Thomas Goetz: It's time to redesign medical data

Prevoditelj: Sanja Blažević Recezent: Tilen Pigac - EFZG

I'm going to be talking to you

Pričat ću vam

about how we can tap

o tome kako možemo iskoristiti

a really underutilized resource in health care,

premalo korišten resurs u zdravstvu,

which is the patient,

a to je sam pacijent,

or, as I like to use the scientific term,

ili -- pošto volim koristiti znanstveni izraz --

people.

ljudi.

Because we are all patients, we are all people.

Jer svi smo mi pacijenti, svi smo mi ljudi.

Even doctors are patients at some point.

Čak su i liječnici pacijenti u jednom trenutku.

So I want to talk about that

Želim dakle, govoriti o tome

as an opportunity

kao o mogućnosti

that we really have failed to engage with very well in this country

s kojom smo se zaista propustili ispravno pozabaviti u ovoj zemlji

and, in fact, worldwide.

ali i u svjetskim razmjerima.

If you want to get at the big part --

Ako želite doći do većeg dijela --

I mean from a public health level, where my training is --

mislim na razinu javnog zdravstva, što je i moje područje usavršavanja --

you're looking at behavioral issues.

susrest ćete se s problemima u ponašanju,

You're looking at things where people are actually given information,

susrest ćete se sa situacijama gdje je ljudima u suštini dana informacija,

and they're not following through with it.

ali oni ne postupaju u skladu s tom informacijom.

It's a problem that manifests itself in diabetes,

To je problem koji se manifestira kod dijabetesa,

obesity, many forms of heart disease,

pretilosti, raznih vrsta srčanih bolesti,

even some forms of cancer -- when you think of smoking.

čak i kod nekih oblika raka -- sjetite se problema pušenja.

Those are all behaviors where people know what they're supposed to do.

To su ponašanja kod kojih ljudi znaju što bi trebali činiti.

They know what they're supposed to be doing,

Znaju što bi trebali raditi

but they're not doing it.

ali to ne rade.

Now behavior change is something

Promjena ponašanja je nešto

that is a long-standing problem in medicine.

što je dugogodišnji problem u medicini.

It goes all the way back to Aristotle.

Počinje još tamo od vremena Aristotela.

And doctors hate it, right?

I liječnici to mrze, zapravo.

I mean, they complain about it all the time.

Mislim, neprekidno se žale na to.

We talk about it in terms of engagement, or non-compliance.

Pričamo o tome u smislu angažmana ili nepridržavanja,

When people don't take their pills,

kada ljudi ne uzimaju svoje tablete,

when people don't follow doctors' orders --

kada se ljudi ne pridržavaju naputaka liječnika.

these are behavior problems.

To su problemi u ponašanju.

But for as much as clinical medicine

No koliko se god klinička medicina

agonizes over behavior change,

muči oko promjene ponašanja,

there's not a lot of work done

nije mnogo napravljeno

in terms of trying to fix that problem.

u smislu pokušaja da se problem doista riješi.

So the crux of it

Dakle srž svega

comes down to this notion of decision-making --

se svodi na ideju donošenja odluke --

giving information to people in a form

pružanja informacija ljudima na način

that doesn't just educate them

da ih ne samo educira

or inform them,

ili informira,

but actually leads them to make better decisions,

već ih doista i navodi na donošenje boljih odluka,

better choices in their lives.

boljeg izbora u njihovim životima.

One part of medicine, though,

Jedan dio medicine se ipak

has faced the problem of behavior change pretty well,

vrlo dobro suočio s problemom promjene ponašanja,

and that's dentistry.

i to je stomatologija.

Dentistry might seem -- and I think it is --

Stomatologija se može činiti -- i mislim da je to tako --

many dentists would have to acknowledge

većina stomatologa treba priznati

it's somewhat of a mundane backwater of medicine.

da su poput zadnje rupe na svirali u medicini.

Not a lot of cool, sexy stuff happening in dentistry.

Ne događa se puno cool, seksi stvari u stomatologiji.

But they have really taken this problem of behavior change

Ali oni su se doista uhvatili ukoštac s problemom promjene ponašanja

and solved it.

i riješili ga.

It's the one great preventive health success

To je jedini veliki uspjeh preventive u zdravstvu

we have in our health care system.

koji imamo u našem zdravstvenom sustavu.

