TEDMED 2010
Thomas Goetz: It's time to redesign medical data
Thomas Goetz: Vrijeme je za redizajniranje medicinskih podataka
Filmed:
Readability: 3.5
587,895 views
Vaš medicinski karton: teško dostupan, nečitljiv -- i pun informacija koje bi vas mogle učiniti zdravijima kada biste samo znali kako ih upotrijebiti. Na TEDMED-u, Thomas Goetz razmatra medicinske podatke i čini odvažan potez redizajniranja i dobivanja boljeg uvida u njihov sadržaj.
Thomas Goetz - Healthcare communicator
Thomas Goetz is the co-founder of Iodine and author of "The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.” Full bio
Thomas Goetz is the co-founder of Iodine and author of "The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.” Full bio
Double-click the English transcript below to play the video.
00:15
I'm going to be talking to you
0
0
2000
Pričat ću vam
00:17
about how we can tap
1
2000
2000
o tome kako možemo iskoristiti
00:19
a really underutilized resource in health care,
2
4000
2000
premalo korišten resurs u zdravstvu,
00:21
which is the patient,
3
6000
2000
a to je sam pacijent,
00:23
or, as I like to use the scientific term,
4
8000
3000
ili -- pošto volim koristiti znanstveni izraz --
00:26
people.
5
11000
2000
ljudi.
00:28
Because we are all patients, we are all people.
6
13000
2000
Jer svi smo mi pacijenti, svi smo mi ljudi.
00:30
Even doctors are patients at some point.
7
15000
2000
Čak su i liječnici pacijenti u jednom trenutku.
00:32
So I want to talk about that
8
17000
2000
Želim dakle, govoriti o tome
00:34
as an opportunity
9
19000
2000
kao o mogućnosti
00:36
that we really have failed to engage with very well in this country
10
21000
3000
s kojom smo se zaista propustili ispravno pozabaviti u ovoj zemlji
00:39
and, in fact, worldwide.
11
24000
2000
ali i u svjetskim razmjerima.
00:41
If you want to get at the big part --
12
26000
2000
Ako želite doći do većeg dijela --
00:43
I mean from a public health level, where my training is --
13
28000
3000
mislim na razinu javnog zdravstva, što je i moje područje usavršavanja --
00:46
you're looking at behavioral issues.
14
31000
2000
susrest ćete se s problemima u ponašanju,
00:48
You're looking at things where people are actually given information,
15
33000
3000
susrest ćete se sa situacijama gdje je ljudima u suštini dana informacija,
00:51
and they're not following through with it.
16
36000
2000
ali oni ne postupaju u skladu s tom informacijom.
00:53
It's a problem that manifests itself in diabetes,
17
38000
4000
To je problem koji se manifestira kod dijabetesa,
00:57
obesity, many forms of heart disease,
18
42000
2000
pretilosti, raznih vrsta srčanih bolesti,
00:59
even some forms of cancer -- when you think of smoking.
19
44000
3000
čak i kod nekih oblika raka -- sjetite se problema pušenja.
01:02
Those are all behaviors where people know what they're supposed to do.
20
47000
3000
To su ponašanja kod kojih ljudi znaju što bi trebali činiti.
01:05
They know what they're supposed to be doing,
21
50000
2000
Znaju što bi trebali raditi
01:07
but they're not doing it.
22
52000
2000
ali to ne rade.
01:09
Now behavior change is something
23
54000
2000
Promjena ponašanja je nešto
01:11
that is a long-standing problem in medicine.
24
56000
2000
što je dugogodišnji problem u medicini.
01:13
It goes all the way back to Aristotle.
25
58000
2000
Počinje još tamo od vremena Aristotela.
01:15
And doctors hate it, right?
26
60000
2000
I liječnici to mrze, zapravo.
01:17
I mean, they complain about it all the time.
27
62000
2000
Mislim, neprekidno se žale na to.
01:19
We talk about it in terms of engagement, or non-compliance.
28
64000
3000
Pričamo o tome u smislu angažmana ili nepridržavanja,
01:22
When people don't take their pills,
29
67000
2000
kada ljudi ne uzimaju svoje tablete,
01:24
when people don't follow doctors' orders --
30
69000
2000
kada se ljudi ne pridržavaju naputaka liječnika.
01:26
these are behavior problems.
31
71000
2000
To su problemi u ponašanju.
01:28
But for as much as clinical medicine
32
73000
2000
No koliko se god klinička medicina
01:30
agonizes over behavior change,
33
75000
2000
muči oko promjene ponašanja,
01:32
there's not a lot of work done
34
77000
2000
nije mnogo napravljeno
01:34
in terms of trying to fix that problem.
35
79000
3000
u smislu pokušaja da se problem doista riješi.
01:37
So the crux of it
36
82000
2000
Dakle srž svega
01:39
comes down to this notion of decision-making --
37
84000
2000
se svodi na ideju donošenja odluke --
01:41
giving information to people in a form
38
86000
2000
pružanja informacija ljudima na način
01:43
that doesn't just educate them
39
88000
2000
da ih ne samo educira
01:45
or inform them,
40
90000
2000
ili informira,
01:47
but actually leads them to make better decisions,
41
92000
2000
već ih doista i navodi na donošenje boljih odluka,
01:49
better choices in their lives.
42
94000
2000
boljeg izbora u njihovim životima.
01:51
One part of medicine, though,
43
96000
2000
Jedan dio medicine se ipak
01:53
has faced the problem of behavior change pretty well,
44
98000
4000
vrlo dobro suočio s problemom promjene ponašanja,
01:57
and that's dentistry.
45
102000
2000
i to je stomatologija.
01:59
Dentistry might seem -- and I think it is --
46
104000
2000
Stomatologija se može činiti -- i mislim da je to tako --
02:01
many dentists would have to acknowledge
47
106000
2000
većina stomatologa treba priznati
02:03
it's somewhat of a mundane backwater of medicine.
48
108000
2000
da su poput zadnje rupe na svirali u medicini.
