ABOUT THE SPEAKER
Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.

Why you should listen

Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.

He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.

More profile about the speaker
Ivan Oransky | Speaker | TED.com
TEDMED 2012

Ivan Oransky: Are we over-medicalized?

Ivan Oransky: Estamos sobremedicados?

Filmed:
697,753 views

O editor de "Reuters Health" Ivan Oransky advírtenos de que estamos a sufrir unha epidemia preabsurdas enfermidades en estadios previos: prediabetes, precancro, e moitas máis. Nesta interesante charla de TEDMED, demóstranos como o mundo da atención médica pode mellorar... aprendendo unha importante lección do béisbol.
- Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions. Full bio

Double-click the English transcript below to play the video.

00:16
Those of you who have seen the film "Moneyball,"
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A aqueles de vós que vistes
a película Moneyball
00:20
or have read the book by Michael Lewis,
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ou lestes o libro de Michael Lewis
00:22
will be familiar with the story of Billy Beane.
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soaravos a historia de Billy Beane
00:25
Billy was supposed to be a tremendous ballplayer; all the scouts told him so.
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Billy ía ser un xogador de béisbol xenial,
e todos os recrutadores llo dicían
00:29
They told his parents that
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Dixéronllo aos seus pais
00:31
they predicted that he was going to be a star.
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Predixeron que sería unha estrela.
00:33
But what actually happened when he signed the contract -- and by the way, he didn't
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Pero o que realmente sucedeu
cando firmou o contrato, que por certo,
non quería firmar ese contrato,
el quería ir á universidade,
00:38
want to sign that contract, he wanted to go to
college --
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00:40
which is what my mother, who actually does
love me,
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é o que a miña nai, que me quere ben,
00:43
said that I should do too, and I did --
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díxome que debería facer tamén
e iso fixen.
00:46
well, he didn't do very well. He struggled
mightily.
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Ben, non lle foi moi aló.
Loitou intensamente.
00:49
He got traded a couple of times, he ended up in the Minors for most of his career,
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Cambiou de equipo en varias ocasións,
caeu en ligas menores
durante a maior parte da súa carreira
00:53
and he actually ended up in management. He ended up as a General Manager of the
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e finalmente rematou en administración.
Terminou sendo o director xeral
dos Athletics de Oakland
00:57
Oakland A's.
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00:58
Now for many of you in this room, ending up in management, which is also what I've done,
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Para moitos de vós nesta sala,
acabar en administración,
cousa que tamén eu fixen, é un éxito
01:02
is seen as a success.
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01:04
I can assure you that for a kid trying to make it in the Bigs,
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Pódovos asegurar que para un rapaz
que trata de chegar ás grandes ligas
01:07
going into management ain't no success story. It's a failure.
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rematar en administración
non é ningún éxito, é un fracaso
01:12
And what I want to talk to you about today, and share with you, is that our
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E hoxe quérovos contar,
e compartir con vós
que o noso sistema médico
é igual de malo para facer predicións
01:16
healthcare system, our medical system, is
just as bad at predicting
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01:21
what happens to people in it -- patients,
others --
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do que lles ocorre ás persoas doentes
coma os recrutadores dicindo
o que lle ía pasar a Billy Beane.
01:25
as those scouts were at predicting what would happen to Billy Beane.
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01:30
And yet, every day
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Aínda así, cada día
01:32
thousands of people in this country
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a millares de persoas neste país
01:34
are diagnosed with preconditions.
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diagnostícanselles
enfermidades en estados previos.
01:38
We hear about pre-hypertension, we hear about pre-dementia,
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Oímos falar de prehipertensión,
oímos falar de predemencia
01:42
we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with
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oímos falar de preansiedade,
e estou case seguro
de que me autodiagnostiquei iso
nos camerinos. (Risas)
01:48
that in the green room.
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01:49
We also refer to subclinical conditions.
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Tamén nos referimos
ás afeccións subclínicas
01:53
There's subclinical atherosclerosis, subclinical hardening of the arteries,
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Hai aterosclerose subclínica,
endurecemento das arterias subclínico,
01:58
obviously linked to heart attacks, potentially.
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obviamente vinculado
a ataques cardíacos, potencialmente.
02:02
One of my favorites is called
subclinical acne.
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Un dos meus favoritos
chámase acne subclínico.