People brush and floss their teeth.

Ljudi peru i čiste zube koncem.

They don't do it as much as they should, but they do it.

Ne rade to koliko bi trebali, ali ipak rade.

So I'm going to talk about one experiment

Pričat ću o jednom eksperimentu

that a few dentists in Connecticut

kojeg je nekoliko stomatologa iz Connecticuta

cooked up about 30 years ago.

provelo prije otprilike 30 godina.

So this is an old experiment, but it's a really good one,

To je stari eksperiment ali stvarno vrlo dobar,

because it was very simple,

jer je jako jednostavan,

so it's an easy story to tell.

pa ga je lako prepričati.

So these Connecticut dentists decided

Dakle ti stomatolozi iz Connecticuta su odlučili

that they wanted to get people to brush their teeth and floss their teeth more often,

da žele navesti ljude da češće peru i čiste zube koncem.

and they were going to use one variable:

I odlučili su koristiti jednu varijablu:

they wanted to scare them.

odlučili su ih prestrašiti.

They wanted to tell them how bad it would be

Odlučili su im reći koliko će biti loše

if they didn't brush and floss their teeth.

ako ne peru i čiste zube koncem.

They had a big patient population.

Imali su veliku populaciju pacijenata.

They divided them up into two groups.

Razdijelili su ih u dvije grupe.

They had a low-fear population,

Imali su populaciju koju nisu strašili,

where they basically gave them a 13-minute presentation,

kojoj su u načelu predstavili prezentaciju od 13 minuta,

all based in science,

temeljenoj na znanstvenim činjenicama,

but told them that, if you didn't brush and floss your teeth,

ali rekli su im da, ako ne peru i ne čiste zube koncem,

you could get gum disease. If you get gum disease, you will lose your teeth,

mogu dobiti bolest desnih. Ako dobiju bolest desnih, izgubit će zube,

but you'll get dentures, and it won't be that bad.

ali dobit će protezu, pa i nije tako strašno.

So that was the low-fear group.

To je bila grupa koju nisu puno strašili.

The high-fear group, they laid it on really thick.

Na grupu koju su primjenjivali strah su se dobrano obrušili.

They showed bloody gums.

Pokazali su im krvave desni,

They showed puss oozing out from between their teeth.

usta koja su krvarila između zuba,

They told them that their teeth were going to fall out.

rekli su im da će im zubi pasti,

They said that they could have infections

rekli su im da mogu dobiti infekcije

that would spread from their jaws to other parts of their bodies,

koje se mogu proširiti od ustiju na druge dijelove tijela,

and ultimately, yes, they would lose their teeth.

i naposljetku će, da, izgubiti zube.

They would get dentures, and if you got dentures,

Dobit će proteze, a ako imate protezu,

you weren't going to be able to eat corn-on-the-cob,

nećete moći jesti kukuruz u klipu,

you weren't going to be able to eat apples,

nećete moći jesti jabuke,

you weren't going to be able to eat steak.

nećete moći pojesti odrezak;

You'll eat mush for the rest of your life.

jest ćete kašastu hranu do kraja života.

So go brush and floss your teeth.

Onda idite oprati i očistiti zube koncem.

That was the message. That was the experiment.

To je bila poruka; to je bio eksperiment.

Now they measured one other variable.

Mjerili su još jednu varijablu.

They wanted to capture one other variable,

Željeli su uzeti u obzir još jednu varijablu,

which was the patients' sense of efficacy.

a to je osjećaj pacijenta za efikasnost.

This was the notion of whether the patients felt

To je utisak o tome jesu li pacijenti osjećali

that they actually would go ahead and brush and floss their teeth.

da bi doista išli oprati zube i očistiti ih koncem.

So they asked them at the beginning,

Na početku su ih pitali,

"Do you think you'll actually be able to stick with this program?"

"Smatrate li da ćete doista biti u mogućnosti držati se programa?"

And the people who said, "Yeah, yeah. I'm pretty good about that,"

Ljudi koji su rekli, "Da, naravno, vrlo sam dobar u tome,"

they were characterized as high efficacy,

su bili okarakterizirani kao visoko efikasni,

and the people who said,

a ljudi koji su rekli,

"Eh, I never get around to brushing and flossing as much as I should,"

"Ah, nikada baš ne perem i čistim zube koncem koliko bih trebao,"

they were characterized as low efficacy.

su bili okarakterizirani kao nisko efikasni.

