Ivan Oransky: Are we over-medicalized?

Translator: Carolina Araujo Sabell Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

Those of you who have seen the film "Moneyball,"

A aqueles de vós que vistes a película Moneyball

or have read the book by Michael Lewis,

ou lestes o libro de Michael Lewis

will be familiar with the story of Billy Beane.

soaravos a historia de Billy Beane

Billy was supposed to be a tremendous ballplayer; all the scouts told him so.

Billy ía ser un xogador de béisbol xenial,

e todos os recrutadores llo dicían

They told his parents that

Dixéronllo aos seus pais

they predicted that he was going to be a star.

Predixeron que sería unha estrela.

But what actually happened when he signed the contract -- and by the way, he didn't

Pero o que realmente sucedeu cando firmou o contrato, que por certo,

non quería firmar ese contrato, el quería ir á universidade,

want to sign that contract, he wanted to go to college --

which is what my mother, who actually does love me,

é o que a miña nai, que me quere ben,

said that I should do too, and I did --

díxome que debería facer tamén e iso fixen.

well, he didn't do very well. He struggled mightily.

Ben, non lle foi moi aló. Loitou intensamente.

He got traded a couple of times, he ended up in the Minors for most of his career,

Cambiou de equipo en varias ocasións,

caeu en ligas menores durante a maior parte da súa carreira

and he actually ended up in management. He ended up as a General Manager of the

e finalmente rematou en administración.

Terminou sendo o director xeral dos Athletics de Oakland

Oakland A's.

Now for many of you in this room, ending up in management, which is also what I've done,

Para moitos de vós nesta sala, acabar en administración,

cousa que tamén eu fixen, é un éxito

is seen as a success.

I can assure you that for a kid trying to make it in the Bigs,

Pódovos asegurar que para un rapaz que trata de chegar ás grandes ligas

going into management ain't no success story. It's a failure.

rematar en administración non é ningún éxito, é un fracaso

And what I want to talk to you about today, and share with you, is that our

E hoxe quérovos contar, e compartir con vós

que o noso sistema médico é igual de malo para facer predicións

healthcare system, our medical system, is just as bad at predicting

what happens to people in it -- patients, others --

do que lles ocorre ás persoas doentes

coma os recrutadores dicindo o que lle ía pasar a Billy Beane.

as those scouts were at predicting what would happen to Billy Beane.

And yet, every day

Aínda así, cada día

thousands of people in this country

a millares de persoas neste país

are diagnosed with preconditions.

diagnostícanselles enfermidades en estados previos.

We hear about pre-hypertension, we hear about pre-dementia,

Oímos falar de prehipertensión, oímos falar de predemencia

we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with

oímos falar de preansiedade, e estou case seguro

de que me autodiagnostiquei iso nos camerinos. (Risas)

that in the green room.

We also refer to subclinical conditions.

Tamén nos referimos ás afeccións subclínicas

There's subclinical atherosclerosis, subclinical hardening of the arteries,

Hai aterosclerose subclínica, endurecemento das arterias subclínico,

obviously linked to heart attacks, potentially.

obviamente vinculado a ataques cardíacos, potencialmente.

One of my favorites is called subclinical acne.

Un dos meus favoritos chámase acne subclínico.

If you look up subclinical acne, you may find a website, which I did,

Se buscan acne subclínico, se cadra atopen un sitio web, coma min,

which says that this is the easiest type of acne to treat.

que di que este é o tipo de acne máis fácil de tratar. (Risas)

You don't have the pustules or the redness and inflammation.

Non tes as pústulas nin o avermellamento nin a inflamación.

Maybe that's because you don't actually have acne.

Talvez é que en realidade non tes acne. (Risas)

I have a name for all of these conditions, it's another precondition:

Téñolle un nome para todas estas afeccións,

é outra doenza en estadio previo:

I call them preposterous.

chámolle preabsurdeza. (Risas)

In baseball, the game follows the pre-game.

Ben, en béisbol, o partido vén despois do prepartido

Season follows the pre-season.

A temporada vén despois da pretemporada.

But with a lot of these conditions, that actually isn't the case, or at least it isn't the

Pero isto non ocorre con moitas destas doenzas,

ou polo menos non sempre ocorre

case all the time. It's as if there's a rain delay, every single time in many cases.

