Paula Johnson: His and hers ... healthcare

Prevodilac: Ivana Krivokuća Lektor: Tijana Mihajlović

Some of my most wonderful memories of childhood

Neke od mojih najlepših uspomena iz detinjstva

are of spending time with my grandmother, Mamar,

vezane su za vreme provedeno sa mojom bakom Mamar,

in our four-family home in Brooklyn, New York.

u našoj kući sa četiri stana u Bruklinu u Njujorku.

Her apartment was an oasis.

Njen stan je bio oaza.

It was a place where I could sneak a cup of coffee,

Bilo je to mesto gde sam mogla da prošvercujem kafu,

which was really warm milk with just a touch of caffeine.

što je u stvari bilo toplo mleko sa mrvicom kofeina.

She loved life.

Volela je život.

And although she worked in a factory,

Iako je radila u fabrici,

she saved her pennies and she traveled to Europe.

prikupljala je sitninu i otputovala u Evropu.

And I remember poring over those pictures with her

Sećam se kako sam razgledala te slike sa njom,

and then dancing with her to her favorite music.

a zatim smo igrale uz njenu omiljenu muziku.

And then, when I was eight and she was 60,

Onda, kada sam imala 8 godina, a ona 60,

something changed.

nešto se promenilo.

She no longer worked or traveled.

Više nije radila niti je putovala.

She no longer danced.

Više nije plesala.

There were no more coffee times.

Nije bilo više trenutaka uz kafu.

My mother missed work and took her to doctors

Moja majka je izlazila sa posla i vodila je kod doktora

who couldn't make a diagnosis.

koji nisu mogli da odrede dijagnozu.

And my father, who worked at night, would spend every afternoon with her,

Moj otac, koji je radio noću, provodio bi svako popodne sa njom,

just to make sure she ate.

samo da se pobrine da jede.

Her care became all-consuming for our family.

Briga o njoj je potpuno obuzela našu porodicu.

And by the time a diagnosis was made,

U trenutku kada je dijagnoza doneta,

she was in a deep spiral.

stanje joj se već dosta pogoršalo.

Now many of you will recognize her symptoms.

Mnogi među vama ćete prepoznati njene simptome.

My grandmother had depression.

Moja baka je imala depresiju,

A deep, life-altering depression,

duboku depresiju koja menja život,

from which she never recovered.

od koje se nikada nije oporavila.

And back then, so little was known about depression.

U to vreme se tako malo znalo o depresiji.

But even today, 50 years later,

Čak i danas, 50 godina kasnije,

there's still so much more to learn.

toliko toga još imamo da naučimo.

Today, we know that women are 70 percent more likely

Danas znamo da žene imaju 70 posto veće izglede

to experience depression over their lifetimes

da dožive depresiju tokom života

compared with men.

u poređenju sa muškarcima.

And even with this high prevalence,

Čak i sa tom visokom rasprostranjenošću,

women are misdiagnosed between 30 and 50 percent of the time.

žene dobijaju pogrešnu dijagnozu u 30 do 50 odsto slučajeva.

Now we know that women are more likely

Sada znamo da žene imaju veće šanse

to experience the symptoms of fatigue, sleep disturbance,

da dožive simptome premora, poremećaja sna,

pain and anxiety compared with men.

bola i anksioznosti u poređenju sa muškarcima.

And these symptoms are often overlooked

Ovi simptomi se često ne prepoznaju

as symptoms of depression.

kao simptomi depresije.

And it isn't only depression in which these sex differences occur,

Ove polne razlike ne javljaju se samo kod depresije,

but they occur across so many diseases.

već i kod mnogih drugih oboljenja.

So it's my grandmother's struggles

Stoga me je borba moje bake

that have really led me on a lifelong quest.

podstakla na životnu potragu.

And today, I lead a center in which the mission

Danas predvodim centar

čija je misija da otkrije zašto se te polne razlike javljaju

is to discover why these sex differences occur

and to use that knowledge

i da upotrebi to znanje

to improve the health of women.

da bi se poboljšalo zdravlje žena.

Today, we know that every cell has a sex.

Danas znamo da svaka ćelija ima pol.