So the upshot was this.

Ishod je bio ovakav.

The upshot of this experiment

Ishod eksperimenta

was that fear was not really a primary driver

je da strah zapravo nije primarni pobuđivač

of the behavior at all.

ponašanja uopće.

The people who brushed and flossed their teeth

Ljudi koji su prali zube i čistili ih koncem

were not necessarily the people

nisu nužno bili ljudi

who were really scared about what would happen --

koji su bili istinski uplašeni što bi se moglo dogoditi --

it's the people who simply felt that they had the capacity

već su to bili ljudi koji su osjećali da imaju sposobnost

to change their behavior.

promjene svojega ponašanja.

So fear showed up as not really the driver.

Time se strah nije pokazao primarnim poticajem;

It was the sense of efficacy.

već je to bio osjećaj za efikasnost.

So I want to isolate this,

Ja to želim izolirati,

because it was a great observation --

jer je to bilo veliko opažanje --

30 years ago, right, 30 years ago --

prije 30 godina, stvarno, prije 30 godina --

and it's one that's laid fallow in research.

i ono koje je utjecalo na neprovođenje istraživanja.

It was a notion that really came out

Riječ je o ideji koja je proizašla

of Albert Bandura's work,

iz rada Alberta Bandure

who studied whether

koji je istraživao mogu li

people could get a sense of empowerment.

ljudi dobiti osjećaj osnaženja.

The notion of efficacy basically boils down to one -- that

Ideja o efikasnosti se zapravo svodi na činjenicu da li

if somebody believes that they have the capacity to change their behavior.

osoba vjeruje da ima sposobnost promjene svoga ponašanja.

In health care terms, you could characterize this

U terminima zdravstvene skrbi, ovo se može opisati na način

as whether or not somebody feels

da li netko osjeća

that they see a path towards better health,

da vidi put ka boljem zdravlju,

that they can actually see their way towards getting better health,

i da doista može vidjeti taj put prema boljem zdravlju.

and that's a very important notion.

I to je vrlo značajna misao.

It's an amazing notion.

Nevjerojatna misao.

We don't really know how to manipulate it, though, that well.

Zapravo ne znamo kako njome dobro manipulirati.

Except, maybe we do.

Ili, možda i znamo.

So fear doesn't work, right? Fear doesn't work.

Dakle strah ne funkcionira, tako je, strah ne funkcionira.

And this is a great example

I to je izvrstan primjer

of how we haven't learned that lesson at all.

toga kako nismo uopće naučili lekciju.

This is a campaign from the American Diabetes Association.

Ovo je kampanja Američkog udruženja dijabetičara.

This is still the way we're communicating messages about health.

Još uvijek je ovo način na koji komuniciramo o zdravlju.

I mean, I showed my three-year-old this slide last night,

Pokazao sam mom trogodišnjaku sinoć ovaj slajd,

and he's like, "Papa, why is an ambulance in these people's homes?"

i rekao je, "Tata, zašto je ambulanta u kućama ovih ljudi?"

And I had to explain, "They're trying to scare people."

I trebao sam objasniti, "Ovdje su da straše ljude."

And I don't know if it works.

I ne znam da li to funkcionira.

Now here's what does work:

Ali ono što funkcionira je sljedeće,

personalized information works.

personalizirane informacije funkcioniraju.

Again, Bandura recognized this

Bandura je to uočio

years ago, decades ago.

prije više godina, više desetljeća.

When you give people specific information

Kada daš ljudima specifične informacije

about their health, where they stand,

o njihovom zdravlju, u kojoj su situaciji,

and where they want to get to, where they might get to,

i što žele postići, što bi mogli postići,

that path, that notion of a path --

taj put, misao o tom putu,

that tends to work for behavior change.

funkcionira bolje za promjenu ponašanja.

So let me just spool it out a little bit.

Dopustite da vam ovo malo dočaram.

So you start with personalized data, personalized information

Počinjete s personaliziranim podacima, personaliziranim informacijama,

that comes from an individual,

koje se odnose na pojedinca,

and then you need to connect it to their lives.

i trebate ih povezati s njihovim životima.