02:05
Not a lot of cool, sexy stuff happening in dentistry.
49
110000
3000
Ne događa se puno cool, seksi stvari u stomatologiji.
02:08
But they have really taken this problem of behavior change
50
113000
3000
Ali oni su se doista uhvatili ukoštac s problemom promjene ponašanja
02:11
and solved it.
51
116000
2000
i riješili ga.
02:13
It's the one great preventive health success
52
118000
2000
To je jedini veliki uspjeh preventive u zdravstvu
02:15
we have in our health care system.
53
120000
2000
koji imamo u našem zdravstvenom sustavu.
02:17
People brush and floss their teeth.
54
122000
2000
Ljudi peru i čiste zube koncem.
02:19
They don't do it as much as they should, but they do it.
55
124000
3000
Ne rade to koliko bi trebali, ali ipak rade.
02:22
So I'm going to talk about one experiment
56
127000
2000
Pričat ću o jednom eksperimentu
02:24
that a few dentists in Connecticut
57
129000
2000
kojeg je nekoliko stomatologa iz Connecticuta
02:26
cooked up about 30 years ago.
58
131000
2000
provelo prije otprilike 30 godina.
02:28
So this is an old experiment, but it's a really good one,
59
133000
2000
To je stari eksperiment ali stvarno vrlo dobar,
02:30
because it was very simple,
60
135000
2000
jer je jako jednostavan,
02:32
so it's an easy story to tell.
61
137000
2000
pa ga je lako prepričati.
02:34
So these Connecticut dentists decided
62
139000
2000
Dakle ti stomatolozi iz Connecticuta su odlučili
02:36
that they wanted to get people to brush their teeth and floss their teeth more often,
63
141000
3000
da žele navesti ljude da češće peru i čiste zube koncem.
02:39
and they were going to use one variable:
64
144000
2000
I odlučili su koristiti jednu varijablu:
02:41
they wanted to scare them.
65
146000
2000
odlučili su ih prestrašiti.
02:43
They wanted to tell them how bad it would be
66
148000
3000
Odlučili su im reći koliko će biti loše
02:46
if they didn't brush and floss their teeth.
67
151000
2000
ako ne peru i čiste zube koncem.
02:48
They had a big patient population.
68
153000
3000
Imali su veliku populaciju pacijenata.
02:51
They divided them up into two groups.
69
156000
2000
Razdijelili su ih u dvije grupe.
02:53
They had a low-fear population,
70
158000
2000
Imali su populaciju koju nisu strašili,
02:55
where they basically gave them a 13-minute presentation,
71
160000
2000
kojoj su u načelu predstavili prezentaciju od 13 minuta,
02:57
all based in science,
72
162000
2000
temeljenoj na znanstvenim činjenicama,
02:59
but told them that, if you didn't brush and floss your teeth,
73
164000
3000
ali rekli su im da, ako ne peru i ne čiste zube koncem,
03:02
you could get gum disease. If you get gum disease, you will lose your teeth,
74
167000
3000
mogu dobiti bolest desnih. Ako dobiju bolest desnih, izgubit će zube,
03:05
but you'll get dentures, and it won't be that bad.
75
170000
2000
ali dobit će protezu, pa i nije tako strašno.
03:07
So that was the low-fear group.
76
172000
2000
To je bila grupa koju nisu puno strašili.
03:09
The high-fear group, they laid it on really thick.
77
174000
3000
Na grupu koju su primjenjivali strah su se dobrano obrušili.
03:12
They showed bloody gums.
78
177000
2000
Pokazali su im krvave desni,
03:14
They showed puss oozing out from between their teeth.
79
179000
3000
usta koja su krvarila između zuba,
03:17
They told them that their teeth were going to fall out.
80
182000
2000
rekli su im da će im zubi pasti,
03:19
They said that they could have infections
81
184000
2000
rekli su im da mogu dobiti infekcije
03:21
that would spread from their jaws to other parts of their bodies,
82
186000
3000
koje se mogu proširiti od ustiju na druge dijelove tijela,
03:24
and ultimately, yes, they would lose their teeth.
83
189000
2000
i naposljetku će, da, izgubiti zube.
03:26
They would get dentures, and if you got dentures,
84
191000
2000
Dobit će proteze, a ako imate protezu,
03:28
you weren't going to be able to eat corn-on-the-cob,
85
193000
2000
nećete moći jesti kukuruz u klipu,
03:30
you weren't going to be able to eat apples,
86
195000
2000
nećete moći jesti jabuke,
03:32
you weren't going to be able to eat steak.
87
197000
2000
nećete moći pojesti odrezak;
03:34
You'll eat mush for the rest of your life.
88
199000
2000
jest ćete kašastu hranu do kraja života.
03:36
So go brush and floss your teeth.
89
201000
3000
Onda idite oprati i očistiti zube koncem.
03:39
That was the message. That was the experiment.
90
204000
2000
To je bila poruka; to je bio eksperiment.
03:41
Now they measured one other variable.
91
206000
2000
Mjerili su još jednu varijablu.
03:43
They wanted to capture one other variable,
92
208000
2000
Željeli su uzeti u obzir još jednu varijablu,
03:45
which was the patients' sense of efficacy.
93
210000
3000
a to je osjećaj pacijenta za efikasnost.
03:48
This was the notion of whether the patients felt
94
213000
2000
To je utisak o tome jesu li pacijenti osjećali
03:50
that they actually would go ahead and brush and floss their teeth.
95
215000
3000
da bi doista išli oprati zube i očistiti ih koncem.
03:53
So they asked them at the beginning,
96
218000
2000
Na početku su ih pitali,
03:55
"Do you think you'll actually be able to stick with this program?"
97
220000
2000
"Smatrate li da ćete doista biti u mogućnosti držati se programa?"