Now, that's a term coined by the Institute of Medicine.

To je termin koji je skovao Institut za medicinu.

And what it means is that men and women are different

To znači da su muškarci i žene različiti

down to the cellular and molecular levels.

sve do ćelijskih i molekularnih nivoa.

It means that we're different across all of our organs.

To znači da se svi naši organi razlikuju,

From our brains to our hearts, our lungs, our joints.

od mozga do srca, pluća i zglobova.

Now, it was only 20 years ago

Pre svega 20 godina,

that we hardly had any data on women's health

jedva da smo imali bilo kakve podatke o zdravlju žena

beyond our reproductive functions.

osim reproduktivnih funkcija.

But then in 1993,

Međutim, 1993. godine,

the NIH Revitalization Act was signed into law.

stupio je na snagu Akt o revitalizaciji Nacionalnih instituta za zdravlje.

And what this law did was it mandated

Ovaj zakon je nalagao

that women and minorities be included in clinical trials

da žene i manjine budu uključeni u kliničkim ispitivanjima

that were funded by the National Institutes of Health.

koje su finansirali Nacionalni instituti za zdravlje.

And in many ways, the law has worked.

U mnogo čemu, zakon je delovao.

Women are now routinely included in clinical studies,

Žene su sada redovno obuhvaćene u kliničkim istraživanjima

and we've learned that there are major differences

i saznali smo da postoje velike razlike

in the ways that women and men

u tome kako žene i muškarci

experience disease.

doživljavaju bolesti.

But remarkably,

Ipak, što je neobično,

what we have learned about these differences is often overlooked.

saznali smo da se ove razlike često previde.

So, we have to ask ourselves the question:

Dakle, moramo postaviti sebi pitanje

Why leave women's health to chance?

zašto prepustiti zdravlje žena slučaju,

And we're leaving it to chance in two ways.

a prepuštamo ga slučaju na dva načina.

The first is that there is so much more to learn

Prvi je da ima još toliko toga što treba saznati,

and we're not making the investment

a ne ulažemo

in fully understanding the extent of these sex differences.

u potpuno razumevanje opsega ovih polnih razlika.

And the second is that we aren't taking what we have learned,

Drugi je da ne usvajamo ono što smo saznali

and routinely applying it in clinical care.

i to ne primenjujemo redovno u kliničkoj nezi.

We are just not doing enough.

Jednostavno ne činimo dovoljno.

So, I'm going to share with you three examples

Podeliću sa vama tri primera

of where sex differences have impacted the health of women,

gde su polne razlike uticale na zdravlje žena

and where we need to do more.

i gde je potrebno da učinimo više.

Let's start with heart disease.

Počnimo sa bolestima srca.

It's the number one killer of women in the United States today.

To je ubica žena broj jedan u Sjedinjenim Državama danas.

This is the face of heart disease.

Ovo je lice srčane bolesti.

Linda is a middle-aged woman,

Linda je žena srednjih godina

who had a stent placed in one of the arteries

koja je imala stent u jednoj od arterija

going to her heart.

koje idu ka srcu.

When she had recurring symptoms she went back to her doctor.

Kad je dobila simptome koji se ponavljaju, otišla je ponovo kod doktora.

Her doctor did the gold standard test:

Njen doktor je obavio test „zlatni standard“,

a cardiac catheterization.

kateterizaciju srca.

It showed no blockages.

Pokazalo se da nema začepljenja.

Linda's symptoms continued.

Lindini simptomi su se nastavili.

She had to stop working.

Morala je da prestane da radi.

And that's when she found us.

Tada je pronašla nas.

When Linda came to us, we did another cardiac catheterization

Kada je Linda došla kod nas, sproveli smo još jednu kateterizaciju srca

and this time, we found clues.

i ovoga puta smo našli naznake.

But we needed another test

Međutim, bio nam je potreban još jedan test

to make the diagnosis.

da bismo došli do dijagnoze.

So we did a test called an intracoronary ultrasound,

Stoga smo obavili test zvani intravaskularni ultrazvuk,

where you use soundwaves to look at the artery

gde se koriste zvučni talasi da bi se arterija pregledala iznutra.

from the inside out.