You need to connect it to their lives,

Trebate ih povezati s njihovim životima,

hopefully not in a fear-based way, but one that they understand.

po mogućnosti ne temeljeći na strahu, nego da mogu razumjeti.

Okay, I know where I sit. I know where I'm situated.

U redu, znam gdje sam. Znam kakva je situacija.

And that doesn't just work for me in terms of abstract numbers --

I to ne funkcionira za mene samo u smislu apstraktnih brojeva,

this overload of health information

preopterećenja zdravstvenim informacijama

that we're inundated with.

kojima smo preplavljeni,

But it actually hits home.

ovo doista pogađa u srž.

It's not just hitting us in our heads; it's hitting us in our hearts.

Ne samo da nam dolazi do glava, dolazi i do srca.

There's an emotional connection to information

Postoji emocionalna povezanost s informacijama

because it's from us.

jer su naše vlastite.

That information then needs to be connected to choices,

Ta informacija treba nadalje biti povezana s izborima,

needs to be connected to a range of options,

treba biti povezana s rasponom opcija,

directions that we might go to --

smjerova kojima možemo krenuti --

trade-offs, benefits.

kompromis, koristi.

Finally, we need to be presented with a clear point of action.

Naposljetku, treba nam se prezentirati jasan smjer kretanja.

We need to connect the information

Trebamo povezati informaciju

always with the action,

s akcijom,

and then that action feeds back

tada iz te akcije proizlazi

into different information,

različita informacija,

and it creates, of course, a feedback loop.

što kreira, naravno, krug povratnih informacija.

Now this is a very well-observed and well-established notion

To je dobro istražena i definirana ideja

for behavior change.

za promjenu ponašanja.

But the problem is that things -- in the upper-right corner there --

Ali problem je što se do stvari u gornjem desnom kutu,

personalized data, it's been pretty hard to come by.

personaliziranih podataka, teško dolazilo.

It's a difficult and expensive commodity,

Riječ je o teškom i skupom dobru,

until now.

do sada.

So I'm going to give you an example, a very simple example of how this works.

Dat ću vam primjer, vrlo jednostavan primjer kako ovo funkcionira.

So we've all seen these. These are the "your speed limit" signs.

Svi smo ovo već vidjeli. Ovo su znakovi "ograničenja brzine".

You've seen them all around,

Vidjeli ste ih posvuda,

especially these days as radars are cheaper.

pogotovo ovih dana kada su radari jeftiniji.

And here's how they work in the feedback loop.

I evo kako funkcioniraju unutar kruga povratnih informacija.

So you start with the personalized data

Započinjete s personaliziranim podacima

where the speed limit on the road that you are at that point

kod kojih je ograničenje brzine na cesti gdje se nalazite u ovome trenutku

is 25,

25 (milja na sat),

and, of course, you're going faster than that.

i, naravno, vi vozite brže od toga.

We always are. We're always going above the speed limit.

Uvijek to činimo. Uvijek idemo iznad ograničenja brzine.

The choice in this case is pretty simple.

Izbor u ovome slučaju je prilično jednostavan.

We either keep going fast, or we slow down.

Ili ćemo nastaviti ići brzo, ili ćemo usporiti.

We should probably slow down,

Vjerojatno bismo trebali usporiti,

and that point of action is probably now.

i trenutak za akciju je vjerojatno sada.

We should take our foot off the pedal right now,

Trebamo maknuti nogu s papučice upravo sada.

and generally we do. These things are shown to be pretty effective

I najčešće to i napravimo; ovo se pokazalo dosta efikasnim

in terms of getting people to slow down.

kod navođenja ljudi da uspore.

They reduce speeds by about five to 10 percent.

Smanje brzinu za otprilike pet do 10 posto.

They last for about five miles,

To traje oko pet milja,

in which case we put our foot back on the pedal.

nakon čega ponovno stavimo nogu na papučicu.

But it works, and it even has some health repercussions.

Ali funkcionira, i čak ima određene zdravstvene posljedice.

Your blood pressure might drop a little bit.

Vaš krvni tlak se može malo smanjiti.

Maybe there's fewer accidents, so there's public health benefits.

Možda ima i manji broj nesreća, što je korisno za opće zdravlje.

But by and large, this is a feedback loop

Ali u načelu, ovo je krug povratnih informacija

that's so nifty and too rare.

koji je izvanredan i vrlo rijedak.

