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?
Nikada neću zaboraviti taj dan, u proleće 2006. Bio sam hirurg na specijalizaciji u Džons Hopkins bolnici i primao sam hitne pozive. Oko 2h ujutro pozvali su me pejdžerom u hitnu pomoć da pogledam ženu sa dijabetesnim čirom na stopalu. Još uvek se sećam neke vrste smrada trulog mesa kada sam razgrnuo zavesu da je vidim. Svi su se složili da je žena bila teško bolesna i da treba da je u bolnici. To nije bilo pitanje. Pitanje koje su mi postavili bilo je drukčije, da li joj je potrebna amputacija?
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?
Kada se prisetim te noći, očajnički bih voleo da sam postupao s tom ženom te noći s jednakom empatijom i samilošću koje sam ispoljio prema 27-godišnjoj mladoj, koja je došla u hitnu pomoć tri noći ranije s bolom u donjem delu leđa, što se ispostavilo da je rak pankreasa u poodmakloj fazi. U njenom slučaju sam znao da ništa ne mogu da uradim što bi moglo da joj spase život. Rak je previše napredovao. Međutim, posvetio sam se svemu što sam mogao da joj olakšam boravak. Doneo sam joj toplo ćebe i šolju kafe. Doneo sam i njenim roditeljima. Ali, važnije od toga je bilo da je nisam osuđivao jer očigledno nije bila kriva za to što joj se desilo. Pa zašto sam, nekoliko noći kasnije u toj istoj hitnoj pomoći, odlučan da je pacijentkinji s dijabetesom potrebna amputacija, zašto sam osetio prema njoj gorki prezir?
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.
Vidite, za razliku od žene u noći pre, ova žena je imala dijabetes tipa 2. Bila je debela. Svi znamo da je to zato što se previše jede i nedovoljno vežba, zar ne? Pa, koliko teško to može da bude? Kada sam je pogledao, pomislio sam da ste se samo malo potrudili, ne biste bili sada u ovoj situaciji da lekar, koga nikada pre niste sreli odlučuje o amputaciji vašeg stopala.
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.
Zašto sam smatrao opravdanim da je osuđujem? Želeo bih reći da ne znam. Međutim, znam. Znate, u svojoj oholoj mladosti mislio sam da sam je pročitao. Jela je previše. Nije imala sreće. Dobila je dijabetes. Slučaj je završen.
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.
Ironijom slučaja u to vreme sam baš radio na istraživanju raka, preciznije, na imunskim terapijama kod melanoma i tu sam se zapravo učio da dovodim u pitanje sve, da osporavam sve pretpostavke u skladu sa najvišim mogućim naučnim standardima. Pa ipak, kada se radilo o bolestima kao što je dijabetes koji ubija Amerikance 8 puta češće od melanoma, nisam nijednom doveo u pitanje konvencionalnu mudrost. U stvari samo sam prihvatao patološki redosled događaja koji se u nauci ustalio.
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.
Tri godine kasnije otkrio sam koliko grešim. Ali ovoga puta pacijent sam bio ja. Uprkos svakodnevnom, 3-4 satnom vežbanju i doslovnom pridržavanju piramide pravilne ishrane, ugojio sam se previše i razvio nešto što se naziva metabolički sindrom. Neki od vas su možda čuli za to. Postao sam otporan na insulin.
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.
Zamislite insulin kao glavni hormon koji kontroliše šta će naše telo uraditi s hranom koju pojedemo, da li će je sagoreti ili skladištiti. U žargonu se to naziva podela goriva. Nemogućnost da se proizvede dovoljno insulina je nespojiva sa životom. Insulinska rezistencija, kao što naziv sugeriše znači da vaše ćelije postaju sve otpornije na uticaj insulina koji pokušava da obavi svoj posao. Kada postanete otporni na insulin tada ste na putu dobijanja dijabetesa, što znači da vaš pankreas ne izdržava otpor na insulin i ne stvara ga dovoljno. Tada vaš šećer u krvi raste i cela kaskada patoloških procesa se nadovezuje nekontrolisano, što može dovesti do bolesti srca, raka, čak do Alchajmerove bolesti i amputacije, baš kao kod te žene pre nekoliko godina.
