What your breath could reveal about your health | Julian Burschka

Translator: Joseph Geni Reviewer: Camille Martínez

Prevodilac: Kristina Radosavljević Lektor: Ivana Krivokuća

I have a tendency to assume the worst,

Ja imam običaj da pretpostavljam najgore,

and once in a while, this habit plays tricks on me.

i s vremena na vreme, ta navika se poigra sa mnom.

For example, if I feel unexpected pain in my body

Na primer, ako osetim iznenadni bol u telu

that I have not experienced before and that I cannot attribute,

koji pre toga nisam doživeo i koji ne mogu da identifikujem,

then all of a sudden, my mind might turn a tense back into heart disease

moj mozak ga tada iznenada može pretvoriti u srčano oboljenje,

or calf muscle pain into deep vein thrombosis.

a bol u mišićima u trombozu dubokih vena.

But so far, I haven't been diagnosed with any deadly or incurable disease.

Do sada mi nije dijagnostikovana smrtonosna ili neizlečiva bolest.

Sometimes things just hurt for no clear reason.

Ponekad nešto jednostavno boli bez ikakvog jasnog razloga.

But not everyone is as lucky as me.

Ali nisu svi te sreće kao ja.

Every year, more than 50 million people die worldwide.

Svake godine, širom sveta umre 50 miliona ljudi.

Especially in high-income economies like ours,

Pogotovo u bogatim zemljama, kao što je naša,

a large fraction of deaths is caused by slowly progressing diseases:

veliki broj smrtnih slučajeva uzrokuju bolesti koje se sporo razvijaju:

heart disease, chronic lung disease, cancer, Alzheimer's, diabetes,

srčana oboljenja, hronične bolesti pluća, rak, Alchajmerova bolest i dijabetes

just to name a few.

su samo neke od njih.

Now, humanity has made tremendous progress in diagnosing and treating many of these.

Čovečanstvo je ostvarilo ogroman napredak

u otkrivanju i lečenju većine ovih bolesti.

But we are at a stage where further advancement in health

Trenutno se nalazimo u fazi gde se budući napredak u zdravstvu

cannot be achieved only by developing new treatments.

ne može postići samo razvojem novih lekova.

And this becomes evident when we look at one aspect

Ovo postaje očigledno ako posmatramo jedan aspekt

that many of these diseases have in common:

koji mnoge od ovih bolesti dele.

the probability for successful treatment

Verovatnoća uspešnog lečenja

strongly depends on when treatment is started.

veoma zavisi od momenta kada je lečenje započeto.

But a disease is typically only detected once symptoms occur.

Ali bolest se obično uoči tek kada se pojave simptomi.

The problem here is that, in fact, many diseases can remain asymptomatic,

Problem je što, u stvari, mnoge bolesti ostaju bez simptoma,

hence undetected, for a long period of time.

a samim tim i neotkrivene jako dug period.

Because of this, there is a persisting need for new ways

Upravo zbog ovoga, postoji stalna potreba za novim načinima

of detecting disease at early stage,

otkrivanja bolesti u ranoj fazi,

way before any symptoms occur.

pre nego što se bilo koji simptom pojavi.

In health care, this is called screening.

U zdravstvenoj zaštiti, ovo se zove skrining.

And as defined by the World Health Organization,

Kako je definisan od strane Svetske zdravstvene organizacije,

screening is "the presumptive identification of unrecognized disease

skrining je „pretpostavljena identifikacija neprepoznate bolesti

in an apparently healthy person,

kod naizgled zdrave osobe,

by means of tests ... that can be applied rapidly and easily ..."

kroz razne testove koji se mogu primeniti brzo i lako."

That's a long definition, so let me repeat it:

To je dugačka definicija, pa ću je ponoviti.

identification of unrecognized disease

Identifikacija neprepoznatih bolesti

in an apparently healthy person

kod naizgled zdravih osoba

by means of tests that can be applied both rapidly and easily.

kroz razne testove koji se mogu primeniti brzo i lako.

And I want to put special emphasis on the words "rapidly" and "easily"

Želim posebno da naglasim reči „brzo" i „lako"

because many of the existing screening methods

zato su što mnoge od postojećih metoda skrininga

are exactly the opposite.

upravo suprotno.