Because in health care, most health care,

Jer u zdravstvu, u većini slučajeva,

the data is very removed from the action.

podaci se otklanjaju od akcije.

It's very difficult to line things up so neatly.

Vrlo je teško tako lijepo stvari staviti u red.

But we have an opportunity.

Ali imamo mogućnost.

So I want to talk about, I want to shift now to think about

Želim govoriti, želim se prebaciti kako bismo razmislili o

how we deliver health information in this country,

tome kako prenosimo informacije u ovoj zemlji,

how we actually get information.

kako zapravo dobivamo informacije.

This is a pharmaceutical ad.

Ovo je farmaceutski oglas.

Actually, it's a spoof. It's not a real pharmaceutical ad.

Zapravo je satira, nije stvarna farmaceutska reklama.

Nobody's had the brilliant idea

Nitko još nije došao do briljantne ideje

of calling their drug Havidol quite yet.

da svoj lijek nazove Havidol.

But it looks completely right.

Ali izgleda u redu, u potpunosti.

So it's exactly the way we get

Ovo je način na koji dobivamo

health information and pharmaceutical information,

informacije o zdravlju i farmaceutske informacije,

and it just sounds perfect.

i zapravo zvuči savršeno.

And then we turn the page of the magazine,

Onda okrenemo stranicu časopisa,

and we see this --

i vidimo ovo, da, vidimo ovo.

now this is the page the FDA requires pharmaceutical companies

Ovo je stranica koju FDA zahtijeva od farmaceutskih kompanija

to put into their ads, or to follow their ads,

da je stave u svoje oglase ili da slijedi oglas.

and to me, this is one of the most cynical exercises in medicine.

Za mene, ovo je ciničan primjer u medicini.

Because we know.

Jer mi znamo.

Who among us would actually say that people read this?

Tko bi među nama doista tvrdio da ljudi ovo čitaju?

And who among us would actually say

I tko bi među nama doista tvrdio

that people who do try to read this

da ljudi koji pokušaju ovo čitati

actually get anything out of it?

stvarno i imaju nešto od toga?

This is a bankrupt effort

Ovo je uzaludni trud

at communicating health information.

u komuniciranju zdravstvenih informacija.

There is no good faith in this.

Nema dobre vjere u ovome.

So this is a different approach.

Ovo je drugačiji pristup.

This is an approach that has been developed

Ovo je pristup kojeg je stvorio

by a couple researchers at Dartmouth Medical School,

jedan par znanstvenika u Dartmouth Medical School,

Lisa Schwartz and Steven Woloshin.

Lisa Schwartz i Steven Woloshin.

And they created this thing called the "drug facts box."

Stvorili su stvar koju su nazvali kutijom liječničkih činjenica.

They took inspiration from, of all things,

Inspiraciju su našli u, između svega,

Cap'n Crunch.

Cap'n Crunch (pahuljice).

They went to the nutritional information box

Gledali su prehrambene informacije na kutiji

and saw that what works for cereal, works for our food,

i vidjeli da ono što vrijedi za pahuljice, vrijedi za našu hranu,

actually helps people understand what's in their food.

zapravo pomaže ljudima da razumiju što je u njihovoj hrani.

God forbid we should use that same standard

Ne daj Bože da koristimo isti standard

that we make Cap'n Crunch live by

korišten kod Cap'n Crunch

and bring it to drug companies.

i prenesemo ga na farmaceutske kompanije.

So let me just walk through this quickly.

Dozvolite da brzo prođem kroz ovo.

It says very clearly what the drug is for, specifically who it is good for,

Jasno stoji zašto se lijek koristi, posebice za koga je koristan,

so you can start to personalize your understanding

pa možete početi personalizirati svoje razumijevanje

of whether the information is relevant to you

je li ta informacija za vas značajna

or whether the drug is relevant to you.

ili je li taj lijek značajan za vas.

You can understand exactly what the benefits are.

Možete u potpunosti shvatiti koje su koristi.

It isn't this kind of vague promise that it's going to work no matter what,

To nije neko nejasno obećanje kako će funkcionirati bez obzira na sve,

but you get the statistics for how effective it is.

već dobijete statistiku koliko je korisno.

And finally, you understand what those choices are.

I naposljetku, razumijete koji su izbori.

