TEDMED 2016
David Casarett: A doctor's case for medical marijuana
David Casarett: Os argumentos dun doutor sobre a marihuana medicinal
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O doutor David Casarret estaba canso de ouvir falsas e medias verdades sobre a marihuana medicinal, polo que adoptou unha postura escéptica e púxose a investigar pola súa conta. Volveu cun informe fascinante sobre o que sabemos e o que non sabemos, e sobre o que a medicina convencional podería aprender dos dispensarios de marihuana medicinal de hoxe en día.
David Casarett - Physician
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary? Full bio
David Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary? Full bio
Double-click the English transcript below to play the video.
00:13
I would like to tell you
about the most embarrassing thing
about the most embarrassing thing
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Gustaríame contarlles
a cousa máis embarazosa
a cousa máis embarazosa
00:17
that has ever happened to me in my years
of working as a palliative care physician.
of working as a palliative care physician.
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que me pasou nestes anos traballando
como médico de coidados paliativos.
00:22
This happened a couple of years ago.
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Isto aconteceu hai un par de anos.
00:24
I was asked as a consultant
to see a woman in her 70s --
to see a woman in her 70s --
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Pedíronme que consultara a unha muller
que tería sobre uns 70 anos.
que tería sobre uns 70 anos.
00:28
retired English professor
who had pancreatic cancer.
who had pancreatic cancer.
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Unha profesora de inglés retirada
que tiña cancro de páncreas.
que tiña cancro de páncreas.
00:32
I was asked to see her because
she had pain, nausea, vomiting ...
she had pain, nausea, vomiting ...
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Pedíronme que a consultara
porque tiña dores, náuseas, vómitos...
porque tiña dores, náuseas, vómitos...
00:37
When I went to see her,
we talked about those symptoms
we talked about those symptoms
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Cando fun vela falamos sobre eses síntomas
00:40
and in the course of that consultation,
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e durante a consulta
00:42
she asked me whether I thought
that medical marijuana might help her.
that medical marijuana might help her.
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preguntoume se pensaba
que a marihuana medicinal
que a marihuana medicinal
lle podería axudar.
Intentei lembrar todo
00:48
I thought back to everything
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00:50
that I had learned in medical school
about medical marijuana,
about medical marijuana,
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o que aprendera na universidade
sobre marihuana medicinal.
sobre marihuana medicinal.
00:54
which didn't take very long
because I had learned absolutely nothing.
because I had learned absolutely nothing.
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Non me levou moito
xa que non aprendera nada en absoluto.
xa que non aprendera nada en absoluto.
00:58
And so I told her that as far as I knew,
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Polo tanto, díxenlle todo o que sabía:
01:01
medical marijuana
had no benefits whatsoever.
had no benefits whatsoever.
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que a marihuana medicinal
non tiña ningún beneficio.
non tiña ningún beneficio.
01:05
And she smiled and nodded and reached
into the handbag next to the bed,
into the handbag next to the bed,
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Ela sorriu, asentiu e colleu o bolso
que tiña ao lado da cama
que tiña ao lado da cama
01:09
and pulled out a stack of about a dozen
randomized controlled trials
randomized controlled trials
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e sacou unha morea
de ensaios aleatorizados controlados
de ensaios aleatorizados controlados
01:13
showing that medical
marijuana has benefits
marijuana has benefits
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que mostraban
que a marihuana medicinal é beneficiosa
que a marihuana medicinal é beneficiosa
01:16
for symptoms like nausea
and pain and anxiety.
and pain and anxiety.
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para síntomas como as náuseas,
a dor ou a ansiedade.
a dor ou a ansiedade.
01:20
She handed me those articles and said,
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Ela pasoume eses artigos e dixo:
01:23
"Maybe you should read these
before offering an opinion ...
before offering an opinion ...
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"Quizais debería ler isto
antes de dar unha opinión...
antes de dar unha opinión...
01:28
doctor."
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doutor".
01:30
(Laughter)
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(Risos)
01:31
So I did.
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E fíxeno.
01:33
That night I read all of those articles
and found a bunch more.
and found a bunch more.
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Esa noite lin os artigos
e atopei moitos máis.
e atopei moitos máis.
01:36
When I came to see her the next morning,
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Cando volvín vela á mañá seguinte
01:38
I had to admit that it looks like
there is some evidence
there is some evidence
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tiven que admitir que parecía
que si que había probas
que si que había probas
01:42
that marijuana can offer medical benefits
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de que a marihuana
pode ofrecer beneficios médicos
pode ofrecer beneficios médicos
01:46
and I suggested that if she
really was interested,
really was interested,
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e suxerín que se ela
estaba realmente interesada
estaba realmente interesada
01:49
she should try it.
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debería probala.
01:51
You know what she said?
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Saben o que dixo?
01:54
This 73-year-old,
retired English professor?
retired English professor?
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Esta profesora de inglés
retirada de 73 anos?
retirada de 73 anos?
01:58
She said, "I did try it
about six months ago.
about six months ago.
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Dixo: "Xa a probei hai seis meses.
02:00
It was amazing.
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Foi xenial.
02:02
I've been using it every day since.
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Estouna consumindo dende aquela.
02:04
It's the best drug I've discovered.
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É o mellor remedio que descubrín.
