Peter Attia: What if we're wrong about diabetes?

Translator: Joseph Geni Reviewer: Morton Bast

Prevodilac: Maja Budišin Lukin Lektor: Tatjana Jevdjic

I'll never forget that day

Nikada neću zaboraviti taj dan,

back in the spring of 2006.

u proleće 2006.

I was a surgical resident

Bio sam hirurg na specijalizaciji

at The Johns Hopkins Hospital,

u Džons Hopkins bolnici

taking emergency call.

i primao sam hitne pozive.

I got paged by the E.R. around 2 in the morning

Oko 2h ujutro pozvali su me pejdžerom u hitnu pomoć

to come and see a woman with a diabetic ulcer

da pogledam ženu sa dijabetesnim čirom

on her foot.

na stopalu.

I can still remember sort of that smell of rotting flesh

Još uvek se sećam neke vrste smrada trulog mesa

as I pulled the curtain back to see her.

kada sam razgrnuo zavesu da je vidim.

And everybody there agreed this woman was very sick

Svi su se složili da je žena bila teško bolesna

and she needed to be in the hospital.

i da treba da je u bolnici.

That wasn't being asked.

To nije bilo pitanje.

The question that was being asked of me was a different one,

Pitanje koje su mi postavili bilo je drukčije,

which was, did she also need an amputation?

da li joj je potrebna amputacija?

Now, looking back on that night,

Kada se prisetim te noći,

I'd love so desperately to believe that I treated that woman

očajnički bih voleo da sam postupao s tom ženom

on that night with the same empathy and compassion

te noći s jednakom empatijom i samilošću

I'd shown the 27-year-old newlywed

koje sam ispoljio prema 27-godišnjoj mladoj,

who came to the E.R. three nights earlier

koja je došla u hitnu pomoć tri noći ranije

with lower back pain

s bolom u donjem delu leđa,

that turned out to be advanced pancreatic cancer.

što se ispostavilo da je rak pankreasa u poodmakloj fazi.

In her case, I knew there was nothing I could do

U njenom slučaju sam znao da ništa ne mogu da uradim

that was actually going to save her life.

što bi moglo da joj spase život.

The cancer was too advanced.

Rak je previše napredovao.

But I was committed to making sure that

Međutim, posvetio sam se svemu

I could do anything possible to make her stay

što sam mogao da joj olakšam boravak.

more comfortable. I brought her a warm blanket

Doneo sam joj toplo ćebe

and a cup of a coffee.

i šolju kafe.

I brought some for her parents.

Doneo sam i njenim roditeljima.

But more importantly, see, I passed no judgment on her,

Ali, važnije od toga je bilo da je nisam osuđivao

because obviously she had done nothing

jer očigledno nije bila kriva

to bring this on herself.

za to što joj se desilo.

So why was it that, just a few nights later,

Pa zašto sam, nekoliko noći kasnije

as I stood in that same E.R. and determined

u toj istoj hitnoj pomoći, odlučan

that my diabetic patient did indeed need an amputation,

da je pacijentkinji s dijabetesom potrebna amputacija,

why did I hold her in such bitter contempt?

zašto sam osetio prema njoj gorki prezir?

You see, unlike the woman the night before,

Vidite, za razliku od žene u noći pre,

this woman had type 2 diabetes.

ova žena je imala dijabetes tipa 2.

She was fat.

Bila je debela.

And we all know that's from eating too much

Svi znamo da je to zato što se previše jede

and not exercising enough, right?

i nedovoljno vežba, zar ne?

I mean, how hard can it be?

Pa, koliko teško to može da bude?

As I looked down at her in the bed, I thought to myself,

Kada sam je pogledao, pomislio sam

if you just tried caring even a little bit,

da ste se samo malo potrudili,

you wouldn't be in this situation at this moment

ne biste bili sada u ovoj situaciji

with some doctor you've never met

da lekar, koga nikada pre niste sreli

about to amputate your foot.

odlučuje o amputaciji vašeg stopala.