You can start to unpack the choices involved

Možete razabrati izbore koji se nude

because of the side effects.

zbog nuspojava.

Every time you take a drug, you're walking into a possible side effect.

Svaki put kada uzmete lijek, postoji mogućnost nuspojave.

So it spells those out in very clean terms,

One su navedene ovdje na vrlo jasan način.

and that works.

I to funkcionira.

So I love this. I love that drug facts box.

Volim ovo. Volim kutiju liječničkih informacija.

And so I was thinking about,

I tako sam razmišljao o tome,

what's an opportunity that I could have

kakvu priliku ja mogu imati

to help people understand information?

da pomognem ljudima u razumijevanju informacija?

What's another latent body of information that's out there

Koje su još skrivene informacije tamo negdje

that people are really not putting to use?

koje ljudi ne koriste.

And so I came up with this: lab test results.

I došao sam do ovoga: rezultati laboratorijskih testova.

Blood test results are this great source of information.

Rezultati krvnih testova su izvrstan izvor informacija.

They're packed with information.

Puni su informacija.

They're just not for us. They're not for people. They're not for patients.

Jedino što nisu za nas; nisu za ljude; nisu za pacijente.

They go right to doctors.

Idu odmah ka liječnicima.

And God forbid -- I think many doctors, if you really asked them,

I ne daj Bože -- mislim da puno liječnika, da ih pitate,

they don't really understand all this stuff either.

zapravo ne razumiju sve te stvari.

This is the worst presented information.

Ovo su najgore prezentirane informacije.

You ask Tufte, and he would say,

Pitajte Tuftea i rekao bi,

"Yes, this is the absolute worst presentation of information possible."

"Da, ovo je najgora moguća prezentacija informacija."

What we did at Wired

Ono što smo mi napravili u Wiredu,

was we went, and I got our graphic design department

je da smo krenuli i tražio sam od našeg odjela za grafički dizajn

to re-imagine these lab reports.

da nanovo predstave ta laboratorijska izvješća.

So that's what I want to walk you through.

To vam želim pokazati.

So this is the general blood work before,

Ovo je uobičajen izvještaj krvi prije,

and this is the after, this is what we came up with.

a ovo je poslije, ovo smo osmislili.

The after takes what was four pages --

Ovaj poslije uzima ono sa četiri stranice --

that previous slide was actually

onaj prijašnji slajd je zapravo

the first of four pages of data

prva od četiri stranice podataka

that's just the general blood work.

što je ustvari uobičajen izvještaj krvnih rezultata.

It goes on and on and on, all these values, all these numbers you don't know.

Nastavlja se sve dalje i dalje, sve te vrijednosti, ti brojevi koje ne znate.

This is our one-page summary.

Ovo je sažetak na jednoj stranici.

We use the notion of color.

Koristimo načelo boje.

It's an amazing notion that color could be used.

Prekrasno načelo mogućnosti korištenja boje.

So on the top-level you have your overall results,

Na gornjem dijelu imate ukupne rezultate,

the things that might jump out at you from the fine print.

stvari koje mogu iskočiti iz cjeline izvješća.

Then you can drill down

Onda možete prijeći na detalje

and understand how actually we put your level in context,

i razumjeti kako zapravo stavljamo vašu situaciju u kontekst,

and we use color to illustrate

i koristimo boju da ilustriramo

exactly where your value falls.

točno gdje su vaše vrijednosti.

In this case, this patient is slightly at risk of diabetes

U ovome slučaju, pacijent ima mali rizik od dijabetesa

because of their glucose level.

zbog razine glukoze.

Likewise, you can go over your lipids

Također, možete pogledati lipide

and, again, understand what your overall cholesterol level is

i, ponovno, shvatiti kolika je opća razina kolesterola

and then break down into the HDL and the LDL if you so choose.

i razdijeliti ga na HDL i LDL ako tako odaberete.

But again, always using color

No ponovno, uvijek koristeći boju

and personalized proximity

i personaliziranu blizinu

to that information.

tih informacija.

All those other values,

Sve ove druge vrijednosti,

all those pages and pages of values that are full of nothing,

sve te stranice i stranice vrijednosti koje ništa ne označavaju,

we summarize.

mi sažimamo.

We tell you that you're okay, you're normal.