03:57
And the people who said, "Yeah, yeah. I'm pretty good about that,"
98
222000
2000
Ljudi koji su rekli, "Da, naravno, vrlo sam dobar u tome,"
03:59
they were characterized as high efficacy,
99
224000
2000
su bili okarakterizirani kao visoko efikasni,
04:01
and the people who said,
100
226000
2000
a ljudi koji su rekli,
04:03
"Eh, I never get around to brushing and flossing as much as I should,"
101
228000
2000
"Ah, nikada baš ne perem i čistim zube koncem koliko bih trebao,"
04:05
they were characterized as low efficacy.
102
230000
2000
su bili okarakterizirani kao nisko efikasni.
04:07
So the upshot was this.
103
232000
3000
Ishod je bio ovakav.
04:10
The upshot of this experiment
104
235000
2000
Ishod eksperimenta
04:12
was that fear was not really a primary driver
105
237000
3000
je da strah zapravo nije primarni pobuđivač
04:15
of the behavior at all.
106
240000
2000
ponašanja uopće.
04:17
The people who brushed and flossed their teeth
107
242000
2000
Ljudi koji su prali zube i čistili ih koncem
04:19
were not necessarily the people
108
244000
2000
nisu nužno bili ljudi
04:21
who were really scared about what would happen --
109
246000
2000
koji su bili istinski uplašeni što bi se moglo dogoditi --
04:23
it's the people who simply felt that they had the capacity
110
248000
3000
već su to bili ljudi koji su osjećali da imaju sposobnost
04:26
to change their behavior.
111
251000
2000
promjene svojega ponašanja.
04:28
So fear showed up as not really the driver.
112
253000
3000
Time se strah nije pokazao primarnim poticajem;
04:31
It was the sense of efficacy.
113
256000
3000
već je to bio osjećaj za efikasnost.
04:34
So I want to isolate this,
114
259000
2000
Ja to želim izolirati,
04:36
because it was a great observation --
115
261000
2000
jer je to bilo veliko opažanje --
04:38
30 years ago, right, 30 years ago --
116
263000
2000
prije 30 godina, stvarno, prije 30 godina --
04:40
and it's one that's laid fallow in research.
117
265000
3000
i ono koje je utjecalo na neprovođenje istraživanja.
04:43
It was a notion that really came out
118
268000
2000
Riječ je o ideji koja je proizašla
04:45
of Albert Bandura's work,
119
270000
2000
iz rada Alberta Bandure
04:47
who studied whether
120
272000
2000
koji je istraživao mogu li
04:49
people could get a sense of empowerment.
121
274000
3000
ljudi dobiti osjećaj osnaženja.
04:52
The notion of efficacy basically boils down to one -- that
122
277000
3000
Ideja o efikasnosti se zapravo svodi na činjenicu da li
04:55
if somebody believes that they have the capacity to change their behavior.
123
280000
3000
osoba vjeruje da ima sposobnost promjene svoga ponašanja.
04:58
In health care terms, you could characterize this
124
283000
3000
U terminima zdravstvene skrbi, ovo se može opisati na način
05:01
as whether or not somebody feels
125
286000
2000
da li netko osjeća
05:03
that they see a path towards better health,
126
288000
2000
da vidi put ka boljem zdravlju,
05:05
that they can actually see their way towards getting better health,
127
290000
2000
i da doista može vidjeti taj put prema boljem zdravlju.
05:07
and that's a very important notion.
128
292000
2000
I to je vrlo značajna misao.
05:09
It's an amazing notion.
129
294000
2000
Nevjerojatna misao.
05:11
We don't really know how to manipulate it, though, that well.
130
296000
3000
Zapravo ne znamo kako njome dobro manipulirati.
05:14
Except, maybe we do.
131
299000
3000
Ili, možda i znamo.
05:17
So fear doesn't work, right? Fear doesn't work.
132
302000
2000
Dakle strah ne funkcionira, tako je, strah ne funkcionira.
05:19
And this is a great example
133
304000
2000
I to je izvrstan primjer
05:21
of how we haven't learned that lesson at all.
134
306000
3000
toga kako nismo uopće naučili lekciju.
05:24
This is a campaign from the American Diabetes Association.
135
309000
3000
Ovo je kampanja Američkog udruženja dijabetičara.
05:27
This is still the way we're communicating messages about health.
136
312000
3000
Još uvijek je ovo način na koji komuniciramo o zdravlju.
05:30
I mean, I showed my three-year-old this slide last night,
137
315000
3000
Pokazao sam mom trogodišnjaku sinoć ovaj slajd,
05:33
and he's like, "Papa, why is an ambulance in these people's homes?"
138
318000
4000
i rekao je, "Tata, zašto je ambulanta u kućama ovih ljudi?"
05:37
And I had to explain, "They're trying to scare people."
139
322000
3000
I trebao sam objasniti, "Ovdje su da straše ljude."
05:40
And I don't know if it works.
140
325000
2000
I ne znam da li to funkcionira.
05:42
Now here's what does work:
141
327000
2000
Ali ono što funkcionira je sljedeće,
05:44
personalized information works.
142
329000
2000
personalizirane informacije funkcioniraju.
05:46
Again, Bandura recognized this
143
331000
2000
Bandura je to uočio
05:48
years ago, decades ago.
144
333000
2000
prije više godina, više desetljeća.
05:50
When you give people specific information
145
335000
2000
Kada daš ljudima specifične informacije
05:52
about their health, where they stand,
146
337000
2000
o njihovom zdravlju, u kojoj su situaciji,
05:54
and where they want to get to, where they might get to,
147
339000
2000
i što žele postići, što bi mogli postići,
05:56
that path, that notion of a path --
148
341000
2000
taj put, misao o tom putu,
05:58
that tends to work for behavior change.
149
343000
2000
funkcionira bolje za promjenu ponašanja.
06:00
So let me just spool it out a little bit.
150
345000
2000
Dopustite da vam ovo malo dočaram.
06:02
So you start with personalized data, personalized information
151
347000
3000
Počinjete s personaliziranim podacima, personaliziranim informacijama,
06:05
that comes from an individual,
152
350000
2000
koje se odnose na pojedinca,
06:07
and then you need to connect it to their lives.
