Ramanan Laxminarayan: The coming crisis in antibiotics

Prevoditelj: Katarina Licht Recezent: Ivan Stamenković

The first patient to ever be treated with an antibiotic

Prvi pacijent liječen antibioticima

was a policeman in Oxford.

bio je policajac u Oxfordu.

On his day off from work,

Na njegov slobodan dan,

he was scratched by a rose thorn while working in the garden.

ogrebao se o trn ruže radeći u vrtu.

That small scratch became infected.

Ta je mala ogrebotina postala inficirana.

Over the next few days, his head was swollen

Tijekom sljedećih dana, glava mu je natekla

with abscesses,

od gnojnih čireva

and in fact his eye was so infected

i oko mu je bilo toliko inficirano

that they had to take it out,

da su mu ga morali izvaditi.

and by February of 1941,

Do kraja veljače 1941. godine,

this poor man was on the verge of dying.

ovaj je jadni čovjek bio na rubu smrti.

He was at Radcliffe Infirmary in Oxford,

Nalazio se u Radcliffe ambulanti u Oxfordu

and fortunately for him,

i, na njegovu sreću,

a small team of doctors

mali tim liječnika

led by a Dr. Howard Florey

predvođen doktorom Howardom Floreyem

had managed to synthesize

uspio je sintetizirati

a very small amount of penicillin,

veoma malu količinu penicilina,

a drug that had been discovered

lijeka kojeg je otkrio

12 years before by Alexander Fleming

Alexander Fleming 12 godina prije,

but had never actually been used to treat a human,

ali nikada nije primijenjen na čovjeka

and indeed no one even knew if the drug would work,

i nitko nije znao hoće li lijek djelovati,

if it was full of impurities that would kill the patient,

sadrži li nečistoće koje bi mogle ubiti pacijenta,

but Florey and his team figured

ali su Florey i njegov tim shvatili

if they had to use it, they might as well use it

da ako već moraju, mogli bi ga upotrijebiti

on someone who was going to die anyway.

na nekome tko će svakako umrijeti.

So they gave Albert Alexander,

Tako su Albertu Alexanderu,

this Oxford policeman, the drug,

oxfordskom policajcu, dali lijek

and within 24 hours,

i unutar 24 sata,

he started getting better.

počeo se oporavljati.

His fever went down, his appetite came back.

Spustila mu se temperatura, vratio mu se apetit.

Second day, he was doing much better.

Drugog mu je dana bilo puno bolje.

They were starting to run out of penicillin,

Počelo im je nedostajati penicilina

so what they would do was run with his urine

pa bi trčali s njegovim urinom

across the road to re-synthesize the penicillin from his urine

preko ceste, kako bi resintetizirali penicilin iz njegova urina

and give it back to him,

i ponovno mu ga dali,

and that worked.

i to je uspijevalo.

Day four, well on the way to recovery.

Četvrti je dan bio na dobrom putu oporavka.

This was a miracle.

To je bilo čudo.

Day five, they ran out of penicillin,

Peti dan su ostali bez penicilina

and the poor man died.

i siroti je čovjek preminuo.

So that story didn't end that well,

Tako da ta priča nije završila baš lijepo,

but fortunately for millions of other people,

ali, na sreću milijuna drugih ljudi,

like this child who was treated again in the early 1940s,

kao ovog djeteta liječenog u ranim 1940-ima,

who was again dying of a sepsis,

koje je umiralo od sepse

and within just six days, you can see,

i koje se u samo šest dana, kao što možete vidjeti,

recovered thanks to this wonder drug, penicillin.

oporavilo zahvaljujući ovom čudesnom lijeku, penicilinu.

Millions have lived,

Milijuni su preživjeli

and global health has been transformed.

i globalno zdravstvo se transformiralo.

Now, antibiotics have been used

Antibiotici su se koristili

for patients like this,

za pacijente poput ovih,

but they've also been used rather frivolously

ali korišteni su i veoma neozbiljno

in some instances,

u nekim slučajevima,

for treating someone with just a cold or the flu,

za liječenje samo prehlade ili gripe,

which they might not have responded to an antibiotic,

koje ne bi reagirale na antibiotik.

and they've also been used in large quantities

Također su korišteni u velikim količinama

sub-therapeutically, which means in small concentrations,

ne-terapeutski, odnosno u malim koncentracijama

to make chicken and hogs grow faster.

za brži rast pilića i svinja.

