TEDxSaltLakeCity
Kevin B. Jones: Why curiosity is the key to science and medicine
Kevin Džouns (Kevin Jones): Zašto je radoznalost ključna za nauku i medicinu
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Nauka je proces učenja koji uključuje eksperimentisanje, neuspeh i reviziju, pa tu ni medicina nije izuzetak. Kevin B. Džouns, koji se bavi istraživanjem kancera, suočava se sa velikim nepoznanicama u hirurgiji i medicinskoj nezi sa jednostavnim odgovorom: iskrenošću. U ovom misaonom govoru o prirodi znanja, Džouns pokazuje kako nauka postiže najbolje rezultate kada naučnik skromno prizna šta je to što još uvek ne razume.
Kevin B. Jones - Cancer researcher
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio
Kevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us. Full bio
Double-click the English transcript below to play the video.
00:12
Science.
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Nauka.
00:14
The very word for many of you conjures
unhappy memories of boredom
unhappy memories of boredom
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Baš ona reči koja mnoge od vas
asocira na nesrećne trenutke dosade
asocira na nesrećne trenutke dosade
00:18
in high school biology or physics class.
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na časovima biologije ili fizike
u srednjoj školi.
u srednjoj školi.
00:21
But let me assure that what you did there
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Međutim, dopustite da vas uverim
da ono što ste tamo radili
da ono što ste tamo radili
00:24
had very little to do with science.
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nema baš mnogo veze sa naukom.
00:26
That was really the "what" of science.
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To je bilo ono „šta“ u nauci.
00:28
It was the history
of what other people had discovered.
of what other people had discovered.
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To je bila istorija
onoga što su drugi otkrili.
onoga što su drugi otkrili.
00:32
What I'm most interested in as a scientist
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Ono što mene kao naučnika najviše zanima
00:35
is the "how" of science.
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u nauci je „kako“.
00:37
Because science is knowledge in process.
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Jer nauka je proces saznavanja.
00:41
We make an observation,
guess an explanation for that observation,
guess an explanation for that observation,
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Prvo ide opažanje, pa naslućivanje
objašnjenja za to opažanje,
objašnjenja za to opažanje,
00:44
and then make a prediction
that we can test
that we can test
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a onda predviđanje koje možemo proveriti
00:46
with an experiment or other observation.
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eksperimentom ili drugim opažanjem.
00:49
A couple of examples.
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Evo nekoliko primera.
00:50
First of all, people noticed
that the Earth was below, the sky above,
that the Earth was below, the sky above,
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Pre svega, ljudi su primetili
da im je zemlja ispod, nebo iznad,
da im je zemlja ispod, nebo iznad,
00:54
and both the Sun and the Moon
seemed to go around them.
seemed to go around them.
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a i Sunce i Mesec su izgledali
kao da se okreću oko njih.
kao da se okreću oko njih.
00:58
Their guessed explanation
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Njihovo naslućeno objašnjenje
01:00
was that the Earth must be
the center of the universe.
the center of the universe.
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bilo je da Zemlja
mora da je centar univerzuma.
mora da je centar univerzuma.
01:04
The prediction: everything
should circle around the Earth.
should circle around the Earth.
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Predviđanje: sve bi trebalo
da kruži oko Zemlje.
da kruži oko Zemlje.
01:08
This was first really tested
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Ovo je prvi put istinski testirano
01:09
when Galileo got his hands
on one of the first telescopes,
on one of the first telescopes,
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kada je Galilej došao u posed
jednog od prvih teleskopa,
jednog od prvih teleskopa,
01:12
and as he gazed into the night sky,
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i dok je posmatrao noćno nebo,
01:15
what he found there was a planet, Jupiter,
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ono što je tamo otkrio
bila je planeta Jupiter,
bila je planeta Jupiter,
01:18
with four moons circling around it.
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sa četiri satelita oko sebe.
01:23
He then used those moons
to follow the path of Jupiter
to follow the path of Jupiter
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Potom je on koristio te satelite
da prati Jupiterovu putanju
da prati Jupiterovu putanju
01:28
and found that Jupiter
also was not going around the Earth
also was not going around the Earth
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i otkrio je da Jupiter takođe
ne kruži oko Zemlje,
ne kruži oko Zemlje,
01:31
but around the Sun.
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već oko Sunca.
01:35
So the prediction test failed.
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Tako da je test sa predviđanjem
bio neuspešan.
bio neuspešan.
01:38
And this led to
the discarding of the theory
the discarding of the theory
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To je dovelo do odbacivanja teorije
01:40
that the Earth was the center
of the universe.
of the universe.
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da je Zemlja centar univerzuma.
01:42
Another example: Sir Isaac Newton
noticed that things fall to the Earth.
noticed that things fall to the Earth.
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Drugi primer: Ser Isak Njutn
je primetio da stvari padaju na zemlju.
je primetio da stvari padaju na zemlju.
01:46
The guessed explanation was gravity,
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Naslućeno objašnjenje je bilo gravitacija,
01:50
the prediction that everything
should fall to the Earth.
should fall to the Earth.
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predviđanje da bi sve trebalo
da pada na zemlju.
da pada na zemlju.
01:53
But of course, not everything
does fall to the Earth.
does fall to the Earth.
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No, naravno, ne pada sve na zemlju.
01:58
So did we discard gravity?
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Da li smo odbacili gravitaciju?
02:00
No. We revised the theory and said,
gravity pulls things to the Earth
gravity pulls things to the Earth
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Ne. Izvršili smo reviziju teorije i rekli
da gravitacija privlači stvari ka Zemlji
da gravitacija privlači stvari ka Zemlji
02:05
unless there is an equal
and opposite force in the other direction.
and opposite force in the other direction.