02:07
I don't know why it took me 73 years
to discover this stuff. It's amazing."
to discover this stuff. It's amazing."
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Non sei como me levou 73 anos descubrila.
É xenial".
02:11
(Laughter)
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(Risos)
Nese momento decateime
02:12
That was the moment at which I realized
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02:14
I needed to learn something
about medical marijuana
about medical marijuana
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de que precisaba aprender algo
sobre a marihuana medicinal
sobre a marihuana medicinal
02:17
because what I was prepared for
in medical school
in medical school
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porque a formación
que me deran na facultade
que me deran na facultade
02:20
bore no relationship to reality.
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non tiña nada que ver coa realidade.
02:23
So I started reading more articles,
I started talking to researchers,
I started talking to researchers,
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Entón comecei a ler máis artigos
e a falar con investigadores.
e a falar con investigadores.
02:27
I started talking to doctors,
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Comecei a falar con doutores
02:28
and most importantly,
I started listening to patients.
I started listening to patients.
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e o máis importante:
comecei a ouvir aos pacientes.
comecei a ouvir aos pacientes.
02:32
I ended up writing a book
based on those conversations,
based on those conversations,
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Acabei escribindo un libro
sobre esas conversas.
sobre esas conversas.
02:35
and that book really revolved
around three surprises --
around three surprises --
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E ese libro centrábase sobre todo
en tres sorpresas.
en tres sorpresas.
02:38
surprises to me, anyway.
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Sorpresas para min, polo menos.
02:40
One I already alluded to --
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Sobre unha xa falei.
02:41
that there really are some benefits
to medical marijuana.
to medical marijuana.
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Que realmente hai algúns beneficios
na marihuana medicinal.
na marihuana medicinal.
02:45
Those benefits may not be
as huge or as stunning
as huge or as stunning
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Pode que eses beneficios non sexan
tan grandes nin sorprendentes
tan grandes nin sorprendentes
02:48
as some of the most avid proponents
of medical marijuana
of medical marijuana
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como a maioría
dos defensores da marihuana medicinal
dos defensores da marihuana medicinal
02:51
would have us believe,
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nos farían crer.
02:52
but they are real.
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Pero son reais.
02:54
Surprise number two:
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Sorpresa número dúas:
a marihuana medicinal ten algúns riscos.
02:56
medical marijuana does have some risks.
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02:59
Those risks may not be
as huge and as scary
as huge and as scary
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Pode que eses riscos non sexan
tan grandes nin aterradores
tan grandes nin aterradores
03:02
as some of the opponents of medical
marijuana would have us believe,
marijuana would have us believe,
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como a maioría dos opositores
da marihuana medicinal nos farían crer.
da marihuana medicinal nos farían crer.
03:05
but they are real risks, nonetheless.
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Non obstante, son riscos reais.
03:08
But it was the third surprise
that was most ...
that was most ...
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Pero foi a terceira sorpresa a máis...
03:10
surprising.
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sorprendente.
03:12
And that is that a lot
of the patients I talked with
of the patients I talked with
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Moitos dos pacientes cos que falei
03:15
who've turned to medical
marijuana for help,
marijuana for help,
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recorreran á marihuana medicinal
en busca de axuda.
en busca de axuda.
03:18
weren't turning to medical marijuana
because of its benefits
because of its benefits
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Non recorreran a ela polos seus beneficios
ou o equilibrio entre riscos e beneficios
03:21
or the balance of risks and benefits,
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03:23
or because they thought
it was a wonder drug,
it was a wonder drug,
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ou porque pensaran
que era unha droga marabillosa.
que era unha droga marabillosa.
03:25
but because it gave them
control over their illness.
control over their illness.
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Senón porque lles daba
control sobre a súa enfermidade.
control sobre a súa enfermidade.
03:29
It let them manage their health
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Permítelles xestionar a súa saúde
03:31
in a way that was productive and efficient
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de forma produtiva, eficiente
e cómoda para eles.
e cómoda para eles.
03:34
and effective and comfortable for them.
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Para amosárllelo
falareilles doutra paciente.
falareilles doutra paciente.
03:38
To show you what I mean,
let me tell you about another patient.
let me tell you about another patient.
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Robin tiña sobre 40 anos cando a coñecín.
03:41
Robin was in her early 40s when I met her.
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03:43
She looked though
like she was in her late 60s.
like she was in her late 60s.
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Pero semellaba que tiña máis de 60.
03:46
She had suffered from rheumatoid arthritis
for the last 20 years,
for the last 20 years,
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Sufrira de artrite reumatoide
durante os últimos 20 anos.
durante os últimos 20 anos.
03:50
her hands were gnarled by arthritis,
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Tiña as mans tortas pola artrite.
03:52
her spine was crooked,
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A columna vertebral encurvada.
03:54
she had to rely
on a wheelchair to get around.
on a wheelchair to get around.
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Dependía da cadeira de rodas
para desprazarse.
para desprazarse.
03:56
She looked weak and frail,
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Víase débil e fráxil.
03:58
and I guess physically she probably was,
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E supoño que fisicamente o era.
04:00
but emotionally,
cognitively, psychologically,
cognitively, psychologically,
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Mais emocionalmente,
cognitivamente e psicoloxicamente
cognitivamente e psicoloxicamente
04:03
she was among the toughest
people I've ever met.
people I've ever met.
