TEDMED 2016
David Casarett: A doctor's case for medical marijuana
David Casarett: Liječnički slučaj s medicinskom konopljom
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Liječnik David Casarett bio je umoran od slušanja razvikanih priča i poluistina o medicinskoj konoplji, stoga je s priličnom skepsom počeo sam istraživati. Vraća se s fascinantnim izvješćem o tome što znamo i ne znamo, kao i što bi službena medicina mogla naučiti od modernih ambulanti u kojima se izdaje medicinska konoplja.
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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Ispričao bih vam najneugodniju situaciju
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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koja mi se ikada dogodila u dugogodišnjoj
praksi kao liječniku palijativne njege.
praksi kao liječniku palijativne njege.
Dogodilo se to prije nekoliko godina.
00:22
This happened a couple of years ago.
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Tražili su me da kao konzultant
posjetim ženu od 70-ak godina,
posjetim ženu od 70-ak godina,
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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00:28
retired English professor
who had pancreatic cancer.
who had pancreatic cancer.
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umirovljenu profesoricu engleskog
koja je imala tumor gušterače.
koja je imala tumor gušterače.
00:32
I was asked to see her because
she had pain, nausea, vomiting ...
she had pain, nausea, vomiting ...
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Tražili su me da je vidim jer je patila
od boli, mučnine, povraćanja...
od boli, mučnine, povraćanja...
00:37
When I went to see her,
we talked about those symptoms
we talked about those symptoms
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Kada sam je posjetio,
pričali smo o tim simptomima
pričali smo o tim simptomima
00:40
and in the course of that consultation,
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i tijekom te konzultacije,
00:42
she asked me whether I thought
that medical marijuana might help her.
that medical marijuana might help her.
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pitala me mislim li može li joj
pomoći medicinska konoplja.
pomoći medicinska konoplja.
00:48
I thought back to everything
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Prisjetio sam se svega
00:50
that I had learned in medical school
about medical marijuana,
about medical marijuana,
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što sam naučio na fakultetu
o medicinskoj konoplji,
o medicinskoj konoplji,
00:54
which didn't take very long
because I had learned absolutely nothing.
because I had learned absolutely nothing.
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što nije dugo trajalo,
jer nisam naučio apsolutno ništa.
jer nisam naučio apsolutno ništa.
00:58
And so I told her that as far as I knew,
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I tako sam joj rekao da, koliko znam,
01:01
medical marijuana
had no benefits whatsoever.
had no benefits whatsoever.
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od medicinske konoplje
nema baš nikakve koristi.
nema baš nikakve koristi.
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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Nasmijala se, kimnula i posegnula
za svojom torbicom pored kreveta
za svojom torbicom pored kreveta
01:09
and pulled out a stack of about a dozen
randomized controlled trials
randomized controlled trials
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i izvukla snop od desetak
nasumično kontroliranih pokusa,
nasumično kontroliranih pokusa,
koji pokazuju da medicinska konoplja
ima povoljne učinke
ima povoljne učinke
01:13
showing that medical
marijuana has benefits
marijuana has benefits
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01:16
for symptoms like nausea
and pain and anxiety.
and pain and anxiety.
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za simptome poput mučnine,
bolova i tjeskobe.
bolova i tjeskobe.
01:20
She handed me those articles and said,
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Dala mi je te članke i rekla:
01:23
"Maybe you should read these
before offering an opinion ...
before offering an opinion ...
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"Možda biste trebali ovo pročitati
prije negoli dajete svoje mišljenje,
prije negoli dajete svoje mišljenje,
01:28
doctor."
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doktore."
01:30
(Laughter)
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(Smijeh)
01:31
So I did.
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I pročitao sam.
01:33
That night I read all of those articles
and found a bunch more.
and found a bunch more.
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Te noći pročitao sam sve te članke
i našao još hrpu novih.
i našao još hrpu novih.
01:36
When I came to see her the next morning,
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Kada sam je posjetio sljedeće jutro,
01:38
I had to admit that it looks like
there is some evidence
there is some evidence
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morao sam priznati da izgleda
kako postoji neki dokaz
kako postoji neki dokaz
01:42
that marijuana can offer medical benefits
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da konoplja može biti medicinski korisna
01:46
and I suggested that if she
really was interested,
really was interested,
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i predložio sam joj,
ako je zaista zainteresirana,
ako je zaista zainteresirana,
01:49
she should try it.
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neka je proba.
01:51
You know what she said?
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Znate li što je rekla?
01:54
This 73-year-old,
retired English professor?
retired English professor?
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Ta 73-godišnja umirovljena
profesorica engleskog?
profesorica engleskog?
Rekla je: "Probala sam je
prije otprilike šest mjeseci.
prije otprilike šest mjeseci.
01:58
She said, "I did try it
about six months ago.
about six months ago.
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02:00
It was amazing.
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Bilo je nevjerojatno.
02:02
I've been using it every day since.
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Od tada je uzimam svaki dan.
02:04
It's the best drug I've discovered.
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To je najbolji lijek koji sam otkrila.
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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Ne znam zašto mi je trebalo 73 godine
da je otkrijem."
da je otkrijem."