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.
U tom strahu, radikalno sam promenio svoju ishranu, dodavanjem i oduzimanjem namirnica za koje bi većina od vas smatrala skoro sigurno, šokantnim. Na taj način sam izgubio oko 18 kg, za čudo s manje vežbanja. Kao što možete videti, pretpostavljam, nisam više pretežak. Mnogo važnije je da nisam otporan na insulin.
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.
Ali najvažnije je da su mi ostala ova tri goruća pitanja: kako mi se to moglo dogoditi kada sam radio sve kako treba? Ako me je konvencionalna mudrost o ishrani zavarala, da li je moguće da zavara i nekog drugog? Proučavajući ta pitanja, postao sam skoro manijački opsednut u pokušaju razumevanja stvarne veze između gojaznosti i insulinske rezistencije.
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.
Većina istraživača veruje da je gojaznost uzrok insulinske rezistencije. Logično je u tom slučaju da ako želite da lečite insulinsku rezistenciju, tražite od ljudi da izgube kilažu, zar ne? Lečite gojaznost. Ali šta ako je obrnuto? Šta ako gojaznost uopšte nije uzrok insulinske rezistencije? U stvari, šta ako je simptom mnogo dubljeg problema, ako je vrh ledenog brega? Znam da zvuči ludo jer smo očito u sredini epidemije gojaznosti, ali saslušajte šta ću reći. Šta ako je gojaznost sposobnost adaptacije na daleko opasniji problem koji se odvija na nivou ćelije? Ne sugerišem da je gojaznost benigna, već da može biti manje zlo od dva metabolička zla.
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.
Zamislite da je insulinska rezistencija naš smanjen kapacitet da podelimo gorivo, na šta sam aludirao ranije, pri čemu unesene kalorije na odgovarajući način sagorevaju i tvore zalihe. Kada postanemo otporni na insulin, homeostaza je u tom stanju narušena. Tako da sada, kada insulin naloži ćeliji da sagori više energije nego što je sigurno za ćeliju, ćelija odgovara: "Ne, hvala, radije bih sačuvala tu energiju." Pošto masnim ćelijama nedostaje većina složene ćelijske mašinerije koja postoji u drugim ćelijama, one su verovatno najsigurnije mesto za skladištenje. Dakle za mnoge od nas, oko 75 miliona Amerikanaca, odgovarajući odgovor na insulinsku rezistenciju može biti u skladištenju masti, a ne obratno da je insulinska rezistencija odgovor na gojaznost.
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.
Ovo je zaista suptilna razlika, ali implikacije mogu biti duboke. Razmotrite sledeću analogiju: pomislite na modricu na cevanici kada slučajno udarite nogu o stočić za kafu. Naravno, modrica pakleno boli i skoro sigurno vam se ne sviđa njen izgled, ali svi znamo da modrice, same po sebi, nisu problem. U stvari je suprotno. To je zdrav odgovor na povredu, sve te imunološke ćelije žure na mesto povrede da spasu ćelijske ostatke i spreče širenje infekcije u telu. Sada zamislite da smo mislili da su modrice problem i da smo razvili gigantske medicinske strukture i kulturu oko lečenja modrica: maskirne kreme, lekove protiv bolova, itd, sve vreme ignorišući činjenicu da ljudi i dalje udaraju cevanice o stočić za kafu. Koliko bi nam bilo bolje kada bismo lečili uzrok - govoreći ljudima da obrate pažnju kada prolaze kroz dnevnu sobu - umesto lečenja posledice? Pravilna postavka o uzroku i posledici poboljšava sve na svetu. Pogrešna postavka i farmaceutska industrija i dalje će dobro funkcionisati za svoje akcionare, ali ništa se neće poboljšati ljudima s modricom na cevanici. Uzrok i posledica.
