Why Medicine Often Has Dangerous Side Effects for Women | Alyson McGregor | TED Talks

Prevoditelj: Anja Kolobarić Recezent: Ivan Stamenković

We all go to doctors.

Svi mi idemo doktorima,

And we do so with trust and blind faith

i to s povjerenjem i slijepo vjerujući

that the test they are ordering and the medications they're prescribing

da su pretrage na koje nas šalju i lijekovi koje nam prepisuju

are based upon evidence --

utemeljeni na dokazima -

evidence that's designed to help us.

dokazima koji su zamišljeni s ciljem da nam pomognu.

However, the reality is that that hasn't always been the case for everyone.

No, to nije uvijek bilo tako za sve.

What if I told you

Što kad bih vam rekla

that the medical science discovered over the past century

da je zdravstvena znanost otkrivena tijekom prošlog stoljeća

has been based on only half the population?

temeljena na samo polovici populacije?

I'm an emergency medicine doctor.

Ja sam liječnik hitne pomoći.

I was trained to be prepared in a medical emergency.

Obučena sam za nošenje s hitnim slučajevima.

It's about saving lives. How cool is that?

Spašavanje života je najvažnije. Nije li to cool?

OK, there's a lot of runny noses and stubbed toes,

Dobro, ima tu i puno prehlada i udarenih nožnih prstiju,

but no matter who walks through the door to the ER,

ali bez obzira na to tko prolazi kroz vrata do sobe za pružanje hitne pomoći,

we order the same tests,

pošaljemo ih na iste pretrage,

we prescribe the same medication,

prepišemo im iste lijekove

without ever thinking about the sex or gender of our patients.

ne razmišljajući o spolu i rodu naših pacijenata.

Why would we?

Zašto bismo?

We were never taught that there were any differences between men and women.

Nikad nas nisu učili da postoje ikakve razlike između muškaraca i žena.

A recent Government Accountability study revealed that 80 percent of the drugs

Nedavno istraživanje o odgovornosti Vlade otkrilo je da je 80 % lijekova

withdrawn from the market

maknuto s tržišta

are due to side effects on women.

jer je izazivalo određene nuspojave kod žena.

So let's think about that for a minute.

Razmislimo o tome na trenutak.

Why are we discovering side effects on women

Zašto nuspojave kod žena otkrivamo

only after a drug has been released to the market?

tek nakon što je lijek pušten u prodaju?

Do you know that it takes years for a drug to go from an idea

Znate li da su potrebne godine da se lijek pretvori iz ideje

to being tested on cells in a laboratory,

u nešto što se testira na stanicama u laboratoriju,

to animal studies,

kasnije na životinjama,

to then clinical trials on humans,

pa se rade klinička ispitivanja na ljudima

finally to go through a regulatory approval process,

sve dok se ne dođe do postupka odobravanja

to be available for your doctor to prescribe to you?

kako bi vam ga vaš liječnik mogao prepisati?

Not to mention the millions and billions of dollars of funding

A da ne spominjemo milijune i milijarde dolara uloženih

it takes to go through that process.

u sam proces.

So why are we discovering unacceptable side effects

Zašto onda neželjene nuspojave otkrivamo

on half the population after that has gone through?

na polovici populacije nakon što je lijek prošao sve to?

What's happening?

Što se događa?

Well, it turns out that those cells used in that laboratory,

Ispostavilo se da su stanice korištene u laboratoriju

they're male cells,

zapravo muške stanice,

and the animals used in the animal studies were male animals,

a životinje na kojima se lijek testirao također su mužjaci,

and the clinical trials have been performed almost exclusively on men.

a klinička ispitivanja provode se gotovo isključivo na muškarcima.

How is it that the male model became our framework for medical research?

Kako to da nam je muškarac postao okvir rada za medicinska istraživanja?

Let's look at an example that has been popularized in the media,

Proučimo primjer populariziran u medijima.

and it has to do with the sleep aid Ambien.

a vezan je uz Ambien, lijek za spavanje.