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osim ako ne postoji jednaka,
a suprotna sila u suprotnom smeru.
a suprotna sila u suprotnom smeru.
02:10
This led us to learn something new.
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Ovako smo naučili nešto novo.
02:12
We began to pay more attention
to the bird and the bird's wings,
to the bird and the bird's wings,
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Počeli smo da obraćamo više pažnje
na ptice i njihova krila,
na ptice i njihova krila,
02:16
and just think of all the discoveries
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i pomislite samo na sva otkrića
02:18
that have flown
from that line of thinking.
from that line of thinking.
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koja su ponikla tom linijom razmišljanja.
02:21
So the test failures,
the exceptions, the outliers
the exceptions, the outliers
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Neuspela testiranja, izuzeci i odstupanja
02:26
teach us what we don't know
and lead us to something new.
and lead us to something new.
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nas uče onome što ne znamo
i vode nas nečemu novom.
i vode nas nečemu novom.
02:32
This is how science moves forward.
This is how science learns.
This is how science learns.
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Ovako nauka napreduje. Ovako nauka uči.
02:35
Sometimes in the media,
and even more rarely,
and even more rarely,
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Ponekad će se u medijima
pojaviti, čak sve ređe,
pojaviti, čak sve ređe,
02:38
but sometimes even scientists will say
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ali će i naučnici ponekad reći
02:40
that something or other
has been scientifically proven.
has been scientifically proven.
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da je ovo ili ono naučno dokazano.
02:43
But I hope that you understand
that science never proves anything
that science never proves anything
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No, nadam se da shvatate
da nauka nikad ne dokazuje ništa
da nauka nikad ne dokazuje ništa
02:48
definitively forever.
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definitivno i zauvek.
02:51
Hopefully science remains curious enough
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Nadajmo se da će nauka
ostati dovoljno radoznala
ostati dovoljno radoznala
02:55
to look for
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da traga
02:56
and humble enough to recognize
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i dovoljno skromna da prizna
02:58
when we have found
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kada se pronađe
03:00
the next outlier,
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sledeće odstupanje,
03:02
the next exception,
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sledeći izuzetak,
03:03
which, like Jupiter's moons,
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koji nas, poput Jupiterovih satelita,
03:05
teaches us what we don't actually know.
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uče onome što zapravo ne znamo.
03:09
We're going to change gears
here for a second.
here for a second.
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Napraviću digresiju ovde za trenutak.
03:11
The caduceus, or the symbol of medicine,
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Kaducej, simbol medicine,
03:13
means a lot of different things
to different people,
to different people,
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ne predstavlja isto svim ljudima,
ali većina našeg javnog diskursa
na temu medicine
na temu medicine
03:16
but most of our
public discourse on medicine
public discourse on medicine
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03:18
really turns it into
an engineering problem.
an engineering problem.
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to u stvari pretvara
u inženjerski problem.
u inženjerski problem.
03:21
We have the hallways of Congress,
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Imamo holove Kongresa
03:23
and the boardrooms of insurance companies
that try to figure out how to pay for it.
that try to figure out how to pay for it.
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i direktorske kancelarije osiguravajućih
kompanija koje smišljaju kako to da plate.
kompanija koje smišljaju kako to da plate.
03:27
The ethicists and epidemiologists
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Etičari i epidemiolozi
03:29
try to figure out
how best to distribute medicine,
how best to distribute medicine,
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razmišljaju kako najbolje
da distribuiraju medicinu;
da distribuiraju medicinu;
03:32
and the hospitals and physicians
are absolutely obsessed
are absolutely obsessed
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a bolnice i lekari su apsolutno opsednuti
03:34
with their protocols and checklists,
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svojim protokolima i kontrolnim listama,
03:36
trying to figure out
how best to safely apply medicine.
how best to safely apply medicine.
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pokušavajući da shvate
kako najbolje da primene medicinu.
kako najbolje da primene medicinu.
03:40
These are all good things.
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Sve su ovo dobre stvari.
03:42
However, they also all assume
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Međutim, oni takođe pretpostavljaju,
03:45
at some level
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na nekom nivou,
03:47
that the textbook of medicine is closed.
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da je udžbenik medicine zatvoren.
03:51
We start to measure
the quality of our health care
the quality of our health care
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Počinjemo da merimo
kvalitet zdravstvene nege
kvalitet zdravstvene nege
03:53
by how quickly we can access it.
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po tome koiiko brzo joj pristupamo.
03:56
It doesn't surprise me
that in this climate,
that in this climate,
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Ne iznenađuje me što u takvoj atmosferi
03:58
many of our institutions
for the provision of health care
for the provision of health care
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mnoge institucije
za pružanje zdravstvene nege
za pružanje zdravstvene nege
04:01
start to look a heck of a lot
like Jiffy Lube.
like Jiffy Lube.
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počinju baš da podsećaju
na automehaničarsku radnju.
na automehaničarsku radnju.
04:03
(Laughter)
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(Smeh)
04:06
The only problem is that
when I graduated from medical school,
when I graduated from medical school,
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Jedini problem je što,
kada sam diplomirao na medicini,
kada sam diplomirao na medicini,
04:10
I didn't get one of those
little doohickeys
little doohickeys
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nisam dobio jednu od onih napravica
04:12
that your mechanic
has to plug into your car
has to plug into your car
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koje mehaničar mora da uključi u vaš auto
04:14
and find out exactly what's wrong with it,
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i da sazna šta tačno nije u redu sa njim,
04:17
because the textbook of medicine
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jer udžbenik medicine
04:19
is not closed.
