Ivan Oransky: Are we over-medicalized?

53,682 views ・ 2012-06-19

TED


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Prevoditelj: Senzos Osijek Recezent: Suzana Baric
00:15
Those of you who have seen the film "Moneyball,"
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Onima koji su vidjeli film "Igra pobjednika"
00:19
or have read the book by Michael Lewis,
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ili su čitali knjigu Michaela Lewisa
00:21
will be familiar with the story of Billy Beane.
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bit će poznata priča o Billyju Beaneu.
00:24
Billy was supposed to be a tremendous ballplayer; all the scouts told him so.
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Billy je trebao biti veliki igrač baseballa; svi lovci na talente rekli su mu to.
00:29
They told his parents that
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Rekli su njegovim roditeljima da
00:30
they predicted that he was going to be a star.
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predviđaju da će biti zvijezda.
00:32
But what actually happened when he signed the contract -- and by the way, he didn't
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Ali što se zapravo dogodilo kada je potpisao ugovor – usput rečeno, on nije
00:37
want to sign that contract, he wanted to go to college --
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htio potpisati taj ugovor, htio je ići na fakultet –
00:39
which is what my mother, who actually does love me,
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što je moja majka, koja me zapravo voli,
00:42
said that I should do too, and I did --
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rekla da bih ja trebao učiniti, a to sam i učinio –
00:45
well, he didn't do very well. He struggled mightily.
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a on nije dobro prošao. Žestoko se trudio.
00:48
He got traded a couple of times, he ended up in the Minors for most of his career,
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Mijenjali su ga nekoliko puta, bio je u maloj ligi većinu svoje karijere
00:52
and he actually ended up in management. He ended up as a General Manager of the
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i zapravo na kraju završio u menadžmentu. Završio je kao glavni direktor
00:57
Oakland A's.
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00:57
Now for many of you in this room, ending up in management, which is also what I've done,
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Oakland A kluba.
Za mnoge od vas završiti kao direktor, kao što sam i ja učinio,
01:02
is seen as a success.
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zapravo je uspjeh.
01:03
I can assure you that for a kid trying to make it in the Bigs,
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Uvjeravam vas da za dijete koje pokušava dospjeti do velike lige
01:07
going into management ain't no success story. It's a failure.
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posao direktora nije uspjeh. To je promašaj.
01:11
And what I want to talk to you about today, and share with you, is that our
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A ono o čemu vam želim pričati danas i što želim podijeliti s vama jest da je naš
01:16
healthcare system, our medical system, is just as bad at predicting
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zdravstveni sustav, naš sustav medicine jednako loš u predviđanju
01:20
what happens to people in it -- patients, others --
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što će se dogoditi ljudima u njemu – pacijentima, drugima –
01:24
as those scouts were at predicting what would happen to Billy Beane.
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kao što su bili loši i oni lovci na talente koji su predviđali što će se dogoditi s Billyjem Beaneom.
01:29
And yet, every day
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Ali ipak, svaki dan
01:32
thousands of people in this country
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tisućama ljudi u ovoj državi
01:34
are diagnosed with preconditions.
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dijagnosticirani su preduvjeti za bolest.
01:37
We hear about pre-hypertension, we hear about pre-dementia,
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Slušamo o predhipertenziji, slušamo o preddemenciji,
01:42
we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with
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slušamo o predanksioznosti i poprilično sam siguran da sam si sam to dijagnosticirao
01:47
that in the green room.
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u zelenoj sobi.
01:48
We also refer to subclinical conditions.
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Također mislimo i na subklinička stanja.
01:53
There's subclinical atherosclerosis, subclinical hardening of the arteries,
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Postoji subklinička arteroskleroza, subkliničko otvrdnjavanje arterija,
01:57
obviously linked to heart attacks, potentially.
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potencijalno, ali očigledno povezano sa srčanim udarima.
02:01
One of my favorites is called subclinical acne.
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Jedno od meni najdražih stanja naziva se subkliničkim aknama.
02:04
If you look up subclinical acne, you may find a website, which I did,
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Ako potražite subkliničke akne možete pronaći web stranicu, koju sam ja našao,
02:08
which says that this is the easiest type of acne to treat.