Ambien was released on the market over 20 years ago,

Ambien se na tržištu pojavio prije više od 20 godina,

and since then, hundreds of millions of prescriptions have been written,

a otada je pacijentima prepisan stotine milijuna puta,

primarily to women, because women suffer more sleep disorders than men.

najčešće ženama jer žene češće pate od poremećaja spavanja od muškaraca.

But just this past year,

No, prošle godine

the Food and Drug Administration recommended cutting the dose in half

FDA je preporučila da se njegovo doziranje prepolovi

for women only,

samo za žene

because they just realized that women metabolize the drug

jer su shvatili da žene sporije probavljaju lijek

at a slower rate than men,

od muškaraca,

causing them to wake up in the morning

zbog čega se one ujutro probude

with more of the active drug in their system.

s više aktivne droge u organizmu

And then they're drowsy and they're getting behind the wheel of the car,

pa postanu pospane, sjednu za volan

and they're at risk for motor vehicle accidents.

i riskiraju izazivanje prometnih nesreća.

And I can't help but think, as an emergency physician,

Kao liječnica prve pomoći, ne mogu ne pomisliti

how many of my patients that I've cared for over the years

koliko je mojih pacijenata koje sam liječila tijekom godina

were involved in a motor vehicle accident

sudjelovalo u automobilskoj nesreći

that possibly could have been prevented

koja se mogla spriječiti

if this type of analysis was performed and acted upon 20 years ago

da se ovakva analiza provela i da su se ti zaključci primijenili prije 20 godina

when this drug was first released.

kad se ovaj lijek tek pojavio na tržištu.

How many other things need to be analyzed by gender?

Koje se još stvari trebaju analizirati po spolovima?

What else are we missing?

Što nam je još promaklo?

World War II changed a lot of things,

Drugi svjetski rat promijenio je puno toga,

and one of them was this need to protect people

a jedna od tih stvari bila je potreba za zaštitom ljudi

from becoming victims of medical research without informed consent.

od toga da budu žrtve medicinskih istraživanja bez informiranog pristanka.

So some much-needed guidelines or rules were set into place,

Postavljene su neke nužne smjernice i pravila,

and part of that was this desire to protect women of childbearing age

a dio toga bila je ta želja da se zaštiti žene koje su u reprodukcijskoj dobi

from entering into any medical research studies.

od sudjelovanja u bilo kakvim medicinskim istraživanjima.

There was fear: what if something happened to the fetus during the study?

Strahovalo se od toga da se fetusu nešto ne dogodi tijekom istraživanja.

Who would be responsible?

Tko bi bio odgovoran?

And so the scientists at this time actually thought

Znanstvenici su u to vrijeme zaista mislili

this was a blessing in disguise,

da je to bila sreća u nesreći

because let's face it -- men's bodies are pretty homogeneous.

jer su tijela muškaraca prilično homogena.

They don't have the constantly fluctuating levels of hormones

Nemaju stalne promjene u razinama hormona

that could disrupt clean data they could get if they had only men.

koje bi ometale čiste podatke koje su dobivali istraživanjima s muškarcima.

It was easier. It was cheaper.

Bilo je lakše, jeftinije,

Not to mention, at this time, there was a general assumption

a da ni ne pričamo o tome kako se vjerovalo

that men and women were alike in every way,

da su muškarci i žene potpuno isti u svakom pogledu,

apart from their reproductive organs and sex hormones.

osim njihovih reproduktivnih organa i spolnih hormona.

So it was decided:

Donesena je odluka:

medical research was performed on men,

medicinska istraživanja provodila su se na muškarcima,

and the results were later applied to women.

a njihovi rezultati kasnije su primijenjeni na žene.

What did this do to the notion of women's health?

Što je to učinilo za žensko zdravlje?

Women's health became synonymous with reproduction:

Žensko zdravlje postalo je sinonim za reprodukciju:

breasts, ovaries, uterus, pregnancy.

grudi, jajnici, maternica, trudnoća.

It's this term we now refer to as "bikini medicine."