And those of you who have undergone colonoscopy

A oni koji su bili podvrgnuti koloskopiji

as part of a screening program for colorectal cancer

kao delu skrininga za rak debelog creva

will know what I mean.

znaju o čemu govorim.

Obviously, there's a variety of medical tools available

Očigledno, postoje brojni medicinski alati

to perform screening tests.

da bi se izvršio test skrininga.

This ranges from imaging techniques such as radiography

Od tehnika snimanja, kao što je npr. radiografija,

or magnetic resonance imaging

ili magnetna rezonanca,

to the analysis of blood or tissue.

do analiza krvi i tkiva.

We have all had such tests.

Svi smo prošli takve testove.

But there's one medium that for long has been overlooked:

Ali postoji jedan način koji je dugo vremena bio zapostavljen,

a medium that is easily accessible,

način koji je lako dostupan,

basically nondepletable,

koji je u suštini neiscrpan,

and it holds tremendous promise for medical analysis.

i ima neverovatan potencijal za medicinske analize.

And that is our breath.

A to je naš dah.

Human breath is essentially composed of five components:

Ljudski dah je u osnovi sačinjen od pet komponenti:

nitrogen, oxygen, carbon dioxide, water and argon.

azot, kiseonik, ugljen-dioksid, voda i argon.

But besides these five, there are hundreds of other components

Pored ovih pet, postoje stotine drugih sastojaka

that are present in very low quantity.

koji su prisutni u veoma malim količinama.

These are called volatile organic compounds,

Oni se nazivaju isparljiva organska jedinjenja,

and we release hundreds, even thousands of them

i mi ih ispuštamo na stotine, ako ne i hiljade

every time we exhale.

sa svakim izdahom.

The analysis of these volatile organic compounds in our breath

Analiza ovih isparljivih organskih jedinjenja iz našeg daha

is called breath analysis.

naziva se analiza daha.

In fact, I believe that many of you have already experienced breath analysis.

U stvari, ja verujem da je dosta vas već imalo iskustva sa analizom daha.

Imagine: you're driving home late at night,

Zamislite: vozite se kući kasno noću,

when suddenly, there's a friendly police officer

kad odjednom, prijatan policajac

who asks you kindly but firmly

vas ljubazno, ali odlučno,

to pull over and blow into a device like this one.

zamoli da stanete i da duvate u napravu sličnu ovoj.

This is an alcohol breath tester

Ovo je alko-tester na dah,

that is used to measure the ethanol concentration in your breath

koji se koristi kako bi se izmerio nivo etanola u vašem dahu

and determine whether driving in your condition is a clever idea.

da bi se videlo da li je vožnja u vašem stanju pametna ideja.

Now, I'd say my driving was pretty good,

Rekao bih da sam dobro vozio,

but let me check.

ali hajde da proverim.

(Beep)

(Bip)

0.0, so nothing to worry about, all fine.

Pokazuje 0,0 - znači, nema potrebe za brigom, sve je u redu.

(Laughter)

(Smeh)

Now imagine a device like this one,

Sad zamislite napravu sličnu ovoj,

that does not only measure alcohol levels in your breath,

koja ne samo da meri nivo alkohola u vašem dahu,

but that detects diseases like the ones I've shown you

nego detektuje bolesti, kao one što sam vam pokazivao

and potentially many more.

i možda još mnogo više.

The concept of correlating the smell of a person's breath

Koncept povezivanja mirisa iz nečijeg daha

with certain medical conditions,

sa određenim medicinskim problemima

in fact, dates back to Ancient Greece.

u stvari datira iz drevne Grčke.

But only recently, research efforts on breath analysis have skyrocketed,

Međutim, tek je nedavno napor istraživača vezan za analizu daha urodio plodom,

and what once was a dream is now becoming reality.

te ono što je nekada bilo san sada postaje stvarnost.

And let me pull up this list again that I showed you earlier.

Dozvolite mi da vratim listu koju sam vam pokazao ranije.

For the majority of diseases listed here,

Za većinu ovde nabrojanih bolesti,

there's substantial scientific evidence

postoje značajni naučni dokazi

suggesting that the disease could be detected by breath analysis.

koji upućuju na to da se bolest može otkriti analizom daha.