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nije gotov.
04:21
Medicine is science.
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Medicina je nauka.
04:23
Medicine is knowledge in process.
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Medicina je proces saznavanja.
04:27
We make an observation,
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Prvo radimo opažanje,
04:28
we guess an explanation
of that observation,
of that observation,
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naslućujemo objašnjenje tog opažanja,
04:30
and then we make a prediction
that we can test.
that we can test.
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a onda pravimo predviđanje
koje možemo testirati.
koje možemo testirati.
04:33
Now, the testing ground
of most predictions in medicine
of most predictions in medicine
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Predmet testiranja
većine predviđanja u medicini
većine predviđanja u medicini
04:37
is populations.
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su ljudi.
04:38
And you may remember
from those boring days in biology class
from those boring days in biology class
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Možda ćete se setiti
sa onih dosadnih časova biologije
sa onih dosadnih časova biologije
da populacija ima tendenciju
da se raspodeljuje
da se raspodeljuje
04:42
that populations tend to distribute
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04:44
around a mean
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oko srednje vrednosti
04:45
as a Gaussian or a normal curve.
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kao Gausova ili normalna kriva.
04:47
Therefore, in medicine,
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Stoga, u medicini,
04:49
after we make a prediction
from a guessed explanation,
from a guessed explanation,
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nakon što izvedemo predviđanje
iz naslućenog objašnjenja,
iz naslućenog objašnjenja,
04:52
we test it in a population.
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to testiramo na populaciji.
04:55
That means that what we know in medicine,
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To znači da ono što znamo u medicini,
04:58
our knowledge and our know-how,
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naše znanje i veštine,
05:00
comes from populations
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dolazi iz populacije,
05:02
but extends only as far
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ali dopire samo do te granice
05:05
as the next outlier,
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dok ne naiđe na sledeće odstupanje,
05:07
the next exception,
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sledeći izuzetak,
05:08
which, like Jupiter's moons,
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koji će nas, poput Jupiterovih satelita,
05:10
will teach us what we don't actually know.
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naučiti onome što zapravo ne znamo.
05:14
Now, I am a surgeon
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E, sad, ja sam hirurg
05:15
who looks after patients with sarcoma.
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koji brine o pacijentima sa sarkomom.
05:17
Sarcoma is a very rare form of cancer.
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Sarkom je veoma redak oblik raka.
05:20
It's the cancer of flesh and bones.
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To je rak mesa i kostiju.
05:23
And I would tell you that every one
of my patients is an outlier,
of my patients is an outlier,
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I reći ću vam da je svaki
moj pacijent odstupanje,
moj pacijent odstupanje,
05:27
is an exception.
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izuzetak.
05:30
There is no surgery I have ever performed
for a sarcoma patient
for a sarcoma patient
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Ne postoji nijedna operacija
koju sam izveo na obolelom od sarkoma
koju sam izveo na obolelom od sarkoma
05:33
that has ever been guided
by a randomized controlled clinical trial,
by a randomized controlled clinical trial,
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koja se vodila nekim kliničkim
ispitivanjem na nasumičnom uzorku,
ispitivanjem na nasumičnom uzorku,
05:37
what we consider the best kind
of population-based evidence in medicine.
of population-based evidence in medicine.
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što smatramo najboljom vrstom
dokaza na populaciji u medicini.
dokaza na populaciji u medicini.
05:42
People talk about thinking
outside the box,
outside the box,
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Pričaju vam da razmišljate izvan kutije,
05:44
but we don't even have a box in sarcoma.
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ali kod sarkoma
mi čak nemamo ni tu kutiju.
mi čak nemamo ni tu kutiju.
05:47
What we do have as we take
a bath in the uncertainty
a bath in the uncertainty
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Ono što imamo, dok koračamo u neizvesno,
05:50
and unknowns and exceptions
and outliers that surround us in sarcoma
and outliers that surround us in sarcoma
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nepoznato, izuzetke i odstupanja
koja nas okružuju kod sarkoma
koja nas okružuju kod sarkoma
05:55
is easy access to what I think
are those two most important values
are those two most important values
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je lak pristup onome što mislim
da su dve najvažnije vrednosti
da su dve najvažnije vrednosti
05:59
for any science:
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za nauku:
06:01
humility and curiosity.
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poniznost i radoznalost.
06:04
Because if I am humble and curious,
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Jer ako sam ponizan i radoznao,
06:06
when a patient asks me a question,
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kada mi pacijent postavi pitanje,
06:08
and I don't know the answer,
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i ja ne znam odgovor,
06:10
I'll ask a colleague
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pitaću nekog kolegu,
06:12
who may have a similar
albeit distinct patient with sarcoma.
albeit distinct patient with sarcoma.
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koji je imao sličnog, a opet
jedinstvenog pacijenta sa sarkomom.
jedinstvenog pacijenta sa sarkomom.
06:15
We'll even establish
international collaborations.
international collaborations.
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Čak ćemo uspostaviti međunarodnu saradnju.
Ovi pacijenti će početi da komuniciraju
putem pričaonica na internetu
putem pričaonica na internetu
06:17
Those patients will start
to talk to each other through chat rooms
to talk to each other through chat rooms
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06:21
and support groups.
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i grupa za podršku.
06:22
It's through this kind
of humbly curious communication
of humbly curious communication
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Kroz ovakvu vrstu
ponizne i radoznale komunikacije
ponizne i radoznale komunikacije
06:26
that we begin to try and learn new things.