To je pojam koji sada nazivamo medicinom bikini-zone,

And this stayed this way until about the 1980s,

a tako je i ostalo do 1980-ih

when this concept was challenged by the medical community

kad je taj koncept pokušalo osporiti medicinsko društvo

and by the public health policymakers when they realized that

i tvorci zdravstvene politike kad su shvatili

by excluding women from all medical research studies

da smo ženama, isključivši ih iz formalnih medicinskih istraživanjima,

we actually did them a disservice,

učinili medvjeđu uslugu

in that apart from reproductive issues,

jer se osim reproduktivnih pitanja

virtually nothing was known about the unique needs

gotovo ništa nije znalo o jedinstvenim potrebama

of the female patient.

pacijentica.

Since that time, an overwhelming amount of evidence has come to light

Otada je ogromna količina dokaza izašla na vidjelo

that shows us just how different men and women are in every way.

koji pokazuju kako su muškarci i žene potpuno drugačiji.

You know, we have this saying in medicine:

U medicini koristimo ovu izreku:

children are not just little adults.

djeca nisu samo odrasli u malom.

And we say that to remind ourselves

To si govorimo da se podsjetimo

that children actually have a different physiology than normal adults.

da djeca zapravo imaju drugačiju fiziologiju od normalnih odraslih ljudi.

And it's because of this that the medical specialty of pediatrics came to light.

Zbog toga se rodila pedijatrija.

And we now conduct research on children in order to improve their lives.

Sad možemo provoditi istraživanja na djeci kako bismo im poboljšali živote.

And I know the same thing can be said about women.

Isto se može reći i za žene.

Women are not just men with boobs and tubes.

Žene nisu samo muškarci s grudima i jajovodom -

But they have their own anatomy and physiology

one imaju vlastitu anatomiju i fiziologiju

that deserves to be studied with the same intensity.

koja zaslužuje biti proučavana istim intenzitetom.

Let's take the cardiovascular system, for example.

Npr. promotrimo kardiovaskularni sustav.

This area in medicine has done the most to try to figure out

Ovo područje medicine potrudilo se saznati

why it seems men and women have completely different heart attacks.

zašto muškarci i žene doživljavaju potpuno različite srčane udare.

Heart disease is the number one killer for both men and women,

Bolesti srca vodeći su uzročnik smrti i muškaraca i žena,

but more women die within the first year of having a heart attack than men.

ali više žena umire tijekom godine dana nakon doživljenog srčanog udara.

Men will complain of crushing chest pain --

Muškarci se žale na teške bolove u prsima -

an elephant is sitting on their chest.

kao da im slon sjedi na prsima.

And we call this typical.

To je za njih tipično.

Women have chest pain, too.

I žene pate od bolova u prsima,

But more women than men will complain of "just not feeling right,"

ali žene se žale na to da se "jednostavno ne osjećaju dobro",

"can't seem to get enough air in,"

"nemaju dovoljno zraka u plućima",

"just so tired lately."

"u zadnje vrijeme su umorne".

And for some reason we call this atypical,

Iz nekog razloga to je netipično

even though, as I mentioned, women do make up half the population.

iako, kao što već spomenuh, žene čine polovicu populacije.

And so what is some of the evidence to help explain some of these differences?

Kojim dokazima možemo objasniti neke od ovih razlika?

If we look at the anatomy,

Promotrimo anatomiju:

the blood vessels that surround the heart are smaller in women compared to men,

krvne žile koje okružuju srce kod žena su manje nego kod muškaraca,

and the way that those blood vessels develop disease is different

a drugačiji je i način na koji te krvne žile razvijaju bolesti

in women compared to men.

kod žena i muškaraca.

And the test that we use to determine if someone is at risk for a heart attack,

Test kojim ispitujemo prijeti li nekome opasnost od srčanog udara

well, they were initially designed and tested and perfected in men,

osmišljen je, ispitan i usavršen na muškarcima,

and so aren't as good at determining that in women.

stoga nije toliko dobar u utvrđivanju opasnosti kod žena.

And then if we think about the medications --

Zatim lijekovi -

common medications that we use, like aspirin.

uobičajeni lijekovi koje koristimo, lijekovi poput aspirina.