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era unha das persoas máis fortes
que xamais coñecín.
que xamais coñecín.
04:08
And when I sat down next to her
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Cando sentei ao seu lado
04:09
in a medical marijuana dispensary
in Northern California
in Northern California
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nun dispensario
de marihuana medicinal en California
de marihuana medicinal en California
04:12
to ask her about why she turned
to medical marijuana,
to medical marijuana,
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para preguntarlle
por que recorrera á marihuana medicinal,
por que recorrera á marihuana medicinal,
04:15
what it did for her and how it helped her,
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que fixera por ela e como lle axudara,
04:18
she started out by telling me things
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comezou contándome cousas
04:20
that I had heard
from many patients before.
from many patients before.
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que xa lles escoitara a moitos pacientes.
04:22
It helped with her anxiety;
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Axudoulle coa ansiedade.
04:24
it helped with her pain;
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Axudoulle coa dor.
04:26
when her pain was better,
she slept better.
she slept better.
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Cando a dor mingua dorme mellor.
Todo iso xa o escoitara.
04:28
And I'd heard all that before.
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Pero logo dixo algo
que nunca escoitara antes:
que nunca escoitara antes:
04:29
But then she said something
that I'd never heard before,
that I'd never heard before,
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04:32
and that is that it gave her
control over her life
control over her life
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que lle dera control sobre a súa vida
04:36
and over her health.
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e sobre a súa saúde.
04:37
She could use it when she wanted,
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Podía consumila cando quixera,
04:39
in the way that she wanted,
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como quixera,
04:41
at the dose and frequency
that worked for her.
that worked for her.
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a dose e frecuencia que lle viña mellor.
04:43
And if it didn't work for her,
then she could make changes.
then she could make changes.
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E se non lle ía ben
podía facer algúns cambios.
podía facer algúns cambios.
04:47
Everything was up to her.
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Ela podía decidir.
04:48
The most important thing she said
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O máis importante era
04:50
was she didn't need
anybody else's permission --
anybody else's permission --
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que non precisaba o permiso de ninguén
04:53
not a clinic appointment,
not a doctor's prescription,
not a doctor's prescription,
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nin unha cita médica, nin unha receita
04:55
not a pharmacist's order.
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nin un pedido do farmacéutico.
04:57
It was all up to her.
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Era ela a que decidía.
04:59
She was in control.
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Era ela quen tiña o control.
05:01
And if that seems like a little thing
for somebody with chronic illness,
for somebody with chronic illness,
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E se iso parece pouco
para alguén con unha doenza crónica
para alguén con unha doenza crónica
non o é en absoluto.
05:05
it's not -- not at all.
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Cando nos enfrontamos
a unha doenza crónica
a unha doenza crónica
05:07
When we face a chronic serious illness,
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05:09
whether it's rheumatoid arthritis
or lupus or cancer or diabetes,
or lupus or cancer or diabetes,
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sexa artrite reumatoide, lupus, cancro,
diabetes ou cirrose
05:14
or cirrhosis,
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05:16
we lose control.
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perdémo-lo control.
05:18
And note what I said: "when," not "if."
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E decátense de que digo "cando", non "se".
Porque nalgún momento das nosas vidas
05:20
All of us at some point in our lives
will face a chronic serious illness
will face a chronic serious illness
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sufriremos unha doenza crónica seria
que nos fará perder o control.
05:25
that causes us to lose control.
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Veremos como as nosas funcións diminúen.
05:27
We'll see our function decline,
some of us will see our cognition decline,
some of us will see our cognition decline,
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Algúns verán como a cognición diminúe.
05:31
we'll be no longer able
to care for ourselves,
to care for ourselves,
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Non poderemos coidarnos a nós mesmos.
05:34
to do the things that we want to do.
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Facer as cousas que queiramos.
05:36
Our bodies will betray us,
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Os nosos corpos traizoarannos
05:38
and in that process, we'll lose control.
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e nese proceso, perderémo-lo control.
05:41
And that's scary.
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E iso mete medo.
05:43
Not just scary -- that's frightening,
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Non so mete medo, senón que é temible.
05:45
it's terrifying.
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É aterrador.
05:46
When I talk to my patients,
my palliative care patients,
my palliative care patients,
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Cando falo cos meus pacientes
de coidados paliativos,
de coidados paliativos,
05:49
many of whom are facing illnesses
that will end their lives,
that will end their lives,
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moitos dos cales se enfrontan a doenzas
que acabaran coas súas vidas,
que acabaran coas súas vidas,
05:53
they have a lot of be frightened of --
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teñen moito que temer:
05:55
pain, nausea, vomiting,
constipation, fatigue,
constipation, fatigue,
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dores, náuseas, vómitos,
estrinximento, canseira,
estrinximento, canseira,
a súa inminente mortalidade.
05:59
their impending mortality.
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06:00
But what scares them
more than anything else
more than anything else
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Pero o que os aterra máis que nada
06:03
is this possibility that at some point,
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é a posibilidade de que nalgún momento,
06:05
tomorrow or a month from now,
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ben sexa mañá ou dentro dun mes,
06:07
they're going to lose
control of their health,
control of their health,
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van perder o control sobre a súa saúde,
06:10
of their lives,
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a súa vida,
06:12
of their healthcare,
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a súa atención sanitaria,
06:13
and they're going to become
dependent on others,
dependent on others,
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e volveranse dependentes doutra persoa,
06:16
and that's terrifying.