02:05
If you look up subclinical acne, you may find a website, which I did,
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Se buscan acne subclínico,
se cadra atopen un sitio web, coma min,
02:09
which says that this is the easiest type of acne to treat.
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que di que este é o tipo de acne
máis fácil de tratar. (Risas)
02:13
You don't have the pustules or the redness and inflammation.
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Non tes as pústulas nin o avermellamento
nin a inflamación.
02:20
Maybe that's because you don't actually
have acne.
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Talvez é que en realidade
non tes acne. (Risas)
02:23
I have a name for all of these conditions, it's another precondition:
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Téñolle un nome
para todas estas afeccións,
é outra doenza en estadio previo:
02:30
I call them preposterous.
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chámolle preabsurdeza. (Risas)
02:32
In baseball, the game follows the pre-game.
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Ben, en béisbol, o partido
vén despois do prepartido
02:38
Season follows the pre-season.
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A temporada vén despois
da pretemporada.
02:40
But with a lot of these conditions, that actually isn't the case, or at least it isn't the
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Pero isto non ocorre con moitas
destas doenzas,
ou polo menos non sempre ocorre
02:45
case all the time. It's as if there's a rain delay, every single time in many cases.
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é coma se sempre aprazaran
o partido por choiva en moitos casos.
02:49
We have pre-cancerous lesions,
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Existen lesións precanceríxenas,
02:51
which often don't turn into cancer.
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que a miúdo non se transforman en cancro.
02:55
And yet,
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Aínda así, se poñemos por caso
a osteoporose subclínica,
02:56
if you take, for example, subclinical
osteoporosis, a bone thinning disease,
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un mal que debilita os ósos,
03:00
the precondition,
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03:02
otherwise known as osteopenia,
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cuxa enfermidade previa
é coñecida como osteopenia
03:04
you would have to treat 270
women for three years
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teríamos que tratar a 270 mulleres
durante 3 anos
03:08
in order to prevent one broken bone.
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para evitar un caso de fractura.
03:10
That's an awful lot of women
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Son moitísimas mulleres
03:12
when you multiply by the number of women
who were diagnosed
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se multiplicamos polo número
das que foron diagnosticadas
03:15
with this osteopenia.
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con osteopenia
03:17
And so is it any wonder,
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Non resulta sorprendente,
03:19
given all of the costs and the side effects
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tendo en conta os custos
e os efectos secundarios
03:21
of the drugs that we're using to treat these preconditions, that every year
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das menciñas que se usan
para tratar estes males en estado previo,
que esteamos a gastar máis de dous billóns
de dólares en sanidade, e con todo,
03:25
we're spending more than two trillion dollars on healthcare and yet
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03:29
100,000 people a year -- and that's a conservative estimate -- are dying
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100.000 persoas cada ano, e esa
é unha estimación moderada,
están a morrer, e non polas afeccións
que padecen
03:32
not because of the conditions they have,
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03:34
but because of the treatments that we're giving them and the complications of those treatments?
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senón polos tratamentos que estamos a dar
e as súas correspondentes complicacións
03:39
We've medicalized everything
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Medicalizamos todo neste país.
03:41
in this country.
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03:42
Women in the audience, I have
some
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Para as mulleres do público,
teño unha mala nova,
que xa coñecen
03:46
pretty bad news that you already know,
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03:48
and that's that every aspect of your
life
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e é que todos os aspectos das súas vidas
se medicalizaron.
03:50
has been medicalized.
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03:52
Strike one is when you hit puberty.
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O primeiro strike é
cando chegan á puberdade.
03:54
You now have something that happens to you once a month that has been medicalized.
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Agora teñen algo que lles ocorre
unha vez ao mes e que está medicalizado
03:59
It's a condition;
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É unha doenza;
03:59
it has to be treated. Strike two
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ten que ser tratada.
Strike dous é se quedas embarazada.
04:01
is if you get pregnant.
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04:03
That's been medicalized as
well.
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Iso está medicalizado tamén.
04:06
You have to have a high-tech experience