Just to save a few pennies on the price of meat,

Samo kako bi smanjili cijenu mesa za nekoliko penija,

we've spent a lot of antibiotics on animals,

potrošili smo mnogo antibiotika na životinje,

not for treatment, not for sick animals,

ne za liječenje, ne za bolesne životinje,

but primarily for growth promotion.

već prvenstveno za potpomognut rast.

Now, what did that lead us to?

Kamo nas je to dovelo sada?

Basically, the massive use of antibiotics

U osnovi, masivna upotreba antibiotika

around the world

diljem svijeta

has imposed such large selection pressure on bacteria

nametnula je tako veliki selektivni pritisak na bakterije

that resistance is now a problem,

da je sada otpornost postala problem

because we've now selected for just

jer su opstale samo

the resistant bacteria.

rezistentne bakterije.

And I'm sure you've all read about this in the newspapers,

Siguran sam da ste svi čitali o ovome u novinama,

you've seen this in every magazine

da ste vidjeli ovo u svakom časopisu

that you come across,

na koji ste naišli,

but I really want you to appreciate

ali stvarno želim da u potpunosti shvatite

the significance of this problem.

važnost ovog problema

This is serious.

Ovo je ozbiljno.

The next slide I'm about to show you is of carbapenem resistance in acinetobacter.

Sljedeći dijapozitiv prikazuje otpornost acinetobactera na karbapenem.

Acinetobacter is a nasty hospital bug,

Acinetobacter je gadna bolnička bakterija,

and carbapenem is pretty much

i karbapenem je poprilično

the strongest class of antibiotics

najjača vrsta antibiotika

that we can throw at this bug.

kojom možemo napasti ovu bakteriju.

And you can see in 1999

Možete vidjeti da je u 1999.

this is the pattern of resistance,

ovo bio uzorak otpornosti.

mostly under about 10 percent across the United States.

većinom ispod 10 posto širom Sjedinjenih Država.

Now watch what happens when we play the video.

Sada pogledajte što se događa kada pokrenemo video.

So I don't know where you live,

Ne znam gdje živite,

but wherever it is, it certainly is a lot worse now

ali gdjegod to bilo, zasigurno je puno gore sada

than it was in 1999,

nego što je bilo 1999. godine.

and that is the problem of antibiotic resistance.

To je problem s otpornošću na antibiotike.

It's a global issue

Ovo je globalno pitanje

affecting both rich and poor countries,

koji jednako pogađa i bogate i siromašne zemlje,

and at the heart of it, you might say, well,

i u njegovoj srži, mogli biste pitati

isn't this really just a medical issue?

nije li to zapravo samo medicinski problem?

If we taught doctors how not to use antibiotics as much,

Ako bismo naučili doktore ne koristiti antibiotike toliko,

if we taught patients how not to demand antibiotics,

ako bismo naučili pacijente ne zahtijevati antibiotike,

perhaps this really wouldn't be an issue,

možda ovo zapravo ne bi bio problem

and maybe the pharmaceutical companies

i možda bi farmaceutske kompanije

should be working harder to develop

trebale više raditi na razvoju

more antibiotics.

više antibiotika.

Now, it turns out that there's something fundamental about antibiotics

No, ispada da postoji nešto fundamentalno u vezi s antibioticima

which makes it different from other drugs,

što ih razlikuje od drugih lijekova,

which is that if I misuse antibiotics

a to je da ako ja zloupotrijebim antibiotike

or I use antibiotics,

ili ako koristim antibiotike,

not only am I affected but others are affected as well,

nisam samo ja pogođen, već su i drugi ljudi pogođeni

in the same way as if I choose to drive to work

na isti način kao da odlučim odvesti se na posao

or take a plane to go somewhere,

ili otići negdje avionom,

that the costs I impose on others

troškovi koje nametnem drugima

through global climate change go everywhere,

kroz globalne klimatske promjene prisutni su svugdje

and I don't necessarily take these costs into consideration.

i ja ne uzimam, nužno, te troškove u obzir.

This is what economists might call a problem of the commons,

Ovo je ono što bi ekonomisti mogli nazvati problemom zajednice,

and the problem of the commons is exactly

i problem zajednice je točno

what we face in the case of antibiotics as well:

ono s čim se suočavamo i u slučaju antibiotika:

that we don't consider —

da ne uzimamo u obzir —

and we, including individuals, patients,

i mi, uključujući pojedince, pacijente,

hospitals, entire health systems —

bolnice, čitav zdravstveni sustav —

do not consider the costs that they impose on others

ne uzimamo u obzir troškove koje oni nameću drugima

by the way antibiotics are actually used.

načinom na koji su antibiotici zapravo korišteni.

