TEDxSaltLakeCity
Kevin B. Jones: Why curiosity is the key to science and medicine
Kevin Jones: Zašto je znatiželja ključ znanosti i medicine
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Znanost je proces učenja koji uključuje eksperimentiranje, neuspjeh i ponvanjanje – i medicinska znanost nije iznimka. Istraživač raka Kevin B. Jones se suočava s velikim nepoznanicama u kirurgiji i medicinskoj njezi jednostavnim odgovorom: iskrenošću. U obazrivom govoru o prirodi znanja, Jones pokazuje kako je znanost najbolja kada znanstvenici skromno priznaju ono što još ne razumiju.
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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Znanost.
00:14
The very word for many of you conjures
unhappy memories of boredom
unhappy memories of boredom
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Riječ koja mnogima priziva
nesretne sjećanja na dosadu
nesretne sjećanja na dosadu
00:18
in high school biology or physics class.
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na satovima biologije ili
fizike u srednjoj školi.
fizike u srednjoj školi.
00:21
But let me assure that what you did there
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Ali uvjeravam vas da ono
što ste radili tamo
što ste radili tamo
00:24
had very little to do with science.
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nije imalo previše veze sa znanošću.
00:26
That was really the "what" of science.
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To je zapravo bilo "što” od znanosti.
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 povijest onoga što
su drugi ljudi otkrili.
su drugi ljudi otkrili.
00:32
What I'm most interested in as a scientist
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Ono što me najviše zanima kao znanstvenika
00:35
is the "how" of science.
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je “kako” u znanosti.
00:37
Because science is knowledge in process.
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Zato što je znanost znanje u procesu.
00:41
We make an observation,
guess an explanation for that observation,
guess an explanation for that observation,
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Opazimo nešto, predložimo
objašnjenje za to opažanje
objašnjenje za to opažanje
00:44
and then make a prediction
that we can test
that we can test
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i napravimo predviđanje
koje možemo testirati
koje možemo testirati
00:46
with an experiment or other observation.
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pokusom ili drugim opažanjem.
00:49
A couple of examples.
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Nekoliko primjera.
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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Prvo, ljudi su primjetili da je
Zemlja ispod, nebo iznad
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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i da se čini da se Sunce i
Mjesec kreću oko njih.
Mjesec kreću oko njih.
00:58
Their guessed explanation
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Njihovo predloženo objašnjenje
01:00
was that the Earth must be
the center of the universe.
the center of the universe.
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je bilo da Zemlja mora
biti središte svemira.
biti središte svemira.
01:04
The prediction: everything
should circle around the Earth.
should circle around the Earth.
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Predviđanje: sve bi trebalo
kružiti oko Zemlje.
kružiti oko Zemlje.
01:08
This was first really tested
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Ovo je prvotno stvarno ispitano
01:09
when Galileo got his hands
on one of the first telescopes,
on one of the first telescopes,
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kada se Galileo dokopao
jednog od prvih teleskopa,
jednog od prvih teleskopa,
01:12
and as he gazed into the night sky,
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i gledajući noćno nebo
01:15
what he found there was a planet, Jupiter,
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na njemu našao planet, Jupiter,
01:18
with four moons circling around it.
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s četiri mjeseca koja su
kružila oko njega.
kružila oko njega.
01:23
He then used those moons
to follow the path of Jupiter
to follow the path of Jupiter
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Zatim je iskoristio te mjesece
kako bi pratio putanju Jupitera
kako bi pratio putanju Jupitera
01:28
and found that Jupiter
also was not going around the Earth
also was not going around the Earth
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te je otkrio da Jupiter također
ne kruži oko Zemlje
ne kruži oko Zemlje
01:31
but around the Sun.
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već i oko Sunca.
01:35
So the prediction test failed.
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Tako je ispitivanje predviđanja
bilo neuspješno.
bilo neuspješno.
01:38
And this led to
the discarding of the theory
the discarding of the theory
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To je dovelo do napuštanja teorije
01:40
that the Earth was the center
of the universe.
of the universe.
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da je Zemlja središte svemira.
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 primjer: Sir Isaac Newton je
primjetio da stvari padaju na Zemlju.
primjetio da stvari padaju na Zemlju.
01:46
The guessed explanation was gravity,
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Predloženo objašnjenje
je bilo gravitacija,
je bilo gravitacija,
01:50
the prediction that everything
should fall to the Earth.
should fall to the Earth.
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a predviđanje da bi sve
trebalo pasti na Zemlju.
trebalo pasti na Zemlju.
01:53
But of course, not everything
does fall to the Earth.
does fall to the Earth.
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Naravno, ne padaju sve stvari na Zemlju.