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koja kaže da je ovo najjednostavniji oblik akni za liječenje.
02:12
You don't have the pustules or the redness and inflammation.
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Nemate gnoj niti crvenilo ni upalu.
02:19
Maybe that's because you don't actually have acne.
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Možda zato što zapravo nemate akne.
02:23
I have a name for all of these conditions, it's another precondition:
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Imam naziv za sva ova stanja, još jedno predstanje:
02:29
I call them preposterous.
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zovem ih besmislicom.
02:31
In baseball, the game follows the pre-game.
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U baseballu igra prati predigru.
02:37
Season follows the pre-season.
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Sezona prati predsezonu.
02:40
But with a lot of these conditions, that actually isn't the case, or at least it isn't the
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Ali s mnogima od ovih stanja to nije slučaj ili bar nije
02:44
case all the time. It's as if there's a rain delay, every single time in many cases.
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uvijek slučaj. To je svaki put poput zakašnjele kiše u mnogim slučajevima.
02:49
We have pre-cancerous lesions,
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Imamo predtumorske ozljede
02:50
which often don't turn into cancer.
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koje često ne postanu tumori.
02:54
And yet,
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Ali, na primjer,
02:56
if you take, for example, subclinical osteoporosis, a bone thinning disease,
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ako uzmete subkliničku osteoporozu, bolest omekšanja kostiju,
03:00
the precondition,
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preduvjet
03:01
otherwise known as osteopenia,
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za bolest poznatu kao osteopenija,
03:04
you would have to treat 270 women for three years
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morali biste liječiti 270 žena tri godine
03:07
in order to prevent one broken bone.
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kako biste spriječili jednu slomljenu kost.
03:10
That's an awful lot of women
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To je jako puno žena,
03:11
when you multiply by the number of women who were diagnosed
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kada se pomnože sa brojem žena kojima je dijagnosticirana
03:14
with this osteopenia.
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osteopenija.
03:16
And so is it any wonder,
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I je li ikakvo čudo,
03:18
given all of the costs and the side effects
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gledajući trošak i sve nuspojave
03:21
of the drugs that we're using to treat these preconditions, that every year
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lijekova koje koristimo kako bi tretirali preduvjet za bolest, da svake godine
03:25
we're spending more than two trillion dollars on healthcare and yet
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trošimo više od dva bilijuna dolara na zdravstveno osiguranje, a ipak
03:29
100,000 people a year -- and that's a conservative estimate -- are dying
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100,000 ljudi godišnje – i to je blaga procjena – umire
03:32
not because of the conditions they have,
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ne zbog stanja koje imaju
03:34
but because of the treatments that we're giving them and the complications of those treatments?
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već zbog liječenja koje im je pruženo i komplikacija nastalih tim liječenjem?
03:38
We've medicalized everything
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Sve kategoriziramo kao nešto što treba liječiti
03:41
in this country.
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u ovoj državi.
03:42
Women in the audience, I have some
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Žene u publici, imam
03:45
pretty bad news that you already know,
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poprilično loše vijesti koje već znate,
03:47
and that's that every aspect of your life
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a to je da je svaki dio vašeg života
03:50
has been medicalized.
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bio kategoriziran kao nešto što se treba liječiti.
03:51
Strike one is when you hit puberty.
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Počevši od vašeg puberteta.
03:54
You now have something that happens to you once a month that has been medicalized.
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Sada imate nešto što se dogodi jednom mjesečno i kategorizirano je.
03:58
It's a condition;
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To je stanje,
03:59
it has to be treated. Strike two
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treba se tretirati. Zatim,
04:00
is if you get pregnant.
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ako ste bile trudne.
04:02
That's been medicalized as well.
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To je također kategorizirano.
04:05
You have to have a high-tech experience
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Tijekom trudnoće sve mora biti
04:07
of pregnancy, otherwise something might go wrong.
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modernizirano jer u protivnom nešto može poći po zlu.
04:10
Strike three is menopause.
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Zatim ide menopauza.