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e iso é aterrador.
06:18
So it's no wonder really
that patients like Robin,
that patients like Robin,
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Por iso non é sorprendente
que pacientes como Robin,
que pacientes como Robin,
06:22
who I just told you about,
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da que lles acabo de falar,
e a quen coñecín nesa clínica,
06:24
who I met in that clinic,
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06:25
turn to medical marijuana
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recorrera á marihuana medicinal
06:27
to try to claw back
some semblance of control.
some semblance of control.
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para tentar recuperar un pouco de control.
06:30
How do they do it though?
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Pero como o fan?
06:32
How do these medical
marijuana dispensaries --
marijuana dispensaries --
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Como estes dispensarios
de marihuana medicinal
de marihuana medicinal
06:34
like the one where I met Robin --
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como aquel en que coñecín a Robin,
06:36
how do they give patients like Robin
back the sort of control that they need?
back the sort of control that they need?
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lles devolven aos pacientes coma ela
o tipo de control que precisan?
E como o fan
06:43
And how do they do it
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06:44
in a way that mainstream
medical hospitals and clinics,
medical hospitals and clinics,
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dunha forma na que hospitais
e clínicas convencionais
e clínicas convencionais
06:48
at least for Robin, weren't able to?
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polo menos para Robin, non foron capaces?
06:51
What's their secret?
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Cal é o seu segredo?
06:53
So I decided to find out.
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Decidín achalo.
06:55
I went to a seedy clinic
in Venice Beach in California
in Venice Beach in California
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Fun a unha clínica con mala fama
en Venice Beach, California
en Venice Beach, California
06:59
and got a recommendation
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e conseguín unha recomendación
07:01
that would allow me
to be a medical marijuana patient.
to be a medical marijuana patient.
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que me permitiría
ser un paciente de marihuana medicinal.
ser un paciente de marihuana medicinal.
Conseguín unha carta de recomendación
07:04
I got a letter of recommendation
that would let me buy medical marijuana.
that would let me buy medical marijuana.
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que me permitiría comprar
marihuana medicinal.
marihuana medicinal.
07:08
I got that recommendation illegally,
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Conseguina de forma ilegal
07:10
because I'm not
a resident of California --
a resident of California --
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porque non son residente en California.
07:12
I should note that.
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Debería mencionalo.
07:14
I should also note, for the record,
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Tamén debo facer constar
07:15
that I never used that letter
of recommendation to make a purchase,
of recommendation to make a purchase,
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que nunca a usei para facer unha compra.
07:19
and to all of you DEA agents out there --
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E a todos os axentes da DEA
que andan por aí...
que andan por aí...
07:22
(Laughter)
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(Risos)
adoro o traballo que fan.
07:23
love the work that you're doing,
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Sigan así.
07:24
keep it up.
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(Risos)
07:26
(Laughter)
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07:27
Even though it didn't let me
make a purchase though,
make a purchase though,
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Aínda que non me permitira
facer unha compra
facer unha compra
07:30
that letter was priceless
because it let me be a patient.
because it let me be a patient.
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esa carta era valiosísima
porque me permitía ser un paciente.
porque me permitía ser un paciente.
07:34
It let me experience
what patients like Robin experience
what patients like Robin experience
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Permitíame pórme na pel
de pacientes coma Robin
de pacientes coma Robin
07:38
when they go to a medical
marijuana dispensary.
marijuana dispensary.
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cando van a un dispensario
de marihuana medicinal.
de marihuana medicinal.
07:41
And what I experienced --
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E o que experimentei,
07:43
what they experience every day,
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o que eles experimentan cada día,
07:45
hundreds of thousands
of people like Robin --
of people like Robin --
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centos de miles de persoas coma Robin
07:48
was really amazing.
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foi asombroso.
07:51
I walked into the clinic,
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Entrei na clínica
07:52
and from the moment that I entered
many of these clinics and dispensaries,
many of these clinics and dispensaries,
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e dende o momento en que entrei
en moitas desas clínicas e dispensarios
en moitas desas clínicas e dispensarios
07:55
I felt like that dispensary, that clinic,
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sentín que ese dispensario, esa clínica
07:58
was there for me.
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estaba aí para min.
08:00
There were questions
at the outset about who I am,
at the outset about who I am,
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Ao comezo había preguntas sobre quen era,
08:03
what kind of work I do,
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cal era o meu traballo,
08:05
what my goals are in looking
for a medical marijuana prescription,
for a medical marijuana prescription,
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con que fins buscaba
receitas de marihuana medicinal,
08:09
or product,
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477760
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ou produtos,
cales eran os meus obxectivos,
as miñas preferencias,
as miñas preferencias,
08:12
what my goals are,
what my preferences are,
what my preferences are,
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08:15
what my hopes are,
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cales eran as miñas esperanzas,
08:16
how do I think, how do I hope
this might help me,
this might help me,
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como pensaba ou esperaba
que me ía axudar,
que me ía axudar,
08:18
what am I afraid of.
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que temía...