153
352000
3000
i trebate ih povezati s njihovim životima.
06:10
You need to connect it to their lives,
154
355000
2000
Trebate ih povezati s njihovim životima,
06:12
hopefully not in a fear-based way, but one that they understand.
155
357000
2000
po mogućnosti ne temeljeći na strahu, nego da mogu razumjeti.
06:14
Okay, I know where I sit. I know where I'm situated.
156
359000
3000
U redu, znam gdje sam. Znam kakva je situacija.
06:17
And that doesn't just work for me in terms of abstract numbers --
157
362000
3000
I to ne funkcionira za mene samo u smislu apstraktnih brojeva,
06:20
this overload of health information
158
365000
2000
preopterećenja zdravstvenim informacijama
06:22
that we're inundated with.
159
367000
2000
kojima smo preplavljeni,
06:24
But it actually hits home.
160
369000
2000
ovo doista pogađa u srž.
06:26
It's not just hitting us in our heads; it's hitting us in our hearts.
161
371000
2000
Ne samo da nam dolazi do glava, dolazi i do srca.
06:28
There's an emotional connection to information
162
373000
2000
Postoji emocionalna povezanost s informacijama
06:30
because it's from us.
163
375000
2000
jer su naše vlastite.
06:32
That information then needs to be connected to choices,
164
377000
3000
Ta informacija treba nadalje biti povezana s izborima,
06:35
needs to be connected to a range of options,
165
380000
2000
treba biti povezana s rasponom opcija,
06:37
directions that we might go to --
166
382000
2000
smjerova kojima možemo krenuti --
06:39
trade-offs, benefits.
167
384000
2000
kompromis, koristi.
06:41
Finally, we need to be presented with a clear point of action.
168
386000
3000
Naposljetku, treba nam se prezentirati jasan smjer kretanja.
06:44
We need to connect the information
169
389000
2000
Trebamo povezati informaciju
06:46
always with the action,
170
391000
2000
s akcijom,
06:48
and then that action feeds back
171
393000
2000
tada iz te akcije proizlazi
06:50
into different information,
172
395000
2000
različita informacija,
06:52
and it creates, of course, a feedback loop.
173
397000
2000
što kreira, naravno, krug povratnih informacija.
06:54
Now this is a very well-observed and well-established notion
174
399000
3000
To je dobro istražena i definirana ideja
06:57
for behavior change.
175
402000
2000
za promjenu ponašanja.
06:59
But the problem is that things -- in the upper-right corner there --
176
404000
3000
Ali problem je što se do stvari u gornjem desnom kutu,
07:02
personalized data, it's been pretty hard to come by.
177
407000
2000
personaliziranih podataka, teško dolazilo.
07:04
It's a difficult and expensive commodity,
178
409000
3000
Riječ je o teškom i skupom dobru,
07:07
until now.
179
412000
2000
do sada.
07:09
So I'm going to give you an example, a very simple example of how this works.
180
414000
3000
Dat ću vam primjer, vrlo jednostavan primjer kako ovo funkcionira.
07:12
So we've all seen these. These are the "your speed limit" signs.
181
417000
3000
Svi smo ovo već vidjeli. Ovo su znakovi "ograničenja brzine".
07:15
You've seen them all around,
182
420000
2000
Vidjeli ste ih posvuda,
07:17
especially these days as radars are cheaper.
183
422000
2000
pogotovo ovih dana kada su radari jeftiniji.
07:19
And here's how they work in the feedback loop.
184
424000
2000
I evo kako funkcioniraju unutar kruga povratnih informacija.
07:21
So you start with the personalized data
185
426000
2000
Započinjete s personaliziranim podacima
07:23
where the speed limit on the road that you are at that point
186
428000
2000
kod kojih je ograničenje brzine na cesti gdje se nalazite u ovome trenutku
07:25
is 25,
187
430000
2000
25 (milja na sat),
07:27
and, of course, you're going faster than that.
188
432000
2000
i, naravno, vi vozite brže od toga.
07:29
We always are. We're always going above the speed limit.
189
434000
3000
Uvijek to činimo. Uvijek idemo iznad ograničenja brzine.
07:32
The choice in this case is pretty simple.
190
437000
2000
Izbor u ovome slučaju je prilično jednostavan.
07:34
We either keep going fast, or we slow down.
191
439000
2000
Ili ćemo nastaviti ići brzo, ili ćemo usporiti.
07:36
We should probably slow down,
192
441000
2000
Vjerojatno bismo trebali usporiti,
07:38
and that point of action is probably now.
193
443000
2000
i trenutak za akciju je vjerojatno sada.
07:40
We should take our foot off the pedal right now,
194
445000
3000
Trebamo maknuti nogu s papučice upravo sada.
07:43
and generally we do. These things are shown to be pretty effective
195
448000
3000
I najčešće to i napravimo; ovo se pokazalo dosta efikasnim
07:46
in terms of getting people to slow down.
196
451000
2000
kod navođenja ljudi da uspore.
07:48
They reduce speeds by about five to 10 percent.
197
453000
2000
Smanje brzinu za otprilike pet do 10 posto.
07:50
They last for about five miles,
198
455000
2000
To traje oko pet milja,
07:52
in which case we put our foot back on the pedal.
199
457000
2000
nakon čega ponovno stavimo nogu na papučicu.
07:54
But it works, and it even has some health repercussions.
200
459000
2000
Ali funkcionira, i čak ima određene zdravstvene posljedice.
07:56
Your blood pressure might drop a little bit.
201
461000
2000
Vaš krvni tlak se može malo smanjiti.
07:58
Maybe there's fewer accidents, so there's public health benefits.
202
463000
3000
Možda ima i manji broj nesreća, što je korisno za opće zdravlje.
08:01
But by and large, this is a feedback loop
203
466000
2000
Ali u načelu, ovo je krug povratnih informacija
08:03
that's so nifty and too rare.
204
468000
3000
koji je izvanredan i vrlo rijedak.