Now, that's a problem that's similar

Ovaj je problem sličan

to another area that we all know about,

drugome području za koje svi znamo,

which is of fuel use and energy,

a to je upotreba goriva i energije,

and of course energy use

i naravno, upotreba energije

both depletes energy as well as

i iscrpljuje energiju kao što i

leads to local pollution and climate change.

vodi do lokalnog zagađenja i klimatskih promjena.

And typically, in the case of energy,

I tipično, u slučaju energije,

there are two ways in which you can deal with the problem.

postoje dva načina na koja se može nositi s problemom.

One is, we can make better use of the oil that we have,

Jedan je da bolje koristimo naftu koju imamo,

and that's analogous to making better use

što je analogno boljoj upotrebi

of existing antibiotics,

postojećih antibiotika,

and we can do this in a number of ways

a to možemo učiniti na brojne načine

that we'll talk about in a second,

o kojima ćemo pričati ubrzo,

but the other option is the "drill, baby, drill" option,

dok je druga opcija poticanje traženja novih naftnih bušotina,

which in the case of antibiotics is to go find new antibiotics.

odnosno, u slučaju antibiotika, traženje novih antibiotika.

Now, these are not separate.

Ovo dva načina nisu odvojena.

They're related, because if we invest heavily

Povezani su, jer ako mnogo ulažemo

in new oil wells,

u nove naftne bušotine,

we reduce the incentives for conservation of oil

smanjujemo poticaje za očuvanje nafte

in the same way that's going to happen for antibiotics.

i to će se na isti način dogoditi s antibioticima.

The reverse is also going to happen, which is that

Događa se i obrnuto,

if we use our antibiotics appropriately,

ako prigodno koristimo naše antibiotike,

we don't necessarily have to make the investments

ne moramo nužno ulagati

in new drug development.

u razvoj novih lijekova.

And if you thought that these two were entirely,

Ako ste mislili da je ovo dvoje u cjelosti,

fully balanced between these two options,

potpuno balansirano između ove dvije opcije,

you might consider the fact that

mogli bi razmotriti činjenicu da

this is really a game that we're playing.

je ovo zapravo igra koju igramo.

The game is really one of coevolution,

To je zapravo igra koevolucije,

and coevolution is, in this particular picture,

a koevolucija je, na ovoj slici,

between cheetahs and gazelles.

između geparda i gazela.

Cheetahs have evolved to run faster,

Gepardi su evoluirali tako da trče brže,

because if they didn't run faster,

jer da ne trče brže

they wouldn't get any lunch.

ne bi imali što jesti za ručak.

Gazelles have evolved to run faster because

Gazele su evoluirale da trče brže jer

if they don't run faster, they would be lunch.

ako ne bi trčale brže, one bi postale ručak.

Now, this is the game we're playing against the bacteria,

To je igra koju mi igramo protiv bakterija,

except we're not the cheetahs,

samo što mi nismo gepardi,

we're the gazelles,

mi smo gazele,

and the bacteria would,

i bakterija bi,

just in the course of this little talk,

samo za vrijeme ovog kratkog govora,

would have had kids and grandkids

dobila djecu i unuke,

and figured out how to be resistant

i shvatila kako biti rezistentna

just by selection and trial and error,

samo putem selekcije te probom i pogreškom,

trying it over and over again.

pokušavajući neprestano iznova.

Whereas how do we stay ahead of the bacteria?

S obzirom na to, kako ostati ispred bakterija?

We have drug discovery processes,

Imamo procese otkrivanja lijekova,

screening molecules,

provjeravanje molekula,

we have clinical trials,

imamo klinička ispitivanja,

and then, when we think we have a drug,

i onda kada mislimo da imamo lijek,

then we have the FDA regulatory process.

onda imamo regulatorni proces Uprave za hranu i lijekove.

And once we go through all of that,

Nakon što prođemo kroz to sve,

then we try to stay one step ahead

onda pokušavamo ostati korak ispred

of the bacteria.

bakterija.

Now, this is clearly not a game that can be sustained,

Jasno je da je ovo igra koja ne može biti održana,

or one that we can win

ili koja se može pobijediti

by simply innovating to stay ahead.

samo inovacijama kako biti u prednosti.