08:20
These are the sorts of questions
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Este é o tipo de preguntas
08:22
that patients like Robin
get asked all the time.
get asked all the time.
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490200
2456
que pacientes coma Robin
reciben todo o tempo.
reciben todo o tempo.
08:24
These are the sorts of questions
that make me confident
that make me confident
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Este é o tipo de preguntas
que me fan confiar en que
que me fan confiar en que
08:27
that the person I'm talking with
really has my best interests at heart
really has my best interests at heart
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a persoa coa que estou falando
pensa nos meus mellores intereses
pensa nos meus mellores intereses
08:31
and wants to get to know me.
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e quere coñecerme.
08:34
The second thing I learned
in those clinics
in those clinics
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A segunda cousa
que aprendín nestas clínicas
que aprendín nestas clínicas
08:36
is the availability of education.
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é a dispoñibilidade da educación.
08:39
Education from the folks
behind the counter,
behind the counter,
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Educación das persoas
ao outro lado do mostrador.
ao outro lado do mostrador.
08:41
but also education
from folks in the waiting room.
from folks in the waiting room.
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Pero tamén das persoas na sala de espera.
08:45
People I met were more than happy,
as I was sitting next to them --
as I was sitting next to them --
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3536
Coñecín persoas que estaban encantadas,
cando eu sentaba á súa beira,
cando eu sentaba á súa beira,
08:48
people like Robin --
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1255
xente coma Robin,
08:50
to tell me about who they are,
why they use medical marijuana,
why they use medical marijuana,
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3777
de contarme quen eran
e por que consumían marihuana medicinal,
e por que consumían marihuana medicinal,
08:53
what helps them, how it helps them,
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en que lles axudaba e como,
08:56
and to give me advice and suggestions.
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e de darme consellos e suxestións.
08:58
Those waiting rooms really are
a hive of interaction, advice and support.
a hive of interaction, advice and support.
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5640
Esas salas de espera son coma unha colmea
de interacción, consello e apoio.
E o terceiro,
a xente de detrás do mostrador.
a xente de detrás do mostrador.
09:04
And third, the folks behind the counter.
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09:06
I was amazed at how willing
those people were
those people were
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Estaba asombrado
por como esa xente estaba disposta
por como esa xente estaba disposta
09:10
to spend sometimes an hour or more
talking me through the nuances
talking me through the nuances
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a estar unha hora ou máis
explicando os matices
explicando os matices
09:14
of this strain versus that strain,
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entre distintas cepas,
09:16
smoking versus vaporizing,
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entre fumala e vaporizala,
09:18
edibles versus tinctures --
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546680
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entre comestibles e tinturas.
09:20
all, remember, without me
making any purchase whatsoever.
making any purchase whatsoever.
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3760
E recorden, todo isto sen eu ter intención
de facer compra ningunha.
de facer compra ningunha.
09:25
Think about the last time
you went to any hospital or clinic
you went to any hospital or clinic
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Pensen na última vez
que foron a un hospital ou clínica
que foron a un hospital ou clínica
09:29
and the last time anybody spent an hour
explaining those sorts of things to you.
explaining those sorts of things to you.
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557080
4800
e alguén estivo unha hora
explicándolles ese tipo de cousas.
explicándolles ese tipo de cousas.
09:34
The fact that patients like Robin
are going to these clinics,
are going to these clinics,
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3616
O feito de que pacientes coma Robin
vaian a estas clínicas e dispensarios
09:38
are going to these dispensaries
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566320
1576
e reciban este tipo
de atención personalizada
de atención personalizada
09:39
and getting that sort
of personalized attention
of personalized attention
208
567920
2936
09:42
and education and service,
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570880
1856
e educación e servizo
09:44
really should be a wake-up call
to the healthcare system.
to the healthcare system.
210
572760
3416
debería ser unha chamada de atención
para o sistema sanitario.
para o sistema sanitario.
09:48
People like Robin are turning away
from mainstream medicine,
from mainstream medicine,
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2976
Xente coma Robin está rexeitando
a medicina convencional,
a medicina convencional,
09:51
turning to medical marijuana dispensaries
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579200
2336
e acudindo a dispensarios
de marihuana medicinal
de marihuana medicinal
09:53
because those dispensaries
are giving them what they need.
are giving them what they need.
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3880
porque estes ofrécenlles o que precisan.
09:58
If that's a wake-up call
to the medical establishment,
to the medical establishment,
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586440
2576
Se é unha chamada de atención
para o sistema sanitario,
para o sistema sanitario,
10:01
it's a wake-up call that many
of my colleagues are either not hearing
of my colleagues are either not hearing
215
589040
3776
é unha chamada que moitos
dos meus compañeiros non escoitan
dos meus compañeiros non escoitan
10:04
or not wanting to hear.
216
592840
1720
ou non queren escoitar.
Cando falo cos meus compañeiros,
en particular con doutores,
en particular con doutores,
10:07
When I talk to my colleagues,
physicians in particular,
physicians in particular,
217
595240
2736
10:10
about medical marijuana,
218
598000
1336
sobre marihuana medicinal din:
10:11
they say, "Oh, we need more evidence.
219
599360
2656
"Precisamos máis probas.