And what we found

Otkrili smo

was that Linda's disease didn't look like

da Lindino oboljenje nije izgledalo

the typical male disease.

kao tipično muško oboljenje.

The typical male disease looks like this.

Tipično muško oboljenje izgleda ovako.

There's a discrete blockage or stenosis.

Postoji izdvojena zapušenost ili stenoza.

Linda's disease, like the disease of so many women,

Lindino oboljenje, kao i oboljenje kod mnogo žena,

looks like this.

izgleda ovako.

The plaque is laid down more evenly, more diffusely

Plak oblaže ravnomernije,

difuznije duž arterije i teže ga je uočiti.

along the artery, and it's harder to see.

So for Linda, and for so many women,

Zato za Lindu, kao i za mnogo žena,

the gold standard test wasn't gold.

test „zlatni standard“ nije zlatan.

Now, Linda received the right treatment.

Linda je dobila odgovarajuće lečenje.

She went back to her life and, fortunately, today

Vratila se svom životu i, srećom,

she is doing well.

danas joj je dobro.

But Linda was lucky.

Međutim, Linda je imala sreće.

She found us, we found her disease.

Pronašla je nas, mi smo pronašli njeno oboljenje.

But for too many women, that's not the case.

To nije slučaj kod isuviše mnogo žena.

We have the tools.

Imamo sredstva.

We have the technology to make the diagnosis.

Imamo tehnologiju za donošenje dijagnoze.

But it's all too often that these sex diffferences

Ipak, te polne razlike se prečesto previđaju.

are overlooked.

So what about treatment?

Šta je sa lečenjem?

A landmark study that was published two years ago

Značajna studija objavljena pre dve godine

asked the very important question:

postavila je veoma važno pitanje:

What are the most effective treatments for heart disease in women?

koji su najdelotvorniji tretmani bolesti srca kod žena?

The authors looked at papers written over a 10-year period,

Autori su pregledali papire ispisane tokom perioda od 10 godina

and hundreds had to be thrown out.

i stotine je moralo da bude bačeno.

And what they found out was that of those that were tossed out,

Otkrili su da je, od onih koji su odbačeni,

65 percent were excluded

65 posto izostavljeno

because even though women were included in the studies,

jer, iako su žene obuhvaćene studijom,

the analysis didn't differentiate between women and men.

analiza nije pravila razliku između žena i muškaraca.

What a lost opportunity.

Kakva propuštena prilika.

The money had been spent

Novac je potrošen,

and we didn't learn how women fared.

a nismo saznali šta se desilo sa ženama.

And these studies could not contribute one iota

Ove studije nisu ni mrvicu doprinele

to the very, very important question,

vrlo, vrlo važnom pitanju -

what are the most effective treatments

koji su najdelotvorniji tretmani

for heart disease in women?

za bolesti srca kod žena?

I want to introduce you to Hortense, my godmother,

Želim da vam predstavim Hortens, moju kumu,

Hung Wei, a relative of a colleague,

Hung Vej, rođaku jednog kolege,

and somebody you may recognize --

i nekog koga možda prepoznajete,

Dana, Christopher Reeve's wife.

Dejnu, ženu Kristofera Riva.

All three women have something very important in common.

Ove tri žene imaju nešto zajedničko što je veoma važno.

All three were diagnosed with lung cancer,

Sve tri su dobile dijagnozu raka pluća,

the number one cancer killer of women

ubice žena broj jedan među vrstama raka

in the United States today.

u Sjedinjenim Državama danas.

All three were nonsmokers.

Sve tri su bile nepušači.

Sadly, Dana and Hung Wei died of their disease.

Nažalost, Dejna i Hung Vej su preminule zbog svoje bolesti.

Today, what we know is that women who are nonsmokers are three times more likely

Danas znamo da žene nepušači imaju tri puta veću šansu

to be diagnosed with lung cancer than are men

da dobiju dijagnozu raka pluća

nego muškarci koji su nepušači.

who are nonsmokers.

Now interestingly, when women are diagnosed with lung cancer,

Zanimljivo je da, kada je ženama dijagnostikovan rak pluća,

their survival tends to be better than that of men.

njihovo preživljavanje obično bude bolje nego kod muškaraca.