Why did I feel justified in judging her?

Zašto sam smatrao opravdanim da je osuđujem?

I'd like to say I don't know.

Želeo bih reći da ne znam.

But I actually do.

Međutim, znam.

You see, in the hubris of my youth,

Znate, u svojoj oholoj mladosti

I thought I had her all figured out.

mislio sam da sam je pročitao.

She ate too much. She got unlucky.

Jela je previše. Nije imala sreće.

She got diabetes. Case closed.

Dobila je dijabetes. Slučaj je završen.

Ironically, at that time in my life,

Ironijom slučaja u to vreme sam

I was also doing cancer research,

baš radio na istraživanju raka,

immune-based therapies for melanoma, to be specific,

preciznije, na imunskim terapijama kod melanoma

and in that world I was actually taught to question everything,

i tu sam se zapravo učio da dovodim u pitanje sve,

to challenge all assumptions

da osporavam sve pretpostavke

and hold them to the highest possible scientific standards.

u skladu sa najvišim mogućim naučnim standardima.

Yet when it came to a disease like diabetes

Pa ipak, kada se radilo o bolestima kao što je dijabetes

that kills Americans eight times more frequently than melanoma,

koji ubija Amerikance 8 puta češće od melanoma,

I never once questioned the conventional wisdom.

nisam nijednom doveo u pitanje konvencionalnu mudrost.

I actually just assumed the pathologic sequence of events

U stvari samo sam prihvatao patološki redosled događaja

was settled science.

koji se u nauci ustalio.

Three years later, I found out how wrong I was.

Tri godine kasnije otkrio sam koliko grešim.

But this time, I was the patient.

Ali ovoga puta pacijent sam bio ja.

Despite exercising three or four hours every single day,

Uprkos svakodnevnom, 3-4 satnom vežbanju

and following the food pyramid to the letter,

i doslovnom pridržavanju piramide pravilne ishrane,

I'd gained a lot of weight and developed something

ugojio sam se previše i razvio nešto

called metabolic syndrome.

što se naziva metabolički sindrom.

Some of you may have heard of this.

Neki od vas su možda čuli za to.

I had become insulin-resistant.

Postao sam otporan na insulin.

You can think of insulin as this master hormone

Zamislite insulin kao glavni hormon

that controls what our body does with the foods we eat,

koji kontroliše šta će naše telo uraditi s hranom koju pojedemo,

whether we burn it or store it.

da li će je sagoreti ili skladištiti.

This is called fuel partitioning in the lingo.

U žargonu se to naziva podela goriva.

Now failure to produce enough insulin is incompatible with life.

Nemogućnost da se proizvede dovoljno insulina je nespojiva sa životom.

And insulin resistance, as its name suggests,

Insulinska rezistencija, kao što naziv sugeriše

is when your cells get increasingly resistant

znači da vaše ćelije postaju sve otpornije

to the effect of insulin trying to do its job.

na uticaj insulina koji pokušava da obavi svoj posao.

Once you're insulin-resistant,

Kada postanete otporni na insulin

you're on your way to getting diabetes,

tada ste na putu dobijanja dijabetesa,

which is what happens when your pancreas

što znači da vaš pankreas

can't keep up with the resistance and make enough insulin.

ne izdržava otpor na insulin i ne stvara ga dovoljno.

Now your blood sugar levels start to rise,

Tada vaš šećer u krvi raste

and an entire cascade of pathologic events

i cela kaskada patoloških procesa

sort of spirals out of control that can lead to heart disease,

se nadovezuje nekontrolisano, što može dovesti do bolesti srca,

cancer, even Alzheimer's disease,

raka, čak do Alchajmerove bolesti

and amputations, just like that woman a few years earlier.

i amputacije, baš kao kod te žene pre nekoliko godina.

With that scare, I got busy changing my diet radically,

U tom strahu, radikalno sam promenio svoju ishranu,

adding and subtracting things most of you would find

dodavanjem i oduzimanjem namirnica za koje bi većina od vas smatrala

almost assuredly shocking.

skoro sigurno, šokantnim.