Precisamos máis estudos
sobre os beneficios
sobre os beneficios
10:14
We need more research into benefits,
we need more evidence about risks."
we need more evidence about risks."
220
602040
3960
e máis probas sobre os riscos".
10:18
And you know what? They're right.
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606600
1856
E saben que? Teñen razón.
Toda a razón.
10:20
They're absolutely right.
222
608480
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Si que precisamos moitas máis probas
10:21
We do need much more evidence
about the benefits of medical marijuana.
about the benefits of medical marijuana.
223
609760
4176
sobre os beneficios
da marihuana medicinal.
da marihuana medicinal.
10:25
We also need to ask the federal government
to reschedule marijuana to Schedule II,
to reschedule marijuana to Schedule II,
224
613960
5376
Tamén debemos pedirlle ao goberno federal
que modifique as restricións da marihuana
que modifique as restricións da marihuana
10:31
or to deschedule it entirely
to make that research possible.
to make that research possible.
225
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3560
para facer posible ese estudo.
10:35
We also need more research
into medical marijuana's risks.
into medical marijuana's risks.
226
623760
3656
Tamén precisamos máis estudos
sobre os riscos da marihuana medicinal.
sobre os riscos da marihuana medicinal.
Os riscos da marihuana medicinal...
10:39
Medical marijuana's risks --
227
627440
1376
10:40
we know a lot about
the risks of recreational use,
the risks of recreational use,
228
628840
2376
Sabemos moito sobre os do uso recreativo
10:43
we know next to nothing
about the risks of medical marijuana.
about the risks of medical marijuana.
229
631240
2896
pero non sabemos nada
sobre os da marihuana medicinal.
sobre os da marihuana medicinal.
10:46
So we absolutely do need research,
230
634160
2576
Por iso precisamos investigar,
10:48
but to say that we need research
231
636760
2336
pero dicir que precisamos investigar
10:51
and not that we need
to make any changes now
to make any changes now
232
639120
3056
e non dicir que precisamos
facer cambios agora
facer cambios agora
10:54
is to miss the point entirely.
233
642200
1936
non ten sentido ningún.
10:56
People like Robin
aren't seeking out medical marijuana
aren't seeking out medical marijuana
234
644160
2576
Xente coma Robin
non busca marihuana medicinal
non busca marihuana medicinal
porque a consideren
unha droga marabillosa
unha droga marabillosa
10:58
because they think it's a wonder drug,
235
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1856
11:00
or because they think
it's entirely risk-free.
it's entirely risk-free.
236
648640
2736
ou porque pensen que non ten ningún risco.
11:03
They seek it out because the context
in which it's delivered and administered
in which it's delivered and administered
237
651400
4656
Búscana porque o contorno
no que se vende, administra ou usa
11:08
and used,
238
656080
1216
11:09
gives them the sort of control
they need over their lives.
they need over their lives.
239
657320
3536
dálles o control que precisan
sobre as súas vidas.
sobre as súas vidas.
11:12
And that's a wake-up call
we really need to pay attention to.
we really need to pay attention to.
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660880
3040
E esa é unha chamada de atención
á que lle temos que facer caso.
á que lle temos que facer caso.
11:17
The good news though is that
there are lessons we can learn today
there are lessons we can learn today
241
665040
3736
O bo é que hai leccións
que hoxe podemos aprender
que hoxe podemos aprender
11:20
from those medical marijuana dispensaries.
242
668800
2976
dos dispensarios de marihuana medicinal.
11:23
And those are lessons
we really should learn.
we really should learn.
243
671800
2136
E son leccións que deberiamos aprender.
11:25
These are often small,
mom-and-pop operations
mom-and-pop operations
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673960
2736
Estes son normalmente
pequenos negocios familiares
pequenos negocios familiares
11:28
run by people with no medical training.
245
676720
2456
xestionados por xente
sen formación médica.
sen formación médica.
E aínda que é vergoñento pensar
11:31
And while it's embarrassing to think
246
679200
2576
11:33
that many of these clinics
and dispensaries are providing services
and dispensaries are providing services
247
681800
4056
que moitas destas clínicas e dispensarios
están ofrecendo servizos e apoio
están ofrecendo servizos e apoio
11:37
and support and meeting patients' needs
248
685880
2376
e cubrindo as necesidades dos pacientes
11:40
in ways that billion-dollar
healthcare systems aren't --
healthcare systems aren't --
249
688280
4016
dun xeito que os millonarios
sistemas sanitarios non fan
sistemas sanitarios non fan
11:44
we should be embarrassed by that --
250
692320
1696
--debería darnos vergoña--,
11:46
but we can also learn from that.
251
694040
1896
tamén podemos aprender diso.
11:47
And there are probably
three lessons at least
three lessons at least
252
695960
2136
E hai polo menos tres leccións
11:50
that we can learn
from those small dispensaries.
from those small dispensaries.
253
698120
2240
que podemos aprender
deses pequenos dispensarios.
deses pequenos dispensarios.
11:52
One: we need to find ways
to give patients more control
to give patients more control
254
700840
3656
Unha: precisamos atopar formas
de darlles máis control aos pacientes
de darlles máis control aos pacientes
11:56
in small but important ways.
255
704520
2016
en cousas pequenas pero importantes.