(Smijeh)
'Nevjerojatna je.'
02:11
(Laughter)
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02:12
That was the moment at which I realized
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To je bio trenutak u kojem sam shvatio
02:14
I needed to learn something
about medical marijuana
about medical marijuana
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da trebam nešto naučiti o
medicinskoj konoplji
medicinskoj konoplji
02:17
because what I was prepared for
in medical school
in medical school
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jer ono za što sam se
pripremao na fakultetu,
pripremao na fakultetu,
02:20
bore no relationship to reality.
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nije imalo veze sa stvarnošću.
02:23
So I started reading more articles,
I started talking to researchers,
I started talking to researchers,
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Stoga sam počeo čitati više članaka,
razgovarati s istraživačima,
razgovarati s istraživačima,
počeo sam razgovarati s liječnicima,
02:27
I started talking to doctors,
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02:28
and most importantly,
I started listening to patients.
I started listening to patients.
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i najvažnije, počeo sam slušati pacijente.
I tako sam napisao knjigu koja se
temelji na tim razgovorima,
temelji na tim razgovorima,
02:32
I ended up writing a book
based on those conversations,
based on those conversations,
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02:35
and that book really revolved
around three surprises --
around three surprises --
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i ta knjiga je zaista
obradila tri iznenađenja,
obradila tri iznenađenja,
02:38
surprises to me, anyway.
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iznenađenja za mene.
Jedno, koje sam već dao naslutiti,
02:40
One I already alluded to --
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02:41
that there really are some benefits
to medical marijuana.
to medical marijuana.
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da medicinska konoplja
zaista daje neke povoljne učinke.
zaista daje neke povoljne učinke.
02:45
Those benefits may not be
as huge or as stunning
as huge or as stunning
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Ti učinci ne moraju biti
toliko veliki ili zapanjujući,
toliko veliki ili zapanjujući,
kao što bi neki od najgorljivijih
predlagatelja medicinske konoplje
predlagatelja medicinske konoplje
02:48
as some of the most avid proponents
of medical marijuana
of medical marijuana
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02:51
would have us believe,
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željeli da vjerujemo,
no, ti učinci su stvarni.
02:52
but they are real.
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02:54
Surprise number two:
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Drugo iznenađenje,
02:56
medical marijuana does have some risks.
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medicinska konoplja ima neke rizike.
02:59
Those risks may not be
as huge and as scary
as huge and as scary
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Ti rizici ne moraju biti
toliko veliki ili zastrašujući,
toliko veliki ili zastrašujući,
kao što bi neki od protivnika
medicinske konoplje željeli da vjerujemo,
medicinske konoplje željeli da vjerujemo,
03:02
as some of the opponents of medical
marijuana would have us believe,
marijuana would have us believe,
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03:05
but they are real risks, nonetheless.
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ali to jesu stvarni rizici,
bez obzira na sve.
bez obzira na sve.
03:08
But it was the third surprise
that was most ...
that was most ...
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No, treće iznenađenje bilo je
03:10
surprising.
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najiznenađujuće.
03:12
And that is that a lot
of the patients I talked with
of the patients I talked with
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A to je da mnogi pacijenti
s kojima sam razgovarao,
s kojima sam razgovarao,
03:15
who've turned to medical
marijuana for help,
marijuana for help,
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a koji su se okrenuli
medicinskoj konoplji radi pomoći,
medicinskoj konoplji radi pomoći,
03:18
weren't turning to medical marijuana
because of its benefits
because of its benefits
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nisu joj se okrenuli samo zbog
njezinih povoljnih učinaka,
njezinih povoljnih učinaka,
ili zbog ravnoteže
između rizika i koristi,
između rizika i koristi,
03:21
or the balance of risks and benefits,
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ili zato što su mislili
da je ona čudotvoran lijek,
da je ona čudotvoran lijek,
03:23
or because they thought
it was a wonder drug,
it was a wonder drug,
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03:25
but because it gave them
control over their illness.
control over their illness.
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nego zato što im je pružila
kontrolu nad njihovom bolešću.
kontrolu nad njihovom bolešću.
03:29
It let them manage their health
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Pomoću nje upravljali su svojim zdravljem
03:31
in a way that was productive and efficient
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na produktivan i učinkovit način,
03:34
and effective and comfortable for them.
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te učinkovit i ležeran za njih same.
Da bolje predočim, pričat ću
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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i o drugom pacijentu.
Robin je bila u svojim ranim
40-im godinama kada sam je upoznao.
40-im godinama kada sam je upoznao.
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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No, izgledala je kao da je
u svojim kasnim 60-ima.
u svojim kasnim 60-ima.
03:46
She had suffered from rheumatoid arthritis
for the last 20 years,
for the last 20 years,
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Patila je reumatoidnog artritisa
preko 20 godina,
preko 20 godina,
03:50
her hands were gnarled by arthritis,
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ruke su joj zbog artritisa bile kvrgave,
03:52
her spine was crooked,
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kralježnica iskrivljena,
morala je koristiti invalidska kolica
kako bi se kretala.
kako bi se kretala.
03:54
she had to rely
on a wheelchair to get around.
on a wheelchair to get around.