Mi kažemo da si dobro, da si normalan.

But you don't have to wade through it. You don't have to go through the junk.

Ne trebaš gaziti kroz to. Ne trebaš prelaziti kroz smeće.

And then we do two other very important things

Još činimo dvije vrlo važne stvari

that kind of help fill in this feedback loop:

koje pomažu upotpuniti ovaj krug povratnih informacija.

we help people understand in a little more detail

Pomažemo ljudima u detaljnijem razumijevanju

what these values are and what they might indicate.

što su ove vrijednosti i na što mogu ukazivati.

And then we go a further step -- we tell them what they can do.

Tada idemo i korak dalje: kažemo im što mogu napraviti.

We give them some insight

Pružamo im uvid

into what choices they can make, what actions they can take.

u izbore koje mogu uzeti, koje akcije mogu poduzeti.

So that's our general blood work test.

Dakle ovo je naš opći krvni test.

Then we went to CRP test.

Uzeli smo i CRP test.

In this case, it's a sin of omission.

U ovome slučaju, riječ je o grijehu izostavljanja.

They have this huge amount of space,

Ovdje imaju ogromnu količinu prostora,

and they don't use it for anything, so we do.

i ne koriste je za ništa, dok smo mi to učinili.

Now the CRP test is often done

CRP test se često provodi

following a cholesterol test,

nakon testiranja kolesterola,

or in conjunction with a cholesterol test.

ili zajedno s testom razine kolesterola.

So we take the bold step

Mi smo učinili odvažan korak

of putting the cholesterol information on the same page,

stavljanja informacija o kolesterolu na istu stranicu,

which is the way the doctor is going to evaluate it.

što je i način na koji će liječnik napraviti procjenu.

So we thought the patient might actually want to know the context as well.

Mi smo pomislili da bi pacijent želio znati i kontekst.

It's a protein that shows up

To je protein koji pokazuje

when your blood vessels might be inflamed,

kada su vaše krvne žile možda začepljene,

which might be a risk for heart disease.

što može biti rizik za bolest srca.

What you're actually measuring

Ono što zapravo mjerite

is spelled out in clean language.

je detaljno objašnjeno jasnim jezikom.

Then we use the information

Onda koristimo informacije

that's already in the lab report.

koje su već u laboratorijskom izvješću.

We use the person's age and their gender

Uzimamo dob i spol osobe

to start to fill in the personalized risks.

kako bismo upotpunili personalizirani rizik.

So we start to use the data we have

Započinjemo korištenjem podataka koje imamo

to run a very simple calculation

za provedbu vrlo jednostavnog izračuna

that's on all sorts of online calculators

koji je na svim vrstama online kalkulatora

to get a sense of what the actual risk is.

kako bi se dobio osjećaj o tome koliki je stvarni rizik.

The last one I'll show you is a PSA test.

Zadnje što ću vam pokazati je PSA test.

Here's the before, and here's the after.

Ovo je prije a ovo je kasnije.

Now a lot of our effort on this one --

Većina našeg truda kod ovoga --

as many of you probably know,

kao što većina vas vjerojatno zna

a PSA test is a very controversial test.

PSA test je vrlo kontroverzan test.

It's used to test for prostate cancer,

Koristi se za testiranje raka prostate,

but there are all sorts of reasons

ali mnogo je razloga

why your prostate might be enlarged.

zbog kojih prostata može biti povećana.

And so we spent a good deal of our time

I utrošili smo dosta vremena kako bismo

indicating that.

ukazali na to.

We again personalized the risks.

Ponovno smo personalizirali rizik.

So this patient is in their 50s,

Ovaj pacijent je u svojim 50-ima,

so we can actually give them a very precise estimate

i možemo dati vrlo preciznu procjenu

of what their risk for prostate cancer is.

koliki je rizik raka prostate.

In this case it's about 25 percent, based on that.

U ovome je slučaju oko 25%, temeljeno na ovome.

And then again, the follow-up actions.

I ponovno, akcije koje slijede.

So our cost for this was less than 10,000 dollars, all right.

Naš trošak za ovo je manji od $10.000.

That's what Wired magazine spent on this.

Toliko je časopis Wired potrošio na ovo.

Why is Wired magazine doing this?

Zašto časopis Wired to radi?