04:13
We all know what happened when millions of women were given hormone replacement therapy
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Svi znamo što se dogodilo kada su milijuni žena dobivali hormonske zamjene
04:18
for menopausal symptoms
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za simptome menopauze
04:21
for decades until all of a sudden we realized, because a study came out, a big one,
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desetljećima sve dok odjednom nismo shvatili, zato što je napravljeno istraživanje, veliko istraživanje,
04:25
NIH-funded.
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koje je financirao Nacionalni institut za zdravlje.
04:26
It said,
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Otkriveno je
04:27
actually, a lot of that hormone replacement therapy may be doing more harm than good
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da dosta tih terapija hormonskim zamjenama čini više štete nego dobra
04:32
for many of those women.
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većini žena.
04:33
Just in case,
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Za svaki slučaj,
04:36
I don't want to leave the men out --
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ne izostavimo muškarce –
04:37
I am one, after all --
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na kraju, i ja sam jedan –
04:39
I have really bad news for all of you in this room,
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imam lošu vijest za sve vas u sobi,
04:42
and for everyone
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i za sve
04:43
listening and watching elsewhere:
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koji slušaju i gledaju drugdje.
04:44
You all have
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Svi imate
04:46
a universally fatal condition.
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univerzalno smrtonosno stanje.
04:48
So, just take a moment.
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Uzmite si trenutak.
04:52
It's called pre-death.
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To se naziva pred-smrt.
04:53
Every single one of you has it, because you have the risk factor for it,
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Svaki od vas ima to stanje zato što svi imate rizični faktor za njega,
04:58
which is being alive.
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a to je da ste živi.
05:00
But I have some good news for you, because
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Ali imam dobre vijesti za vas, zato što
05:03
I'm a journalist, I like to end things in a happy way or a forward-thinking way.
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sam novinar i volim završiti stvari sretno ili na optimističan način.
05:07
And that good news is that if you can survive to the end of my talk, which
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A dobra vijest je ta da ako možete preživjeti do kraja mog govora što
05:11
we'll see if that happens for everyone,
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ćemo vidjeti hoće li se dogoditi svima,
05:14
you will be a pre-vivor.
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svi ćete biti predživitelji.
05:17
I made up pre-death.
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Izmislio sam pred-smrt.
05:22
If I used someone else's pre-death, I apologize,
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Ako sam koristio tuđu pred-smrt, ispričavam se,
05:26
I think I made it up.
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mislim da sam ju izmislio.
05:27
I didn't make up pre-vivor.
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Nisam izmislio predživitelje.
05:29
Pre-vivor is what a particular cancer advocacy group would like everyone who
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Predživitelj je ime koje bi određene grupe zagovornika tumora
05:34
just has a risk factor,
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voljele upotrijebiti za sve
05:36
but hasn't actually had that cancer,
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koji imaju rizični faktor,
05:38
to call themselves.
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ali nemaju zapravo tumor.
05:40
You are a pre-vivor.
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Vi ste predživitelj.
05:41
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the
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Gledali smo HBO ovdje ujutro. Pitam se je li Mark Burnett negdje
05:46
audience, I'd like to suggest
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u publici jer bih htio predložiti
05:47
a reality TV show called "Pre-vivor."
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reality show koji se zove “Predživitelji”.
05:51
If you develop a disease, you're off the island.
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Ako se razvije bolest, odlazite s otoka.
05:55
But the problem is, we have a system
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Problem je taj što imamo sustav
06:00
that is completely --
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koji se potpuno
06:02
basically promoted this.
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temelji na tome.
06:04
We've selected, at every point in this system,
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Odabrali smo kao svaku točku ovog sustava
06:07
to do what we do, and to give everyone a precondition and then eventually
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raditi što radimo i svima dati preduvjet za bolest, a zatim i
06:11
a condition, in some cases.
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stanje u nekim slučajevima.
06:13
Start with the doctor-patient relationship. Doctors, most of them,
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Počnimo s odnosom liječnika i pacijenta. Liječnici, većina njih,
06:17
are in a fee-for-service system. They are basically incentivized to do more --
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u naplatnom su sustavu. Oni su zapravo potaknuti da čine više –
06:22
procedures, tests,
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zahvata, pretraga,
06:24
prescribe medications.
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propisivanja lijekova.