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03:56
She looked weak and frail,
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Izgledala je nemoćno i slabo,
03:58
and I guess physically she probably was,
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mislim da je fizički
vjerojatno i bila takva,
vjerojatno i bila takva,
04:00
but emotionally,
cognitively, psychologically,
cognitively, psychologically,
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no emocionalno, kognitivno, psihološki,
04:03
she was among the toughest
people I've ever met.
people I've ever met.
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bila je među najčvršćim ljudima
koje sam ikada upoznao.
koje sam ikada upoznao.
04:08
And when I sat down next to her
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I kada sam sjeo pored nje
u jednoj ambulanti za
medicinsku konoplju,
medicinsku konoplju,
04:09
in a medical marijuana dispensary
in Northern California
in Northern California
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u Sjevernoj Karolini,
04:12
to ask her about why she turned
to medical marijuana,
to medical marijuana,
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kako bih je pitao zašto se okrenula
uzimanju medicinske konoplje,
uzimanju medicinske konoplje,
04:15
what it did for her and how it helped her,
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kako je utjecala na nju
i kako joj je pomogla,
i kako joj je pomogla,
04:18
she started out by telling me things
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počela mi je govoriti o stvarima
koje sam već čuo
od mnogih pacijenata prije.
od mnogih pacijenata prije.
04:20
that I had heard
from many patients before.
from many patients before.
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04:22
It helped with her anxiety;
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Pomogla joj je kod tjeskobe,
04:24
it helped with her pain;
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pomogla joj je kod boli,
kada se bol smanjila
počela je bolje spavati.
počela je bolje spavati.
04:26
when her pain was better,
she slept better.
she slept better.
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04:28
And I'd heard all that before.
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A sve bih to čuo i prije.
No, tada je rekla nešto
što još nikada nisam čuo,
što još nikada nisam čuo,
04:29
But then she said something
that I'd never heard before,
that I'd never heard before,
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a to je da joj je dala
kontrolu nad životom
kontrolu nad životom
04:32
and that is that it gave her
control over her life
control over her life
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04:36
and over her health.
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i nad njezinim zdravljem.
04:37
She could use it when she wanted,
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Mogla ju je koristiti kada je htjela,
04:39
in the way that she wanted,
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kako je htjela,
u onoj dozi i onoliko često
koliko joj je odgovaralo.
koliko joj je odgovaralo.
04:41
at the dose and frequency
that worked for her.
that worked for her.
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04:43
And if it didn't work for her,
then she could make changes.
then she could make changes.
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A ako joj nije odgovaralo,
mogla je to mijenjati.
mogla je to mijenjati.
04:47
Everything was up to her.
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Sve je ovisilo o njoj.
04:48
The most important thing she said
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Najvažnija stvar koju ju rekla,
04:50
was she didn't need
anybody else's permission --
anybody else's permission --
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bila je ta da nije trebala
ničije dopuštenje,
ničije dopuštenje,
04:53
not a clinic appointment,
not a doctor's prescription,
not a doctor's prescription,
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ni zakazani termin u bolnici,
ni liječnički recept,
ni liječnički recept,
04:55
not a pharmacist's order.
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ni uputu od strane ljekarnika.
04:57
It was all up to her.
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Sve je ovisilo o njoj.
04:59
She was in control.
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Imala je kontrolu.
I ako se to čini kao mala stvar
za nekoga tko ima kroničnu bolest,
za nekoga tko ima kroničnu bolest,
05:01
And if that seems like a little thing
for somebody with chronic illness,
for somebody with chronic illness,
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nije, nije uopće.
05:05
it's not -- not at all.
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Kada se suočimo s ozbiljnom
kroničnom bolešću,
kroničnom bolešću,
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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bio to reumatoidni artritis, lupus,
tumor ili dijabetes,
tumor ili dijabetes,
05:14
or cirrhosis,
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ili ciroza,
05:16
we lose control.
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mi gubimo kontrolu.
05:18
And note what I said: "when," not "if."
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I uočavate što sam rekao -
'kada', a ne 'ako'.
'kada', a ne 'ako'.
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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Svi ćemo se u nekom trenutku u životu
suočiti s ozbiljnom kroničnom bolešću,
suočiti s ozbiljnom kroničnom bolešću,
05:25
that causes us to lose control.
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zbog koje ćemo izgubiti kontrolu.
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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Gledat ćemo kako nam otkazuju vitalne
funkcije, kod nekih i kognitivne funkcije,
funkcije, kod nekih i kognitivne funkcije,
05:31
we'll be no longer able
to care for ourselves,
to care for ourselves,
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više se nećemo moći sami brinuti za sebe,
05:34
to do the things that we want to do.
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raditi ono što želimo.
05:36
Our bodies will betray us,
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Tijelo će nas izdati,
05:38
and in that process, we'll lose control.
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i u tom procesu, izgubit ćemo kontrolu.
05:41
And that's scary.
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A to je strašno.
05:43
Not just scary -- that's frightening,
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Ne samo strašno, to je zastrašujuće,
05:45
it's terrifying.
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užasavajuće.