01:58
So did we discard gravity?
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Jesmo li napustili 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. Izmijenili smo teoriju i rekli,
gravitacija vuče stvari prema Zemlji
gravitacija vuče stvari prema 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 i
suprotna sila u drugom smjeru.
suprotna sila u drugom smjeru.
02:10
This led us to learn something new.
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To nas je dovelo do novih saznanja.
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 pridavati više pažnje
ptici i ptičjim krilima,
ptici i ptičjim krilima,
02:16
and just think of all the discoveries
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i samo pomislite koja su sva otkrića
02:18
that have flown
from that line of thinking.
from that line of thinking.
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izletjela iz tog smjera razmišljanja.
02:21
So the test failures,
the exceptions, the outliers
the exceptions, the outliers
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Tako neuspješna ispitivanja,
iznimke, velike devijacije
iznimke, velike devijacije
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 što ne znamo i
vode nas nečem novom.
vode nas nečem novom.
02:32
This is how science moves forward.
This is how science learns.
This is how science learns.
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To je način na koji znanost napreduje.
Način na koji znanost uči.
Način na koji znanost uči.
02:35
Sometimes in the media,
and even more rarely,
and even more rarely,
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Ponekad u medijima i čak još rijeđe
02:38
but sometimes even scientists will say
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ali ponekad će čak i znanstvenici reći
02:40
that something or other
has been scientifically proven.
has been scientifically proven.
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da je nešto znanstveno dokazano.
02:43
But I hope that you understand
that science never proves anything
that science never proves anything
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Ali nadam se da razumijete da
znanost nikad ništa ne dokazuje
znanost nikad ništa ne dokazuje
02:48
definitively forever.
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definitivno zauvijek.
02:51
Hopefully science remains curious enough
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Nadajmo se da će znanost
ostati dovoljno znatiželjna
ostati dovoljno znatiželjna
02:55
to look for
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da traži
02:56
and humble enough to recognize
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i dovoljno ponizna da prepozna
02:58
when we have found
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kada smo našli
03:00
the next outlier,
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sljedeću devijaciju
03:02
the next exception,
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sljedeću iznimku,
03:03
which, like Jupiter's moons,
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koja, kao Jupiterovi mjeseci,
03:05
teaches us what we don't actually know.
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nas uči što zapravo ne znamo.
03:09
We're going to change gears
here for a second.
here for a second.
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Sada ćemo ovdje na
trenutak promjeniti brzinu.
trenutak promjeniti brzinu.
03:11
The caduceus, or the symbol of medicine,
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Kaudacej, simbol medicine,
03:13
means a lot of different things
to different people,
to different people,
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znači mnogo različitih
stvari različitim ljudima,
stvari različitim ljudima,
03:16
but most of our
public discourse on medicine
public discourse on medicine
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ali većina naše javne
rasprave o medicini
rasprave o medicini
03:18
really turns it into
an engineering problem.
an engineering problem.
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ju zapravo pretvara u inžinjerski problem.
03:21
We have the hallways of Congress,
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Imamo hodnike 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 odbore osiguravajućih kuća koji
pokušavaju odgonetnuti kako ju platiti.
pokušavaju odgonetnuti kako ju platiti.
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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pokušavaju odgonetnuti kako
najbolje rasporediti medicinu,
najbolje rasporediti medicinu,
03:32
and the hospitals and physicians
are absolutely obsessed
are absolutely obsessed
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a bolnice i doktori su poptpuno opsjednuti
03:34
with their protocols and checklists,
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sa svojim protokolima i popisima,
03:36
trying to figure out
how best to safely apply medicine.
how best to safely apply medicine.
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pokušavajući shvatiti kako najbolje
sigurno primjenjivati medicinu.
sigurno primjenjivati medicinu.
03:40
These are all good things.
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Ovo su sve dobre stvari.
03:42
However, they also all assume
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Međutim, također pretpostavljaju
03:45
at some level
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na nekoj razini
03:47
that the textbook of medicine is closed.
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da je udžbenik medicine završen.
03:51
We start to measure
the quality of our health care
the quality of our health care
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Počinjemo mjeriti kvalitetu
našeg zdravstva
našeg zdravstva
03:53
by how quickly we can access it.
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brzinom kojom mu možemo pristupiti.
03:56
It doesn't surprise me
that in this climate,
that in this climate,
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Ne iznenađuje me da u ovoj klimi
03:58
many of our institutions
for the provision of health care
for the provision of health care
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mnoge naše institucije za
pružanje zdravstvene njege
pružanje zdravstvene njege
04:01
start to look a heck of a lot
like Jiffy Lube.
like Jiffy Lube.