é coma se sempre aprazaran o partido por choiva en moitos casos.

We have pre-cancerous lesions,

Existen lesións precanceríxenas,

which often don't turn into cancer.

que a miúdo non se transforman en cancro.

And yet,

Aínda así, se poñemos por caso a osteoporose subclínica,

if you take, for example, subclinical osteoporosis, a bone thinning disease,

un mal que debilita os ósos,

the precondition,

otherwise known as osteopenia,

cuxa enfermidade previa

é coñecida como osteopenia

you would have to treat 270 women for three years

teríamos que tratar a 270 mulleres durante 3 anos

in order to prevent one broken bone.

para evitar un caso de fractura.

That's an awful lot of women

Son moitísimas mulleres

when you multiply by the number of women who were diagnosed

se multiplicamos polo número das que foron diagnosticadas

with this osteopenia.

con osteopenia

And so is it any wonder,

Non resulta sorprendente,

given all of the costs and the side effects

tendo en conta os custos e os efectos secundarios

of the drugs that we're using to treat these preconditions, that every year

das menciñas que se usan para tratar estes males en estado previo,

que esteamos a gastar máis de dous billóns de dólares en sanidade, e con todo,

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

100.000 persoas cada ano, e esa é unha estimación moderada,

not because of the conditions they have,

están a morrer, e non polas afeccións que padecen

but because of the treatments that we're giving them and the complications of those treatments?

senón polos tratamentos que estamos a dar e as súas correspondentes complicacións

We've medicalized everything

Medicalizamos todo neste país.

in this country.

Women in the audience, I have some

Para as mulleres do público,

pretty bad news that you already know,

teño unha mala nova, que xa coñecen

and that's that every aspect of your life

e é que todos os aspectos das súas vidas se medicalizaron.

has been medicalized.

Strike one is when you hit puberty.

O primeiro strike é cando chegan á puberdade.

You now have something that happens to you once a month that has been medicalized.

Agora teñen algo que lles ocorre unha vez ao mes e que está medicalizado

It's a condition;

É unha doenza;

it has to be treated. Strike two

ten que ser tratada.

is if you get pregnant.

Strike dous é se quedas embarazada.

That's been medicalized as well.

Iso está medicalizado tamén.

You have to have a high-tech experience

Tes que usar tecnoloxía punta no embarazo,

of pregnancy, otherwise something might go wrong.

ou algo pode ir mal.

Strike three is menopause.

O terceiro strike é a menopausa.

We all know what happened when millions of women were given hormone replacement therapy

Todos sabemos que aconteceu

cando se lles deu a milleiros de mulleres

unha terapia de substitución hormonal

for menopausal symptoms

para os síntomas da menopausa

for decades until all of a sudden we realized, because a study came out, a big one,

durante décadas

ata que de repente, decatámonos polos resultados dun gran estudo,

NIH-funded.

financiado polo Instituto Nacional de Saúde (NIH)

It said,

actually, a lot of that hormone replacement therapy may be doing more harm than good

que dicía que realmente a terapia de substitución hormonal

podía estar a facerlles máis mal que ben a moitas destas mulleres.

for many of those women.

Just in case,

Por se acaso,

I don't want to leave the men out --

non quero deixar aos homes fóra

I am one, after all --

Con todo, son un deles.

I have really bad news for all of you in this room,

Teño malas novas para todos os que estades nesta sala

and for everyone

e para todos

listening and watching elsewhere:

os que nos escoitades e vedes noutros lugares:

You all have

a universally fatal condition.

todos tedes

unha doenza universal e fatal.

So, just take a moment.

Pensade un momento.

It's called pre-death.

Chámase premorte. (Risas)

Every single one of you has it, because you have the risk factor for it,

Todos vós a padecedes, porque todos vós tedes o factor de risco,

which is being alive.

que é estar vivos.

But I have some good news for you, because

Pero tamén teño boas novas,

I'm a journalist, I like to end things in a happy way or a forward-thinking way.

porque son xornalista, e gústame rematar as cousas

dunha maneira alegre e visionaria.

And that good news is that if you can survive to the end of my talk, which

O lado positivo é que, se podedes sobrevivir ata o final da miña charla,

we'll see if that happens for everyone,

que xa veremos se vos sucede a todos,

you will be a pre-vivor.

seredes "previventes". (Risas)

I made up pre-death.