05:46
When I talk to my patients,
my palliative care patients,
my palliative care patients,
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Kada pričam sa svojim pacijentima
s palijativne njege,
s palijativne njege,
05:49
many of whom are facing illnesses
that will end their lives,
that will end their lives,
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od koji se mnogi suočavaju s bolešću
od koje će umrijeti,
od koje će umrijeti,
05:53
they have a lot of be frightened of --
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oni zaista imaju od čega biti uplašeni.
05:55
pain, nausea, vomiting,
constipation, fatigue,
constipation, fatigue,
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Bol, mučnine, povraćanje,
zatvor, umor,
zatvor, umor,
05:59
their impending mortality.
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nadolazeći kraj.
06:00
But what scares them
more than anything else
more than anything else
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No, ono što ih plaši više od svega,
06:03
is this possibility that at some point,
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je mogućnost da će u nekom trenutku,
06:05
tomorrow or a month from now,
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sutra ili za mjesec dana,
06:07
they're going to lose
control of their health,
control of their health,
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izgubiti kontrolu nad svojim zdravljem,
06:10
of their lives,
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nad svojim životima,
06:12
of their healthcare,
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zdravstvenom njegom,
06:13
and they're going to become
dependent on others,
dependent on others,
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i da će postati ovisni o drugima,
06:16
and that's terrifying.
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a to je zastrašujuće.
06:18
So it's no wonder really
that patients like Robin,
that patients like Robin,
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Stoga nije uopće čudo
da se pacijenti poput Robin,
da se pacijenti poput Robin,
06:22
who I just told you about,
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o kojoj sam vam upravo pričao,
06:24
who I met in that clinic,
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koju sam sreo u toj klinici,
06:25
turn to medical marijuana
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okreću medicinskoj konoplji
06:27
to try to claw back
some semblance of control.
some semblance of control.
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pokušavajući vratiti neki privid kontrole.
06:30
How do they do it though?
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Kako to čine?
Kako te ambulante u kojima se
izdaje medicinska konoplja
izdaje medicinska konoplja
06:32
How do these medical
marijuana dispensaries --
marijuana dispensaries --
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06:34
like the one where I met Robin --
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poput one u kojoj sam sreo 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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kako oni pacijentima poput Robin
vraćaju kontrolu koja im je potrebna?
vraćaju kontrolu koja im je potrebna?
06:43
And how do they do it
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I kako to uspjevaju
06:44
in a way that mainstream
medical hospitals and clinics,
medical hospitals and clinics,
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kada redovne bolnice i klinike,
06:48
at least for Robin, weren't able to?
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barem kod Robin, nisu uspjele?
06:51
What's their secret?
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Koja je njihova tajna?
06:53
So I decided to find out.
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Stoga sam odlučio saznati.
06:55
I went to a seedy clinic
in Venice Beach in California
in Venice Beach in California
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Otišao sam u kliniku na
Venice Beach-u u Kaliforniji
Venice Beach-u u Kaliforniji
06:59
and got a recommendation
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i dobio preporuku
07:01
that would allow me
to be a medical marijuana patient.
to be a medical marijuana patient.
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koja mi dozvoljava kao pacijentu
korištenje medicinske konoplje.
korištenje medicinske konoplje.
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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Dobio sam pismo preporuke koje mi
dozvoljava kupnju medicinske konoplje.
dozvoljava kupnju medicinske konoplje.
07:08
I got that recommendation illegally,
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Dobio sam tu preporuku ilegalno,
07:10
because I'm not
a resident of California --
a resident of California --
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budući nisam stanovnik Kalifornije,
07:12
I should note that.
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trebam to istaknuti.
07:14
I should also note, for the record,
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Trebam istaknuti također, neka se zna,
07:15
that I never used that letter
of recommendation to make a purchase,
of recommendation to make a purchase,
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da nikada nisam iskoristio
to pismo preporuke kako bih je kupio,
to pismo preporuke kako bih je kupio,
07:19
and to all of you DEA agents out there --
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i za sve vas agente DEA-e tamo vani...
(Smijeh)
07:22
(Laughter)
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cijenim to što radite,
07:23
love the work that you're doing,
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samo nastavite.
07:24
keep it up.
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07:26
(Laughter)
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(Smijeh)
07:27
Even though it didn't let me
make a purchase though,
make a purchase though,
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Iako mi to nije omogućilo kupnju,
07:30
that letter was priceless
because it let me be a patient.
because it let me be a patient.
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to pismo je bilo neprocjenjivo,
jer mi je omogućilo da postanem pacijent.
jer mi je omogućilo da postanem pacijent.
07:34
It let me experience
what patients like Robin experience
what patients like Robin experience
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Omogućilo mi je steći iskustvo
koje prolaze pacijenti poput Robin
koje prolaze pacijenti poput Robin
07:38
when they go to a medical
marijuana dispensary.
marijuana dispensary.
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kada idu u ambulantu gdje se izdaje
medicinska konoplja.
medicinska konoplja.
07:41
And what I experienced --
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I kroz što sam sve prošao,
07:43
what they experience every day,
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kroz što oni prolaze svakodnevno,
07:45
hundreds of thousands
of people like Robin --
of people like Robin --
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stotine tisuća ljudi poput Robin,
07:48
was really amazing.