06:25
Patients come to them,
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Pacijenti dolaze k njima,
06:27
they want to do something. We're Americans, we can't just stand
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oni žele nešto učiniti. Mi smo Amerikanci, ne možemo samo mirno stajati,
06:31
there, we have to do something. And so they want a drug.
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moramo učiniti nešto. I zato žele lijekove.
06:34
They want a treatment. They want to be told, this is what you have and this is how
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Žele liječenje. Žele da im se kaže: Ovo je to što imate i ovako
06:37
you treat it. If the doctor doesn't give you that,
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se to liječi. Ako liječnik to ne učini,
06:40
you go somewhere else.
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vi odlazite negdje drugdje.
06:42
That's not very good for doctors' business.
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To nije dobro za liječnički posao.
06:43
Or even worse,
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Ili još gore,
06:45
if you are diagnosed with something eventually, and the doctor didn't order that test,
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ako ste na kraju dobili svoju dijagnozu, možete tužiti liječnika koji je propustio
06:49
you get sued.
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učiniti taj test.
06:51
We have pharmaceutical companies that are constantly trying to expand
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Imamo farmaceutske tvrtke koje neprestano žele proširiti
06:54
the indications, expand the number of people who are eligible for a given treatment,
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pokazatelje, proširiti broj ljudi koji su prikladni za određenu terapiju,
07:00
because that obviously helps their bottom line. We have advocacy groups,
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jer to očigledno pomaže zaradi. Imamo grupe zagovornika,
07:03
like the one that's come up with pre-vivor,
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poput one koja je izmislila predživiteljski status,
07:05
who want to make more and more people feel they are at risk, or might have a condition,
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koje žele učiniti da sve više i više ljudi osjeća kao da su ugroženi ili bolesni,
07:09
so that they can raise more funds
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kako bi mogli sakupiti više novca
07:11
and raise visibility, et cetera.
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i povećati vidokrug, itd.
07:14
But this isn't actually,
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Ali ovdje nije riječ o -
07:16
despite what journalists typically do, this isn't actually about blaming
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bez obzira što novinari obično rade - okrivljavanju
07:19
particular players.
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određenih igrača.
07:20
We are all responsible.
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Svi smo odgovorni.
07:22
I'm responsible.
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Ja sam odgovoran.
07:23
I actually root for the Yankees, I mean talk about
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Ja zapravo navijam za Yankeese. Dakle, govorim o
07:26
rooting for the worst possible
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navijanju za najgoreg mogućeg
07:29
offender when it comes to doing everything you can do.
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prekršitelja što se tiče svega što se može učiniti.
07:32
Thank you.
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Hvala vam.
07:34
But everyone is responsible.
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Ali svi su odgovorni.
07:38
I went to medical school,
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Pohađao sam medicinsku školu
07:40
and I didn't have a course called How to Think Skeptically,
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i nisam imao predmete koji su se zvali "Kako razmišljati skeptično"
07:45
or How Not to Order Tests.
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ili "Kako ne naručiti pretragu".
07:47
We have this system
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Imamo sustav
07:50
where that's what you do.
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u kojem je to ono što radiš.
07:52
And it actually took being a journalist
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I zapravo tek nakon što sam postao novinar
07:55
to understand all these incentives. You know, economists like to say,
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shvatio sam sve te poticaje. Znate, ekonomisti vole reći
07:59
there are no bad people,
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da ne postoje loši ljudi,
08:00
there are just bad incentives.
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već samo loši poticaji.
08:02
And that's actually true.
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I to je zapravo istina.
08:03
Because what we've created is a sort of Field of Dreams, when it comes to medical technology.
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Ono što smo stvorili nekakvo je polje snova kada se radi o medicinskoj tehnologiji.
08:07
So when you put another MRI in every corner, you put a robot
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Zato kada stavite još jedan MRI uređaj u svaki kut, stavljate robota
08:12
in every hospital saying that everyone has to have robotic surgery.
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u svaku bolnicu govoreći da svi moraju imati robotske operacije.
08:16
Well, we've created a system where if you build it, they will come.
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Stvorili smo sustav gdje ako ga izgradiš, oni će doći.