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krećemo sa pokušajima
da saznamo nove stvari.
da saznamo nove stvari.
06:31
As an example, this is a patient of mine
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Primera radi, ovo je jedan moj pacijent
06:33
who had a cancer near his knee.
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koji je imao kancer blizu kolena.
06:35
Because of humbly curious communication
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Zbog ponizno radoznale komunikacije
06:37
in international collaborations,
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putem međunarodne saradnje,
06:40
we have learned that we can repurpose
the ankle to serve as the knee
the ankle to serve as the knee
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saznali smo da možemo
članak staviti u funkciju kolena
članak staviti u funkciju kolena
06:44
when we have to remove the knee
with the cancer.
with the cancer.
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kada moramo da odstranimo
koleno zbog kancera.
koleno zbog kancera.
06:46
He can then wear a prosthetic
and run and jump and play.
and run and jump and play.
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On onda može nositi protezu,
trčati, skakati i igrati se.
trčati, skakati i igrati se.
06:50
This opportunity was available to him
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Ova mogućnost mu se pružila
06:53
because of international collaborations.
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zbog međunarodne saradnje.
06:56
It was desirable to him
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Bila je dobra za njega
06:57
because he had contacted other patients
who had experienced it.
who had experienced it.
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jer je kontaktirao sa drugim obolelima
koji su prošli kroz to.
koji su prošli kroz to.
07:01
And so exceptions and outliers in medicine
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Tako nas izuzeci i odstupanja u medicini
07:06
teach us what we don't know,
but also lead us to new thinking.
but also lead us to new thinking.
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uče onome što ne znamo,
ali i nas i uče novom načinu razmišljanja.
ali i nas i uče novom načinu razmišljanja.
07:11
Now, very importantly,
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Što je veoma važno,
07:12
all the new thinking that outliers
and exceptions lead us to in medicine
and exceptions lead us to in medicine
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sva to novo razmišljanja kome nas vode
odstupanja i izuzeci u medicini
odstupanja i izuzeci u medicini
07:16
does not only apply
to the outliers and exceptions.
to the outliers and exceptions.
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ne važe samo za odstupanja i izuzetke.
07:20
It is not that we only learn
from sarcoma patients
from sarcoma patients
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Ne učimo mi samo od pacijenata sa sarkomom
07:24
ways to manage sarcoma patients.
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kako da tretiramo obolele od sarkoma.
07:26
Sometimes, the outliers
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Katkad, odstupanja
07:29
and the exceptions
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i izuzeci
07:30
teach us things that matter quite a lot
to the general population.
to the general population.
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nas uče stvarima koje dosta znače
opštoj populaciji.
opštoj populaciji.
07:35
Like a tree standing outside a forest,
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Poput stabala izvan šume,
07:37
the outliers and the exceptions
draw our attention
draw our attention
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odstupanja i izuzeci nam privlače pažnju
07:41
and lead us into a much greater sense
of perhaps what a tree is.
of perhaps what a tree is.
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i vode nas ka možda mnogo boljoj spoznaji
o tome šta je to stablo.
o tome šta je to stablo.
07:45
We often talk about
losing the forests for the trees,
losing the forests for the trees,
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Često govorimo
o žrtvovanju šume zbog stabala,
o žrtvovanju šume zbog stabala,
07:48
but one also loses a tree
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ali neko takođe izgubi stablo
07:50
within a forest.
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u svoj toj šumi.
07:53
But the tree that stands out by itself
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Ali ono drvo koje stoji izdvojeno
07:54
makes those relationships
that define a tree,
that define a tree,
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čini da ove veze koje određuju drvo,
07:57
the relationships between trunk
and roots and branches,
and roots and branches,
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veze između stabla, korenja i grana,
08:01
much more apparent.
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budu mnogo vidljivije.
08:03
Even if that tree is crooked
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Čak i ako je to stablo iskrivljeno
08:05
or even if that tree
has very unusual relationships
has very unusual relationships
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ili čak i ako to stablo
ima veoma neobičnu vezu
ima veoma neobičnu vezu
08:08
between trunk and roots and branches,
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između stabla, korena i grana,
08:10
it nonetheless draws our attention
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ono svakako privlači našu pažnju
i dozvoljava nam da izvršimo posmatranja
08:13
and allows us to make observations
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08:15
that we can then test
in the general population.
in the general population.
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i to posle primenimo na opštu populaciju.
08:18
I told you that sarcomas are rare.
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Rekao sam vam da je sarkom redak.
08:20
They make up about one percent
of all cancers.
of all cancers.
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Čini oko jedan posto svih kancera.
08:23
You also probably know that cancer
is considered a genetic disease.
is considered a genetic disease.
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Verovatno znate da se kancer
smatra genetskom bolešću.
smatra genetskom bolešću.
08:27
By genetic disease we mean
that cancer is caused by oncogenes
that cancer is caused by oncogenes
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Pod genetskom bolešću mislimo
da kancer izazivaju onkogeni
da kancer izazivaju onkogeni
koji se aktiviraju kod kancera
08:31
that are turned on in cancer
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08:32
and tumor suppressor genes
that are turned off to cause cancer.
that are turned off to cause cancer.
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i tumor supresorski geni
koji se isključuju kako bi nastao kancer.
koji se isključuju kako bi nastao kancer.