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bilo je zaista nevjerojatno.
07:51
I walked into the clinic,
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Ušao sam u kliniku,
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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i od trenutka kada sam ušao
u mnoge od tih klinika i ambulanti,
u mnoge od tih klinika i ambulanti,
07:55
I felt like that dispensary, that clinic,
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imao sam osjećaj kako je
ta ambulanta, ta klinika,
ta ambulanta, ta klinika,
07:58
was there for me.
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tu zbog mene.
08:00
There were questions
at the outset about who I am,
at the outset about who I am,
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Bilo je pitanja na početku
o tome tko sam,
o tome tko sam,
08:03
what kind of work I do,
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što točno radim,
08:05
what my goals are in looking
for a medical marijuana prescription,
for a medical marijuana prescription,
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što točno želim tražeći recept
za medicinsku marihuanu,
za medicinsku marihuanu,
08:09
or product,
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ili proizvod,
08:12
what my goals are,
what my preferences are,
what my preferences are,
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koji su moji ciljevi,
koji su moji prioriteti,
koji su moji prioriteti,
08:15
what my hopes are,
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moje nade,
08:16
how do I think, how do I hope
this might help me,
this might help me,
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što mislim, čemu se nadam,
kako bi mi to moglo pomoći,
kako bi mi to moglo pomoći,
08:18
what am I afraid of.
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čega se bojim.
08:20
These are the sorts of questions
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To su vrste pitanja
08:22
that patients like Robin
get asked all the time.
get asked all the time.
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koja se pacijentima poput Robin
neprestano postavljaju.
neprestano postavljaju.
08:24
These are the sorts of questions
that make me confident
that make me confident
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To su vrste pitanja s kojima sam siguran
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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da osoba s kojom razgovaram
iskreno radi u mojem najboljem interesu
iskreno radi u mojem najboljem interesu
08:31
and wants to get to know me.
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i želi me dobro upoznati.
08:34
The second thing I learned
in those clinics
in those clinics
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Druga stvar koju sam naučio
u tim klinikama
u tim klinikama
08:36
is the availability of education.
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je dostupnost informacija.
08:39
Education from the folks
behind the counter,
behind the counter,
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Informiranost od strane osoblja za pultom,
08:41
but also education
from folks in the waiting room.
from folks in the waiting room.
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ali i od ljudi u čekaonici.
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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Ljudi koje sam sretao bili su
više nego srdačni, dok sam sjedio uz njih,
više nego srdačni, dok sam sjedio uz njih,
08:48
people like Robin --
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ljudi poput Robin,
08:50
to tell me about who they are,
why they use medical marijuana,
why they use medical marijuana,
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kako bi mi ispričali tko su,
zašto uzimaju medicinsku konoplju,
zašto uzimaju medicinsku konoplju,
08:53
what helps them, how it helps them,
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što im pomaže, kako im pomaže,
08:56
and to give me advice and suggestions.
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te kako bi mi dali savjet i preporuke.
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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Te čekaonice su zaista poput košnica
za interakciju, savjete i podršku.
za interakciju, savjete i podršku.
09:04
And third, the folks behind the counter.
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I treće, osoblje za pultom.
09:06
I was amazed at how willing
those people were
those people were
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Bio sam zadivljen
koliko su ti ljudi bili željni
koliko su ti ljudi bili željni
09:10
to spend sometimes an hour or more
talking me through the nuances
talking me through the nuances
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provesti ponekad sat vremena i više,
pričajući mi o nijansama
pričajući mi o nijansama
09:14
of this strain versus that strain,
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ove vrste biljke naspram one druge,
09:16
smoking versus vaporizing,
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pušenja naspram udisanja pare,
09:18
edibles versus tinctures --
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uzimanja kroz hranu naspram tinktura,
09:20
all, remember, without me
making any purchase whatsoever.
making any purchase whatsoever.
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sve to, zapamtite, bez da sam išta kupio.
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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Sjetite se kada ste zadnji puta
otišli u neku bolnicu illi kliniku
otišli u neku bolnicu illi kliniku
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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4800
i kada je zadnji puta itko s vama proveo
jedan sat, objašnjavajući vam ovako nešto.
jedan sat, objašnjavajući vam ovako nešto.
09:34
The fact that patients like Robin
are going to these clinics,
are going to these clinics,
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Činjenica da pacijenti
poput Robin idu u te klinike,
poput Robin idu u te klinike,
09:38
are going to these dispensaries
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idu u te ambulante,
09:39
and getting that sort
of personalized attention
of personalized attention
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i dobivaju ovakvu vrstu osobne,
prilagođene pažnje
prilagođene pažnje
09:42
and education and service,
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potrebne informacije i uslugu,
09:44
really should be a wake-up call
to the healthcare system.
to the healthcare system.
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zaista treba postati poziv na buđenje
sustavu zdravstvene skrbi.
sustavu zdravstvene skrbi.
09:48
People like Robin are turning away
from mainstream medicine,
from mainstream medicine,
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Ljudi poput Robin okreću leđa
službenoj medicini,
službenoj medicini,
09:51
turning to medical marijuana dispensaries
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okreću se ambulantama
za medicinsku konoplju,
za medicinsku konoplju,
09:53
because those dispensaries
are giving them what they need.
are giving them what they need.