We've got to slow the pace of coevolution down,

Moramo usporiti tempo koevolucije,

and there are ideas that we can borrow from energy

i postoje ideje koje možemo posuditi od energije

that are helpful in thinking about

i koje su od pomoći kada razmišljamo

how we might want to do this in the case

kako bi to mogli napraviti u slučaju

of antibiotics as well.

antibiotika, također.

Now, if you think about how we deal with

Ako razmislite kako se nosimo s

energy pricing, for instance,

cijenom energije, na primjer,

we consider emissions taxes,

uzimamo u obzir porez na emisije,

which means we're imposing the costs of pollution

što znači da namećemo trošak zagađenja

on people who actually use that energy.

ljudima koji zapravo koriste tu energiju.

We might consider doing that for antibiotics as well,

Mogli bi razmotriti da isto učinimo s antibioticima,

and perhaps that would make sure that antibiotics

i možda bi to osiguralo da se antibiotici

actually get used appropriately.

zapravo umjesno koriste.

There are clean energy subsidies,

Postoje subvencije za čistu energiju,

which are to switch to fuels which don't pollute as much

koja koristi goriva koja ne zagađuju toliko

or perhaps don't need fossil fuels.

ili možda ne treba fosilna goriva.

Now, the analogy here is, perhaps we need

Analogija je slijedeća: možda se trebamo

to move away from using antibiotics,

udaljiti od upotrebe antibiotika,

and if you think about it, what are good substitutes for antibiotics?

i ako razmislite o tome, koje su dobre zamjene za antibiotike?

Well, turns out that anything that reduces

Izgleda da bi bilo što što smanjuje

the need for the antibiotic would really work,

potrebu za antibioticima stvarno funkcioniralo,

so that could include improving hospital infection control

tako da bi to moglo uključivati bolju kontrolu bolničkih infekcija

or vaccinating people,

ili cijepljenje ljudi,

particularly against the seasonal influenza.

pogotovo protiv sezonske gripe.

And the seasonal flu is probably

Sezonska je, gripa vjerojatno,

the biggest driver of antibiotic use,

najveći pokretač upotrebe antibiotika,

both in this country as well as in many other countries,

kako u ovoj zemlji, tako i u mnogim drugim zemljama,

and that could really help.

i to bi stvarno moglo pomoći.

A third option might include something like tradeable permits.

Treća bi opcija mogla uključiti nešto poput razmjenjivih kvota.

And these seem like faraway scenarios,

Ovo se može činiti kao daleki scenarij,

but if you consider the fact that we might not

ali ako razmotrimo činjenicu da možda

have antibiotics for many people who have infections,

nećemo imati antibiotika za mnoge ljude s infekcijama,

we might consider the fact that we might

mogli bi uzeti u obzir činjenicu da bi možda

want to allocate who actually gets to use

željeli raspodijeliti tko bi trebao zapravo korisiti

some of these antibiotics over others,

neke od tih antibiotika od drugih,

and some of these might have to be on the basis of clinical need,

i to bi mogli biti na bazi kliničke potrebe

but also on the basis of pricing.

ali i na bazi cijene.

And certainly consumer education works.

Zasigurno i educiranje potrošača pomaže.

Very often, people overuse antibiotics

Veoma često, ljudi previše koriste antibiotike

or prescribe too much without necessarily

ili previše propisuju bez da, nužno,

knowing that they do so,

znaju da to rade

and feedback mechanisms

pa su se mehanizmi koji daju podatke o rezultatima

have been found to be useful,

pokazali korisnima,

both on energy —

također, i na energiji-

When you tell someone that they're using

kada kažete nekome da troši

a lot of energy during peak hour,

puno energije tijekom špice,

they tend to cut back,

skloni su smanjiti potrošnju,

and the same sort of example has been performed

i isti je primjer izveden

even in the case of antibiotics.

i u slučaju antibiotika.

A hospital in St. Louis basically would put up

Bolnica u St. Louisu bi, u biti, postavila

on a chart the names of surgeons

na tablu imena kirurga

in the ordering of how much antibiotics they'd used

poredana po tome koliko su antibiotika koristili

in the previous month,

u prethodnom mjesecu,

and this was purely an informational feedback,

i to je čisto bila povratna informacija,

there was no shaming,

nije bilo nikakvog posramljivanja,

but essentially that provided some information back

nego je, u osnovi, pružilo neke informacije

to surgeons that maybe they could rethink

kirurzima i možda ih potaklo da razmisle

how they were using antibiotics.

kako koriste antibiotike.