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počinju jako izgledati kao Jiffy Lube.
04:03
(Laughter)
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(Smijeh)
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 kad sam
završio medicinski fakultet
završio medicinski fakultet
04:10
I didn't get one of those
little doohickeys
little doohickeys
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nisam dobio jednu od onih malih zvrčki
04:12
that your mechanic
has to plug into your car
has to plug into your car
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koju mehaničar mora uključiti u vaš auto
04:14
and find out exactly what's wrong with it,
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kako bi saznao što točno
nije u redu s njim,
nije u redu s njim,
04:17
because the textbook of medicine
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zato što udžbenik medicine
04:19
is not closed.
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nije završen.
04:21
Medicine is science.
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Medicina je znanost.
04:23
Medicine is knowledge in process.
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Medicina je znanje u procesu.
04:27
We make an observation,
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Opazimo nešto,
04:28
we guess an explanation
of that observation,
of that observation,
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predložimo objašnjenje za to opažanje,
04:30
and then we make a prediction
that we can test.
that we can test.
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i potom napravimo predviđanje
koje možemo ispitivati.
koje možemo ispitivati.
04:33
Now, the testing ground
of most predictions in medicine
of most predictions in medicine
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Poligon ispitivanja većine
predviđanja u medicini
predviđanja u medicini
04:37
is populations.
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su populacije.
04:38
And you may remember
from those boring days in biology class
from those boring days in biology class
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I možda se sjećate sa onih
dosadnih sati biologije
dosadnih sati biologije
04:42
that populations tend to distribute
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da populacije imaju
tendenciju distribucije
tendenciju distribucije
04:44
around a mean
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oko srednje vrijednosti
04:45
as a Gaussian or a normal curve.
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kao Gausova ili
krivulja normalne distribucije.
krivulja normalne distribucije.
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 napravimo predviđanje
iz predloženog objašnjenja,
iz predloženog objašnjenja,
04:52
we test it in a population.
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testiramo ga u 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 načine kako,
05:00
comes from populations
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dolazi iz populacija
05:02
but extends only as far
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ali doseže samo toliko daleko
05:05
as the next outlier,
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kolika je sljedeća devijacija,
05:07
the next exception,
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sljedeća iznimka,
05:08
which, like Jupiter's moons,
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koja, kao i Jupiterovi mjeseci,
05:10
will teach us what we don't actually know.
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će nas naučiti što zapravo ne znamo.
05:14
Now, I am a surgeon
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Ja sam kirurg
05:15
who looks after patients with sarcoma.
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koji se brine za pacijente sa sarkomom.
05:17
Sarcoma is a very rare form of cancer.
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Sarkom je vrlo rijedak 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 rekao bih vam da je svaki
od mojih pacijenata devijacija,
od mojih pacijenata devijacija,
05:27
is an exception.
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da je iznimka.
05:30
There is no surgery I have ever performed
for a sarcoma patient
for a sarcoma patient
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Nijedna operacija koju sam
izveo na pacijentu sa sarkomom
izveo na pacijentu sa sarkomom
05:33
that has ever been guided
by a randomized controlled clinical trial,
by a randomized controlled clinical trial,
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nije bila vođena randomiziranim
kontroliranim ispitivanjem
kontroliranim ispitivanjem
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
temeljenog na populaciji u medicini.
temeljenog na populaciji u medicini.
05:42
People talk about thinking
outside the box,
outside the box,
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Ljudi pričaju o razmišljanju izvan okvira,
05:44
but we don't even have a box in sarcoma.
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ali kod sarkoma nemamo ni okvir.
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 se
kupamo u neizvjesnosti,
kupamo u neizvjesnosti,
05:50
and unknowns and exceptions
and outliers that surround us in sarcoma
and outliers that surround us in sarcoma
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i nepoznanicama, i iznimkama, i
devijacijama koje nas okružuju u sarkomu
devijacijama koje nas okružuju u sarkomu
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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jest lagan pristup stvarima za koje
mislim da su dvije najvažnije vrijednosti
mislim da su dvije najvažnije vrijednosti
05:59
for any science:
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za bilo koju znanost:
06:01
humility and curiosity.
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poniznost i znatiželja.
06:04
Because if I am humble and curious,
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Zato što ako sam ponizan i znatiželjan,
06:06
when a patient asks me a question,
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kada me pacijent nešto pita,
06:08
and I don't know the answer,
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a ja ne znam odgovor,
06:10
I'll ask a colleague
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pitat ću kolegu
06:12
who may have a similar
albeit distinct patient with sarcoma.
albeit distinct patient with sarcoma.
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koji možda ima sličnog, iako
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 međunarodne suradnje.