But how does it work, exactly?

Kako to tačno funkcioniše?

The essential part is a sensor device

Osnovni deo je senzor naprave

that detects the volatile organic compounds in our breath.

koji detektuje isparljiva organska jedinjenja u našem dahu.

Simply put: when exposed to a breath sample,

Jednostavno rečeno, kada se izloži uzorku daha,

the sensor outputs a complex signature

senzor izbacuje složen šablon

that results from the mixture of volatile organic compounds that we exhale.

koji je rezultat mešavine isparljivih organskih jedinjenja koje smo izdahnuli.

Now, this signature represents a fingerprint of your metabolism,

Ovaj šablon je otisak našeg metabolizma,

your microbiome

vašeg mikrobioma

and the biochemical processes that occur in your body.

i biohemijskih procesa koji se javljaju u vašem telu.

If you have a disease,

Ako imate neku bolest,

your organism will change,

vaš organizam će se promeniti,

and so will the composition of your exhaled breath.

a isto tako i struktura vašeg izdaha.

And then the only thing that is left to do is to correlate a certain signature

Sve što tada ostaje da se uradi je da se poveže određeni šablon

with the presence or absence of certain medical conditions.

sa prisustvom ili odsustvom određenog medicinskog stanja.

The technology promises several undeniable benefits.

Ova tehnologija nudi nekoliko nepobitnih koristi.

Firstly, the sensor can be miniaturized

Prvo, senzor može biti minijaturan

and integrated into small, handheld devices

i stavljen u ručne naprave

like this alcohol breath tester.

kao što je ovaj alko-test na dah.

This would allow the test to be used in many different settings

To bi omogućilo da se ovaj test koristi u različitim okruženjima,

and even at home,

čak i kod kuće,

so that a visit at the doctor's office

što znači da posete doktoru

is not needed each time a test shall be performed.

nisu potrebne svaki put kad se ovaj test radi.

Secondly, breath analysis is noninvasive

Drugo, analiza daha je neinvazivna

and can be as simple as blowing into an alcohol breath tester.

i može biti jednostavna kao duvanje u alko-tester.

Such simplicity and ease of use would reduce patient burden

Ovakva jednostavnost i lako korišćenje bi smanjilo teret pacijenta

and provide an incentive for broad adoption of the technology.

i podstaklo širu upotrebu ove tehnologije.

And thirdly, the technology is so flexible

Treće, ova tehnologija je tako fleksibilna

that the same device could be used

da se jedna naprava može koristiti

to detect a broad range of medical conditions.

za otkrivanje širokog spektra medicinskih stanja.

Breath analysis could be used to screen for multiple diseases at the same time.

Analiza daha može se koristiti za skrining više bolesti u isto vreme.

Nowadays, each disease typically requires a different medical tool

U današnje vreme, svaka bolest obično zahteva drugačiji medicinski alat

to perform a screening test.

da bi se izvršio test skrininga.

But this means you can only find what you're looking for.

Što znači da možete naći samo ono za čim tragate.

With all of these features, breath analysis is predestined

Uz sve ove karakteristike, analiza daha je predodređena

to deliver what many traditional screening tests are lacking.

da pruži ono što mnogim tradicionalnim testovima skrininga manjka.

And most importantly,

A ono što je najvažnije,

all of these features should eventually provide us

sve ove karakteristike bi jednom trebalo da nam obezbede

with a platform for medical analysis

platformu za medicinsku analizu

that can operate at attractively low cost per test.

koja može da funkcioniše sa veoma niskom cenom po testu.

On the contrary, existing medical tools

Suprotno tome, postojeći medicinski alati

often lead to rather high cost per test.

obično vode ka skupoj ceni po testu.

Then, in order to keep costs down,

Onda, da bi se snizili troškovi,

the number of tests needs to be restricted,

broj testova mora biti ograničen,

and this means (a) that the tests can only be performed

što znači, pod a, da se testovi mogu sprovesti

on a narrow part of the population, for example, the high-risk population;

samo na malom delu populacije, npr. u visokorizičnim grupama;

and (b) that the number of tests per person needs to be kept at a minimum.

i pod b, da broj testova po osobi treba držati na minimumu.