I did this and lost 40 pounds, weirdly while exercising less.

Na taj način sam izgubio oko 18 kg, za čudo s manje vežbanja.

I, as you can see, I guess I'm not overweight anymore.

Kao što možete videti, pretpostavljam, nisam više pretežak.

More importantly, I don't have insulin resistance.

Mnogo važnije je da nisam otporan na insulin.

But most important, I was left

Ali najvažnije je da su mi ostala

with these three burning questions that wouldn't go away:

ova tri goruća pitanja:

How did this happen to me if I was supposedly

kako mi se to moglo dogoditi kada sam

doing everything right?

radio sve kako treba?

If the conventional wisdom about nutrition had failed me,

Ako me je konvencionalna mudrost o ishrani zavarala,

was it possible it was failing someone else?

da li je moguće da zavara i nekog drugog?

And underlying these questions,

Proučavajući ta pitanja,

I became almost maniacally obsessed

postao sam skoro manijački opsednut

in trying to understand the real relationship

u pokušaju razumevanja stvarne veze

between obesity and insulin resistance.

između gojaznosti i insulinske rezistencije.

Now, most researchers believe obesity

Većina istraživača veruje da je gojaznost

is the cause of insulin resistance.

uzrok insulinske rezistencije.

Logically, then, if you want to treat insulin resistance,

Logično je u tom slučaju da ako želite da lečite insulinsku rezistenciju,

you get people to lose weight, right?

tražite od ljudi da izgube kilažu, zar ne?

You treat the obesity.

Lečite gojaznost.

But what if we have it backwards?

Ali šta ako je obrnuto?

What if obesity isn't the cause of insulin resistance at all?

Šta ako gojaznost uopšte nije uzrok insulinske rezistencije?

In fact, what if it's a symptom of a much deeper problem,

U stvari, šta ako je simptom mnogo dubljeg problema,

the tip of a proverbial iceberg?

ako je vrh ledenog brega?

I know it sounds crazy because we're obviously in the midst

Znam da zvuči ludo jer smo očito u sredini

of an obesity epidemic, but hear me out.

epidemije gojaznosti, ali saslušajte šta ću reći.

What if obesity is a coping mechanism

Šta ako je gojaznost sposobnost adaptacije

for a far more sinister problem going on

na daleko opasniji problem

underneath the cell?

koji se odvija na nivou ćelije?

I'm not suggesting that obesity is benign,

Ne sugerišem da je gojaznost benigna,

but what I am suggesting is it may be the lesser

već da može biti manje zlo

of two metabolic evils.

od dva metabolička zla.

You can think of insulin resistance as the reduced capacity

Zamislite da je insulinska rezistencija naš smanjen

of our cells to partition fuel,

kapacitet da podelimo gorivo,

as I alluded to a moment ago,

na šta sam aludirao ranije,

taking those calories that we take in

pri čemu unesene kalorije

and burning some appropriately and storing some appropriately.

na odgovarajući način sagorevaju i tvore zalihe.

When we become insulin-resistant,

Kada postanemo otporni na insulin,

the homeostasis in that balance deviates from this state.

homeostaza je u tom stanju narušena.

So now, when insulin says to a cell,

Tako da sada, kada insulin naloži ćeliji

I want you to burn more energy

da sagori više energije

than the cell considers safe, the cell, in effect, says,

nego što je sigurno za ćeliju, ćelija odgovara:

"No thanks, I'd actually rather store this energy."

"Ne, hvala, radije bih sačuvala tu energiju."

And because fat cells are actually missing most of

Pošto masnim ćelijama nedostaje većina

the complex cellular machinery found in other cells,

složene ćelijske mašinerije koja postoji u drugim ćelijama,

it's probably the safest place to store it.

one su verovatno najsigurnije mesto za skladištenje.