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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Pacijenti će početi razgovarati
kroz sobe za čavrljavenje
kroz sobe za čavrljavenje
06:21
and support groups.
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i grupe potpore.
06:22
It's through this kind
of humbly curious communication
of humbly curious communication
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Kroz ovakvu vrstu ponizno
znatiželjne komunikacije
znatiželjne komunikacije
06:26
that we begin to try and learn new things.
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počinjemo i pokušavama učiti nove stvari.
06:31
As an example, this is a patient of mine
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Primjerice, ovo je moj pacijent
06:33
who had a cancer near his knee.
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koji je imao rak blizu koljena.
06:35
Because of humbly curious communication
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Zbog ponizno znatiželjne komunikacije
06:37
in international collaborations,
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i međunarodnih suradnji,
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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naučili smo da možemo prenamjeniti
gležanj da služi kao koljeno
gležanj da služi kao koljeno
06:44
when we have to remove the knee
with the cancer.
with the cancer.
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kada smo primorani
odstraniti koljeno s rakom.
odstraniti koljeno s rakom.
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 tada 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 prilika je za njega bila dragocjena
06:53
because of international collaborations.
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zbog međunarodnih suradnji.
06:56
It was desirable to him
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Bila mu je poželjna
06:57
because he had contacted other patients
who had experienced it.
who had experienced it.
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jer je kontaktirao druge
pacijente koji su to iskusili.
pacijente koji su to iskusili.
07:01
And so exceptions and outliers in medicine
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Tako iznimke i devijacije 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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nas uče ono što ne znamo, ali
također dovode i do novog razmišljanja.
također dovode i do novog razmišljanja.
07:11
Now, very importantly,
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Sad, vrlo 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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svo novo razmišljanje kojem nas
devijacije i iznimke vode u medicini
devijacije i iznimke vode u medicini
07:16
does not only apply
to the outliers and exceptions.
to the outliers and exceptions.
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nije primjenjivo samo na
devijacije i iznimke.
devijacije i iznimke.
07:20
It is not that we only learn
from sarcoma patients
from sarcoma patients
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Nije da od pacijenata sa
sarkomom učimo samo
sarkomom učimo samo
07:24
ways to manage sarcoma patients.
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kako se brinuti o
pacijentima sa sarkomom.
pacijentima sa sarkomom.
07:26
Sometimes, the outliers
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Ponekad, devijacije
07:29
and the exceptions
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i iznimke
07:30
teach us things that matter quite a lot
to the general population.
to the general population.
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nas nauče stvari koje su vrlo
bitne u općoj populaciji.
bitne u općoj populaciji.
07:35
Like a tree standing outside a forest,
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Kao stablo koje stoji izvan šume,
07:37
the outliers and the exceptions
draw our attention
draw our attention
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devijacije i iznimke privlače
našu pozornost
našu pozornost
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 u veće razumjevanje
onoga što je možda stablo.
onoga što je možda 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 neprimjećivanje
šume među stablima,
šume među stablima,
07:48
but one also loses a tree
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ali također možemo izgubiti stablo
07:50
within a forest.
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unutar šume.
07:53
But the tree that stands out by itself
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Ali stablo koje stoji samo
07:54
makes those relationships
that define a tree,
that define a tree,
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čini odnose koji definiraju stablo,
07:57
the relationships between trunk
and roots and branches,
and roots and branches,
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odnose između debla
i korjenja i grana
i korjenja i grana
08:01
much more apparent.
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mnogo vidljivijima.
08:03
Even if that tree is crooked
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Čak i ako je stablo nakrivljeno
08:05
or even if that tree
has very unusual relationships
has very unusual relationships
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ili čak ako stablo ima
vrlo neobične odnose
vrlo neobične odnose
08:08
between trunk and roots and branches,
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između debla i korjenja i grana
08:10
it nonetheless draws our attention
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svejedno privlači našu pozornost
08:13
and allows us to make observations
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i dopušta nam da napravimo promatranja
08:15
that we can then test
in the general population.
in the general population.
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koja možemo potom testirati
u općoj populaciji.
u općoj populaciji.
08:18
I told you that sarcomas are rare.
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Rekao sam vam da su sarkomi rijetki.
08:20
They make up about one percent
of all cancers.
of all cancers.
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Oni čine samo oko jedan posto svih rakova.
08:23
You also probably know that cancer
is considered a genetic disease.
is considered a genetic disease.
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Također vjerojatno znate da se
rak smatra genetičkom bolešću.
rak smatra genetičkom bolešću.
