoh
For the past year, I've been fortunate enough to work on this problem with the most amazing team of diabetes and obesity researchers in the country, and the best part is, just like Abraham Lincoln surrounded himself with a team of rivals, we've done the same thing. We've recruited a team of scientific rivals, the best and brightest who all have different hypotheses for what's at the heart of this epidemic. Some think it's too many calories consumed. Others think it's too much dietary fat. Others think it's too many refined grains and starches. But this team of multi-disciplinary, highly skeptical and exceedingly talented researchers do agree on two things. First, this problem is just simply too important to continue ignoring because we think we know the answer. And two, if we're willing to be wrong, if we're willing to challenge the conventional wisdom with the best experiments science can offer, we can solve this problem.
Vitin e fundit, kam qene mjaf me fat qe kam punuar mbi kete problem me nje grup te mrekullueshem hulumtuesish te obezitetit dhe diabetit ne vend, dhe pjesa me e bukur eshte qe, sikunderse Abraham Lincoln e rrethoi veten me nje grup pune rivalesh, dhe ne kemi bere te njejten gje. Kemi rekrutuar nje grup pune me shkencetare rival, me te miret dhe me te ndriturit por qe te gjithe kane hipotezat e veta rreth asaj cka mund te jete ne zemer te epidemise. Disa mendojne qe eshte sasia e madhe e kalorive te konsumuara. Te tjere mendojne se eshte konsumi i madh i nje diete te yndyrshme. Per te tjere problemi qendron te konsumi i drithrave dhe niseshtese. Por ky grup pune i hulumtuesve multi disiplinor, mjaft te edukuar dhe mjaft te talentuar, jane dakort ne dy gjera. E para, ky problem eshte shume i rendesishem per te vazhduar ta injorojme thjesht sepse ne mendojme se i dime pergjigjet. Dhe e dyta, nese pranojme te jemi gabim, nese pranojme te sfidojme njohurine e deritanishme me eksperimentet me te mira ofruar nga shkenca, problemi mund te zgjidhet.
I know it's tempting to want an answer right now, some form of action or policy, some dietary prescription -- eat this, not that — but if we want to get it right, we're going to have to do much more rigorous science before we can write that prescription.
E di qe eshte mjaft joshese te dashurit te mesosh pergjigjen qe tani, politikat dhe masat, rekomandimet dietike-- ha kete, jo ate-- por nese duam ta idenitfikojme ekzaktesisht, na duhet te bejme nje shkence mjaft rigoroze para se te nisim te japim rekomandime.
Briefly, to address this, our research program is focused around three meta-themes, or questions. First, how do the various foods we consume impact our metabolism, hormones and enzymes, and through what nuanced molecular mechanisms? Second, based on these insights, can people make the necessary changes in their diets in a way that's safe and practical to implement? And finally, once we identify what safe and practical changes people can make to their diet, how can we move their behavior in that direction so that it becomes more the default rather than the exception? Just because you know what to do doesn't mean you're always going to do it. Sometimes we have to put cues around people to make it easier, and believe it or not, that can be studied scientifically.
Shkurtimisht, per te adresuar kete, programi yne i kerkimit eshte i fokusuar rreth tre temave ose pyetjeve kryesore. Se pari, si ndikojne ushqimet e ndryshme qe konsumojme ne metabolizem, hormone dhe enzima, dhe nepermjet cfare mekanizmi molekular? Se dyti, duke u bazuar ne keto te dhena, a munden njerezit te bejne ndryshimet e nevojshme ne dieten e tyre ne nje menyre qe te jete e sigurt dhe praktike implementimi? Dhe si perfundim, kur e identifikojme se cfare jane ndryshimet e sigurta dhe praktike qe njerezit mund ti bejne dietes se tyre, si mund ta drejtojme sjelljen e tyre drejt atij drejtimi qe te behet e perditshmja dhe jo perjashtimi? Te diturit se cfare duhet te besh nuk do te thote qe ti gjithomone do ta besh ate. Ndonjehere eshte e nevojshme te vendosim te dhena rreth njerezve per ta bere me te lehte, dhe besojeni ose jo, kjo gje mund te studjohet shkencerisht.
I don't know how this journey is going to end, but this much seems clear to me, at least: We can't keep blaming our overweight and diabetic patients like I did. Most of them actually want to do the right thing, but they have to know what that is, and it's got to work. I dream of a day when our patients can shed their excess pounds and cure themselves of insulin resistance, because as medical professionals, we've shed our excess mental baggage and cured ourselves of new idea resistance sufficiently to go back to our original ideals: open minds, the courage to throw out yesterday's ideas when they don't appear to be working, and the understanding that scientific truth isn't final, but constantly evolving. Staying true to that path will be better for our patients and better for science. If obesity is nothing more than a proxy for metabolic illness, what good does it do us to punish those with the proxy?
Nuk e di se si do te perfundoje ky udhetim, por kaq gje me duket e qarte te pakten: Nuk mund te vazhdojme te fajesojme pacientet mbipeshe dhe diabetike sic bera une. Shumica prej tyre faktikisht duan te bejne gjene e duhur, por ata duhen te dine se cfare eshte kjo, dhe duhet te funksionoje. Enderroj per diten kur pacientet tane do mund te dobesohen dhe ta kurojne veten nga rezistenca e insulines, pasi si profesionist mjekesie, ne e kemi djersitur bagazhin tone mendor dhe e kemi sheruar veten nga rezistenca ndaj ideve mjaftueshem per t'ju kthyer idealeve tona te origjines: mendje hapur, me kurajon per te hedhur tutje idete e djeshme kur ato nuk japin rezultate, dhe te kuptuarit qe e verteta shkencore nuk eshte fjala e fundit, por ne evolim i vazhdueshem. Ti qendrosh besnik asaj rruge do jete me mire per pacientet tane dhe me mire per shkencen, Nese obeziteti nuk eshte gje tjeter vec kamuflazhi i semundjeve te metabolizmit, c'e mire na vjen duke i ndeshkuar ato qe vuajne prej saj?
Sometimes I think back to that night in the E.R. seven years ago. I wish I could speak with that woman again. I'd like to tell her how sorry I am. I'd say, as a doctor, I delivered the best clinical care I could, but as a human being, I let you down. You didn't need my judgment and my contempt. You needed my empathy and compassion, and above all else, you needed a doctor who was willing to consider maybe you didn't let the system down. Maybe the system, of which I was a part, was letting you down. If you're watching this now, I hope you can forgive me.
Me ndodh te mendoj per naten ne urgjence 7 vite me pare. Do desha te mund te flisja serish me ate grua. Do te desha ti thoja se sa keq me vinte. Do ti thoja qe si mjeke, i dhashe sherbimin me te mire klinik qe munda, por si qenie njerezore, nuk e trajtova si duhej. Nuk kishe nevoje per gjykimin tim. Ti kishe nevoje per simpatine dhe keqardhjen time, dhe mbi te gjitha kishe nevoje per nje mjek i cili te ishte i gatshem te konsideronte faktin qe ti mund te ishe jashte kornizave te sistemit. Ndoshta sistemi, pjese e se cilit isha dhe une, nuk ju ndihmoi. Nese jeni duke e pare kete tani, shpresoj te mund te me falni.
(Applause)
(Duartrokitje)