08:19
But you can actually perversely
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I zapravo možete izopačeno
08:23
tell people to come, convince them
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reći ljudima da dođu, uvjeriti ih
08:26
that they have to come.
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da moraju doći.
08:27
It was when I became a journalist that I really realized how I was part of this problem,
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Nakon što sam postao novinar shvatio sam da sam ja dio ovog problema
08:32
and how we all are part of this problem.
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i kako smo svi dio ovog problema.
08:34
I was medicalizing every risk factor, I was writing stories, commissioning stories,
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Kategorizirao sam svaki rizični faktor, pisao sam priče, odobravao priče,
08:38
every day, that were trying to,
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svaki dan, koje su ne nužno
08:41
not necessarily make people worried, although that was what often happened.
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pokušavale zabrinuti ljude, iako se to često događalo.
08:44
But, you know, there are ways out.
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Ali, znate, postoje načini za izlazak iz ove situacije.
08:47
I saw my own internist last week,
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Posjetio sam svog internista prošli tjedan
08:49
and he said to me,
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i rekao mi je:
08:52
"You know," and he told me something that
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"Znate", i rekao mi je nešto što bi mi
08:54
everyone in this audience could have told me for free,
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svi u publici mogli reći besplatno,
08:57
but I paid him for the privilege, which is that
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ali ja sam platio za tu povlasticu, a to je
08:59
I need to lose some weight.
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da trebam smršaviti.
09:01
Well, he's right. I've had honest-to-goodness high blood pressure
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I u pravu je. Istina je da imam visok krvni tlak
09:05
for a dozen years now, same
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već dvanaestak godina, ista
09:07
age my father got it,
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dob u kojoj je i moj otac dobio visok tlak
09:09
and it's a real disease. It's not pre-hypertension, it's actual
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i to je prava bolest. Nije predhipertenzija, to je prava
09:13
hypertension, high blood pressure.
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hipertenzija, visoki krvni tlak.
09:15
Well, he's right,
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Pa, u pravu je,
09:16
but he didn't say to me,
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ali nije mi rekao:
09:19
well, you have pre-obesity or
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"Znate, imate predpretilost ili
09:20
you have pre-diabetes, or anything like that. He didn't say,
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imate preddijabetes ili nešto poput toga." Nije rekao da je
09:24
better start taking this Statin, you need to lower your cholesterol.
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bolje da počnem uzimati ovaj Statin, da trebam smanjiti kolesterol.
09:27
No, he said, "Go out and lose some weight. Come back and see me in a bit,
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Ne, rekao je: "Idi i izgubi na težini. Vrati se i posjeti me uskoro
09:30
or just give me a call and let me know how you're doing."
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ili me samo nazovi i reci kako se osjećaš."
09:32
So that's, to me,
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I to je za mene
09:34
a way forward.
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plan za budućnost.
09:36
Billy Beane, by the way, learned the same thing.
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Billy Beane je, usput, naučio isto to.
09:38
He learned,
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Naučio je
09:40
from watching this kid who he eventually hired, who was really successful for him,
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iz promatranja djeteta koje je zaposlio i koje je postalo uspješno,
09:43
that it wasn't swinging for the fences, it wasn't swinging at every pitch
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da nije dobro udarati prema ogradi, nije dobro udarati sve
09:48
like the sluggers do, which is what all the expensive teams like the Yankees like to --
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kao razbijač, što skupi timovi poput Yankeesa vole raditi –
09:53
they like to pick up those guys.
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vole uzimati takve likove.
09:54
This kid told him, you know, you gotta watch the guys, and you gotta go out and find
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Dijete mu je reklo: "Znate, morate promatrati dečke, morate izaći i pronaći
09:59
the guys who like to walk,
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dečke koji vole hodati
10:00
because getting on base by a walk
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zato što doći na bazu hodajući
10:02
is just as good, and in our healthcare system
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je isto tako dobro, a u našem zdravstvenom sustavu
10:05
we need to figure out,
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moramo otkriti
10:06
is that really a good pitch
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je li to doista dobro bacanje
10:08
or should we let it go by and not swing at everything?
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ili ga trebamo propustiti i ne zamahnuti palicom na sve.
10:11
Thanks.
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Hvala.
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