08:06
Because in health care, most health care,
205
471000
2000
Jer u zdravstvu, u većini slučajeva,
08:08
the data is very removed from the action.
206
473000
3000
podaci se otklanjaju od akcije.
08:11
It's very difficult to line things up so neatly.
207
476000
3000
Vrlo je teško tako lijepo stvari staviti u red.
08:14
But we have an opportunity.
208
479000
2000
Ali imamo mogućnost.
08:16
So I want to talk about, I want to shift now to think about
209
481000
2000
Želim govoriti, želim se prebaciti kako bismo razmislili o
08:18
how we deliver health information in this country,
210
483000
2000
tome kako prenosimo informacije u ovoj zemlji,
08:20
how we actually get information.
211
485000
3000
kako zapravo dobivamo informacije.
08:23
This is a pharmaceutical ad.
212
488000
3000
Ovo je farmaceutski oglas.
08:26
Actually, it's a spoof. It's not a real pharmaceutical ad.
213
491000
2000
Zapravo je satira, nije stvarna farmaceutska reklama.
08:28
Nobody's had the brilliant idea
214
493000
2000
Nitko još nije došao do briljantne ideje
08:30
of calling their drug Havidol quite yet.
215
495000
3000
da svoj lijek nazove Havidol.
08:34
But it looks completely right.
216
499000
2000
Ali izgleda u redu, u potpunosti.
08:36
So it's exactly the way we get
217
501000
2000
Ovo je način na koji dobivamo
08:38
health information and pharmaceutical information,
218
503000
3000
informacije o zdravlju i farmaceutske informacije,
08:41
and it just sounds perfect.
219
506000
2000
i zapravo zvuči savršeno.
08:43
And then we turn the page of the magazine,
220
508000
2000
Onda okrenemo stranicu časopisa,
08:45
and we see this --
221
510000
3000
i vidimo ovo, da, vidimo ovo.
08:48
now this is the page the FDA requires pharmaceutical companies
222
513000
3000
Ovo je stranica koju FDA zahtijeva od farmaceutskih kompanija
08:51
to put into their ads, or to follow their ads,
223
516000
3000
da je stave u svoje oglase ili da slijedi oglas.
08:54
and to me, this is one of the most
cynical exercises in medicine.
cynical exercises in medicine.
224
519000
4000
Za mene, ovo je ciničan primjer u medicini.
08:58
Because we know.
225
523000
2000
Jer mi znamo.
09:00
Who among us would actually say that people read this?
226
525000
2000
Tko bi među nama doista tvrdio da ljudi ovo čitaju?
09:02
And who among us would actually say
227
527000
2000
I tko bi među nama doista tvrdio
09:04
that people who do try to read this
228
529000
2000
da ljudi koji pokušaju ovo čitati
09:06
actually get anything out of it?
229
531000
2000
stvarno i imaju nešto od toga?
09:08
This is a bankrupt effort
230
533000
2000
Ovo je uzaludni trud
09:10
at communicating health information.
231
535000
3000
u komuniciranju zdravstvenih informacija.
09:13
There is no good faith in this.
232
538000
2000
Nema dobre vjere u ovome.
09:15
So this is a different approach.
233
540000
2000
Ovo je drugačiji pristup.
09:17
This is an approach that has been developed
234
542000
3000
Ovo je pristup kojeg je stvorio
09:20
by a couple researchers at Dartmouth Medical School,
235
545000
3000
jedan par znanstvenika u Dartmouth Medical School,
09:23
Lisa Schwartz and Steven Woloshin.
236
548000
2000
Lisa Schwartz i Steven Woloshin.
09:25
And they created this thing called the "drug facts box."
237
550000
3000
Stvorili su stvar koju su nazvali kutijom liječničkih činjenica.
09:28
They took inspiration from, of all things,
238
553000
2000
Inspiraciju su našli u, između svega,
09:30
Cap'n Crunch.
239
555000
2000
Cap'n Crunch (pahuljice).
09:32
They went to the nutritional information box
240
557000
3000
Gledali su prehrambene informacije na kutiji
09:35
and saw that what works for cereal, works for our food,
241
560000
3000
i vidjeli da ono što vrijedi za pahuljice, vrijedi za našu hranu,
09:38
actually helps people understand what's in their food.
242
563000
3000
zapravo pomaže ljudima da razumiju što je u njihovoj hrani.
09:42
God forbid we should use that same standard
243
567000
2000
Ne daj Bože da koristimo isti standard
09:44
that we make Cap'n Crunch live by
244
569000
2000
korišten kod Cap'n Crunch
09:46
and bring it to drug companies.
245
571000
3000
i prenesemo ga na farmaceutske kompanije.
09:49
So let me just walk through this quickly.
246
574000
2000
Dozvolite da brzo prođem kroz ovo.
09:51
It says very clearly what the drug is for, specifically who it is good for,
247
576000
3000
Jasno stoji zašto se lijek koristi, posebice za koga je koristan,
09:54
so you can start to personalize your understanding
248
579000
2000
pa možete početi personalizirati svoje razumijevanje
09:56
of whether the information is relevant to you
249
581000
2000
je li ta informacija za vas značajna
09:58
or whether the drug is relevant to you.
250
583000
2000
ili je li taj lijek značajan za vas.
10:00
You can understand exactly what the benefits are.
251
585000
3000
Možete u potpunosti shvatiti koje su koristi.
10:03
It isn't this kind of vague promise that it's going to work no matter what,
252
588000
3000
To nije neko nejasno obećanje kako će funkcionirati bez obzira na sve,
10:06
but you get the statistics for how effective it is.
253
591000
3000
već dobijete statistiku koliko je korisno.
10:09
And finally, you understand what those choices are.
254
594000
3000
I naposljetku, razumijete koji su izbori.
10:12
You can start to unpack the choices involved
255
597000
2000
Možete razabrati izbore koji se nude
10:14
because of the side effects.
256
599000
2000
zbog nuspojava.
10:16
Every time you take a drug, you're walking into a possible side effect.