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3880
jer im one daju ono što im treba.
09:58
If that's a wake-up call
to the medical establishment,
to the medical establishment,
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Ako je ovo poziv na buđenje
medicinskom sustavu,
medicinskom sustavu,
10:01
it's a wake-up call that many
of my colleagues are either not hearing
of my colleagues are either not hearing
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poziv je također kojeg
mnogi moji kolege ili ne čuju,
mnogi moji kolege ili ne čuju,
10:04
or not wanting to hear.
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ili ne žele čuti.
Kada razgovaram sa svojim kolegama,
naročito s liječnicima,
naročito s liječnicima,
10:07
When I talk to my colleagues,
physicians in particular,
physicians in particular,
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10:10
about medical marijuana,
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o medicinskoj konoplji,
10:11
they say, "Oh, we need more evidence.
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oni kažu: 'Trebamo više dokaza o tome.'
10:14
We need more research into benefits,
we need more evidence about risks."
we need more evidence about risks."
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Trebamo više istraživanja o povoljnim
učincima te više dokaza o rizicima.'
učincima te više dokaza o rizicima.'
10:18
And you know what? They're right.
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I znate što? U pravu su.
10:20
They're absolutely right.
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Apsolutno su u pravu.
10:21
We do need much more evidence
about the benefits of medical marijuana.
about the benefits of medical marijuana.
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Zaista trebamo mnogo više dokaza o
povoljnim učincima medicinske konoplje.
povoljnim učincima medicinske konoplje.
10:25
We also need to ask the federal government
to reschedule marijuana to Schedule II,
to reschedule marijuana to Schedule II,
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Trebamo također tražiti našu vladu
da prebaci konoplju u skupinu II,
da prebaci konoplju u skupinu II,
10:31
or to deschedule it entirely
to make that research possible.
to make that research possible.
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ili posve izbaci iz klasifikacija,
kako bi se omogućilo istraživanje.
kako bi se omogućilo istraživanje.
10:35
We also need more research
into medical marijuana's risks.
into medical marijuana's risks.
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Također, trebamo više istraživanja
o rizicima medicinske konoplje.
o rizicima medicinske konoplje.
Rizicima medicinske konoplje,
10:39
Medical marijuana's risks --
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10:40
we know a lot about
the risks of recreational use,
the risks of recreational use,
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2376
mnogo znamo o rizicima
rekreativne uporabe,
rekreativne uporabe,
a ne znamo skoro ništa
o rizicima medicinske konoplje.
o rizicima medicinske konoplje.
10:43
we know next to nothing
about the risks of medical marijuana.
about the risks of medical marijuana.
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10:46
So we absolutely do need research,
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Dakle, apsolutno trebamo istraživanja,
10:48
but to say that we need research
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ali reći da trebamo istraživanja,
10:51
and not that we need
to make any changes now
to make any changes now
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a ne reći da trebamo sada
i nešto promijeniti,
i nešto promijeniti,
10:54
is to miss the point entirely.
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1936
znači posve promašiti bit svega.
10:56
People like Robin
aren't seeking out medical marijuana
aren't seeking out medical marijuana
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2576
Ljudi poput Robin ne traže
medicinsku konoplju
medicinsku konoplju
10:58
because they think it's a wonder drug,
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jer misle da je ona čudotvoran lijek,
11:00
or because they think
it's entirely risk-free.
it's entirely risk-free.
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2736
ili jer misle da nema nikakvih rizika.
11:03
They seek it out because the context
in which it's delivered and administered
in which it's delivered and administered
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4656
Traže je jer okruženje u kojem se ona
isporučuje te njome upravlja
isporučuje te njome upravlja
11:08
and used,
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i koristi,
11:09
gives them the sort of control
they need over their lives.
they need over their lives.
239
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3536
daje im jednu vrstu kontrole
koja im je potrebna nad njihovim životom.
koja im je potrebna nad njihovim životom.
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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I to je poziv na buđenje kojem zaista
trebamo posvetiti pažnju.
trebamo posvetiti pažnju.
11:17
The good news though is that
there are lessons we can learn today
there are lessons we can learn today
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Ipak, dobra vijest je što postoje lekcije
koje danas možemo naučiti
koje danas možemo naučiti
11:20
from those medical marijuana dispensaries.
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od tih mjesta koja izdaju
medicinsku konoplju.
medicinsku konoplju.
I to su lekcije koje zaista
trebamo usvojiti.
trebamo usvojiti.
11:23
And those are lessons
we really should learn.
we really should learn.
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11:25
These are often small,
mom-and-pop operations
mom-and-pop operations
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2736
To su često mala okruženja
11:28
run by people with no medical training.
245
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koja vode osobe
bez medicinskog obrazovanja.
bez medicinskog obrazovanja.