But wouldn't it actually be beneficial

Zar ne bi bilo korisno

if the test was performed on a larger group of people,

da se test izvodi na većoj grupi ljudi,

and more often and over a longer period of time for each individual?

češće i u dužem periodu za svakog ponaosob?

Especially the latter would give access to something very valuable

Ovo drugo bi dalo pristup nečem veoma vrednom,

that is called longitudinal data.

a to su longitudinalni podaci.

Longitudinal data is a data set that tracks the same patient

Longitudinalni podaci su skup podataka koji se odnose na jednog pacijenta,

over the course of many months or years.

prikupljenih tokom mnogo meseci ili godina.

Nowadays, medical decisions are often based on a limited data set,

Medicinske odluke danas su često zasnovane na ograničenom skupu podataka,

where only a glimpse of a patient's medical history

pri čemu je samo delić pacijentove medicinske istorije

is available for decision-making.

dostupan za donošenje odluke.

In such a case,

U ovakvim slučajevima,

abnormalities are typically detected

anomalije se obično otkrivaju

by comparing a patient's health profile

poređenjem zdravstvenog profila pacijenta

to the average health profile of a reference population.

sa prosečnim zdravstvenim profilom referentne populacije.

Longitudinal data would open up a new dimension

Longitudalni podaci bi otvorili sasvim novu dimenziju

and allow abnormalities to be detected

i dozvolili anomalijama da budu otkrivene

based on a patient's own medical history.

na osnovu medicinske istorije pacijenta.

This will pave the way for personalized treatment.

Ovo će trasirati put ka personalizovanom lečenju.

Sounds pretty great, right?

Zvuči odlično, zar ne?

Now you will certainly have a question that is something like,

Sada ćete verovatno pitati sledeće:

"If the technology is as great as he says, then why aren't we using it today?"

„Ako je ta tehnologija tako dobra kao što tvrdi, zašto je ne koristimo?”

And the only answer I can give you is:

Jedini odgovor koji vam mogu dati je:

not everything is as easy as it sounds.

nije sve tako jednostavno kao što zvuči.

There are technical challenges, for example.

Postoje tehnički izazovi.

Na primer, potrebni su veoma pouzdani senzori

There's the need for extremely reliable sensors

that can detect mixtures of volatile organic compounds

koji mogu otkriti mešavine isparljivih organskih jedinjenja

with sufficient reproducibility.

sa dovoljnom mogućnošću ponavljanja rezultata.

And another technical challenge is this:

A tu je još jedan tehnički izazov:

How do you sample a person's breath in a very defined manner

kako uzimati uzorak daha na veoma određen način

so that the sampling process itself

da sam proces uzimanja uzorka

does not alter the result of the analysis?

ne menja rezultate analize?

And there's the need for data.

Takođe postoji i potreba za podacima.

Breath analysis needs to be validated in clinical trials,

Analiza daha treba da bude potvrđena kliničkim ispitivanjima

and enough data needs to be collected

i potrebno je prikupiti dovoljno podataka

so that individual conditions can be measured against baselines.

kako bi se pojedinačna stanja mogla uporediti sa osnovnim parametrom.

Breath analysis can only succeed

Analiza daha može biti uspešna

if a large enough data set can be generated

samo ako može da se prikupi dovoljno velika baza podataka

and made available for broad use.

koja će biti dostupna za širu upotrebu.

If breath analysis holds up to its promises,

Ako analiza daha ispuni očekivanja,

this is a technology that could truly aid us

onda je ovo tehnologija koja nam stvarno može pomoći

to transform our health care system --

da transformišemo naš zdravstveni sistem -

transform it from a reactive system

transformišemo ga iz reaktivnog sistema,

where treatment is triggered by symptoms of disease

gde je lečenje inicirano simptomima bolesti,

to a proactive system,

u proaktivni sistem,

where disease detection, diagnosis and treatment

gde se bolest otkriva, dijagnostikuje i leči

can happen at early stage,

u ranoj fazi,

way before any symptoms occur.

mnogo pre nego što se simptomi pojave.

Now this brings me to my last point, and it's a fundamental one.

Što me dovodi do poslednje tačke, koja je najznačajnija.