257
601000
3000
Svaki put kada uzmete lijek, postoji mogućnost nuspojave.
10:19
So it spells those out in very clean terms,
258
604000
2000
One su navedene ovdje na vrlo jasan način.
10:21
and that works.
259
606000
2000
I to funkcionira.
10:23
So I love this. I love that drug facts box.
260
608000
2000
Volim ovo. Volim kutiju liječničkih informacija.
10:25
And so I was thinking about,
261
610000
2000
I tako sam razmišljao o tome,
10:27
what's an opportunity that I could have
262
612000
2000
kakvu priliku ja mogu imati
10:29
to help people understand information?
263
614000
3000
da pomognem ljudima u razumijevanju informacija?
10:32
What's another latent body of information that's out there
264
617000
4000
Koje su još skrivene informacije tamo negdje
10:36
that people are really not putting to use?
265
621000
3000
koje ljudi ne koriste.
10:39
And so I came up with this: lab test results.
266
624000
3000
I došao sam do ovoga: rezultati laboratorijskih testova.
10:42
Blood test results are this great source of information.
267
627000
3000
Rezultati krvnih testova su izvrstan izvor informacija.
10:45
They're packed with information.
268
630000
2000
Puni su informacija.
10:47
They're just not for us. They're not for people. They're not for patients.
269
632000
3000
Jedino što nisu za nas; nisu za ljude; nisu za pacijente.
10:50
They go right to doctors.
270
635000
2000
Idu odmah ka liječnicima.
10:52
And God forbid -- I think many doctors, if you really asked them,
271
637000
3000
I ne daj Bože -- mislim da puno liječnika, da ih pitate,
10:55
they don't really understand all this stuff either.
272
640000
3000
zapravo ne razumiju sve te stvari.
10:58
This is the worst presented information.
273
643000
3000
Ovo su najgore prezentirane informacije.
11:01
You ask Tufte, and he would say,
274
646000
3000
Pitajte Tuftea i rekao bi,
11:04
"Yes, this is the absolute worst presentation of information possible."
275
649000
3000
"Da, ovo je najgora moguća prezentacija informacija."
11:07
What we did at Wired
276
652000
2000
Ono što smo mi napravili u Wiredu,
11:09
was we went, and I got our graphic design department
277
654000
2000
je da smo krenuli i tražio sam od našeg odjela za grafički dizajn
11:11
to re-imagine these lab reports.
278
656000
2000
da nanovo predstave ta laboratorijska izvješća.
11:13
So that's what I want to walk you through.
279
658000
2000
To vam želim pokazati.
11:15
So this is the general blood work before,
280
660000
3000
Ovo je uobičajen izvještaj krvi prije,
11:18
and this is the after, this is what we came up with.
281
663000
2000
a ovo je poslije, ovo smo osmislili.
11:20
The after takes what was four pages --
282
665000
2000
Ovaj poslije uzima ono sa četiri stranice --
11:22
that previous slide was actually
283
667000
2000
onaj prijašnji slajd je zapravo
11:24
the first of four pages of data
284
669000
2000
prva od četiri stranice podataka
11:26
that's just the general blood work.
285
671000
2000
što je ustvari uobičajen izvještaj krvnih rezultata.
11:28
It goes on and on and on, all these values, all these numbers you don't know.
286
673000
3000
Nastavlja se sve dalje i dalje, sve te vrijednosti, ti brojevi koje ne znate.
11:31
This is our one-page summary.
287
676000
3000
Ovo je sažetak na jednoj stranici.
11:34
We use the notion of color.
288
679000
2000
Koristimo načelo boje.
11:36
It's an amazing notion that color could be used.
289
681000
3000
Prekrasno načelo mogućnosti korištenja boje.
11:39
So on the top-level you have your overall results,
290
684000
3000
Na gornjem dijelu imate ukupne rezultate,
11:42
the things that might jump out at you from the fine print.
291
687000
3000
stvari koje mogu iskočiti iz cjeline izvješća.
11:45
Then you can drill down
292
690000
2000
Onda možete prijeći na detalje
11:47
and understand how actually we put your level in context,
293
692000
3000
i razumjeti kako zapravo stavljamo vašu situaciju u kontekst,
11:50
and we use color to illustrate
294
695000
2000
i koristimo boju da ilustriramo
11:52
exactly where your value falls.
295
697000
2000
točno gdje su vaše vrijednosti.
11:54
In this case, this patient is slightly at risk of diabetes
296
699000
3000
U ovome slučaju, pacijent ima mali rizik od dijabetesa
11:57
because of their glucose level.
297
702000
2000
zbog razine glukoze.
11:59
Likewise, you can go over your lipids
298
704000
2000
Također, možete pogledati lipide
12:01
and, again, understand what your overall cholesterol level is
299
706000
3000
i, ponovno, shvatiti kolika je opća razina kolesterola
12:04
and then break down into the HDL and the LDL if you so choose.
300
709000
3000
i razdijeliti ga na HDL i LDL ako tako odaberete.
12:07
But again, always using color
301
712000
2000
No ponovno, uvijek koristeći boju
12:09
and personalized proximity
302
714000
2000
i personaliziranu blizinu
12:11
to that information.
303
716000
2000
tih informacija.
12:13
All those other values,
304
718000
2000
Sve ove druge vrijednosti,
12:15
all those pages and pages of values that are full of nothing,
305
720000
2000
sve te stranice i stranice vrijednosti koje ništa ne označavaju,
12:17
we summarize.
306
722000
2000
mi sažimamo.
12:19
We tell you that you're okay, you're normal.
307
724000
2000
Mi kažemo da si dobro, da si normalan.
12:21
But you don't have to wade through it. You don't have to go through the junk.
308
726000
3000
Ne trebaš gaziti kroz to. Ne trebaš prelaziti kroz smeće.
12:24
And then we do two other very important things
309
729000
2000
Još činimo dvije vrlo važne stvari
12:26
that kind of help fill in this feedback loop:
310
731000
2000
koje pomažu upotpuniti ovaj krug povratnih informacija.