Now, there's a lot that can be done

Također je mnogo toga moguće napraviti

on the supply side as well.

s aspekta opskrbe.

If you look at the price of penicillin,

Ako pogledate cijenu penicilina,

the cost per day is about 10 cents.

trošak po danu iznosi oko 10 centa.

It's a fairly cheap drug.

To je relativno jeftin lijek.

If you take drugs that have been introduced since then —

Ako uzmete lijekove otkrivene od tada-

linezolid or daptomycin —

linezolid ili daptomicin-

those are significantly more expensive,

oni su značajno skuplji,

so to a world that has been used to paying 10 cents a day for antibiotics,

tako da se svijetu naviknutom plaćati 10 centi po danu za antibiotike,

the idea of paying 180 dollars per day

ideja plaćanja 180 dolara po danu

seems like a lot.

čini puno.

But what is that really telling us?

No, što nam to zapravo govori?

That price is telling us

Cijena nam govori

that we should no longer

da više ne bi trebali

take cheap, effective antibiotics as a given

uzimati jeftine, učinkovite antibiotike zdravo za gotovo

into the foreseeable future,

u doglednoj budućnosti,

and that price is a signal to us

i cijena nam je signal

that perhaps we need to be paying

da bi možda trebali obraćati

much more attention to conservation.

puno više pažnje očuvanju.

That price is also a signal

Cijena je, također, signal

that maybe we need to start looking at other technologies,

da bi možda trebali početi gledati na druge tehnologije,

in the same way that gasoline prices are a signal

na isti način na koji su cijene benzina signal

and an impetus, to, say,

i pokretna sila za, na primjer,

the development of electric cars.

razvoj električnih auta.

Prices are important signals

Cijene su važan signal

and we need to pay attention,

i moramo obratiti pozornost,

but we also need to consider the fact that

ali, isto tako moramo u obzir uzeti činjenicu da

although these high prices seem unusual for antibiotics,

iako se ove visoke cijene čine neobičnima za antibiotike,

they're nothing compared to the price per day

zanemarive su u usporedbi s dnevnim cijenama

of some cancer drugs,

nekih lijekova za rak,

which might save a patient's life only for a few months or perhaps a year,

koji mogu spasiti pacijentov život samo za nekoliko mjeseci ili možda godinu,

whereas antibiotics would potentially

dok bi antibiotici, potencijalno,

save a patient's life forever.

spasili pacijentov život zauvijek.

So this is going to involve

Tako da će ovo uključivati

a whole new paradigm shift,

potpuno novi preokret u pristupu,

and it's also a scary shift because

to je, također, zastrašujuć preokret jer

in many parts of this country,

u mnogim djelovima ove zemlje,

in many parts of the world,

u mnogim djelovima svijeta,

the idea of paying 200 dollars

ideja plaćanja 200 dolara

for a day of antibiotic treatment

za dan liječenja antibioticima

is simply unimaginable.

je jednostavno nezamisliva.

So we need to think about that.

Trebamo razmisliti o tome.

Now, there are backstop options,

Postoje opcije zaštitne mreže,

which is other alternative technologies

odnosno, druge alternativne tehnologije

that people are working on.

na kojima ljudi rade.

It includes bacteriophages, probiotics,

One uključuju bakteriofage, probiotike,

quorum sensing, synbiotics.

međustanična komunikacija, sinbiotici.

Now, all of these are useful avenues to pursue,

Sve su to korisni putevi koje treba istražiti

and they will become even more lucrative

i postati će još unosniji

when the price of new antibiotics starts going higher,

kada cijena novih antibiotika počne rasti,

and we've seen that the market does actually respond,

a vidjeli smo da tržište odgovara,

and the government is now considering

i vlada sada razmatra

ways of subsidizing new antibiotics and development.

načine poticanja razvoja novih antibiotika.

But there are challenges here.

Ali tu postoje izazovi.

We don't want to just throw money at a problem.

Ne želimo samo bacati novac.

What we want to be able to do

Želimo biti u mogućnosti

is invest in new antibiotics

uložiti u novi antibiotik

in ways that actually encourage

na načine da zapravo ohrabrimo

appropriate use and sales of those antibiotics,

umjesnu upotrebu i prodaju tih antibiotika,

and that really is the challenge here.

a upravo je to izazov.