08:27
By genetic disease we mean
that cancer is caused by oncogenes
that cancer is caused by oncogenes
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Genetičkom bolešću mislimo da je
rak uzrokovan onkogenima
rak uzrokovan onkogenima
08:31
that are turned on in cancer
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koji se uključeni u raku
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 supresorskim genima koji su
isključeni u nastanku raka.
isključeni u nastanku raka.
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
08:38
and tumor suppressor genes
from common cancers
from common cancers
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2216
i tumor supresorskim genima
iz čestih rakova
iz čestih rakova
08:40
like breast cancer and prostate cancer
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1976
kao što su rak dojke i rak prostate
08:42
and lung cancer,
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i rak pluća,
08:44
but you'd be wrong.
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ali bili bi ste u krivu.
08:46
We learned about oncogenes
and tumor suppressor genes
and tumor suppressor genes
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Naučili smo o onkogenima i
tumor supresorskim genima
tumor supresorskim genima
08:48
for the first time
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516919
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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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u tom malenom jednom
postotku rakova zvanih sarkomi.
postotku rakova zvanih sarkomi.
08:54
In 1966, Peyton Rous got the Nobel Prize
184
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1966. Peyton Rous je dobio
Nobelovu nagradu
Nobelovu nagradu
08:57
for realizing that chickens
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2016
za otkriće da kod kokoši
08:59
had a transmissible form of sarcoma.
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postoji zarazni oblik sarkoma.
09:03
Thirty years later, Harold Varmus
and Mike Bishop discovered
and Mike Bishop discovered
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Trideset godina poslije Harold Varmus
i Mike Bishop su otkrili
i Mike Bishop su otkrili
09:06
what that transmissible element was.
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2536
koji je to zarazni element.
09:08
It was a virus
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To je bio virus
09:10
carrying a gene,
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1416
Koji nosi 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
09:18
that src is the most frequently
turned on oncogene in all of cancer.
turned on oncogene in all of cancer.
194
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da je src najčešće uključeni
onkogen u svim rakovima.
onkogen u svim rakovima.
09:22
But it was the first oncogene.
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Ali to je bio prvi onkogen.
09:25
The exception, the outlier
196
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2336
Iznimka, devijacija
09:28
drew our attention and led us to something
197
556320
2520
privukao je našu pozornost i
doveo nas do nečega
doveo nas do nečega
09:31
that taught us very important things
about the rest of biology.
about the rest of biology.
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559520
4040
što nas je naučilo vrlo važne
stvari o ostatku biologije.
stvari o ostatku biologije.
09:36
Now, TP53 is the most important
tumor suppressor gene.
tumor suppressor gene.
199
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TP53 je najvažni tumor supresorski gen
09:41
It is the most frequently turned off
tumor suppressor gene
tumor suppressor gene
200
569000
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I najčešće je isključen
tumor supresorski gen
tumor supresorski gen
09:43
in almost every kind of cancer.
201
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u gotovo svakoj vrsti raka.
09:46
But we didn't learn about it
from common cancers.
from common cancers.
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Ali nismo naučili o njemu
iz učestalih rakova.
iz učestalih rakova.
09:48
We learned about it
when doctors Li and Fraumeni
when doctors Li and Fraumeni
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Naučili smo o njemu kada su
doktori Li i Fraumeni
doktori Li i Fraumeni
09:51
were looking at families,
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proučavali obitelji,
09:52
and they realized that these families
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2016
i shvatili da te obitelji
09:54
had way too many sarcomas.
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imaju previše sarkoma.
09:57
I told you that sarcoma is rare.
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Rekao sam vam da je sarkom rijedak.
09:59
Remember that a one
in a million diagnosis,
in a million diagnosis,
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Zapamtite da jedna na milijun dijagnoza
10:02
if it happens twice in one family,
209
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ako se dogodi dvaput u obitelji,
10:05
is way too common in that family.
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previše je učestala u toj obitelji.
10:08
The very fact that these are rare
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Sama činjenica da su oni rijetki
10:11
draws our attention
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privlači našu pozornost
10:13
and leads us to new kinds of thinking.
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2240
dovodi nas do novih načina razmišljanja.
10:17
Now, many of you may say,
214
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Mnogi od vas će možda reći
10:18
and may rightly say,
215
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1536
i mnogi ispravno kažu,
10:20
that yeah, Kevin, that's great,
216
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1896
da, Kevine, to je super
10:22
but you're not talking
about a bird's wing.
about a bird's wing.
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2056
ali ti ne pričaš o ptičjim krilima.
10:24
You're not talking about moons
floating around some planet Jupiter.
floating around some planet Jupiter.
218
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3480
Ti ne pričaš o mjesecima koji plutaju
oko nekog planeta Jupitera.
oko nekog planeta Jupitera.