So for many of us, about 75 million Americans,

Dakle za mnoge od nas, oko 75 miliona Amerikanaca,

the appropriate response to insulin resistance

odgovarajući odgovor na insulinsku rezistenciju

may actually be to store it as fat, not the reverse,

može biti u skladištenju masti, a ne obratno

getting insulin resistance in response to getting fat.

da je insulinska rezistencija odgovor na gojaznost.

This is a really subtle distinction,

Ovo je zaista suptilna razlika,

but the implication could be profound.

ali implikacije mogu biti duboke.

Consider the following analogy:

Razmotrite sledeću analogiju:

Think of the bruise you get on your shin

pomislite na modricu na cevanici

when you inadvertently bang your leg into the coffee table.

kada slučajno udarite nogu o stočić za kafu.

Sure, the bruise hurts like hell, and you almost certainly

Naravno, modrica pakleno boli i skoro sigurno

don't like the discolored look, but we all know

vam se ne sviđa njen izgled, ali svi znamo

the bruise per Se is not the problem.

da modrice, same po sebi, nisu problem.

In fact, it's the opposite. It's a healthy response to the trauma,

U stvari je suprotno. To je zdrav odgovor na povredu,

all of those immune cells rushing to the site of the injury

sve te imunološke ćelije žure na mesto povrede

to salvage cellular debris and prevent the spread

da spasu ćelijske ostatke i spreče širenje

of infection to elsewhere in the body.

infekcije u telu.

Now, imagine we thought bruises were the problem,

Sada zamislite da smo mislili da su modrice problem

and we evolved a giant medical establishment

i da smo razvili gigantske medicinske strukture

and a culture around treating bruises:

i kulturu oko lečenja modrica:

masking creams, painkillers, you name it,

maskirne kreme, lekove protiv bolova, itd,

all the while ignoring the fact that people

sve vreme ignorišući činjenicu da ljudi

are still banging their shins into coffee tables.

i dalje udaraju cevanice o stočić za kafu.

How much better would we be if we treated the cause --

Koliko bi nam bilo bolje kada bismo lečili uzrok -

telling people to pay attention

govoreći ljudima da obrate pažnju

when they walk through the living room --

kada prolaze kroz dnevnu sobu -

rather than the effect?

umesto lečenja posledice?

Getting the cause and the effect right

Pravilna postavka o uzroku i posledici

makes all the difference in the world.

poboljšava sve na svetu.

Getting it wrong, and the pharmaceutical industry

Pogrešna postavka i farmaceutska industrija

can still do very well for its shareholders

i dalje će dobro funkcionisati za svoje akcionare,

but nothing improves for the people with bruised shins.

ali ništa se neće poboljšati ljudima s modricom na cevanici.

Cause and effect.

Uzrok i posledica.

So what I'm suggesting is

Dakle, ono što sugerišem

maybe we have the cause and effect wrong

je da smo možda pobrkali uzrok i posledicu

on obesity and insulin resistance.

kod gojaznosti i insulinske rezistencije.

Maybe we should be asking ourselves,

Možda bi trebalo da se upitamo,

is it possible that insulin resistance causes weight gain

da li je moguće da insulinska rezistencija dovodi do povećanja telesne težine

and the diseases associated with obesity,

i do bolesti povezane s gojaznošću

at least in most people?

bar kod većine ljudi?

What if being obese is just a metabolic response

Šta ako je gojaznost samo odgovor metabolizma

to something much more threatening,

na daleko veću pretnju,

an underlying epidemic,

skrivenu epidemiju,

the one we ought to be worried about?

zbog koje bi trebalo da se zabrinemo?

Let's look at some suggestive facts.

Pogledajmo neke sugestivne činjenice.

We know that 30 million obese Americans

Znamo da 30 miliona gojaznih Amerikanaca

in the United States don't have insulin resistance.

u SAD nemaju insulinsku rezistenciju.

And by the way, they don't appear to be at any

I usput, ne izgleda da su

greater risk of disease than lean people.

pod većim rizikom obolevanja od mršavih ljudi.