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?
Dakle, ono što sugerišem je da smo možda pobrkali uzrok i posledicu kod gojaznosti i insulinske rezistencije. Možda bi trebalo da se upitamo, da li je moguće da insulinska rezistencija dovodi do povećanja telesne težine i do bolesti povezane s gojaznošću bar kod većine ljudi? Šta ako je gojaznost samo odgovor metabolizma na daleko veću pretnju, skrivenu epidemiju, zbog koje bi trebalo da se zabrinemo?
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.
Pogledajmo neke sugestivne činjenice. Znamo da 30 miliona gojaznih Amerikanaca u SAD nemaju insulinsku rezistenciju. I usput, ne izgleda da su pod većim rizikom obolevanja od mršavih ljudi. Nasuprot tome, znamo da je 6 miliona mršavih ljudi u SAD otporno na insulin, i uzgred, izgleda da kod njih postoji veći rizik za razvoj bolesti metabolizma, koje sam spomenuo, nego kod njihovih gojaznih kolega. Ne znam zašto, no to bi moglo biti zato što njihove ćelije zapravo nisu shvatile pravu stvar koju treba uraditi s tim viškom energije. Dakle, ako možete biti gojazni bez insulinske rezistencije, a mršavi sa insulinskom rezistencijom to sugeriše da bi gojaznost mogla biti samo zaštitni posrednik za ono što se dešava.
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?
Šta ako se borimo u pogrešnom ratu, suzbijamo gojaznost umesto insulinsku rezistenciju? Još gore, šta ako okrivljavanje gojaznih znači da okrivljujemo žrtve? Šta ako je neka od naših osnovnih ideja o gojaznosti jednostavno pogrešna?
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.
Lično, ne mogu više da sebi dozvolim luksuz arogancije, a kamoli luksuz uverenja. Imam ideje o tome šta bi mogao biti uzrok, ali sam široko otvoren za ostale ideje. Pošto me svi stalno pitaju, moja pretpostavka je ovo. Ako se pitate, od čega ćelija želi da se zaštiti kada postane otporna na insulin, odgovor verovatno nije od previše hrane. Verovatnije je od previše glukoze: šećera u krvi. Znamo da rafinirane žitarice i skrob brzo podižu nivo šećera u krvi i čak postoje razlozi za verovanje da šećer direktno može dovesti do insulinske rezistencije. Dakle, ako uključite ove fiziološke procese pretpostavio bih da bi naš povećan unos rafiniranih žitarica, šećera i skroba mogao biti uzrok epidemije gojaznosti i dijabetesa, ali putem insulinske rezistencije. Razumete, nije nužno da je samo od previše jela i premalo vežbanja.
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.
Kada sam izgubio 18 kg pre par godina, to mi je uspelo izbegavanjem tačno tih stvari, što, priznajem, govori da sam pristrasan na osnovu ličnog iskustva. Ali to ne znači da je moja pristrasnost pogrešna i najvažnije je da se sve to može naučno proveriti. Ali prvi korak je prihvatanje mogućnosti da su naša sadašnja uverenja o gojaznosti, dijabetesu i insulinskoj rezistenciji možda pogrešna i zato se moraju proveriti. Kladim se u svoju karijeru za to. Danas posvećujem sve svoje vreme radu na tom problemu i ići ću kuda god me nauka vodi. Odlučio sam da ne mogu i neću više da se pretvaram da imam odgovore kada ih nemam. Dovoljno me je ponizilo sve to što ne znam.
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.