08:36
You might think
that we learned about oncogenes
that we learned about oncogenes
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Možda mislite da smo naučili o onkogenima
i tumor supresorskim genima
iz uobičajenih kancera
iz uobičajenih kancera
08:38
and tumor suppressor genes
from common cancers
from common cancers
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08:40
like breast cancer and prostate cancer
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1976
poput raka dojke ili prostate
08:42
and lung cancer,
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i raka pluća,
08:44
but you'd be wrong.
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ali pogrešili biste.
08:46
We learned about oncogenes
and tumor suppressor genes
and tumor suppressor genes
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O onkogenima i tumor
supresorskim genima naučili smo
supresorskim genima naučili smo
08:48
for the first time
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po prvi put
08:50
in that itty-bitty little one percent
of cancers called sarcoma.
of cancers called sarcoma.
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iz tog sitnog jednog procenta
kancera koji se zove sarkom.
kancera koji se zove sarkom.
08:54
In 1966, Peyton Rous got the Nobel Prize
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Pejton Rus je 1966. dobio Nobelovu nagradu
08:57
for realizing that chickens
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za saznanje da pilići
08:59
had a transmissible form of sarcoma.
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imaju prenosivi oblik sarkoma.
Trideset godina kasnije,
Harold Vermus i Majk Bišop otkrivaju
Harold Vermus i Majk Bišop otkrivaju
09:03
Thirty years later, Harold Varmus
and Mike Bishop discovered
and Mike Bishop discovered
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09:06
what that transmissible element was.
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koji je to prenosivi element bio.
09:08
It was a virus
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Bio je to virus
09:10
carrying a gene,
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koji prenosi jedan gen,
09:11
the src oncogene.
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src onkogen.
09:13
Now, I will not tell you
that src is the most important oncogene.
that src is the most important oncogene.
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Neću vam reći da je src
najvažniji onkogen.
najvažniji onkogen.
09:17
I will not tell you
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Neću vam reći da se src onkogen
09:18
that src is the most frequently
turned on oncogene in all of cancer.
turned on oncogene in all of cancer.
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koji se najčešće aktivira
kod svih kancera.
kod svih kancera.
09:22
But it was the first oncogene.
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Međutim, to je bio prvi onkogen.
09:25
The exception, the outlier
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Taj izuzetak i to odstupanje
09:28
drew our attention and led us to something
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556320
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nam je privuklo pažnju
i odvelo nas ka nečemu
i odvelo nas ka nečemu
09:31
that taught us very important things
about the rest of biology.
about the rest of biology.
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što nas je naučilo veoma važnim stvarima
o ostatku biologije.
o ostatku biologije.
09:36
Now, TP53 is the most important
tumor suppressor gene.
tumor suppressor gene.
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TP53 je najvažniji tumor supresorski gen.
09:41
It is the most frequently turned off
tumor suppressor gene
tumor suppressor gene
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569000
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To je tumor supresorski gen
koji se najčešće deaktivira
koji se najčešće deaktivira
09:43
in almost every kind of cancer.
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u skoro svakoj vrsti kancera.
09:46
But we didn't learn about it
from common cancers.
from common cancers.
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No, o tome nismo naučili
iz uobičajenih kancera.
iz uobičajenih kancera.
09:48
We learned about it
when doctors Li and Fraumeni
when doctors Li and Fraumeni
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O tome smo naučili
kada su lekari Li i Fraumeni
kada su lekari Li i Fraumeni
09:51
were looking at families,
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posmatrali porodice
09:52
and they realized that these families
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580720
2016
i shvatili da u ovim porodicama
09:54
had way too many sarcomas.
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ima previše slučajeva sarkoma.
09:57
I told you that sarcoma is rare.
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Rekao sam vam da je sarkom redak.
09:59
Remember that a one
in a million diagnosis,
in a million diagnosis,
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Upamtite da je jedna od milion dijagnoza,
10:02
if it happens twice in one family,
209
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ako se desi dva puta u jednoj porodici,
10:05
is way too common in that family.
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previše česta u toj porodici.
10:08
The very fact that these are rare
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Sama činjenica da se ovo retko dešava
10:11
draws our attention
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privlači našu pažnju
10:13
and leads us to new kinds of thinking.
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i usmerava nas na novi način razmišljanja.
10:17
Now, many of you may say,
214
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Mnogi od vas mogu reći,
10:18
and may rightly say,
215
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i to sa punim pravom,
10:20
that yeah, Kevin, that's great,
216
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da, Kevine, sve je to super,
10:22
but you're not talking
about a bird's wing.
about a bird's wing.
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ali ne pričaš o krilima ptica.
10:24
You're not talking about moons
floating around some planet Jupiter.
floating around some planet Jupiter.
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Ne pričaš o satelitima koji kruže
oko tamo neke planete Jupiter.
oko tamo neke planete Jupiter.
10:28
This is a person.
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Ovo je osoba.
10:30
This outlier, this exception,
may lead to the advancement of science,
may lead to the advancement of science,
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Ovo odstupanje, ovaj izuzetak,
može dovesti do napretka u nauci,
može dovesti do napretka u nauci,
10:33
but this is a person.
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ali ovo je osoba.
10:36
And all I can say
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I sve što mogu reći
10:37
is that I know that all too well.
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je da sve to previše dobro znam.
10:41
I have conversations with these patients
with rare and deadly diseases.
with rare and deadly diseases.
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Razgovarao sam sa pacijentima
obolelim od retkih i smrtonosnih bolesti.
obolelim od retkih i smrtonosnih bolesti.
10:45
I write about these conversations.
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Pišem o ovim razgovorima.
10:47
These conversations are terribly fraught.
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Ovi razgovori unose strašan nemir.