Conversely, we know that six million lean people

Nasuprot tome, znamo da je 6 miliona mršavih ljudi

in the United States are insulin-resistant,

u SAD otporno na insulin,

and by the way, they appear to be at even greater risk

i uzgred, izgleda da kod njih postoji veći rizik

for those metabolic diseases I mentioned a moment ago

za razvoj bolesti metabolizma, koje sam spomenuo,

than their obese counterparts.

nego kod njihovih gojaznih kolega.

Now I don't know why, but it might be because,

Ne znam zašto, no to bi moglo biti

in their case, their cells haven't actually figured out

zato što njihove ćelije zapravo nisu shvatile

the right thing to do with that excess energy.

pravu stvar koju treba uraditi s tim viškom energije.

So if you can be obese and not have insulin resistance,

Dakle, ako možete biti gojazni bez insulinske rezistencije,

and you can be lean and have it,

a mršavi sa insulinskom rezistencijom

this suggests that obesity may just be a proxy

to sugeriše da bi gojaznost mogla biti samo zaštitni posrednik

for what's going on.

za ono što se dešava.

So what if we're fighting the wrong war,

Šta ako se borimo u pogrešnom ratu,

fighting obesity rather than insulin resistance?

suzbijamo gojaznost umesto insulinsku rezistenciju?

Even worse, what if blaming the obese

Još gore, šta ako okrivljavanje gojaznih

means we're blaming the victims?

znači da okrivljujemo žrtve?

What if some of our fundamental ideas about obesity

Šta ako je neka od naših osnovnih ideja o gojaznosti

are just wrong?

jednostavno pogrešna?

Personally, I can't afford the luxury of arrogance anymore,

Lično, ne mogu više da sebi dozvolim luksuz arogancije,

let alone the luxury of certainty.

a kamoli luksuz uverenja.

I have my own ideas about what could be at the heart of this,

Imam ideje o tome šta bi mogao biti uzrok,

but I'm wide open to others.

ali sam široko otvoren za ostale ideje.

Now, my hypothesis, because everybody always asks me,

Pošto me svi stalno pitaju, moja pretpostavka

is this.

je ovo.

If you ask yourself, what's a cell trying to protect itself from

Ako se pitate, od čega ćelija želi da se zaštiti

when it becomes insulin resistant,

kada postane otporna na insulin,

the answer probably isn't too much food.

odgovor verovatno nije od previše hrane.

It's more likely too much glucose: blood sugar.

Verovatnije je od previše glukoze: šećera u krvi.

Now, we know that refined grains and starches

Znamo da rafinirane žitarice i skrob

elevate your blood sugar in the short run,

brzo podižu nivo šećera u krvi

and there's even reason to believe that sugar

i čak postoje razlozi za verovanje da šećer

may lead to insulin resistance directly.

direktno može dovesti do insulinske rezistencije.

So if you put these physiological processes to work,

Dakle, ako uključite ove fiziološke procese

I'd hypothesize that it might be our increased intake

pretpostavio bih da bi naš povećan unos

of refined grains, sugars and starches that's driving

rafiniranih žitarica, šećera i skroba mogao biti uzrok

this epidemic of obesity and diabetes,

epidemije gojaznosti i dijabetesa,

but through insulin resistance,

ali putem insulinske rezistencije.

you see, and not necessarily through just overeating and under-exercising.

Razumete, nije nužno da je samo od previše jela i premalo vežbanja.

When I lost my 40 pounds a few years ago,

Kada sam izgubio 18 kg pre par godina,

I did it simply by restricting those things,

to mi je uspelo izbegavanjem tačno tih stvari,

which admittedly suggests I have a bias

što, priznajem, govori da sam pristrasan

based on my personal experience.

na osnovu ličnog iskustva.

But that doesn't mean my bias is wrong,

Ali to ne znači da je moja pristrasnost pogrešna

and most important, all of this can be tested scientifically.

i najvažnije je da se sve to može naučno proveriti.