11:58
How to interact with healthcare providers,
256
706560
2056
Como conversar con profesionais médicos,
12:00
when to interact
with healthcare providers,
with healthcare providers,
257
708640
2176
cando conversar con eles,
12:02
how to use medications
in ways that work for them.
in ways that work for them.
258
710840
3616
como usar os medicamentos
de forma que funcionen para eles.
de forma que funcionen para eles.
No meu caso
12:06
In my own practice,
259
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1216
volvinme moito máis creativo e flexible
12:07
I've gotten much more
creative and flexible
creative and flexible
260
715720
2736
apoiando aos meus pacientes para que usen
12:10
in supporting my patients
in using drugs safely
in using drugs safely
261
718480
3136
os medicamentos de forma segura
12:13
to manage their symptoms --
262
721640
1496
para xestionar os síntomas
pondo énfase na seguridade.
12:15
with the emphasis on safely.
263
723160
1376
12:16
Many of the drugs I prescribe
are drugs like opioids or benzodiazepines
are drugs like opioids or benzodiazepines
264
724560
4456
Moitos dos medicamentos que prescribo
son opioides ou benzodiacepinas
son opioides ou benzodiacepinas
que poden ser perigosos
se se consomen en exceso.
se se consomen en exceso.
12:21
which can be dangerous if overused.
265
729040
2776
12:23
But here's the point.
266
731840
1216
Mais esta é a cuestión.
12:25
They can be dangerous if they're overused,
267
733080
2056
Poden ser perigosos se se usan en exceso,
12:27
but they can also be ineffective
if they're not used in a way
if they're not used in a way
268
735160
2896
pero poden ser ineficaces
se non se usan de xeito consistente
se non se usan de xeito consistente
12:30
that's consistent with
what patients want and need.
what patients want and need.
269
738080
2656
co que os pacientes queren e precisan.
12:32
So that flexibility,
if it's delivered safely,
if it's delivered safely,
270
740760
3216
Polo que esa flexibilidade,
se se ofrece de forma segura
se se ofrece de forma segura
12:36
can be extraordinarily valuable
for patients and their families.
for patients and their families.
271
744000
3096
pode ser moi valiosa
para os pacientes e as súas familias.
para os pacientes e as súas familias.
12:39
That's number one.
272
747120
1216
Esa é a número un.
12:40
Number two: education.
273
748360
2016
Número dous: educación.
12:42
Huge opportunities
274
750400
1216
Grandes oportunidades
12:43
to learn from some of the tricks
of those medical marijuana dispensaries
of those medical marijuana dispensaries
275
751640
3456
para aprender algúns trucos
deses dispensarios de marihuana
deses dispensarios de marihuana
12:47
to provide more education
276
755120
1376
para ofrecer máis formación
12:48
that doesn't require
a lot of physician time necessarily,
a lot of physician time necessarily,
277
756520
2736
que pode non requirirlle
a un médico moito máis tempo,
a un médico moito máis tempo,
12:51
or any physician time,
278
759280
1736
ou ningún,
12:53
but opportunities to learn
about what medications we're using
about what medications we're using
279
761040
4376
senón oportunidades para aprender
sobre que medicamentos usan
sobre que medicamentos usan
12:57
and why,
280
765440
1216
e por que,
12:58
prognoses, trajectories of illness,
281
766680
2056
prognoses, traxectoria da doenza,
e o máis importante,
13:00
and most importantly,
282
768760
1216
oportunidades para os pacientes
de aprender uns doutros.
de aprender uns doutros.
13:02
opportunities for patients
to learn from each other.
to learn from each other.
283
770000
2736
13:04
How can we replicate what goes on
284
772760
1936
Como podemos imitar o que pasa
13:06
in those clinic and medical
dispensary waiting rooms?
dispensary waiting rooms?
285
774720
3416
nas salas de espera
desas clínicas ou dispensarios médicos?
desas clínicas ou dispensarios médicos?
13:10
How patients learn from each other,
how people share with each other.
how people share with each other.
286
778160
3680
Como os pacientes aprenden uns doutros,
como a xente comparte.
como a xente comparte.
13:14
And last but not least,
287
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1376
E por último,
13:15
putting patients first the way
those medical marijuana dispensaries do,
those medical marijuana dispensaries do,
288
783880
4056
pór aos pacientes primeiro,
igual que fan os dispensarios.
igual que fan os dispensarios.
13:19
making patients feel
legitimately like what they want,
legitimately like what they want,
289
787960
4816
Facer que os pacientes sintan de verdade
que o que eles queren,
que o que eles queren,
13:24
what they need,
290
792800
1256
o que precisan
13:26
is why, as healthcare providers,
291
794080
1696
é a razón pola que estamos aquí
como profesionais médicos.
como profesionais médicos.
13:27
we're here.
292
795800
1200
13:29
Asking patients about their hopes,
their fears, their goals and preferences.
their fears, their goals and preferences.
293
797640
4216
Preguntarlles sobre as súas esperanzas,
temores, metas e preferencias.
temores, metas e preferencias.
Como provedor de coidados paliativos
13:33
As a palliative care provider,
294
801880
1456
13:35
I ask all my patients what they're
hoping for and what they're afraid of.
hoping for and what they're afraid of.
295
803360
3520
pregúntolles a todos os meus pacientes
que esperan e que temen.
que esperan e que temen.