11:31
And while it's embarrassing to think
246
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I dok je neugodno i pomisliti
11:33
that many of these clinics
and dispensaries are providing services
and dispensaries are providing services
247
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da mnoge od tih klinika i ambulanti
pružaju usluge i podršku,
pružaju usluge i podršku,
11:37
and support and meeting patients' needs
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zadovoljavajući potrebe pacijenata,
11:40
in ways that billion-dollar
healthcare systems aren't --
healthcare systems aren't --
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na načine na koje zdravstveni sustavi
vrijedni milijarde dolara to ne čine,
vrijedni milijarde dolara to ne čine,
11:44
we should be embarrassed by that --
250
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trebalo bi nas biti sram zbog toga,
11:46
but we can also learn from that.
251
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no, iz toga možemo i nešto naučiti.
11:47
And there are probably
three lessons at least
three lessons at least
252
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Postoje vjerojatno najmanje tri lekcije
11:50
that we can learn
from those small dispensaries.
from those small dispensaries.
253
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2240
koje možemo naučiti
od tih malih ambulanti.
od tih malih ambulanti.
11:52
One: we need to find ways
to give patients more control
to give patients more control
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Prva, moramo naći načina
da pacijentima damo više kontrole
da pacijentima damo više kontrole
11:56
in small but important ways.
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2016
kroz male ali važne načine.
Kako komunicirati
s medicinskim djelatnicima,
s medicinskim djelatnicima,
11:58
How to interact with healthcare providers,
256
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12:00
when to interact
with healthcare providers,
with healthcare providers,
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gdje komunicirati
s medicinskim djelatnicima,
s medicinskim djelatnicima,
12:02
how to use medications
in ways that work for them.
in ways that work for them.
258
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kako uzimati lijekove
a da im oni koriste.
a da im oni koriste.
U svojoj vlastitoj praksi,
12:06
In my own practice,
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postao sam mnogo
kreativniji i fleksibilniji
kreativniji i fleksibilniji
12:07
I've gotten much more
creative and flexible
creative and flexible
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12:10
in supporting my patients
in using drugs safely
in using drugs safely
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u podršci pacijentima, da koriste
lijekove na siguran način,
lijekove na siguran način,
12:13
to manage their symptoms --
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nadzirući simptome,
12:15
with the emphasis on safely.
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s naglaskom na sigurnost.
12:16
Many of the drugs I prescribe
are drugs like opioids or benzodiazepines
are drugs like opioids or benzodiazepines
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Mnogi lijekovi koje propisujem su oni
poput opioida ili benzodiazepina,
poput opioida ili benzodiazepina,
12:21
which can be dangerous if overused.
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koji mogu biti opasni
ako se premaši doza.
ako se premaši doza.
12:23
But here's the point.
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Ali ovo je ključno.
Oni mogu biti opasni
ako se premaši doza,
ako se premaši doza,
12:25
They can be dangerous if they're overused,
267
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ali mogu biti i bez učinka
ako se ne koriste na način,
ako se ne koriste na način,
12:27
but they can also be ineffective
if they're not used in a way
if they're not used in a way
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koji je dosljedan u onome što
pacijenti žele i trebaju.
pacijenti žele i trebaju.
12:30
that's consistent with
what patients want and need.
what patients want and need.
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12:32
So that flexibility,
if it's delivered safely,
if it's delivered safely,
270
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Zato ta fleksibilnost,
ako je pružena na siguran način,
ako je pružena na siguran način,
12:36
can be extraordinarily valuable
for patients and their families.
for patients and their families.
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može biti izvanredno vrijedna
za pacijente i njihove obitelji.
za pacijente i njihove obitelji.
12:39
That's number one.
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To je prvo.
12:40
Number two: education.
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Drugo - edukacija.
12:42
Huge opportunities
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Ogromne su mogućnosti
za naučiti neke od trikova tih ustanova
koje izdaju medicinsku konoplju,
koje izdaju medicinsku konoplju,
12:43
to learn from some of the tricks
of those medical marijuana dispensaries
of those medical marijuana dispensaries
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da bi se pružilo više edukacije
12:47
to provide more education
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12:48
that doesn't require
a lot of physician time necessarily,
a lot of physician time necessarily,
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a koja ne traži nužno
mnogo vremena od strane liječnika,
mnogo vremena od strane liječnika,
12:51
or any physician time,
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ili ikakvo njegovo vrijeme,
12:53
but opportunities to learn
about what medications we're using
about what medications we're using
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već mogućnosti da naučimo
koje lijekove koristimo
koje lijekove koristimo
12:57
and why,
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i zašto,
12:58
prognoses, trajectories of illness,
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prognoze, tijek bolesti,
13:00
and most importantly,
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i ono najvažnije,
13:02
opportunities for patients
to learn from each other.
to learn from each other.
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mogućnosti za pacijente
da uče jedni od drugih.
da uče jedni od drugih.
13:04
How can we replicate what goes on
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Kako možemo preslikati
ono što se događa
ono što se događa
13:06
in those clinic and medical
dispensary waiting rooms?
dispensary waiting rooms?
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u čekaonicama tih klinika
i medicinskih ambulanti?
i medicinskih ambulanti?
13:10
How patients learn from each other,
how people share with each other.
how people share with each other.
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Kako pacijenti uče jedni od drugih,
kako ljudi međusobno dijele iskustva.
kako ljudi međusobno dijele iskustva.