Xa Inventei premorte.

If I used someone else's pre-death, I apologize,

Se usei o termo doutra persoa, síntoo,

I think I made it up.

I didn't make up pre-vivor.

pero creo que o inventei eu.

Non inventei "previventes"

Pre-vivor is what a particular cancer advocacy group would like everyone who

Previvente é como algún grupo de apoio a persoas con cancro

querería que lles chamásemos

just has a risk factor,

but hasn't actually had that cancer,

aos que só teñen o factor de risco

to call themselves.

pero non tiveron o cancro.

You are a pre-vivor.

Vós sodes previventes.

We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the

Estivo aquí xente da HBO esta mañá.

Pregúntome se Mark Burnett se atopa entre o público.

audience, I'd like to suggest

a reality TV show called "Pre-vivor."

Gustaríame propoñerlle un programa de telerrealidade

que se chame "Previvente"

If you develop a disease, you're off the island.

Se enfermas, estás fóra da illa. (Risas)

But the problem is, we have a system

Pero o problema é que temos un sistema

that is completely --

que é completamente...

basically promoted this.

basicamente promoveuisto.

We've selected, at every point in this system,

Escollemos, en cada momento deste sistema,

to do what we do, and to give everyone a precondition and then eventually

facer o que facemos, e atribuír a todos unha enfermidade en estado previo

e finalmente, nalgúns casos, unha doenza.

a condition, in some cases.

Start with the doctor-patient relationship. Doctors, most of them,

Comecemos pola relación médico-doente.

A maioría dos médicos teñen un sistema de pago por servizo.

are in a fee-for-service system. They are basically incentivized to do more --

Principalmente, teñen incentivos para facer máis

procedures, tests,

procedementos, probas,

prescribe medications.

prescribir menciñas.

Patients come to them,

Os doentes acoden a eles, queren facer algo.

they want to do something. We're Americans, we can't just stand

Non podemos quedar mirando. Somos americanos, temos que facer algo.

there, we have to do something. And so they want a drug.

Por iso, queren un medicamento. Queren un tratamento.

They want a treatment. They want to be told, this is what you have and this is how

Queren que lles digan: isto é o que tes e así é como se trata.

you treat it. If the doctor doesn't give you that,

Se o médico non che dá iso vaste para outra parte.

you go somewhere else.

That's not very good for doctors' business.

Pero iso non é bo para o negocio dos médicos.

Or even worse,

Ou aínda peor, se ao final lles diagnostican algo,

if you are diagnosed with something eventually, and the doctor didn't order that test,

e o médico non pediu esa proba, demándano.

you get sued.

We have pharmaceutical companies that are constantly trying to expand

Hai compañías farmacéuticas que tratan constantemente de ampliar

the indications, expand the number of people who are eligible for a given treatment,

as indicacións, ampliar o número de persoas

que son aptas para certos tratamentos

because that obviously helps their bottom line. We have advocacy groups,

porque obviamente isto incrementa os seus ingresos

Existen grupos de apoio como os que inventaron a palabra previvente,

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,

que queren facer que as persoas sintan

que están en perigo, ou que pode que padezan unha doenza

so that they can raise more funds

and raise visibility, et cetera.

para así obter máis fondos, e ser máis visibles, etcétera.

But this isn't actually,

Pero non se trata, a pesar de que os xornalistas o fagan normalmente,

despite what journalists typically do, this isn't actually about blaming

non se trata de culpar a ninguén en particular.

particular players.

We are all responsible.

Todos somos responsables,

I'm responsible.

eu son responsable.

I actually root for the Yankees, I mean talk about

A verdade é que apoio aos Yankees, é dicir,

rooting for the worst possible

apoio ao máximo culpable

offender when it comes to doing everything you can do.

cando se trata de facer todo o que se pode facer

Thank you.

Grazas. (Risas)

But everyone is responsible.

Pero todo o mundo é culpable.

I went to medical school,

Fun á facultade de medicina,

and I didn't have a course called How to Think Skeptically,

e non tiven unha clase de "Como pensar con escepticismo"

or How Not to Order Tests.

ou "Como non pedir análises".

