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

Prevodilac: Ivana Krivokuća Lektor: Tijana Mihajlović

We all go to doctors.

Svi mi idemo kod lekara

And we do so with trust and blind faith

i to činimo sa poverenjem i slepom verom

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

da su testovi koje oni naručuju i lekovi koje prepisuju

are based upon evidence --

zasnovani na dokazima -

evidence that's designed to help us.

dokazima koji su predviđeni da nam pomognu.

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

Međutim, u stvarnosti, to nije uvek bio slučaj za svakog.

What if I told you

Šta ako vam kažem

that the medical science discovered over the past century

da je ono što je medicinska nauka otkrila tokom proteklog veka

has been based on only half the population?

zasnovano na svega polovini populacije?

I'm an emergency medicine doctor.

Ja sam doktor urgentne medicine.

I was trained to be prepared in a medical emergency.

Obučena sam da budem pripremljena u slučaju medicinske hitnosti.

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

Radi se o spašavanju života. Zar to nije kul?

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

Okej, ima mnogo kijavica i ozleda na nožnim prstima,

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

ali bez obzira na to ko ušeta kroz vrata hitne službe,

we order the same tests,

zatražimo iste testove,

we prescribe the same medication,

prepisujemo iste lekove,

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

a da nikada ne razmišljamo o polu ili rodu naših pacijenata.

Why would we?

Zašto bismo?

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

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

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

Nedavna studija odgovornosti vlade je pokazala da je 80 odsto lekova

withdrawn from the market

povučeno sa tržišta

are due to side effects on women.

zbog neželjenih dejstava na žene.

So let's think about that for a minute.

Hajde da razmislimo o tome na minut.

Why are we discovering side effects on women

Zašto otkrivamo neželjena dejstva na žene

only after a drug has been released to the market?

tek nakon što je lek pušten na tržište?

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

Da li znate da su potrebne godine da bi lek prešao put od ideje

to being tested on cells in a laboratory,

do testiranja na ćelijama u laboratoriji,

to animal studies,

do studija na životinjama,

to then clinical trials on humans,

do kliničkih ispitivanja na ljudima,

finally to go through a regulatory approval process,

da bi konačno prošao kroz regulacioni proces odobravanja,

to be available for your doctor to prescribe to you?

da bi bio na raspolaganju doktoru da vam ga prepiše?

Not to mention the millions and billions of dollars of funding

Da ne pominjemo finansiranje od miliona i milijardi dolara

it takes to go through that process.

koje je potrebno da prođe kroz taj proces.

So why are we discovering unacceptable side effects

Pa zašto otkrivamo neprihvatljive nuspojave

on half the population after that has gone through?

kod polovine populacije nakon što se prošlo kroz sve to?

What's happening?

Šta se dešava?

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

Pa, ispostavilo se da su ćelije koje su korišćene u toj laboratoriji

they're male cells,

muške ćelije,

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

a životinje korišćene u životinjskim studijama su mužjaci,

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

a klinička ispitivanja se sprovode skoro isključivo na muškarcima.

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

Kako to da je muški model postao naš okvir za medicinska istraživanja?

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

Hajde da pogledamo primer koji je popularizovan u medijima,

and it has to do with the sleep aid Ambien.

a radi se o Ambienu, pomoćnom sredstvu za uspavljivanje.

Ambien was released on the market over 20 years ago,

Ambien je pušten na tržište pre više od 20 godina

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

i od tada su napisane stotine miliona recepata,

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

naročito ženama, jer žene više pate od poremećaja sna nego muškarci.

But just this past year,

Međutim, prošle godine,

the Food and Drug Administration recommended cutting the dose in half

Uprava za hranu i lekove je preporučila smanjivanje doze upola

for women only,

samo za žene,

because they just realized that women metabolize the drug

jer su upravo shvatili da žene metabolišu lek

at a slower rate than men,

sporije od muškaraca,

causing them to wake up in the morning

što uzrokuje da se probude ujutru

with more of the active drug in their system.

sa više aktivnog leka u svom sistemu.

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

Tada su pospane, a sednu da voze

and they're at risk for motor vehicle accidents.

i u riziku su od saobraćajnih nesreća.

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

Ne mogu da ne pomislim, kao lekar za hitne slučajeve,

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

koliko je mojih pacijenata o kojima sam brinula svih ovih godina

were involved in a motor vehicle accident

bilo u nesrećama u motornom vozilu

that possibly could have been prevented

koje su mogle biti sprečene

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

da je ovakva analiza sprovedena i da se postupalo u skladu sa njom

pre 20 godina, kada je lek pušten u prodaju.

when this drug was first released.