12:28
we help people understand in a little more detail
311
733000
2000
Pomažemo ljudima u detaljnijem razumijevanju
12:30
what these values are and what they might indicate.
312
735000
3000
što su ove vrijednosti i na što mogu ukazivati.
12:33
And then we go a further step -- we tell them what they can do.
313
738000
3000
Tada idemo i korak dalje: kažemo im što mogu napraviti.
12:36
We give them some insight
314
741000
2000
Pružamo im uvid
12:38
into what choices they can make, what actions they can take.
315
743000
3000
u izbore koje mogu uzeti, koje akcije mogu poduzeti.
12:41
So that's our general blood work test.
316
746000
3000
Dakle ovo je naš opći krvni test.
12:44
Then we went to CRP test.
317
749000
2000
Uzeli smo i CRP test.
12:46
In this case, it's a sin of omission.
318
751000
2000
U ovome slučaju, riječ je o grijehu izostavljanja.
12:48
They have this huge amount of space,
319
753000
2000
Ovdje imaju ogromnu količinu prostora,
12:50
and they don't use it for anything, so we do.
320
755000
2000
i ne koriste je za ništa, dok smo mi to učinili.
12:52
Now the CRP test is often done
321
757000
2000
CRP test se često provodi
12:54
following a cholesterol test,
322
759000
2000
nakon testiranja kolesterola,
12:56
or in conjunction with a cholesterol test.
323
761000
2000
ili zajedno s testom razine kolesterola.
12:58
So we take the bold step
324
763000
2000
Mi smo učinili odvažan korak
13:00
of putting the cholesterol information on the same page,
325
765000
3000
stavljanja informacija o kolesterolu na istu stranicu,
13:03
which is the way the doctor is going to evaluate it.
326
768000
2000
što je i način na koji će liječnik napraviti procjenu.
13:05
So we thought the patient might actually want to know the context as well.
327
770000
3000
Mi smo pomislili da bi pacijent želio znati i kontekst.
13:08
It's a protein that shows up
328
773000
2000
To je protein koji pokazuje
13:10
when your blood vessels might be inflamed,
329
775000
2000
kada su vaše krvne žile možda začepljene,
13:12
which might be a risk for heart disease.
330
777000
2000
što može biti rizik za bolest srca.
13:14
What you're actually measuring
331
779000
2000
Ono što zapravo mjerite
13:16
is spelled out in clean language.
332
781000
2000
je detaljno objašnjeno jasnim jezikom.
13:18
Then we use the information
333
783000
2000
Onda koristimo informacije
13:20
that's already in the lab report.
334
785000
2000
koje su već u laboratorijskom izvješću.
13:22
We use the person's age and their gender
335
787000
2000
Uzimamo dob i spol osobe
13:24
to start to fill in the personalized risks.
336
789000
3000
kako bismo upotpunili personalizirani rizik.
13:27
So we start to use the data we have
337
792000
2000
Započinjemo korištenjem podataka koje imamo
13:29
to run a very simple calculation
338
794000
2000
za provedbu vrlo jednostavnog izračuna
13:31
that's on all sorts of online calculators
339
796000
2000
koji je na svim vrstama online kalkulatora
13:33
to get a sense of what the actual risk is.
340
798000
3000
kako bi se dobio osjećaj o tome koliki je stvarni rizik.
13:36
The last one I'll show you is a PSA test.
341
801000
2000
Zadnje što ću vam pokazati je PSA test.
13:38
Here's the before, and here's the after.
342
803000
3000
Ovo je prije a ovo je kasnije.
13:41
Now a lot of our effort on this one --
343
806000
2000
Većina našeg truda kod ovoga --
13:43
as many of you probably know,
344
808000
2000
kao što većina vas vjerojatno zna
13:45
a PSA test is a very controversial test.
345
810000
2000
PSA test je vrlo kontroverzan test.
13:47
It's used to test for prostate cancer,
346
812000
2000
Koristi se za testiranje raka prostate,
13:49
but there are all sorts of reasons
347
814000
2000
ali mnogo je razloga
13:51
why your prostate might be enlarged.
348
816000
2000
zbog kojih prostata može biti povećana.
13:53
And so we spent a good deal of our time
349
818000
2000
I utrošili smo dosta vremena kako bismo
13:55
indicating that.
350
820000
2000
ukazali na to.
13:57
We again personalized the risks.
351
822000
2000
Ponovno smo personalizirali rizik.
13:59
So this patient is in their 50s,
352
824000
2000
Ovaj pacijent je u svojim 50-ima,
14:01
so we can actually give them a very precise estimate
353
826000
2000
i možemo dati vrlo preciznu procjenu
14:03
of what their risk for prostate cancer is.
354
828000
2000
koliki je rizik raka prostate.
14:05
In this case it's about 25 percent, based on that.
355
830000
3000
U ovome je slučaju oko 25%, temeljeno na ovome.
14:08
And then again, the follow-up actions.
356
833000
3000
I ponovno, akcije koje slijede.
14:11
So our cost for this was less than 10,000 dollars, all right.
357
836000
3000
Naš trošak za ovo je manji od $10.000.
14:14
That's what Wired magazine spent on this.
358
839000
3000
Toliko je časopis Wired potrošio na ovo.
14:17
Why is Wired magazine doing this?
359
842000
2000
Zašto časopis Wired to radi?
14:19
(Laughter)
360
844000
3000
(Smijeh)
14:22
Quest Diagnostics and LabCorp,
361
847000
2000
Quest Diagnostics i LabCorp,
14:24
the two largest lab testing companies --
362
849000
3000
dvije najveće kompanije laboratorijskog testiranja:
14:27
last year, they made profits of over 700 million dollars
363
852000
3000
Prošle godine, ostvarile su profit od preko 700 milijuna dolara
14:30
and over 500 million dollars respectively.
364
855000
3000
odnosno preko 500 milijuna dolara.
14:33
Now this is not a problem of resources;
365
858000
2000
Prema tome, ovo nije problem resursa,
14:35
this is a problem of incentives.