Now, here are some clues.

Evo nekih nagoveštaja.

Our investigators have found that there are

Naši istraživači su otkrili da postoje izvesni geni

certain genes in the lung tumor cells of both women and men.

u ćelijama tumora na plućima kod žena i kod muškaraca.

And these genes are activated

Te gene aktivira

mainly by estrogen.

uglavnom estrogen.

And when these genes are over-expressed,

Kada su ti geni previše izraženi,

it's associated with improved survival

to je u vezi sa poboljšanim preživljavanjem

only in young women.

samo kod mladih žena.

Now this is a very early finding

Ovo je skorašnji nalaz

and we don't yet know whether it has relevance

i još ne znamo da li je od značaja

to clinical care.

za kliničku negu.

But it's findings like this that may provide hope

Ipak, nalazi poput ovoga mogu pružiti nadu

and may provide an opportunity to save lives

i mogućnost za spasavanje života

of both women and men.

i žena i muškaraca.

Now, let me share with you an example

Dopustite da podelim sa vama jedan primer kako, kada uzmemo u obzir polne razlike,

of when we do consider sex differences, it can drive the science.

to može da pokrene nauku.

Several years ago a new lung cancer drug

Pre nekoliko godina, novi lek protiv raka pluća

was being evaluated,

prolazio je kroz evaluaciju,

and when the authors looked at whose tumors shrank,

a kada su autori razmotrili čiji su se tumori smanjili,

they found that 82 percent were women.

otkrili su da su 82 procenta činile žene.

This led them to ask the question: Well, why?

To ih je navelo da se zapitaju zašto je to tako.

And what they found

Otkrili su

was that the genetic mutations that the drug targeted

da je genetska mutacija na koju je gen usmeren

were far more common in women.

daleko češća kod žena.

And what this has led to

Ovo je dovelo

is a more personalized approach

do personalizovanijeg pristupa

to the treatment of lung cancer that also includes sex.

u lečenju raka pluća koje podrazumeva i pol.

This is what we can accomplish

To je ono što možemo postići

when we don't leave women's health to chance.

kada ne prepustimo zdravlje žena slučaju.

We know that when you invest in research,

Znamo da, kada uložite u istraživanje,

you get results.

dobijate rezultate.

Take a look at the death rate from breast cancer over time.

Pogledajte stopu smrtnosti od raka dojke tokom vremena.

And now take a look at the death rates

Sada pogledajte stopu smrtnosti

from lung cancer in women over time.

od raka pluća kod žena tokom vremena.

Now let's look at the dollars invested in breast cancer --

Hajde da sada pogledamo iznos u dolarima koji je uložen u rak dojke -

these are the dollars invested per death --

to su dolari uloženi po smrti -

and the dollars invested in lung cancer.

i dolare uložene u rak pluća.

Now, it's clear that our investment in breast cancer

Jasno je da je naše ulaganje u rak dojke

has produced results.

proizvelo rezultate.

They may not be fast enough,

Možda nisu dovoljno brzi,

but it has produced results.

ali je dovelo do rezultata.

We can do the same

Možemo isto postići

for lung cancer and for every other disease.

kod raka pluća i svake druge bolesti.

So let's go back to depression.

Vratimo se na depresiju.

Depression is the number one cause

Depresija je uzrok broj jedan

of disability in women in the world today.

za invaliditet žena u svetu danas.

Our investigators have found

Naši istraživači su otkrili

that there are differences in the brains

da postoje razlike u mozgu

of women and men

žena i muškaraca

in the areas that are connected with mood.

u oblastima koje su povezane sa raspoloženjem.

And when you put men and women

Kada stavite muškarce i žene

in a functional MRI scanner --

pod skener funkcionalne MRT -

that's the kind of scanner that shows how the brain is functioning when it's activated --

to je vrsta skenera koja pokazuje kako mozak funkcioniše kada se aktivira -

so you put them in the scanner and you expose them to stress.

dakle, stavite ih u skener i izložite ih stresu.

You can actually see the difference.

Možete zaista videti razliku.