We have this system

Temos este sistema

where that's what you do.

onde iso é o que se fai.

And it actually took being a journalist

Tiven que ser xornalista para entender estes incentivos.

to understand all these incentives. You know, economists like to say,

Sabedes, os economistas adoitan dicir

there are no bad people,

que non hai xente mala,

there are just bad incentives.

só malos incentivos.

And that's actually true.

E de feito, iso é certo.

Because what we've created is a sort of Field of Dreams, when it comes to medical technology.

Porque creamos unha especie de "Campo de Soños"

no ámbito da tecnoloxía médica.

So when you put another MRI in every corner, you put a robot

Poñemos máquinas de resonancia magnética por todas partes,

in every hospital saying that everyone has to have robotic surgery.

non queda un hospital sen unha máquina que di

que todos necesitamos cirurxía robótica

Well, we've created a system where if you build it, they will come.

Creamos un sistema de "se o constrúes, eles virán".

But you can actually perversely

Pero pódese convencer de maneira perversa

tell people to come, convince them

á xente sa de que teñen que vir.

that they have to come.

It was when I became a journalist that I really realized how I was part of this problem,

Pero, cando me fixen xornalista foi cando me dei conta

de como eu era parte do problema

and how we all are part of this problem.

e de como todos somos parte do problema.

I was medicalizing every risk factor, I was writing stories, commissioning stories,

Medicalizaba todos os factores de risco,

escribía historias, encargaba artigos, que non trataban

every day, that were trying to,

not necessarily make people worried, although that was what often happened.

de preocupar á xente, pero iso era o que ocorría con frecuencia.

But, you know, there are ways out.

Pero sabedes, hai saída.

I saw my own internist last week,

Vin ao meu internista a semana pasada e díxome

and he said to me,

"You know," and he told me something that

"Xa sabes", e informoume de algo que calquera dos que estades aquí

everyone in this audience could have told me for free,

podería dicirme gratuitamente,

but I paid him for the privilege, which is that

pero eu pagueille pola exclusiva:

I need to lose some weight.

Teño que perder peso.

Well, he's right. I've had honest-to-goodness high blood pressure

Ben, ten razón. Son hipertenso dende hai doce anos xa,

for a dozen years now, same

á mesma idade que empezou a selo meu pai,

age my father got it,

and it's a real disease. It's not pre-hypertension, it's actual

Non se trata de prehipertensión,

hypertension, high blood pressure.

é hipertensión de verdade, presión arterial alta.

Well, he's right,

Ben, ten razón, pero non me dixo

but he didn't say to me,

well, you have pre-obesity or

tes preobesidade, ou prediabetes, ou algo así

you have pre-diabetes, or anything like that. He didn't say,

Non me dixo que empezara a tomar estatinas

better start taking this Statin, you need to lower your cholesterol.

para baixar o colesterol.

No, he said, "Go out and lose some weight. Come back and see me in a bit,

Non, díxome: vai perder peso e volve verme nun tempiño

or just give me a call and let me know how you're doing."

ou chámame e dime que tal vas.

So that's, to me,

a way forward.

Iso é para min o camiño para seguir.

Billy Beane, by the way, learned the same thing.

Billy Beane, por certo, aprendeu o mesmo.

He learned,

Decatouse, observando este rapaz,

from watching this kid who he eventually hired, who was really successful for him,

a quen ao final contratou, e tivo moito éxito,

that it wasn't swinging for the fences, it wasn't swinging at every pitch

que non se trataba de batear a pelota fóra do campo,

ou de batear todos os lanzamentos, como fan os mellores,

like the sluggers do, which is what all the expensive teams like the Yankees like to --

que é o que lles gusta a todos os equipos con cartos,

coma os Yankees, que escollen esa clase de xogadores.

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

Este rapaz díxolle: tes que observar aos mozos,

tes que saír buscar aos que lles guste camiñar,

the guys who like to walk,

because getting on base by a walk

porque chegar a unha base camiñando

is just as good, and in our healthcare system

é igual de válido, e no noso sistema de saúde

we need to figure out,

temos que reflexionar:

is that really a good pitch

é iso un bo lanzamento,

or should we let it go by and not swing at everything?

ou temos que deixalo pasar e non tratar de batealo todo?

Thanks.

Grazas. (Aplausos)