I zadnje, ali ne manje važno,
13:14
And last but not least,
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13:15
putting patients first the way
those medical marijuana dispensaries do,
those medical marijuana dispensaries do,
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stavljajući pacijente na prvo mjesto,
kao što to rade te male ambulante,
kao što to rade te male ambulante,
13:19
making patients feel
legitimately like what they want,
legitimately like what they want,
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čime bi se pacijenti osjećali
da imaju pravo na ono što žele
da imaju pravo na ono što žele
13:24
what they need,
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i ono što trebaju,
razlog je što smo mi,
13:26
is why, as healthcare providers,
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pružatelji medicinskih usluga, ovdje.
13:27
we're here.
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13:29
Asking patients about their hopes,
their fears, their goals and preferences.
their fears, their goals and preferences.
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Pitati pacijente za njihove nade,
strahove, ciljeve i prioritete.
strahove, ciljeve i prioritete.
13:33
As a palliative care provider,
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Kao pružatelj palijativne njege,
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.
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pitam sve svoje pacijente
čemu se nadaju i čega se boje.
čemu se nadaju i čega se boje.
Ali stvar je u sljedećem.
13:39
But here's the thing.
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Pacijenti ne bi trebali čekati
da postanu teško, kronično bolesni,
da postanu teško, kronično bolesni,
13:40
Patients shouldn't have to wait
until they're chronically seriously ill,
until they're chronically seriously ill,
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13:44
often near the end of life,
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često blizu kraja svog života,
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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ne bi smjeli čekati da
posjete liječnika poput mene,
posjete liječnika poput mene,
13:50
before somebody asks them,
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prije nego ih netko upita,
13:52
"What are you hoping for?"
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'Čemu se nadate?'
13:53
"What are you afraid of?"
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'Čega se bojite?'
13:54
That should be baked into the way
that healthcare is delivered.
that healthcare is delivered.
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To bi trebalo biti sastavni dio onoga
što zdravstvena skrb pruža.
što zdravstvena skrb pruža.
13:59
We can do this --
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Mi to možemo,
14:01
we really can.
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zaista možemo.
14:02
Medical marijuana dispensaries
and clinics all across the country
and clinics all across the country
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Ambulante i klinike diljem zemlje,
koje izdaju medicinsku konoplju
koje izdaju medicinsku konoplju
14:05
are figuring this out.
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to shvaćaju.
14:07
They're figuring this out
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One to shvaćaju
14:08
in ways that larger, more mainstream
health systems are years behind.
health systems are years behind.
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na načine za kojima veliki, standardni
zdravstveni sustavi zaostaju godinama.
zdravstveni sustavi zaostaju godinama.
14:14
But we can learn from them,
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No, mi možemo učiti od njih,
14:15
and we have to learn from them.
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i moramo učiti od njih.
14:17
All we have to do is swallow our pride --
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Samo moramo progutati svoj ponos,
14:19
put aside the thought for a minute
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na minutu staviti misao po strani,
14:21
that because we have
lots of letters after our name,
lots of letters after our name,
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da to što imamo mnogo slova
i titula iza svog imena,
i titula iza svog imena,
14:23
because we're experts,
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jer mi smo ipak stručnjaci,
14:25
because we're chief medical officers
of a large healthcare system,
of a large healthcare system,
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jer smo važne medicinske osobe
u velikom sustavu zdravstvene skrbi,
u velikom sustavu zdravstvene skrbi,
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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da zato znamo sve što treba o tome
kako zadovoljiti potrebe pacijenata.
kako zadovoljiti potrebe pacijenata.
14:32
We need to swallow our pride.
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Trebamo progutati svoj ponos.
Trebamo posjetiti nekoliko ustanova
koje izdaju medicinsku konoplju.
koje izdaju medicinsku konoplju.
14:34
We need to go visit
a few medical marijuana dispensaries.
a few medical marijuana dispensaries.
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14:37
We need to figure out what they're doing.
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Moramo shvatiti što oni rade.
14:39
We need to figure out
why so many patients like Robin
why so many patients like Robin
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Moramo shvatiti zašto
toliko pacijenata poput Robin
toliko pacijenata poput Robin
14:41
are leaving our mainstream medical clinics
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napušta naše standardne medicinske klinike
14:43
and going to these medical
marijuana dispensaries instead.
marijuana dispensaries instead.
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i umjesto njih odlaze u te ustanove
gdje se izdaje medicinska konoplja.
gdje se izdaje medicinska konoplja.
14:47
We need to figure out
what their tricks are,
what their tricks are,
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Moramo shvatiti koji su njihovi trikovi,
14:49
what their tools are,
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koji su njihovi alati
14:50
and we need to learn from them.
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i moramo učiti od njih.
14:52
If we do,
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I ako to učinimo,
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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a mislim da možemo
i apsolutno mislim da moramo,
i apsolutno mislim da moramo,
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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možemo jamčiti da će svi naši pacijenti
imati mnogo bolje iskustvo.
imati mnogo bolje iskustvo.
15:01
Thank you.
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Hvala vam.
15:02
(Applause)
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(Pljesak)
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