How many other things need to be analyzed by gender?

Koliko još stvari treba analizirati kroz polne razlike?

What else are we missing?

Šta još propuštamo?

World War II changed a lot of things,

Drugi svetski rat je promenio mnogo toga,

and one of them was this need to protect people

a doneo je i potrebu da se ljudi zaštite da ne bi postali žrtve

from becoming victims of medical research without informed consent.

medicinskih istraživanja bez davanja informacija i saglasnosti.

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

Stoga su preko potrebne smernice ili pravila postavljeni na svoje mesto,

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

a deo toga je bila želja da se zaštite žene u plodnim godinama

from entering into any medical research studies.

od uključivanja u bilo kakve studije medicinskih ispitivanja.

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

Postojao je strah: šta ako se nešto dogodi fetusu za vreme studije?

Who would be responsible?

Ko bi bio odgovoran?

And so the scientists at this time actually thought

Tako su naučnici u tom trenutku pomislili

this was a blessing in disguise,

da je ovo bila sreća u nesreći,

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

jer, budimo realni - tela muškaraca su prilično homogena.

They don't have the constantly fluctuating levels of hormones

Kod njih ne postoji stalno fluktuiranje nivoa hormona, koje može da poremeti

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

čiste podatke koje mogu da dobiju ako imaju samo muškarce.

It was easier. It was cheaper.

Bilo je lakše. Bilo je jeftinije.

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

Da ne napominjem da je u ovo vreme postojala opšta pretpostavka

that men and women were alike in every way,

da su muškarci i žene jednaki u svakom pogledu,

apart from their reproductive organs and sex hormones.

izuzev njihovih reproduktivnih organa i polnih hormona.

So it was decided:

Tako je odlučeno:

medical research was performed on men,

medicinska istraživanja su sprovođena na muškarcima,

and the results were later applied to women.

a rezultati su kasnije primenjivani na ženama.

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

Šta je ovo učinilo sa poimanjem zdravlja žena?

Women's health became synonymous with reproduction:

Zdravlje žena je postalo sinonim za reprodukciju:

breasts, ovaries, uterus, pregnancy.

grudi, jajnici, materica, trudnoća.

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

To je termin o kome sada govorimo kao o „bikini medicini“.

And this stayed this way until about the 1980s,

To je ostalo tako otprilike do '80-ih,

when this concept was challenged by the medical community

kada je ovaj koncept dovela u pitanje medicinska zajednica

and by the public health policymakers when they realized that

i donosioci odluka u javnom zdravstvu kada su shvatili da smo ženama,

by excluding women from all medical research studies

isključujući ih iz svih medicinskih istraživanja,

we actually did them a disservice,

učinili medveđu uslugu,

in that apart from reproductive issues,

time da se osim reproduktivnih problema

virtually nothing was known about the unique needs

praktično ništa nije znalo o jedinstvenim potrebama

of the female patient.

ženskih pacijenata.

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

Od tada, ogroman broj dokaza je izašao na videlo

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

koji nam pokazuju koliko su muškarci i žene različiti u svakom pogledu.

You know, we have this saying in medicine:

Znate, imamo ovu izreku u medicini:

children are not just little adults.

deca nisu samo mali odrasli.

And we say that to remind ourselves

To kažemo da bismo se podsetili da deca zapravo imaju

that children actually have a different physiology than normal adults.

različitu fiziologiju od normalnih odraslih osoba.

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

Zbog toga je medicinska specijalizacija pedijatrije izašla na svetlost dana

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

i sada sprovodimo istraživanja na deci kako bismo poboljšali njihove živote.

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

Znam da isto to može da se kaže za žene.

Women are not just men with boobs and tubes.

Žene nisu samo muškarci sa grudima i jajovodima,

But they have their own anatomy and physiology

već imaju i sopstvenu anatomiju i fiziologiju

that deserves to be studied with the same intensity.

koja zaslužuje da se izučava istim intenzitetom.

Let's take the cardiovascular system, for example.

Uzmimo kardiovaskularni sistem, na primer.

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

Ova oblast medicine je najviše uradila pokušavajući da otkrije

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

zašto se čini da muškarci i žene imaju potpuno različite srčane udare.