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Tes que usar tecnoloxía punta no embarazo,
04:08
of pregnancy, otherwise something might go wrong.
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ou algo pode ir mal.
04:10
Strike three is menopause.
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O terceiro strike é a menopausa.
Todos sabemos que aconteceu
04:14
We all know what happened when millions of women were given hormone replacement therapy
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cando se lles deu a milleiros de mulleres
unha terapia de substitución hormonal
04:18
for menopausal symptoms
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para os síntomas da menopausa
04:21
for decades until all of a sudden we realized, because a study came out, a big one,
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durante décadas
ata que de repente, decatámonos
polos resultados dun gran estudo,
financiado polo
Instituto Nacional de Saúde (NIH)
04:26
NIH-funded.
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04:27
It said,
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04:28
actually, a lot of that hormone replacement therapy may be doing more harm than good
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que dicía que realmente
a terapia de substitución hormonal
podía estar a facerlles máis mal que ben
a moitas destas mulleres.
04:32
for many of those women.
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04:34
Just in case,
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Por se acaso,
04:36
I don't want to leave the men out --
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non quero deixar aos homes fóra
04:38
I am one, after all --
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Con todo, son un deles.
04:40
I have really bad news for all of you in
this room,
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Teño malas novas para todos
os que estades nesta sala
04:42
and for everyone
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e para todos
04:43
listening and watching elsewhere:
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os que nos escoitades e vedes
noutros lugares:
04:45
You all have
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04:46
a universally fatal condition.
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todos tedes
unha doenza universal e fatal.
04:49
So, just take a moment.
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Pensade un momento.
04:52
It's called pre-death.
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Chámase premorte. (Risas)
04:54
Every single one of you has it, because
you have the risk factor for it,
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Todos vós a padecedes,
porque todos vós tedes o factor de risco,
04:59
which is being alive.
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que é estar vivos.
05:01
But I have some good news for you,
because
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Pero tamén teño boas novas,
05:04
I'm a journalist, I like to end things in a happy way or a forward-thinking way.
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porque son xornalista,
e gústame rematar as cousas
dunha maneira alegre e visionaria.
05:08
And that good news is that if you can survive to the end of my talk, which
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O lado positivo é que, se podedes
sobrevivir ata o final da miña charla,
05:12
we'll see if that happens for everyone,
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que xa veremos se vos sucede a todos,
05:14
you will be a pre-vivor.
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seredes "previventes". (Risas)
05:17
I made up pre-death.
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Xa Inventei premorte.
05:22
If I used someone else's pre-death, I apologize,
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Se usei o termo doutra persoa, síntoo,
05:26
I think I made it up.
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pero creo que o inventei eu.
05:28
I didn't make up pre-vivor.
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Non inventei "previventes"
05:30
Pre-vivor is what a particular cancer advocacy group would like everyone who
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Previvente é como algún grupo de apoio
a persoas con cancro
querería que lles chamásemos
05:35
just has a risk factor,
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05:36
but hasn't actually had that cancer,
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aos que só teñen o factor de risco
pero non tiveron o cancro.
05:39
to call themselves.
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05:40
You are a pre-vivor.
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Vós sodes previventes.
05:42
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the
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Estivo aquí xente da HBO esta mañá.
Pregúntome se Mark Burnett
se atopa entre o público.
05:46
audience, I'd like to suggest
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Gustaríame propoñerlle
un programa de telerrealidade
05:48
a reality TV show called "Pre-vivor."
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que se chame "Previvente"
05:52
If you develop a disease, you're off
the island.
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Se enfermas, estás fóra da illa. (Risas)
05:55
But the problem is, we have a system
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Pero o problema é que temos un sistema
06:01
that is completely --
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que é completamente...
06:02
basically promoted this.
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basicamente promoveuisto.
06:04
We've selected, at every point in this system,
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Escollemos, en cada momento deste sistema,
facer o que facemos, e atribuír a todos
unha enfermidade en estado previo
06:07
to do what we do, and to give everyone a