10:50
They're fraught with horrible phrases
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1816
Unose nemir sa užasnim frazama
10:51
like "I have bad news"
or "There's nothing more we can do."
or "There's nothing more we can do."
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3240
poput „Imam loše vesti za vas“
ili „Ne možemo ništa više da uradimo.“
ili „Ne možemo ništa više da uradimo.“
10:55
Sometimes these conversations
turn on a single word:
turn on a single word:
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Ponekad se ovi razgovori
svedu na jednu jedinu reč:
svedu na jednu jedinu reč:
10:59
"terminal."
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„neizlečivo“.
11:04
Silence can also be rather uncomfortable.
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Tišina takođe može biti
prilično nelagodna.
prilično nelagodna.
11:09
Where the blanks are in medicine
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Prazna polja u medicini
11:11
can be just as important
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mogu biti isto toliko važna,
11:13
as the words that we use
in these conversations.
in these conversations.
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koliko i reči pri ovakvim razgovorima.
11:17
What are the unknowns?
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Šta su nepoznate?
11:18
What are the experiments
that are being done?
that are being done?
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Kakvi su eksperimenti koji se izvode?
11:21
Do this little exercise with me.
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Uradimo zajedno ovu malu vežbu.
11:23
Up there on the screen,
you see this phrase, "no where."
you see this phrase, "no where."
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3216
Gore na ekranu, vidite frazu „ni gde“.
11:26
Notice where the blank is.
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Pogledajte prazno polje.
11:28
If we move that blank one space over
240
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Ako prazno polje pomerimo za jedno mesto,
11:32
"no where"
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„ne gde“
11:34
becomes "now here,"
242
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postaje „sada ovde“,
11:36
the exact opposite meaning,
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dobija potpuno suprotno značenje,
11:38
just by shifting the blank one space over.
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samo pomeranjem praznog polja
za jedno mesto.
za jedno mesto.
11:43
I'll never forget the night
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Nikad neću zaboraviti noć
11:45
that I walked into
one of my patients' rooms.
one of my patients' rooms.
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kada sam ušao u sobu jednog pacijenta.
11:48
I had been operating long that day
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Dugo sam bio u operacionoj sali,
11:49
but I still wanted to come and see him.
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ali sam ipak želeo da ga obiđem.
11:52
He was a boy I had diagnosed
with a bone cancer a few days before.
with a bone cancer a few days before.
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Bio je to dečak kome sam dijagnostikovao
rak kostiju nešto ranije.
rak kostiju nešto ranije.
On i njegova majka su se sastali
sa doktorima za hemoterapiju
sa doktorima za hemoterapiju
11:55
He and his mother had been meeting
with the chemotherapy doctors
with the chemotherapy doctors
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prethodno tog dana,
11:58
earlier that day,
251
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i primili su ga u bolnicu
kako bi počeo sa hemoterapijama.
kako bi počeo sa hemoterapijama.
12:00
and he had been admitted
to the hospital to begin chemotherapy.
to the hospital to begin chemotherapy.
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12:03
It was almost midnight
when I got to his room.
when I got to his room.
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2176
Bila je skoro ponoć
kada sam ušao u sobu.
kada sam ušao u sobu.
12:05
He was asleep, but I found his mother
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2176
Spavao je, ali zatekao sam mu majku
12:07
reading by flashlight
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kako čita uz baterijsku lampu
12:09
next to his bed.
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pored njegovog kreveta.
12:10
She came out in the hall
to chat with me for a few minutes.
to chat with me for a few minutes.
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Izašla je u hodnik da popriča sa mnom
na nekoliko minuta.
na nekoliko minuta.
12:14
It turned out that
what she had been reading
what she had been reading
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Ispostavilo se da je ono što je čitala
bio protokol koji su im lekari
za hemoterapiju dali tog dana.
za hemoterapiju dali tog dana.
12:16
was the protocol
that the chemotherapy doctors
that the chemotherapy doctors
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12:18
had given her that day.
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12:20
She had memorized it.
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Naučila ga je napamet.
12:23
She said, "Dr. Jones, you told me
262
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3536
Rekla je: „Dr Džounse, rekli ste mi
12:26
that we don't always win
263
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2176
da ne pobeđujemo uvek
12:28
with this type of cancer,
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ovu vrstu kancera,
12:31
but I've been studying this protocol,
and I think I can do it.
and I think I can do it.
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ali proučavala sam ovaj protokol,
i smatram da mogu.
i smatram da mogu.
12:35
I think I can comply
with these very difficult treatments.
with these very difficult treatments.
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Mislim da mogu da se izborim
sa ovim vrlo teškim tretmanima.
sa ovim vrlo teškim tretmanima.
12:39
I'm going to quit my job.
I'm going to move in with my parents.
I'm going to move in with my parents.
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Ostaviću posao.
Preseliću se kod roditelja.
Preseliću se kod roditelja.
12:42
I'm going to keep my baby safe."
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Sve ću uraditi da spasem mog mališu.“
12:47
I didn't tell her.
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Nisam joj rekao.
12:49
I didn't stop to correct her thinking.
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2920
Nisam probao da je razuverim.
12:53
She was trusting in a protocol
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2256
Ona je imala vere u protokol
12:55
that even if complied with,
272
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3216
koji, čak i ako ga se pridržava,
12:59
wouldn't necessarily save her son.
273
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2400
ne znači da bi spasio njenog sina.
13:03
I didn't tell her.
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Nisam joj rekao.
13:06
I didn't fill in that blank.
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1400
Nisam popunio prazno polje.