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

Srčana oboljenja su ubica broj jedan i za muškarce i za žene,

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

ali više žena nego muškaraca umire u toku prve godine od dobijanja srčanog udara.

Men will complain of crushing chest pain --

Muškarci se žale na pritiskajući bol u grudima,

an elephant is sitting on their chest.

kao da im slon sedi na grudima,

And we call this typical.

a to nazivamo tipičnim.

Women have chest pain, too.

Žene takođe imaju bolove u grudima.

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

Međutim, više žena nego muškaraca požaliće se

da se „ne osećaju baš najbolje“, da „ne mogu da uhvate dovoljno vazduha“,

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

"just so tired lately."

da su „baš umorne u poslednje vreme“.

And for some reason we call this atypical,

Iz nekog razloga to nazivamo atipičnim,

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

iako, kao što sam pomenula, žene sačinjavaju polovinu populacije.

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

Dakle, koji su dokazi koji mogu poslužiti u objašnjenju nekih od ovih razlika?

If we look at the anatomy,

Ako pogledamo anatomiju,

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

krvni sudovi koji okružuju srce su manji kod žena u poređenju sa muškarcima,

and the way that those blood vessels develop disease is different

a način na koji ti krvni sudovi razvijaju oboljenje se razlikuje

in women compared to men.

kod žena u poređenju sa muškarcima.

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

A testovi koje koristimo da bismo ustanovili

da li je neko pod rizikom od srčanog udara,

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

pa, oni su prvobitno osmišljeni, testirani i usavršeni na muškarcima,

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

tako da nisu toliko dobri u utvrđivanju toga kod žena.

And then if we think about the medications --

Zatim, ako razmišljamo o lekovima -

common medications that we use, like aspirin.

uobičajenim lekovima koje koristimo, kao što je aspirin.

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

Dajemo aspirin zdravim muškarcima

da bismo im pomogli u sprečavanju da dobiju srčani udar,

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

ali da li ste znali da je, ako date aspirin zdravoj ženi,

it's actually harmful?

to zapravo štetno?

What this is doing is merely telling us

Ovo nam naprosto govori

that we are scratching the surface.

da smo tek zagrebali površinu.

Emergency medicine is a fast-paced business.

Urgentna medicina je posao koji se radi brzim tempom.

In how many life-saving areas of medicine,

U koliko oblasti medicine od životnog značaja,

like cancer and stroke,

kao što su rak i šlog,

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

postoje značajne razlike između muškaraca i žena

koje možemo iskoristiti?

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

Ili čak, zašto neki ljudi dobijaju kijavicu češće od drugih,

more than others,

ili zašto lekovi za bolove koje dajemo za ozleđene prste na nogama

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

work in some and not in others?

deluju kod nekih, a kod drugih ne?

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

Institut za medicinu kaže da svaka ćeija ima pol.

What does this mean?

Šta to znači?

Sex is DNA.

Pol je DNK.

Gender is how someone presents themselves in society.

Rod je kako se neko predstavlja u društvu,

And these two may not always match up,

a ta dva se ne poklapaju uvek,

as we can see with our transgendered population.

kao što možemo videti kod transrodne populacije.

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

Ipak, važno je shvatiti da, od trenutka začeća,

every cell in our bodies --

svaka ćelija u našem telu -

skin, hair, heart and lungs --

koža, kosa, srce i pluća -

contains our own unique DNA,

sadrži našu sopstvenu jedinstvenu DNK,

and that DNA contains the chromosomes that determine

a ta DNK sadrži hromozome koji određuju

whether we become male or female, man or woman.

da li ćemo postati muško ili žensko, muškarac ili žena.

It used to be thought

Nekada je smatrano

that those sex-determining chromosomes pictured here --

da ti hromozomi koji određuju pol prikazani na slici ovde -

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

XY ako ste muško, XX ako ste žensko -

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

određuju samo da li ćete biti rođeni sa jajnicima ili testisima

and it was the sex hormones that those organs produced

i da su polni hormoni koje ti organi proizvode

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

odgovorni za razlike koje vidimo kod suprotnog pola.

But we now know that that theory was wrong --

Sada znamo da je ta teorija pogrešna -

or it's at least a little incomplete.

ili makar da je nepotpuna.