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,
220
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Ova devijacija, ova iznimka,
može dovesti do napretka znanosti,
može dovesti do napretka znanosti,
10:33
but this is a person.
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ali to 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 to i predobro znam.
10:41
I have conversations with these patients
with rare and deadly diseases.
with rare and deadly diseases.
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Razgovaram s tim pacijentima koji imaju
rijetke i smrtonosne bolesti.
rijetke i smrtonosne bolesti.
10:45
I write about these conversations.
225
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1936
Pišem o tim razgovorima.
10:47
These conversations are terribly fraught.
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Ti su razgovori užasno opterećeni.
10:50
They're fraught with horrible phrases
227
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1816
Opterećeni su sa strašnim izrazima
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 vijesti” ili
“Tu više ništa ne možemo napraviti”
“Tu više ništa ne možemo napraviti”
10:55
Sometimes these conversations
turn on a single word:
turn on a single word:
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3200
Nekada se ovi razgovori svode
na jednu jedinu riječ:
na jednu jedinu riječ:
10:59
"terminal."
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1200
“Terminalni.”
11:04
Silence can also be rather uncomfortable.
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2920
Tišina također može biti vrlo neugodna.
11:09
Where the blanks are in medicine
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Gdje praznine u medicini
11:11
can be just as important
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1856
mogu biti jednako važne
11:13
as the words that we use
in these conversations.
in these conversations.
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kao i rječi koje koristimo
u ovim razgovorima.
u ovim razgovorima.
11:17
What are the unknowns?
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1536
Što su nepoznanice?
11:18
What are the experiments
that are being done?
that are being done?
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2200
Što su pokusi koji se izvode.
11:21
Do this little exercise with me.
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Napravite sa mnom ovu malu vježbu.
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
“no where” (nema gdje)
“no where” (nema gdje)
11:26
Notice where the blank is.
239
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Primjetite gdje je praznina.
11:28
If we move that blank one space over
240
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3200
Ako pomaknete tu prazninu
za samo jedno mjesto
za samo jedno mjesto
11:32
"no where"
241
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1576
“no where” (nema gdje)
11:34
becomes "now here,"
242
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postaje “now here”, (sada ovdje)
11:36
the exact opposite meaning,
243
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1896
potpuno suprotno značenje,
11:38
just by shifting the blank one space over.
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samo pomicanjem praznine za jedno mjesto.
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.
246
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2240
kada sam ušetao u sobu
jednog svojeg pacijenta.
jednog svojeg pacijenta.
11:48
I had been operating long that day
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Taj dan sam bio dugo operirao
11:49
but I still wanted to come and see him.
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697960
2016
ali sam svejedno htio doći i vidjeti ga.
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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On je bio dječak s dijagnosticiranim
rakom kosti nekoliko dana prije.
rakom kosti nekoliko dana prije.
11:55
He and his mother had been meeting
with the chemotherapy doctors
with the chemotherapy doctors
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703840
3056
Njegova majka se bila sastajala s
doktorima za kemoterapiju
doktorima za kemoterapiju
11:58
earlier that day,
251
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1216
ranije toga dana,
12:00
and he had been admitted
to the hospital to begin chemotherapy.
to the hospital to begin chemotherapy.
252
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2976
i on je bio primljen u bolnicu kako
bi se započela kemoterapija.
bi se započela kemoterapija.
12:03
It was almost midnight
when I got to his room.
when I got to his room.
253
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2176
Bila je skoro ponoć kada
sam došao u sobu.
sam došao u sobu.
12:05
He was asleep, but I found his mother
254
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2176
Spavao je, ali sam našao njegovu majku
12:07
reading by flashlight
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kako čita uz lampu
12:09
next to his bed.
256
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1456
kraj 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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2800
Izašla je u hodnik kako bi
nakratko popričala sa mnom.
nakratko popričala sa mnom.
12:14
It turned out that
what she had been reading
what she had been reading
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Ispostavilo se da ono što je čitala
12:16
was the protocol
that the chemotherapy doctors
that the chemotherapy doctors
259
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2176
bio protokol koji su
doktori za kemoterapiju
doktori za kemoterapiju
12:18
had given her that day.
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1240
dali tog dana.
12:20
She had memorized it.
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1240
Zapamtila ga je.
12:23
She said, "Dr. Jones, you told me
262
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3536
Rekla je “Dr. Jones, rekli ste mi
12:26
that we don't always win
263
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2176
da ne pobijedimo uvijek
12:28
with this type of cancer,
264
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1280
s ovim tipom raka,
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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3480
ali proučavala sam ovaj protokol i
mislim da možemo uspjeti.
mislim da možemo uspjeti.