U poslednjih godinu dana, imao sam sreće da radim na ovom problemu sa najneverovatnijim timom istraživača dijabetesa i gojaznosti iz zemlje, a najbolje je da smo se jednako, kao što je Abraham Linkoln uradio, okružili timom rivala. Regrutovali smo tim naučnih rivala, najbolje i najpametnije, s različitim hipotezema o uzroku ove epidemije. Neki misle da je previše unesenih kalorija. Drugi misle da je previše masti u ishrani. Treći misle da je previše rafiniranih žita i skroba. Ali ovaj multidisciplinarni tim veoma skeptičnih i izuzetno talentovanih istraživača se slaže u dve stvari. Prvo, da je ovaj problem isuviše značajan da bismo nastavili da ga zanemarujemo zato što mislimo da znamo odgovor. I drugo, ako smo spremni na greške, ako smo spremni da posumnjamo u konvencionalnu mudrost, uz najbolje eksperimente koje nauka nudi, možemo da rešimo taj problem.
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.
Znam da biste želeli odgovor sada, neki oblik aktivnosti ili smera, neke recepte za ishranu - jedite ovo, a ne to - ali ako želimo da to dobro uradimo, moraćemo da se posvetimo mnogo rigoroznije nauci pre nego što bismo mogli da napišemo takav recept.
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.
Ukratko, za rešavanje ovoga, naš istraživački program je fokusiran na tri ciljne teme ili pitanja: prvo, kako različite namirnice koje konzumiramo utiču na naš metabolizam, na hormone i enzime i putem kojih nijansiranih molekularnih mehanizama? Drugo, na osnovu tih uvida, mogu li ljudi napraviti neophodne izmene u svojoj ishrani na način koji je siguran i praktično izvodljiv? I na kraju, kada smo identifikovali šta je sigurno i praktične promene koje ljudi mogu da uvedu u svoju ishranu, kako možemo da pokrenemo njihovo ponašanje u tom smeru da bi postalo standardnije, a ne samo izuzetak? Samo zato što znate šta treba da uradite ne znači da ćete to uvek i učiniti. Ponekad moramo da postavimo znake oko ljudi da olakšamo i verovali ili ne to se može naučno proučavati.
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?
Ne znam kako će se ovo putovanje završiti, ali izgleda da mi je jasno barem ovo: ne možemo nastaviti da osuđujemo naše preteške pacijente sa dijabetesom kao što sam to ja uradio. Većina od njih u stvari želi da uradi pravu stvar, ali moraju da znaju šta je prava stvar i to mora da funkcioniše. Sanjam o danu kada će naši pacijenti moći da skinu višak kilograma i da se izleče od insulinske rezistencije, jer smo se kao zdravstveni profesionalci otarasili viška sopstvenih mentalnih opterećenja i sebe izlečili od otpora na nove ideje u dovoljnoj meri da bismo mogli da se vratimo na naše originalne ideale: otvorene umove, hrabrost odbacivanja dojučerašnjih ideja kada one ne funkcionišu i na shvatanje da naučna istina nije konačna, već da se konstatno razvija. Iskreno posvećivanje takvom putu će biti bolje i za naše pacijente i za nauku. Ako gojaznost nije ništa drugo nego zamena za metaboličku bolest, kakve koristi imamo od kažnjavanja onih sa njom?
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.
Ponekad razmišljam o onoj noći u hitnoj pomoći od pre sedam godina. Voleo bih da mogu ponovo da razgovaram sa tom ženom. Želeo bih da joj kažem kako mi je žao. Rekao bih - kao lekar sam vam pružio najbolju kliničku negu koju sam mogao, ali kao čovek sam vas izneverio. Nije vam bilo potrebno moje osuđivanje i prezir. Bila vam je potrebna moja empatija i saosećanje i iznad svega, lekar koji bi bio spreman da shvati da možda niste vi izneverili sistem. Možda je sistem, čiji sam bio deo, izneverio vas. Ako gledate ovo sada, nadam se da možete da mi oprostite.
(Applause)
(Aplauz)