What exactly is a disease?

Šta je u stvari bolest?

Imagine that breath analysis can be commercialized as I describe it,

Zamislite da se analiza daha komercijalizuje, kao što sam opisao,

and early detection becomes routine.

i rano otkrivanje bolesti postane rutina.

A problem that remains is, in fact, a problem

Problem koji ostaje

that any screening activity has to face

je onaj sa kojim se suočava svaki skrining

because, for many diseases,

zato što je, za mnoge bolesti,

it is often impossible to predict with sufficient certainty

često nemoguće predvideti sa sigurnošću

whether the disease would ever cause any symptoms

da li će bolest uopšte izazvati neke simptome

or put a person's life at risk.

ili dovesti osobu u životnu opasnost.

This is called overdiagnosis,

Ovo se zove hiperdijagnostika,

and it leads to a dilemma.

koja stvara dilemu.

If a disease is identified,

Ako je bolest identifikovana,

you could decide not to treat it

možete odlučiti da je ne lečite

because there's a certain probability that you would never suffer from it.

zato što postoji verovatnoća da nikada nećete oboleti od nje.

But how much would you suffer

Ali koliko biste patili

just from knowing that you have a potentially deadly disease?

od samog saznanja da imate potencijalno smrtonosnu bolest?

And wouldn't you actually regret that the disease was detected

Zar ne biste zažalili što vam je bolest uopšte i otkrivena?

in the first place?

Your second option is to undergo early treatment

Vaša druga opcija je da prihvatite rano lečenje

with the hope for curing it.

sa nadom da ćete je izlečiti.

But often, this would not come without side effects.

Ali često, ovo ne bi išlo bez nekih nuspojava.

To be precise:

Tačnije:

the bigger problem is not overdiagnosis,

veći problem od hiperdijagnostike

it's overtreatment,

je preterano lečenje,

because not every disease has to be treated immediately

zato što ne zahteva svaka bolest trenutno lečenje

just because a treatment is available.

samo zato što je lek dostupan.

The increasing adoption of routine screening

Usvajanje rutinskog skrininga

will raise the question:

je otvorilo pitanje:

What do we call a disease that can rationalize treatment,

kako nazivamo bolest koja može opravdati lečenje,

and what is just an abnormality that should not be a source of concern?

a šta je samo anomalija koja ne treba da nas brine?

My hopes are that routine screening using breath analysis

Ja se nadam da će rutinski skrining koji koristi analizu daha

can provide enough data and insight

moći da obezbedi dovoljno podataka i uvida

so that at some point, we'll be able to break this dilemma

da ćemo u određenom momentu moći da rešimo ovu dilemu

and predict with sufficient certainty

i sa dovoljnom preciznošću predvidimo

whether and when to treat at early stage.

da li i kada lečiti u ranoj fazi.

Our breath and the mixture of volatile organic compounds that we exhale

Naš dah i mešavina isparljivih organskih jedinjenja koje izdahnemo

hold tremendous amounts of information on our physiological condition.

sadrže neverovatnu količinu informacija o našem fiziološkom stanju.

With what we know today, we have only scratched the surface.

Sa onim što znamo danas, samo smo zagrebali površinu.

As we collect more and more data and breath profiles across the population,

Skupljajući sve više podataka i profila analize daha širom populacije,

including all varieties of gender, age, origin and lifestyle,

uključujući različite polove, godine, poreklo i stil života,

the power of breath analysis should increase.

moć analize daha bi trebalo da se poveća.

And eventually, breath analysis should provide us with a powerful tool

U jednom momentu, analiza daha bi trebalo da nam obezbedi moćan alat

not only to proactively detect specific diseases

ne samo da proaktivno otkrijemo određene bolesti,

but to predict and ultimately prevent them.

nego i da ih predvidimo i na kraju sprečimo.

And this should be enough motivation

Ovo bi trebalo da bude dovoljna motivacija

to embrace the opportunities and challenges

da se prihvate šanse i izazovi

that breath analysis can provide,

koje analiza daha može da pruži,

even for people that are not part-time hypochondriacs like me.

čak i kod ljudi koji nisu povremeni hipohondri, kao ja.

Thank you.

Hvala vam.

(Applause)

(Aplauz)