precondition and then eventually
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e finalmente, nalgúns casos,
unha doenza.
06:11
a condition, in some cases.
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06:13
Start with the doctor-patient
relationship. Doctors, most of them,
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Comecemos pola relación médico-doente.
A maioría dos médicos teñen
un sistema de pago por servizo.
06:18
are in a fee-for-service system. They are
basically incentivized to do more --
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Principalmente,
teñen incentivos para facer máis
06:23
procedures, tests,
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procedementos, probas,
prescribir menciñas.
06:24
prescribe medications.
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06:26
Patients come to them,
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Os doentes acoden a eles,
queren facer algo.
06:27
they want to do something. We're
Americans, we can't just stand
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Non podemos quedar mirando.
Somos americanos, temos que facer algo.
06:31
there, we have to do something. And so
they want a drug.
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Por iso, queren un medicamento.
Queren un tratamento.
06:34
They want a treatment. They want to be told, this is what you have and this is how
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Queren que lles digan:
isto é o que tes e así é como se trata.
06:38
you treat it. If the doctor
doesn't give you that,
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Se o médico non che dá iso
vaste para outra parte.
06:40
you go somewhere else.
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06:42
That's not very good for doctors'
business.
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Pero iso non é bo
para o negocio dos médicos.
06:44
Or even worse,
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Ou aínda peor, se ao final
lles diagnostican algo,
06:46
if you are diagnosed with something
eventually, and the doctor didn't order that test,
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e o médico non pediu esa proba,
demándano.
06:50
you get sued.
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06:52
We have pharmaceutical companies that are
constantly trying to expand
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Hai compañías farmacéuticas
que tratan constantemente de ampliar
06:55
the indications, expand the number of people who are eligible for a given treatment,
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as indicacións,
ampliar o número de persoas
que son aptas para certos tratamentos
porque obviamente
isto incrementa os seus ingresos
07:00
because that obviously helps their bottom line.
We have advocacy groups,
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Existen grupos de apoio como
os que inventaron a palabra previvente,
07:03
like the one that's come up with
pre-vivor,
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07:05
who want to make more and more people feel they are at risk, or might have a condition,
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que queren facer que as persoas sintan
que están en perigo, ou que pode
que padezan unha doenza
07:10
so that they can raise more funds
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para así obter máis fondos,
e ser máis visibles, etcétera.
07:12
and raise visibility, et cetera.
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Pero non se trata, a pesar de que
os xornalistas o fagan normalmente,
07:14
But this isn't actually,
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07:16
despite what journalists typically do,
this isn't actually about blaming
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non se trata de culpar
a ninguén en particular.
07:19
particular players.
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07:21
We are all responsible.
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Todos somos responsables,
07:22
I'm responsible.
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eu son responsable.
07:24
I actually root for the Yankees, I mean talk
about
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A verdade é que apoio aos Yankees,
é dicir,
apoio ao máximo culpable
07:27
rooting for the worst
possible
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07:30
offender when it comes to doing
everything you can do.
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cando se trata de facer
todo o que se pode facer
07:33
Thank you.
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Grazas. (Risas)
07:34
But everyone is responsible.
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Pero todo o mundo é culpable.
07:38
I went to medical school,
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Fun á facultade de medicina,
07:41
and I didn't have a course called How to Think Skeptically,
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e non tiven unha clase de
"Como pensar con escepticismo"
07:46
or How Not to Order Tests.
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ou "Como non pedir análises".
07:48
We have this system
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Temos este sistema
07:50
where that's what you do.
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onde iso é o que se fai.
07:53
And it actually took being a journalist
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Tiven que ser xornalista para entender
estes incentivos.
07:55
to understand all these incentives. You know, economists like to say,
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Sabedes, os economistas adoitan dicir
07:59
there are no bad people,
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que non hai xente mala,
08:00
there are just bad incentives.
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só malos incentivos.
08:02
And that's actually true.
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E de feito, iso é certo.