Now, going back to these technologies,

Vraćajući se na te tehnologije,

you all remember the line from that famous

svi ćete se prisjetiti rečenice iz onog poznatog

dinosaur film, "Nature will find a way."

filma o dinosaurima: "Priroda će pronaći put."

So it's not as if these are permanent solutions.

Tako da ovo nisu trajna rješenja.

We really have to remember that, whatever the technology might be,

Stvarno to moramo zapamtiti, kakva god tehnologija bila,

that nature will find some way to work around it.

priroda će naći način kako ju izbjeći.

You might think, well, this is just a problem

Mogli bi pomisliti da je ovo problem

just with antibiotics and with bacteria,

samo sa antibioticima i bakterijama,

but it turns out that we have the exact same

ali ispostavilo se da imamo točno isti,

identical problem in many other fields as well,

identični problem i u mnogim drugim područjima,

with multidrug-resistant tuberculosis,

s tuberkulozom otpornom na više lijekova,

which is a serious problem in India and South Africa.

što je ozbiljan problem u Indiji i Južnoj Africi.

Thousands of patients are dying because

Tisuće pacijenata umire jer

the second-line drugs are so expensive,

su zamjenski lijekovi toliko skupi,

and in some instances, even those don't work

a, u nekim slučajevima, ni oni ne djeluju

and you have XDR TB.

i imate ekstremno otpornu tuberkulozu.

Viruses are becoming resistant.

Virusi postaju rezistentni.

Agricultural pests. Malaria parasites.

Poljoprivredni štetnici. Paraziti malarije.

Right now, much of the world depends on

Trenutno, veliki dio svijeta ovisi o

one drug, artemisinin drugs,

jednom lijeku, artemisininima,

essentially to treat malaria.

za liječenje malarije.

Resistance to artemisinin has already emerged,

Otpornost na artemisinin se već pojavila

and if this were to become widespread,

i ako ona postane široko rasprostranjena,

that puts at risk

riskiramo

the single drug that we have to treat malaria around the world

jedini lijek koji imamo za liječenje malarije širom svijeta

in a way that's currently safe and efficacious.

na siguran i efikasan način.

Mosquitos develop resistance.

Komarci razvijaju otpornost.

If you have kids, you probably know about head lice,

Ako imate djecu, vjerojatno znate za uši,

and if you're from New York City,

a ako ste iz New Yorka,

I understand that the specialty there is bedbugs.

znam da su tamo specijalnost stjenice.

So those are also resistant.

One su također rezistentne.

And we have to bring an example from across the pond.

Moramo proučiti i primjer preko bare.

Turns out that rats are also resistant to poisons.

Ispada da su i štakori otporni na otrove.

Now, what's common to all of these things is

Ono što je zajedničko svim ovim stvarima je

the idea that we've had these technologies

da smo imali ove tehnologije

to control nature only for the last 70, 80 or 100 years

za kontrolu prirode samo za proteklih 70, 80 ili 100 godina

and essentially in a blink,

i u trenutku

we have squandered our ability to control,

smo potratili našu mogućnost kontrole,

because we have not recognized

jer nismo prepoznali da će

that natural selection and evolution was going to find

prirodna selekcija i evolucija pronaći

a way to get back,

način da se osveti,

and we need to completely rethink

i moramo potpuno promisliti

how we're going to use

kako ćemo koristiti

measures to control biological organisms,

mjere za kontrolu bioloških organizama,

and rethink how we incentivize

i promisliti kako ćemo poticati

the development, introduction,

razvoj, uvođenje,

in the case of antibiotics prescription,

u slučaju propisivanja antibiotika

and use of these valuable resources.

i korištenje vrijednih resursa.

And we really now need to start thinking about them

I sada stvarno trebamo početi razmišljati o njima

as natural resources.

kao o prirodnim resursima.

And so we stand at a crossroads.

I tako stojimo na raskrižju.

An option is to go through that rethinking

Opcija je proći kroz ta razmišljanja

and carefully consider incentives

i pažljivo razmotriti poticaje

to change how we do business.

kako bi promijenili način poslovanja.

The alternative is

Alternativa je

a world in which even a blade of grass

svijet u kojem je čak i vlat trave

is a potentially lethal weapon.

potencijalno smrtonosno oružje.

Thank you.

Hvala.

(Applause)

(Pljesak)