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

Na sreću, naučnici poput dr Pejdža sa Vajthed Instituta,

who works on the Y chromosome,

koji radi sa Y hromozomom,

and Doctor Yang from UCLA,

i dr Janga sa Univerziteta Kalifornije, Los Anđeles,

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

pronašli su dokaz koji nam govori da ti hromozomi koji određuju pol

that are in every cell in our bodies

koji postoje u svakoj ćeliji u našem telu

continue to remain active for our entire lives

ostaju aktivni celog našeg života

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

i moguće je da su odgovorni za razlike koje vidimo

in the dosing of drugs,

u doziranju lekova,

or why there are differences between men and women

ili za to što postoje razlike između muškaraca i žena

in the susceptibility and severity of diseases.

u pogledu podložnosti bolestima i težini bolesti.

This new knowledge is the game-changer,

Ovo novo saznanje preokreće stvari,

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

i na tim naučnicima je da nastave da pronalaze te dokaze,

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

ali je na kliničarima da počnu sa prenošenjem tih podataka

at the bedside, today.

na bolničku postelju, danas.

Right now.

Upravo sada.

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

Da bih pomogla u tome, ja sam suosnivač nacionalne organizacije

called Sex and Gender Women's Health Collaborative,

pod nazivom Polna i rodna saradnja za zdravlje žena,

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

i mi prikupljamo sve te podatke tako da budu dostupni za podučavanje

and for patient care.

i za negu pacijenata.

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

I radimo na tome da okupimo medicinske edukatore za jednim stolom.

That's a big job.

To je veliki posao.

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

Ovo menja način na koji se sprovodi medicinska obuka još od njenog početka.

But I believe in them.

Ipak, ja verujem u njih.

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

Znam da će videti vrednost uključivanja rodne perspektive

into the current curriculum.

u aktuelni nastavni program.

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

Radi se o ispravnoj obuci budućih zdravstvenih radnika.

And regionally,

A regionalno,

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

ja sam suosnivač jedinice u okviru Odeljenja urgentne medicine

here at Brown University,

ovde na Univerzitetu Braun,

called Sex and Gender in Emergency Medicine,

pod imenom Pol i rod u urgentnoj medicini,

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

i mi sprovodimo istraživanja da bismo ustanovili razlike između muškaraca i žena

in emergent conditions,

u hitnim situacijama,

like heart disease and stroke and sepsis and substance abuse,

kao što su srčana oboljenja, šlog, sepsa, zloupotreba supstanci,

but we also believe that education is paramount.

ali takođe verujemo da je obrazovanje od najvećeg značaja.

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

Napravili smo model obrazovanja od 360 stepeni.

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

Imamo programe za doktore, bolničare, studente

and for the patients.

i pacijente.

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

Jer ovo ne može samo da se prepusti liderima zdravstvene zaštite.

We all have a role in making a difference.

Svi imamo ulogu u donošenju promena.

But I must warn you: this is not easy.

Ipak, moram da vas upozorim: ovo nije lako.

In fact, it's hard.

U stvari, teško je.

It's essentially changing the way we think about medicine

To je u suštini menjanje načina na koji razmišljamo o medicini,

and health and research.

zdravlju i istraživanju.

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

To je promena našeg odnosa sa sistemom zdravstvene zaštite.

But there's no going back.

No, nema povratka.

We now know just enough

Sada znamo tek toliko

to know that we weren't doing it right.

da znamo da nismo radili kako treba.

Martin Luther King, Jr. has said,

Martin Luter King mlađi je rekao:

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

„Promena se neće dokotrljati na točkovima neizbežnosti,

but comes through continuous struggle."

već kroz neprekidnu borbu.“

And the first step towards change is awareness.

A prvi korak ka promeni je svesnost.

This is not just about improving medical care for women.

Ovde se ne radi samo o poboljšanju medicinske nege za žene.

This is about personalized, individualized health care for everyone.

Radi se o personalizovanoj,

individualizovanoj zdravstvenoj zaštiti za sve.

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

Ova svest ima moć da transformiše medicinsku negu za muškarce i žene

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

i hoću da od sada pitate svoje lekare

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

da li je lečenje koje dobijate specifično namenjeno vašem polu i rodu.

They may not know the answer --

Možda ne znaju odgovor -

yet.

još.

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

No, razgovori su otpočeli i zajedno možemo da učimo.

Remember, for me and my colleagues in this field,

Upamtite, za mene i moje kolege u ovom polju,

your sex and gender matter.

vaš pol i rod su bitni.

Thank you.

Hvala.

(Applause)

(Aplauz)