13:09
But a year and a half later
276
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1976
No, godinu i po dana kasnije
13:11
her boy nonetheless died of his cancer.
277
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2720
njen dečak je ipak preminuo od raka.
13:15
Should I have told her?
278
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1320
Je li trebalo da joj kažem?
13:17
Now, many of you may say, "So what?
279
785360
2256
Mnogi od vas će možda reći: „Pa šta?
13:19
I don't have sarcoma.
280
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1256
Nemam sarkom.
13:20
No one in my family has sarcoma.
281
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1896
Niko u mojoj porodici nema sarkom.
13:22
And this is all fine and well,
282
790840
1456
I sve ovo je lepo i korisno,
13:24
but it probably doesn't
matter in my life."
matter in my life."
283
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2696
ali mi verovatno neće trebati u životu.“
13:27
And you're probably right.
284
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1256
I verovatno ste u pravu.
13:28
Sarcoma may not matter
a whole lot in your life.
a whole lot in your life.
285
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2680
Sarkom može uopšte da vas se ne tiče.
13:33
But where the blanks are in medicine
286
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Ali ono gde su prazna polja u medicini
13:35
does matter in your life.
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1320
može veoma da vas se tiče.
13:38
I didn't tell you one dirty little secret.
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Nisam vam otkrio
jednu malu bezobraznu tajnu.
jednu malu bezobraznu tajnu.
13:40
I told you that in medicine,
we test predictions in populations,
we test predictions in populations,
289
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Rekao sam vam da u medicini
testiramo predviđanja na populaciji,
testiramo predviđanja na populaciji,
13:45
but I didn't tell you,
290
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ali vam nisam rekao,
13:46
and so often medicine never tells you
291
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2216
i vrlo često vam medicina ne kaže,
13:48
that every time an individual
292
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da svaki put kada se pojedinac
13:51
encounters medicine,
293
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susretne sa medicinom,
13:53
even if that individual is firmly
embedded in the general population,
embedded in the general population,
294
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4040
čak i ako je taj pojedinac
deo opšte populacije,
deo opšte populacije,
13:59
neither the individual
nor the physician knows
nor the physician knows
295
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ni ta osoba ni lekar ne znaju
14:01
where in that population
the individual will land.
the individual will land.
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gde će u toj populaciji
taj pojedinac zauzeti mesto.
taj pojedinac zauzeti mesto.
14:05
Therefore, every encounter with medicine
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Stoga, svaki susret sa medicinom
14:07
is an experiment.
298
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je jedan eksperiment.
14:09
You will be a subject
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2016
Bićete predmet eksperimenta.
14:11
in an experiment.
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14:14
And the outcome will be either
a better or a worse result for you.
a better or a worse result for you.
301
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A ishod će biti rezultat
koji će vam ići na ruku ili ne.
koji će vam ići na ruku ili ne.
14:20
As long as medicine works well,
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Sve dok medicina funkcioniše dobro,
14:22
we're fine with fast service,
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u redu su nam brze usluge,
14:25
bravado, brimmingly
confident conversations.
confident conversations.
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razmetanje hrabrošću,
razgovori prepuni samopouzdanja.
razgovori prepuni samopouzdanja.
14:29
But when things don't work well,
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No, kada stvari ne teku dobro,
14:31
sometimes we want something different.
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ponekad nam je potrebno nešto drugo.
14:34
A colleague of mine
removed a tumor from a patient's limb.
removed a tumor from a patient's limb.
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Jedan moj kolega uklonio je tumor
sa uda pacijentkinje.
sa uda pacijentkinje.
14:38
He was concerned about this tumor.
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Brinuo ga je ovaj tumor.
14:40
In our physician conferences,
he talked about his concern
he talked about his concern
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Na našim kolegijumima,
pričao nam je kako ga brine
pričao nam je kako ga brine
14:43
that this was a type of tumor
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da je ovo vrsta tumora
14:45
that had a high risk
for coming back in the same limb.
for coming back in the same limb.
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za koju postoji veliki rizik
da se vrati na istom udu.
da se vrati na istom udu.
Međutim, njegovi razgovori
sa pacijentkinjom
sa pacijentkinjom
14:48
But his conversations with the patient
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bili su baš onakvi
kakve je pacijentkinja želela:
kakve je pacijentkinja želela:
14:50
were exactly what a patient might want:
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14:52
brimming with confidence.
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puni samopouzdanja.
14:54
He said, "I got it all
and you're good to go."
and you're good to go."
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Govorio je: „Sve sam odstranio,
dobro vam je i možete da idete.“
dobro vam je i možete da idete.“
14:57
She and her husband were thrilled.
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Ona i suprug su bili oduševljeni.
14:58
They went out, celebrated, fancy dinner,
opened a bottle of champagne.
opened a bottle of champagne.
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Izašli su i proslavili uz raskošnu večeru,
otvorili bocu šampanjca.
otvorili bocu šampanjca.
15:04
The only problem was a few weeks later,
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Jedini problem je bio
što je nakon par nedelja
što je nakon par nedelja
15:06
she started to notice
another nodule in the same area.
another nodule in the same area.
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počela da primećuje
drugi čvorić na istom mestu.
drugi čvorić na istom mestu.
15:09
It turned out he hadn't gotten it all,
and she wasn't good to go.
and she wasn't good to go.
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Ispostavilo se da nije sve odstranio
i nije bila dobro.
i nije bila dobro.
15:13
But what happened at this juncture
absolutely fascinates me.
absolutely fascinates me.
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No, ono što se dogodilo tad
me je apsolutno fasciniralo.
me je apsolutno fasciniralo.