366
860000
3000
ovo je problem poticaja.
14:38
We need to recognize that the target of this information
367
863000
3000
Trebamo shvatiti da ciljna skupina ovih informacija
14:41
should not be the doctor, should not be the insurance company.
368
866000
3000
ne bi smjeli biti liječnici, ne bi smjele biti osiguravajuće kompanije;
14:44
It should be the patient.
369
869000
2000
trebali bi biti pacijenti.
14:46
It's the person who actually, in the end,
370
871000
2000
Riječ je o osobi koja će zapravo, na kraju,
14:48
is going to be having to change their lives
371
873000
2000
promijeniti svoj život
14:50
and then start adopting new behaviors.
372
875000
2000
i početi usvajati nova ponašanja.
14:52
This is information that is incredibly powerful.
373
877000
2000
To je nevjerojatno moćna informacija.
14:54
It's an incredibly powerful catalyst to change.
374
879000
3000
To je nevjerojatno snažan katalizator promjene.
14:57
But we're not using it. It's just sitting there.
375
882000
2000
Ali mi ga ne koristimo; samo stoji tamo.
14:59
It's being lost.
376
884000
2000
Izgubljen.
15:01
So I want to just offer four questions
377
886000
2000
Želim predložiti četiri pitanja
15:03
that every patient should ask,
378
888000
2000
koja bi svaki pacijent trebao postaviti,
15:05
because I don't actually expect people
379
890000
2000
jer ne očekujem zapravo da ljudi
15:07
to start developing these lab test reports.
380
892000
2000
počinju razvijati ova laboratorijska izvješća.
15:09
But you can create your own feedback loop.
381
894000
2000
Ali možete kreirati svoj vlastiti krug povratnih informacija.
15:11
Anybody can create their feedback loop by asking these simple questions:
382
896000
3000
Svatko može kreirati svoj krug povratnih informacija postavljanjem ovih jednostavnih pitanja:
15:14
Can I have my results?
383
899000
2000
Mogu li dobiti svoje rezultate?
15:16
And the only acceptable answer is --
384
901000
2000
I jedini prihvatljivi odgovor je --
15:18
(Audience: Yes.) -- yes.
385
903000
2000
(Auditorij: Da.) -- da.
15:20
What does this mean? Help me understand what the data is.
386
905000
2000
Što to znači? Pomozite mi da razumijem što znače ovi podaci.
15:22
What are my options? What choices are now on the table?
387
907000
3000
Koje su moje mogućnosti? Kakav izbor imam na raspolaganju?
15:25
And then, what's next?
388
910000
2000
I onda, što je sljedeće?
15:27
How do I integrate this information
389
912000
2000
Kako da uključim ovu informaciju
15:29
into the longer course of my life?
390
914000
2000
u budući tijek svoga života?
15:32
So I want to wind up by just showing
391
917000
2000
Želim zaključiti na način da pokažem
15:34
that people have the capacity to understand this information.
392
919000
2000
kako ljudi imaju kapacitet razumijevanja ovih informacija.
15:36
This is not beyond the grasp of ordinary people.
393
921000
3000
To nije izvan dometa običnih ljudi.
15:39
You do not need to have the education level of people in this room.
394
924000
3000
Ne trebate imati razinu obrazovanja ljudi u ovoj prostoriji.
15:42
Ordinary people are capable of understanding this information,
395
927000
3000
Obični ljudi su u stanju razumjeti informaciju,
15:45
if we only go to the effort of presenting it to them
396
930000
3000
samo ako mi imamo želje da je njima prezentiramo
15:48
in a form that they can engage with.
397
933000
2000
na način da se oni njome zaokupe.
15:50
And engagement is essential here,
398
935000
2000
Angažman je ovdje ključan,
15:52
because it's not just giving them information;
399
937000
2000
jer to nije samo pružanje informacije,
15:54
it's giving them an opportunity to act.
400
939000
2000
već davanja prilike za akcijom.
15:56
That's what engagement is. It's different from compliance.
401
941000
2000
To znači angažman; različito je od pridržavanja.
15:58
It works totally different from the way we talk about behavior
402
943000
3000
Funkcionira potpuno drugačije od načina na koji mi razgovaramo o ponašanju
16:01
in medicine today.
403
946000
2000
u medicini danas.
16:03
And this information is out there.
404
948000
2000
I ta informacija je negdje vani.
16:05
I've been talking today about latent information,
405
950000
2000
Danas sam govorio o skrivenim informacijama,
16:07
all this information that exists in the system
406
952000
2000
svim tim informacijama koje postoje u sustavu
16:09
that we're not putting to use.
407
954000
2000
a koje ne koristimo.
16:11
But there are all sorts of other bodies of information
408
956000
2000
Ali postoji i puno drugih vrsta informacija
16:13
that are coming online,
409
958000
2000
koje dolaze online.
16:15
and we need to recognize the capacity of this information
410
960000
3000
Mi trebamo prepoznati sposobnost tih informacija
16:18
to engage people, to help people
411
963000
2000
da uključimo ljude, da im pomognemo
16:20
and to change the course of their lives.
412
965000
2000
u promjeni tijeka njihovih života.
16:22
Thank you very much.
413
967000
2000
Puno vam hvala.
16:24
(Applause)
414
969000
3000
(Pljesak)
ABOUT THE SPEAKER
Thomas Goetz - Healthcare communicatorThomas Goetz is the co-founder of Iodine and author of "The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.”
Why you should listen
Thomas Goetz is the co-founder of Iodine, a new company that gives consumers better information -- and better visualizations -- of their health data. The former executive editor of Wired, Goetz has a Master's of Public Health from UC Berkeley. In 2010 he published The Decision Tree, a fascinating look at modern medical decisionmaking and technology. Former FDA commissioner Dr. David Kessler called the book "a game changer.” His next book, The Remedy, explores the germ theory of disease and the quest to cure tuberculosis.
Thomas Goetz | Speaker | TED.com