12:35
I think I can comply
with these very difficult treatments.
with these very difficult treatments.
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Mislim da mogu pristati
na ove teške tretmane.
na ove teške tretmane.
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.
267
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Dat ću otkaz, uselit ću
se svojim roditeljima
se svojim roditeljima
12:42
I'm going to keep my baby safe."
268
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1960
I brinut ću se da moje
dijete bude sigurno.”
dijete bude sigurno.”
12:47
I didn't tell her.
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Nisam joj rekao.
12:49
I didn't stop to correct her thinking.
270
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2920
Nisam ju ispravio u njenom razmišljanju.
12:53
She was trusting in a protocol
271
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Vjerovala je protokolu
12:55
that even if complied with,
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3216
koji i kada ga se drži,
12:59
wouldn't necessarily save her son.
273
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2400
Ne mora nužno spasiti njezinog 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 ispunio tu prazninu.
13:09
But a year and a half later
276
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1976
Ali godinu i pol poslije
13:11
her boy nonetheless died of his cancer.
277
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2720
njezin dječak je ipak umro od raka.
13:15
Should I have told her?
278
783400
1320
Jesam li joj trebao reći?
13:17
Now, many of you may say, "So what?
279
785360
2256
Mnogi će od vas možda reći, “Pa što?
13:19
I don't have sarcoma.
280
787640
1256
Nemam sarkom.
13:20
No one in my family has sarcoma.
281
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1896
Nitko u mojoj obitelji nema sarkom.
13:22
And this is all fine and well,
282
790840
1456
I ovo je sve u redu i dobro,
13:24
but it probably doesn't
matter in my life."
matter in my life."
283
792320
2696
ali vjerojatno nije previše
važno za moj život.”
važno za moj život.”
13:27
And you're probably right.
284
795040
1256
I vjerojatno bi bili u pravu.
13:28
Sarcoma may not matter
a whole lot in your life.
a whole lot in your life.
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Sarkom možda nije previše
važan u vašem životu.
važan u vašem životu.
13:33
But where the blanks are in medicine
286
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2336
Ali gdje se nalaze praznine u medicini
13:35
does matter in your life.
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803400
1320
jest važno za vaš život.
13:38
I didn't tell you one dirty little secret.
288
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Nisam vam rekao jednu malu prljavu tajnu.
13:40
I told you that in medicine,
we test predictions in populations,
we test predictions in populations,
289
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4376
Rekao sam vam da u medicini ispitujemo
predviđanja u populacijama,
predviđanja u populacijama,
13:45
but I didn't tell you,
290
813240
1256
ali nisam vam rekao,
13:46
and so often medicine never tells you
291
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2216
i često vam medicina nikad ne kaže
13:48
that every time an individual
292
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da svaki puta kada se pojedinac
13:51
encounters medicine,
293
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susretne s 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 čvrsto
ugrađen u opću populaciju,
ugrađen u opću populaciju,
13:59
neither the individual
nor the physician knows
nor the physician knows
295
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2376
ni taj pojedinac ni liječnik ne znaju
14:01
where in that population
the individual will land.
the individual will land.
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koje će mjesto u populaciji
taj pojedinac zauzeti.
taj pojedinac zauzeti.
14:05
Therefore, every encounter with medicine
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Stoga, svaki susret sa medicinom
14:07
is an experiment.
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je eksperiment.
14:09
You will be a subject
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Vi ćete biti predmet
14:11
in an experiment.
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eksperimenta.
14:14
And the outcome will be either
a better or a worse result for you.
a better or a worse result for you.
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A ishod će biti ili bolji
ili lošiji rezultat za vas.
ili lošiji rezultat za vas.
14:20
As long as medicine works well,
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Dok god medicina dobro radi,
14:22
we're fine with fast service,
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u redu nam je brza usluga,
14:25
bravado, brimmingly
confident conversations.
confident conversations.
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razmetanje hrabrošću,
razgovori puni samopouzdanja.
razgovori puni samopouzdanja.
14:29
But when things don't work well,
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Ali kad stvari ne rade dobro,
14:31
sometimes we want something different.
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ponekad želimo nešto drugačije.
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 je odstranio
tumor s pacijentovog uda.
tumor s pacijentovog uda.
14:38
He was concerned about this tumor.
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Bio je zabrinut oko tog tumora.
14:40
In our physician conferences,
he talked about his concern
he talked about his concern
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Na našim liječničkim konferencijama
pričao je o svojoj brizi
pričao je o svojoj brizi
14:43
that this was a type of tumor
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da je to bio tip 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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s velikim rizikom ponovnog
pojavljivanja na istom udu.
pojavljivanja na istom udu.