15:17
My colleague came to me and said,
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Kolega je došao do mene i rekao:
„Kevine, možeš li da pogledaš
moju pacijentkinju umesto mene?“
moju pacijentkinju umesto mene?“
15:18
"Kevin, would you mind
looking after this patient for me?"
looking after this patient for me?"
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15:22
I said, "Why, you know the right thing
to do as well as I do.
to do as well as I do.
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Rekao sam: „Pa, znaš da uradiš
pravu stvar isto kao i ja.
pravu stvar isto kao i ja.
15:25
You haven't done anything wrong."
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Nisi nigde pogrešio.“
15:27
He said, "Please, just look
after this patient for me."
after this patient for me."
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Odgovorio je: „Molim te, samo pogledaj
ovu pacijentkinju umesto mene.“
ovu pacijentkinju umesto mene.“
15:33
He was embarrassed --
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Bilo ga je sramota -
15:34
not by what he had done,
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ne zbog onog što je uradio,
15:37
but by the conversation that he had had,
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već zbog razgovora koji je vodio,
15:39
by the overconfidence.
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zbog previše samopouzdanja.
15:42
So I performed
a much more invasive surgery
a much more invasive surgery
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Tako sam ja izveo
mnogo invazivniju operaciju
mnogo invazivniju operaciju
15:45
and had a very different conversation
with the patient afterwards.
with the patient afterwards.
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i potpuno drugačije razgovarao
sa pacijentkinjom nakon toga.
sa pacijentkinjom nakon toga.
15:48
I said, "Most likely I've gotten it all
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Rekao sam: „Najverovatnije sam
sve odstranio
sve odstranio
15:50
and you're most likely good to go,
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i najverovatnije će vam biti dobro,
15:53
but this is the experiment
that we're doing.
that we're doing.
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ali ovo što radimo je eksperiment.
15:57
This is what you're going to watch for.
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Na to ćete morati da pazite.
15:59
This is what I'm going to watch for.
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Na to ću ja morati da pazim.
16:01
And we're going to work together
to find out if this surgery will work
to find out if this surgery will work
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I zajedno ćemo raditi na tome
da otkrijemo da li ćemo ovom operacijom
da otkrijemo da li ćemo ovom operacijom
16:04
to get rid of your cancer."
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moći da pobedimo kancer."
16:06
I can guarantee you, she and her husband
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Garantujem vam da ona i suprug
16:08
did not crack another bottle of champagne
after talking to me.
after talking to me.
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nisu otvorili flašu šampanjca
posle razgovora sa mnom.
posle razgovora sa mnom.
16:13
But she was now a scientist,
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No, ona je sada bila naučnik,
16:16
not only a subject in her experiment.
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ne samo predmet eksperimenta.
16:21
And so I encourage you
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Zato vas ohrabrujem
16:23
to seek humility and curiosity
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da tražite poniznost i radoznalost
16:27
in your physicians.
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kod svog lekara.
16:28
Almost 20 billion times each year,
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Skoro 20 milijardi puta svake godine,
16:31
a person walks into a doctor's office,
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osoba uđe kod lekara u ordinaciju,
16:35
and that person becomes a patient.
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i ta osoba postane pacijent.
16:39
You or someone you love
will be that patient sometime very soon.
will be that patient sometime very soon.
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Vi ili neko koga volite
će biti taj pacijent uskoro.
će biti taj pacijent uskoro.
16:43
How will you talk to your doctors?
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Kako ćete pričati sa lekarima?
16:46
What will you tell them?
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Šta ćete im reći?
16:48
What will they tell you?
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Šta će oni reći vama?
16:52
They cannot tell you
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Ne mogu vam reći
16:54
what they do not know,
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ono što ne znaju,
16:57
but they can tell you when they don't know
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ali mogu vam reći kada nešto ne znaju
17:02
if only you'll ask.
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ako ih samo pitate.
17:04
So please, join the conversation.
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I zato vas molim, uključite se u razgovor.
17:08
Thank you.
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Hvala vam.
17:09
(Applause)
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(Aplauz)
ABOUT THE SPEAKER
Kevin B. Jones - Cancer researcherKevin B. Jones is a life-long student of human nature, fascinated most by the decision-making capacity intrinsic to each of us.
Why you should listen
Kevin B. Jones diagnoses and performs surgeries to remove rare cancers called sarcomas from the limbs of children and adults. Counseling patients -- especially teenagers with bone cancers -- about the decisions they must make with regard to their bodies has brought the uncertainties of medicine into keen focus for him. How does a person decipher what medicine has told her? How can a person choose among options given very limited understanding of the implications of each? Intrigued by these riddles and conundrums that patient-physician communication frequently creates, Jones wrote a book, What Doctors Cannot Tell You: Clarity, Confidence and Uncertainty in Medicine.
Jones also runs a scientific research laboratory focused on the biology of sarcomas. Here, his team studies the decisions cells make on the way to becoming a cancer. Again the complexities and uncertainties inherent to these decisions are in full relief.
Jones sees patients and does surgery as an associate professor at the University of Utah in the Department of Orthopaedics, working at both Primary Children's Hospital and the Huntsman Cancer Institute. His laboratory is in the Huntsman Cancer Institute, where he is an adjunct faculty member in the Department of Oncological Sciences.
Jones studied English literature at Harvard, medicine at Johns Hopkins, orthopedic surgery at the University of Iowa, and musculoskeletal oncology at the University of Toronto. He lives in Salt Lake City with his wife and four children.
Kevin B. Jones | Speaker | TED.com