We give aspirin to healthy men to help prevent them from having a heart attack,

Aspirin dajemo zdravim muškarcima u svrhu prevencije srčanog udara,

but do you know that if you give aspirin to a healthy woman,

ali jeste li znali da ukoliko aspirin date zdravoj ženi,

it's actually harmful?

to zapravo može biti štetno?

What this is doing is merely telling us

To nam govori

that we are scratching the surface.

da smo tek zagrebali ispod površine.

Emergency medicine is a fast-paced business.

Medicina prve pomoći ubrzan je posao.

In how many life-saving areas of medicine,

U koliko područja medicine koji se bave spašavanjem života,

like cancer and stroke,

poput raka i moždanog udara,

are there important differences between men and women that we could be utilizing?

postoje važne razlike između muškaraca i žena koje bismo mogli koristiti?

Or even, why is it that some people get those runny noses

Ili zašto nekim ljudima curi nos

more than others,

više nego drugima

or why the pain medication that we give to those stubbed toes

ili zašto lijekovi protiv bolova koje dajemo za udarene nožne prste

work in some and not in others?

na neke djeluje, a na druge ne djeluju?

The Institute of Medicine has said every cell has a sex.

Institut medicine tvrdi da svaka stanica ima spol.

What does this mean?

Što to znači?

Sex is DNA.

Spol je DNK.

Gender is how someone presents themselves in society.

Rod je način na koji se netko predstavlja u društvu,

And these two may not always match up,

a to dvoje ne podudara se baš uvijek,

as we can see with our transgendered population.

kao što možemo primijetiti kod transrodnih pojedinaca.

But it's important to realize that from the moment of conception,

Kako bilo, važno je shvatiti da od trenutka začeća

every cell in our bodies --

svaka stanica u našim tijelima -

skin, hair, heart and lungs --

koža, kosa, srce i pluća -

contains our own unique DNA,

sadrži naš jedinstveni DNK,

and that DNA contains the chromosomes that determine

a taj DNK sadrži kromosome koji određuju

whether we become male or female, man or woman.

hoćemo li postati muško ili žensko, muškarac ili žena.

It used to be thought

Nekoć se smatralo

that those sex-determining chromosomes pictured here --

da ti kromosomi koji određuju spol i koji su prikazani ovdje -

XY if you're male, XX if you're female --

XY za muškarca, XX za ženu -

merely determined whether you would be born with ovaries or testes,

samo određuju hoćete li se roditi s jajnicima ili s testisima,

and it was the sex hormones that those organs produced

a spolni hormoni koje su ti organi proizvodili

that were responsible for the differences we see in the opposite sex.

odgovorni su za razlike koje vidimo na suprotnom spolu.

But we now know that that theory was wrong --

Sad znamo da je ta teorija bila pogrešna -

or it's at least a little incomplete.

ili barem da je bila nepotpuna.

And thankfully, scientists like Dr. Page from the Whitehead Institute,

Srećom, znanstvenici poput dr. Pagea s Instituta Whitehead

who works on the Y chromosome,

koji radi na kromosomu Y

and Doctor Yang from UCLA,

i dr. Yang sa Sveučilišta u Kaliforniji

they have found evidence that tells us that those sex-determining chromosomes

pronašli su dokaze koji nam pokazuju da ti kromosomi koji određuju spol,

that are in every cell in our bodies

a koji se nalaze u svakoj stanici našeg tijela,

continue to remain active for our entire lives

ostaju aktivni tijekom cijelih naših života

and could be what's responsible for the differences we see

i mogli bi biti odgovorni za razlike koje vidimo

in the dosing of drugs,

kod doziranja lijekova

or why there are differences between men and women

ili zašto postoje razlike između muškaraca i žena

in the susceptibility and severity of diseases.

u podložnosti i ozbiljnosti pojedine bolesti.

This new knowledge is the game-changer,

To novostečeno znanje mijenja sve,

and it's up to those scientists that continue to find that evidence,

a na znanstvenicima, koji još uvijek pronalaze takve dokaze,

but it's up to the clinicians to start translating this data

ali i na liječnicima je da počnu proučavati te podatke

at the bedside, today.

prije spavanja - još danas.

Right now.

Odmah.