And it's findings like this

Smatramo da nalazi kao što je ovaj

that we believe hold some of the clues

daju neke nagoveštaje

for why we see these very significant sex differences

o tome zašto vidimo vrlo značajne polne razlike

in depression.

kod depresije.

But even though we know

Međutim, iako znamo

that these differences occur,

da se ove razlike javljaju,

66 percent

66 posto

of the brain research that begins in animals

istraživanja mozga koja započinju na životinjama

is done in either male animals

sprovodi se ili na mužjacima

or animals in whom the sex is not identified.

ili na životinjama čiji pol nije ustanovljen.

So, I think we have to ask again the question:

Dakle, mislim da ponovo treba da postavimo pitanje

Why leave women's health to chance?

zašto da prepuštamo zdravlje žena slučaju.

And this is a question that haunts those of us

To je pitanje koje proganja nas u oblasti nauke i medicine

in science and medicine

who believe that we are on the verge of being able to dramatically improve

koji smatramo da smo nadomak mogućnosti da drastično poboljšamo

the health of women.

zdravlje žena.

We know that every cell has a sex.

Znamo da svaka ćelija ima pol.

We know that these differences are often overlooked.

Znamo da se te razlike često previđaju.

And therefore we know that women are not getting the full benefit

Prema tome, znamo da žene danas ne koriste u potpunosti

of modern science and medicine today.

savremenu nauku i medicinu.

We have the tools

Imamo sredstva,

but we lack the collective will and momentum.

ali nam nedostaje kolektivne volje i poleta.

Women's health is an equal rights issue

Žensko zdravlje je problem jednakih prava

as important as equal pay.

podjednako važan kao i jednaka zarada.

And it's an issue of the quality

To je pitanje kvaliteta

and the integrity of science and medicine.

i integriteta nauke i medicine.

(Applause)

(Aplauz)

So imagine the momentum we could achieve

Zamislite zamah koji bismo postigli

in advancing the health of women

u unapređivanju zdravlja žena

if we considered whether these sex differences were present

ako bismo uzeli u obzir da li postoje ove polne razlike

at the very beginning of designing research.

na samom početku osmišljavanja istraživanja,

Or if we analyzed our data by sex.

ili kada bismo analizirali podatke prema polu.

So, people often ask me:

Ljudi me često pitaju:

What can I do?

„Šta mogu da učinim?“

And here's what I suggest:

Evo šta predlažem.

First, I suggest that you think about women's health

Najpre, predlažem da razmišljate o zdravlju žena

in the same way

na isti način

that you think and care about other causes that are important to you.

na koji razmišljate i brinete o drugim ciljevima koji su vam važni.

And second, and equally as important,

Drugo, jednako važno,

that as a woman,

jeste da kao žena

you have to ask your doctor

morate pitati svog doktora

and the doctors who are caring for those who you love:

i doktore koji brinu o onima koje volite:

Is this disease or treatment different in women?

„Da li su ova bolest ili njeno lečenje drugačiji kod žena?“

Now, this is a profound question because the answer is likely yes,

Ovo je obuhvatno pitanje jer je odgovor verovatno potvrdan,

but your doctor may not know the answer, at least not yet.

ali vaš doktor možda još ne zna odgovor,

bar ne za sada.

But if you ask the question, your doctor will very likely

Ipak, ako postavite pitanje, vaš doktor će verovatno

go looking for the answer.

potražiti odgovor.

And this is so important,

Ovo je toliko važno,

not only for ourselves,

ne samo za nas same,

but for all of those whom we love.

već i za sve one koje volimo,

Whether it be a mother, a daughter, a sister,

bilo da je to majka, ćerka, sestra,

a friend or a grandmother.

prijatelj ili baka.

It was my grandmother's suffering

Patnja moje bake

that inspired my work

je inspirisala moj rad

to improve the health of women.

na poboljšanju zdravlja žena.

That's her legacy.

To je njeno zaveštanje.

Our legacy can be to improve the health of women

Naše zaveštanje može biti da poboljšamo zdravlje žena

for this generation

ove generacije

and for generations to come.

i budućih generacija.

Thank you.

Hvala.

(Aplauz)

(Applause)