13:39
But here's the thing.
296
807560
1256
Pero esta é a cuestión:
Eles non deberían ter que esperar
ata sufriren unha doenza crónica,
ata sufriren unha doenza crónica,
13:40
Patients shouldn't have to wait
until they're chronically seriously ill,
until they're chronically seriously ill,
297
808840
3496
13:44
often near the end of life,
298
812360
1816
a miúdo ao final das súas vidas.
13:46
they shouldn't have to wait
until they're seeing a physician like me
until they're seeing a physician like me
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814200
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Non deberían ter que esperar
a ver un doutor coma min
a ver un doutor coma min
13:50
before somebody asks them,
300
818520
1736
antes de que alguén lles pregunte:
13:52
"What are you hoping for?"
301
820280
1256
"Cales son as súas esperanzas?
E os seus temores?"
E os seus temores?"
13:53
"What are you afraid of?"
302
821560
1256
13:54
That should be baked into the way
that healthcare is delivered.
that healthcare is delivered.
303
822840
3400
Debería ir implícito na forma
na que se ofrece o servizo sanitario.
na que se ofrece o servizo sanitario.
13:59
We can do this --
304
827720
1456
Podemos facelo.
14:01
we really can.
305
829200
1216
De verdade que si.
14:02
Medical marijuana dispensaries
and clinics all across the country
and clinics all across the country
306
830440
3376
Os dispensarios e clínicas de marihuana
de todo o país
de todo o país
14:05
are figuring this out.
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están logrando resolvelo.
14:07
They're figuring this out
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Están logrando resolvelo
mentres os sistemas sanitarios
máis grandes e convencionais
máis grandes e convencionais
14:08
in ways that larger, more mainstream
health systems are years behind.
health systems are years behind.
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se están quedando anos atrás.
Pero podemos aprender deles
14:14
But we can learn from them,
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e temos que facelo.
14:15
and we have to learn from them.
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14:17
All we have to do is swallow our pride --
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Só temos que tragar o orgullo
14:19
put aside the thought for a minute
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e deixar de pensar por un minuto
que como temos
moitas letras detrás do noso nome,
moitas letras detrás do noso nome,
14:21
that because we have
lots of letters after our name,
lots of letters after our name,
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14:23
because we're experts,
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somos expertos,
14:25
because we're chief medical officers
of a large healthcare system,
of a large healthcare system,
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ou somos directores médicos
dun gran sistema sanitario
dun gran sistema sanitario
14:28
we know all there is to know
about how to meet patients' needs.
about how to meet patients' needs.
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xa o sabemos todo sobre como cubrir
as necesidades dos pacientes.
as necesidades dos pacientes.
14:32
We need to swallow our pride.
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Debemos tragar o orgullo.
14:34
We need to go visit
a few medical marijuana dispensaries.
a few medical marijuana dispensaries.
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Temos que visitar algúns dispensarios
de marihuana medicinal.
de marihuana medicinal.
Temos que comprender o que fan.
14:37
We need to figure out what they're doing.
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14:39
We need to figure out
why so many patients like Robin
why so many patients like Robin
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Temos que descubrir
por que moitos pacientes coma Robin
por que moitos pacientes coma Robin
14:41
are leaving our mainstream medical clinics
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abandonan as clínicas convencionais
14:43
and going to these medical
marijuana dispensaries instead.
marijuana dispensaries instead.
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e acoden aos dispensarios
de marihuana medicinal.
de marihuana medicinal.
14:47
We need to figure out
what their tricks are,
what their tricks are,
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Temos que descubrir
cales son os seus trucos
cales son os seus trucos
14:49
what their tools are,
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e as súas ferramentas
14:50
and we need to learn from them.
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e precisamos aprender deles.
14:52
If we do,
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Se o facemos,
14:54
and I think we can,
and I absolutely think we have to,
and I absolutely think we have to,
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e penso que podemos,
e por suposto penso que debemos,
e por suposto penso que debemos,
14:57
we can guarantee all of our patients
will have a much better experience.
will have a much better experience.
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podemos garantir que todos os pacientes
terán unha mellor experiencia.
terán unha mellor experiencia.
15:01
Thank you.
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Grazas.
15:02
(Applause)
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(Aplausos)
ABOUT THE SPEAKER
David Casarett - PhysicianDavid Casarett asks: What if mainstream health care operated more like a medical marijuana dispensary?
Why you should listen
In his third book, Stoned: A Doctor's Case for Medical Marijuana, palliative care physician David Casarett takes a first-person investigative journalist's approach to making sense of marijuana's therapeutic potential and adverse effects. He shares what he's learned about this chronically misunderstood drug -- including the control it gives patients over their health and the educational atmosphere of dispensaries -- and outlines what we still need to do to explore its potential health benefits.
Casarett is a professor of medicine at the Duke University School of Medicine and chief of palliative care for the Duke Health System. He is the author of more than 100 journal articles, numerous magazine articles, and Shocked, another nonfiction book about the science of resuscitation. Casarett's first novel in the Ethical Chiang Mai Detective Agency series, Murder at the House of Rooster Happiness, was published in September 2016. The next installment, The Missing Guests of the Magic Grove Hotel, will be published in the fall of 2017.
David Casarett | Speaker | TED.com