But step one is accepting the possibility

Ali prvi korak je prihvatanje mogućnosti

that our current beliefs about obesity,

da su naša sadašnja uverenja o gojaznosti,

diabetes and insulin resistance could be wrong

dijabetesu i insulinskoj rezistenciji možda pogrešna

and therefore must be tested.

i zato se moraju proveriti.

I'm betting my career on this.

Kladim se u svoju karijeru za to.

Today, I devote all of my time to working on this problem,

Danas posvećujem sve svoje vreme radu na tom problemu

and I'll go wherever the science takes me.

i ići ću kuda god me nauka vodi.

I've decided that what I can't and won't do anymore

Odlučio sam da ne mogu i neću više da se

is pretend I have the answers when I don't.

pretvaram da imam odgovore kada ih nemam.

I've been humbled enough by all I don't know.

Dovoljno me je ponizilo sve to što ne znam.

For the past year, I've been fortunate enough

U poslednjih godinu dana, imao sam sreće

to work on this problem with the most amazing team

da radim na ovom problemu sa najneverovatnijim timom

of diabetes and obesity researchers in the country,

istraživača dijabetesa i gojaznosti iz zemlje,

and the best part is,

a najbolje je da smo se jednako,

just like Abraham Lincoln surrounded himself with a team of rivals,

kao što je Abraham Linkoln uradio,

we've done the same thing.

okružili timom rivala.

We've recruited a team of scientific rivals,

Regrutovali smo tim naučnih rivala,

the best and brightest who all have different hypotheses

najbolje i najpametnije, s različitim hipotezema

for what's at the heart of this epidemic.

o uzroku ove epidemije.

Some think it's too many calories consumed.

Neki misle da je previše unesenih kalorija.

Others think it's too much dietary fat.

Drugi misle da je previše masti u ishrani.

Others think it's too many refined grains and starches.

Treći misle da je previše rafiniranih žita i skroba.

But this team of multi-disciplinary,

Ali ovaj multidisciplinarni tim

highly skeptical and exceedingly talented researchers

veoma skeptičnih i izuzetno talentovanih istraživača

do agree on two things.

se slaže u dve stvari.

First, this problem is just simply too important

Prvo, da je ovaj problem isuviše značajan

to continue ignoring because we think we know the answer.

da bismo nastavili da ga zanemarujemo zato što mislimo da znamo odgovor.

And two, if we're willing to be wrong,

I drugo, ako smo spremni na greške,

if we're willing to challenge the conventional wisdom

ako smo spremni da posumnjamo u konvencionalnu mudrost,

with the best experiments science can offer,

uz najbolje eksperimente koje nauka nudi,

we can solve this problem.

možemo da rešimo taj problem.

I know it's tempting to want an answer right now,

Znam da biste želeli odgovor sada,

some form of action or policy, some dietary prescription --

neki oblik aktivnosti ili smera, neke recepte za ishranu -

eat this, not that —

jedite ovo, a ne to -

but if we want to get it right,

ali ako želimo da to dobro uradimo,

we're going to have to do much more rigorous science

moraćemo da se posvetimo mnogo rigoroznije nauci

before we can write that prescription.

pre nego što bismo mogli da napišemo takav recept.

Briefly, to address this, our research program

Ukratko, za rešavanje ovoga, naš istraživački program

is focused around three meta-themes, or questions.

je fokusiran na tri ciljne teme ili pitanja:

First, how do the various foods we consume

prvo, kako različite namirnice koje konzumiramo

impact our metabolism, hormones and enzymes,

utiču na naš metabolizam, na hormone i enzime

and through what nuanced molecular mechanisms?

i putem kojih nijansiranih molekularnih mehanizama?

Second, based on these insights,

Drugo, na osnovu tih uvida,

can people make the necessary changes in their diets

mogu li ljudi napraviti neophodne izmene u svojoj ishrani

in a way that's safe and practical to implement?

na način koji je siguran i praktično izvodljiv?