08:04
Because what we've created is a sort of Field of Dreams, when it comes to medical technology.
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Porque creamos unha especie
de "Campo de Soños"
no ámbito da tecnoloxía médica.
08:07
So when you put another MRI in
every corner, you put a robot
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Poñemos máquinas de resonancia
magnética por todas partes,
non queda un hospital
sen unha máquina que di
08:13
in every hospital saying that everyone has to have robotic surgery.
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que todos necesitamos cirurxía robótica
08:16
Well, we've created a system where if you
build it, they will come.
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Creamos un sistema de
"se o constrúes, eles virán".
08:20
But you can actually perversely
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Pero pódese convencer de maneira perversa
08:24
tell people to come, convince them
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á xente sa de que teñen que vir.
08:26
that they have to come.
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08:28
It was when I became a journalist that I really realized how I was part of this problem,
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Pero, cando me fixen xornalista
foi cando me dei conta
de como eu era parte do problema
08:33
and how we all are part of this problem.
167
497462
2024
e de como todos somos parte do problema.
08:35
I was medicalizing every risk factor, I was writing stories, commissioning stories,
168
499486
3656
Medicalizaba todos os factores de risco,
escribía historias, encargaba artigos,
que non trataban
08:39
every day, that were trying to,
169
503142
3393
de preocupar á xente, pero iso
era o que ocorría con frecuencia.
08:42
not necessarily make people worried, although that was what often happened.
170
506535
2997
08:45
But, you know, there are ways out.
171
509532
3023
Pero sabedes, hai saída.
Vin ao meu internista a semana pasada
e díxome
08:48
I saw my own internist last week,
172
512555
1872
08:50
and he said to me,
173
514427
2532
08:52
"You know," and he told me something that
174
516959
2517
"Xa sabes", e informoume de algo
que calquera dos que estades aquí
08:55
everyone in this audience could have
told me for free,
175
519476
2474
podería dicirme gratuitamente,
08:57
but I paid him for the privilege, which
is that
176
521950
2488
pero eu pagueille pola exclusiva:
09:00
I need to lose some weight.
177
524438
1669
Teño que perder peso.
09:02
Well, he's right. I've had honest-to-goodness high blood pressure
178
526107
4457
Ben, ten razón. Son hipertenso
dende hai doce anos xa,
09:06
for a dozen years now, same
179
530564
1713
á mesma idade que empezou a selo meu pai,
09:08
age my father got it,
180
532277
1774
09:09
and it's a real disease. It's not pre-hypertension, it's actual
181
534051
3787
Non se trata de prehipertensión,
09:13
hypertension, high blood pressure.
182
537838
1973
é hipertensión de verdade,
presión arterial alta.
09:15
Well, he's right,
183
539811
985
Ben, ten razón, pero non me dixo
09:16
but he didn't say to me,
184
540796
3080
09:19
well, you have pre-obesity or
185
543876
1687
tes preobesidade, ou prediabetes,
ou algo así
09:21
you have pre-diabetes, or anything like that. He didn't say,
186
545563
3345
Non me dixo que empezara a tomar estatinas
09:24
better start taking this Statin, you need to lower your cholesterol.
187
548908
3376
para baixar o colesterol.
09:28
No, he said, "Go out and lose some weight. Come back and see me in a bit,
188
552284
3159
Non, díxome: vai perder peso
e volve verme nun tempiño
09:31
or just give me a call and let me know how you're doing."
189
555443
2001
ou chámame e dime que tal vas.
09:33
So that's, to me,
190
557444
2040
Iso é para min o camiño para seguir.
09:35
a way forward.
191
559484
1631
09:37
Billy Beane, by the way, learned the same
thing.
192
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2364
Billy Beane, por certo, aprendeu o mesmo.
09:39
He learned,
193
563479
1536
Decatouse, observando este rapaz,
09:40
from watching this kid who he eventually hired, who was really successful for him,
194
565015
3517
a quen ao final contratou,
e tivo moito éxito,
09:44
that it wasn't swinging for the fences, it
wasn't swinging at every pitch
195
568532
4875
que non se trataba de batear
a pelota fóra do campo,
ou de batear todos os lanzamentos,
como fan os mellores,
09:49
like the sluggers do, which is what all the expensive teams like the Yankees like to --
196
573407
4760
que é o que lles gusta
a todos os equipos con cartos,
coma os Yankees, que escollen
esa clase de xogadores.
09:54
they like to pick up those guys.
197
578176
1340
09:55
This kid told him, you know, you gotta watch the guys, and you gotta go out and find
198
579516
4589
Este rapaz díxolle:
tes que observar aos mozos,
tes que saír buscar
aos que lles guste camiñar,
10:00
the guys who like to walk,
199
584105
1239
10:01
because getting on base by a walk
200
585344
1704
porque chegar a unha base camiñando
10:02
is just as good, and in our healthcare
system
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587048
2768
é igual de válido,
e no noso sistema de saúde
10:05
we need to figure out,
202
589816
1440
temos que reflexionar:
10:07
is that really a good pitch
203
591256
1576
é iso un bo lanzamento,
10:08
or should we let it go by and not swing at everything?
204
592832
2918
ou temos que deixalo pasar
e non tratar de batealo todo?
10:11
Thanks.
205
595750
1775
Grazas. (Aplausos)
Translated by Carolina Araujo Sabell
Reviewed by Servizo de Normalización Lingüística

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ABOUT THE SPEAKER
Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.

Why you should listen

Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.

He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.

More profile about the speaker
Ivan Oransky | Speaker | TED.com
THE ORIGINAL VIDEO ON TED.COM