(Laughter)

(Smijeh)

Quest Diagnostics and LabCorp,

Quest Diagnostics i LabCorp,

the two largest lab testing companies --

dvije najveće kompanije laboratorijskog testiranja:

last year, they made profits of over 700 million dollars

Prošle godine, ostvarile su profit od preko 700 milijuna dolara

and over 500 million dollars respectively.

odnosno preko 500 milijuna dolara.

Now this is not a problem of resources;

Prema tome, ovo nije problem resursa,

this is a problem of incentives.

ovo je problem poticaja.

We need to recognize that the target of this information

Trebamo shvatiti da ciljna skupina ovih informacija

should not be the doctor, should not be the insurance company.

ne bi smjeli biti liječnici, ne bi smjele biti osiguravajuće kompanije;

It should be the patient.

trebali bi biti pacijenti.

It's the person who actually, in the end,

Riječ je o osobi koja će zapravo, na kraju,

is going to be having to change their lives

promijeniti svoj život

and then start adopting new behaviors.

i početi usvajati nova ponašanja.

This is information that is incredibly powerful.

To je nevjerojatno moćna informacija.

It's an incredibly powerful catalyst to change.

To je nevjerojatno snažan katalizator promjene.

But we're not using it. It's just sitting there.

Ali mi ga ne koristimo; samo stoji tamo.

It's being lost.

Izgubljen.

So I want to just offer four questions

Želim predložiti četiri pitanja

that every patient should ask,

koja bi svaki pacijent trebao postaviti,

because I don't actually expect people

jer ne očekujem zapravo da ljudi

to start developing these lab test reports.

počinju razvijati ova laboratorijska izvješća.

But you can create your own feedback loop.

Ali možete kreirati svoj vlastiti krug povratnih informacija.

Anybody can create their feedback loop by asking these simple questions:

Svatko može kreirati svoj krug povratnih informacija postavljanjem ovih jednostavnih pitanja:

Can I have my results?

Mogu li dobiti svoje rezultate?

And the only acceptable answer is --

I jedini prihvatljivi odgovor je --

(Audience: Yes.) -- yes.

(Auditorij: Da.) -- da.

What does this mean? Help me understand what the data is.

Što to znači? Pomozite mi da razumijem što znače ovi podaci.

What are my options? What choices are now on the table?

Koje su moje mogućnosti? Kakav izbor imam na raspolaganju?

And then, what's next?

I onda, što je sljedeće?

How do I integrate this information

Kako da uključim ovu informaciju

into the longer course of my life?

u budući tijek svoga života?

So I want to wind up by just showing

Želim zaključiti na način da pokažem

that people have the capacity to understand this information.

kako ljudi imaju kapacitet razumijevanja ovih informacija.

This is not beyond the grasp of ordinary people.

To nije izvan dometa običnih ljudi.

You do not need to have the education level of people in this room.

Ne trebate imati razinu obrazovanja ljudi u ovoj prostoriji.

Ordinary people are capable of understanding this information,

Obični ljudi su u stanju razumjeti informaciju,

if we only go to the effort of presenting it to them

samo ako mi imamo želje da je njima prezentiramo

in a form that they can engage with.

na način da se oni njome zaokupe.

And engagement is essential here,

Angažman je ovdje ključan,

because it's not just giving them information;

jer to nije samo pružanje informacije,

it's giving them an opportunity to act.

već davanja prilike za akcijom.

That's what engagement is. It's different from compliance.

To znači angažman; različito je od pridržavanja.

It works totally different from the way we talk about behavior

Funkcionira potpuno drugačije od načina na koji mi razgovaramo o ponašanju

in medicine today.

u medicini danas.

And this information is out there.

I ta informacija je negdje vani.

I've been talking today about latent information,

Danas sam govorio o skrivenim informacijama,

all this information that exists in the system

svim tim informacijama koje postoje u sustavu

that we're not putting to use.

a koje ne koristimo.

But there are all sorts of other bodies of information

Ali postoji i puno drugih vrsta informacija

that are coming online,

koje dolaze online.

and we need to recognize the capacity of this information

Mi trebamo prepoznati sposobnost tih informacija

to engage people, to help people

da uključimo ljude, da im pomognemo

and to change the course of their lives.

u promjeni tijeka njihovih života.

Thank you very much.

Puno vam hvala.

(Applause)

(Pljesak)