14:48
But his conversations with the patient
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Ali njegovi razgovori s pacijenticom
14:50
were exactly what a patient might want:
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su upravo ono što bi
pacijentica možda željela:
pacijentica možda željela:
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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Rekao je, “Odstranio sam
sve i možete ići.”
sve i možete ići.”
14:57
She and her husband were thrilled.
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Ona i njen muž 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 van, proslavli, otmjena večera,
otvorili bocu šampanjca.
otvorili bocu šampanjca.
15:04
The only problem was a few weeks later,
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Jedini problem je bio
nekoliko tjedana poslije,
nekoliko tjedana poslije,
15:06
she started to notice
another nodule in the same area.
another nodule in the same area.
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počela je primjećivati drugi
čvor na istom području.
čvor na istom području.
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 da nije bila zdrava.
i da nije bila zdrava.
15:13
But what happened at this juncture
absolutely fascinates me.
absolutely fascinates me.
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Ono što se dogodilo u tom trenutku
me apsolutno fascinira.
me apsolutno fascinira.
15:17
My colleague came to me and said,
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Kolega mi je došao i rekao,
15:18
"Kevin, would you mind
looking after this patient for me?"
looking after this patient for me?"
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“Kevine, možeš li se pobrinuti
za pacijenticu umjesto mene?”
za pacijenticu umjesto mene?”
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, “Zašto, znaš što trebaš
učiniti jednako kao i ja.
učiniti jednako kao i ja.
15:25
You haven't done anything wrong."
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Nisi ništa krivo napravio.”
15:27
He said, "Please, just look
after this patient for me."
after this patient for me."
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Rekao je, “Molim te, pobrini se za ovu
pacijenticu umjesto mene.”
pacijenticu umjesto mene.”
15:33
He was embarrassed --
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Bilo ga je sram –
15:34
not by what he had done,
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ne zbog onog što je učinio,
15:37
but by the conversation that he had had,
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već zbog razgovora kojeg je imao,
15:39
by the overconfidence.
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zbog prevelikog samopouzdanja.
15:42
So I performed
a much more invasive surgery
a much more invasive surgery
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Tako sam izveo mnogo invazivniju operaciju
15:45
and had a very different conversation
with the patient afterwards.
with the patient afterwards.
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i imao bitno drugačiji razgovor s
pacijenticom nakon toga.
pacijenticom nakon toga.
15:48
I said, "Most likely I've gotten it all
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Rekao sam “Najvjerojatnije
sam odstranio sve
sam odstranio sve
15:50
and you're most likely good to go,
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i najvjerojatnije možete bez problema ići,
15:53
but this is the experiment
that we're doing.
that we're doing.
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ali ovo što radimo je ekperiment.
15:57
This is what you're going to watch for.
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To je ono na što ćete paziti.
15:59
This is what I'm going to watch for.
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To je ono na što ću ja paziti.
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 surađivat ćemo kako bismo saznali
hoće li ova operacija uspjeti
hoće li ova operacija uspjeti
16:04
to get rid of your cancer."
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u uklanjanju vašeg raka.”
16:06
I can guarantee you, she and her husband
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Mogu vam jamčiti da ona i njezin muž
16:08
did not crack another bottle of champagne
after talking to me.
after talking to me.
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nisu otvorili bocu šampanjca nakon
razgovora sa mnom.
razgovora sa mnom.
16:13
But she was now a scientist,
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Ali ona je sad znanstvenik,
16:16
not only a subject in her experiment.
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a ne samo predmet eksperimenta.
16:21
And so I encourage you
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I tako vas ohrabrujem
16:23
to seek humility and curiosity
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da tražite skromnost i znatiželju
16:27
in your physicians.
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u svojim liječnicima.
16:28
Almost 20 billion times each year,
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Gotovo 20 milijardi puta svake godine,
16:31
a person walks into a doctor's office,
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osoba ušeta u liječnikovu ambulantu,
16:35
and that person becomes a patient.
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i ta osoba postaje 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 netko koga volite će vrlo
uskoro biti taj pacijent.
uskoro biti taj pacijent.
16:43
How will you talk to your doctors?
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Kako ćete razgovorati
s liječnicima?
s liječnicima?
16:46
What will you tell them?
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Što ćete im reći?
16:48
What will they tell you?
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Što će oni vama reći?
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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što ne znaju
16:57
but they can tell you when they don't know
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ali mogu vam reći kada ne znaju
17:02
if only you'll ask.
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samo ako biste pitali.
17:04
So please, join the conversation.
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Zato vas molim, pridružite se razgovoru.
17:08
Thank you.
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Hvala vam.
17:09
(Applause)
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(Pljesak)
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