And to help do this, I'm a co-founder of a national organization

Kako bih im u tome pomogla, suosnovala sam državnu organizaciju

called Sex and Gender Women's Health Collaborative,

"Spol i rod - suradnja za žensko zdravlje"

and we collect all of this data so that it's available for teaching

i prikupljamo sve te podatke kako bi bilo dostupno za poučavanje

and for patient care.

i brigu o pacijentima.

And we're working to bring together the medical educators to the table.

Radimo na tome da okupimo profesore medicine.

That's a big job.

Velik je to posao

It's changing the way medical training has been done since its inception.

koji mijenja način na koji se provodi medicinska obuka još od njezinih začetaka.

But I believe in them.

No, ja vjerujem u njih.

I know they're going to see the value of incorporating the gender lens

Znam da će oni uvidjeti važnost uključivanja i uvažavanja spola

into the current curriculum.

u trenutni kurikulum.

It's about training the future health care providers correctly.

Radi se o pravilnom obučavanju budućih zdravstvenih djelatnika.

And regionally,

Regionalno

I'm a co-creator of a division within the Department of Emergency Medicine

ja sam sukreatorica odsjeka unutar Odjela za prvu pomoć

here at Brown University,

na Sveučilištu Brown

called Sex and Gender in Emergency Medicine,

pod nazivom "Spol i rod u medicini prve pomoći"

and we conduct the research to determine the differences between men and women

i provodimo istraživanje kako bismo utvrdili razlike između muškaraca i žena

in emergent conditions,

u hitnim stanjima

like heart disease and stroke and sepsis and substance abuse,

poput bolesti srca, moždanog udara, sepse i zlouporabe droga,

but we also believe that education is paramount.

ali također vjerujemo da su odgoj i obrazovanje najvažniji.

We've created a 360-degree model of education.

Stvorili smo model odgoja i obrazovanja od 360 stupnjeva.

We have programs for the doctors, for the nurses, for the students

Imamo programe za liječnike, za medicinske sestre, za studente

and for the patients.

i za pacijente

Because this cannot just be left up to the health care leaders.

jer ovo ne smije biti prepušteno samo zdravstvenim djelatnicima.

We all have a role in making a difference.

Svi imamo ulogu u stvaranju promjena,

But I must warn you: this is not easy.

ali moram vas upozoriti da nije lako.

In fact, it's hard.

Štoviše, teško je.

It's essentially changing the way we think about medicine

U biti se radi o mijenjanju načina na koji razmišljamo o medicini,

and health and research.

zdravlju i istraživanjima.

It's changing our relationship to the health care system.

To će promijeniti naš odnos prema zdravstvenom sustavu,

But there's no going back.

ali nema povratka.

We now know just enough

Znamo tek toliko

to know that we weren't doing it right.

da smo svjesni toga da smo nešto radili krivo.

Martin Luther King, Jr. has said,

Martin Luther King je rekao:

"Change does not roll in on the wheels of inevitability,

"Promjena ne dolazi na krilima neizbježnosti,

but comes through continuous struggle."

već kroz neprestanu borbu."

And the first step towards change is awareness.

Prvi korak prema promjeni jest svijest

This is not just about improving medical care for women.

koja se ne tiče samo poboljšavanja zdravstvene skrbi za žene,

This is about personalized, individualized health care for everyone.

već se tiče i individualiziranije, osobnije zdravstvene skrbi za sve.

This awareness has the power to transform medical care for men and women.

Ta svijest može promijeniti zdravstvenu skrb za muškarce i žene.

And from now on, I want you to ask your doctors

Odsada pa nadalje želim da pitate svoje liječnike

whether the treatments you are receiving are specific to your sex and gender.

je li terapija koju dobivate prilagođena vašem spolu i rodu.

They may not know the answer --

Možda vam neće znati odgovoriti na to pitanje -

yet.

bar ne još.

But the conversation has begun, and together we can all learn.

Dijalog je počeo, a zajedno svi možemo učiti.

Remember, for me and my colleagues in this field,

Zapamtite da je meni i mojim kolegama na ovom području

your sex and gender matter.

vaš spol i rod važan.

Thank you.

Hvala vam.

(Applause)

(Pljesak)