And finally, once we identify what safe

I na kraju, kada smo identifikovali šta je sigurno

and practical changes people can make to their diet,

i praktične promene koje ljudi mogu da uvedu u svoju ishranu,

how can we move their behavior in that direction

kako možemo da pokrenemo njihovo ponašanje u tom smeru

so that it becomes more the default

da bi postalo standardnije,

rather than the exception?

a ne samo izuzetak?

Just because you know what to do doesn't mean

Samo zato što znate šta treba da uradite ne znači

you're always going to do it.

da ćete to uvek i učiniti.

Sometimes we have to put cues around people

Ponekad moramo da postavimo znake oko ljudi

to make it easier, and believe it or not,

da olakšamo i verovali ili ne

that can be studied scientifically.

to se može naučno proučavati.

I don't know how this journey is going to end,

Ne znam kako će se ovo putovanje završiti,

but this much seems clear to me, at least:

ali izgleda da mi je jasno barem ovo:

We can't keep blaming our overweight and diabetic patients

ne možemo nastaviti da osuđujemo naše preteške pacijente sa dijabetesom

like I did.

kao što sam to ja uradio.

Most of them actually want to do the right thing,

Većina od njih u stvari želi da uradi pravu stvar,

but they have to know what that is,

ali moraju da znaju šta je prava stvar

and it's got to work.

i to mora da funkcioniše.

I dream of a day when our patients can

Sanjam o danu kada će naši pacijenti moći

shed their excess pounds

da skinu višak kilograma

and cure themselves of insulin resistance,

i da se izleče od insulinske rezistencije,

because as medical professionals,

jer smo se kao zdravstveni profesionalci

we've shed our excess mental baggage

otarasili viška sopstvenih mentalnih opterećenja

and cured ourselves of new idea resistance sufficiently

i sebe izlečili od otpora na nove ideje u dovoljnoj meri

to go back to our original ideals:

da bismo mogli da se vratimo na naše originalne ideale:

open minds, the courage to throw out yesterday's ideas

otvorene umove, hrabrost odbacivanja dojučerašnjih ideja

when they don't appear to be working,

kada one ne funkcionišu

and the understanding that scientific truth isn't final,

i na shvatanje da naučna istina nije konačna,

but constantly evolving.

već da se konstatno razvija.

Staying true to that path will be better for our patients

Iskreno posvećivanje takvom putu će biti bolje i za naše pacijente

and better for science.

i za nauku.

If obesity is nothing more than a proxy

Ako gojaznost nije ništa drugo nego zamena

for metabolic illness,

za metaboličku bolest,

what good does it do us to punish those with the proxy?

kakve koristi imamo od kažnjavanja onih sa njom?

Sometimes I think back to that night in the E.R.

Ponekad razmišljam o onoj noći u hitnoj pomoći

seven years ago.

od pre sedam godina.

I wish I could speak with that woman again.

Voleo bih da mogu ponovo da razgovaram sa tom ženom.

I'd like to tell her how sorry I am.

Želeo bih da joj kažem kako mi je žao.

I'd say, as a doctor, I delivered

Rekao bih - kao lekar sam vam pružio

the best clinical care I could,

najbolju kliničku negu koju sam mogao,

but as a human being,

ali kao čovek

I let you down.

sam vas izneverio.

You didn't need my judgment and my contempt.

Nije vam bilo potrebno moje osuđivanje i prezir.

You needed my empathy and compassion,

Bila vam je potrebna moja empatija i saosećanje

and above all else, you needed a doctor

i iznad svega, lekar

who was willing to consider

koji bi bio spreman da shvati

maybe you didn't let the system down.

da možda niste vi izneverili sistem.

Maybe the system, of which I was a part,

Možda je sistem, čiji sam bio deo,

was letting you down.

izneverio vas.

If you're watching this now,

Ako gledate ovo sada,

I hope you can forgive me.

nadam se da možete da mi oprostite.

(Applause)

(Aplauz)