TEDMED 2012
Ivan Oransky: Are we over-medicalized?
Ivan Oransky: Suntem prea medicalizaţi?
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Jurnalistul pe probleme de sănătate al agenţiei Reuters, Ivan Oransky , ne avertizează că suferim de o epidemie de prea-absurde pre-stări: pre-diabet, pre-cancer şi multe altele. În acest discurs de la TEDMED, ne arată cum sănătatea poate găsi soluţii... inspirându-se din baseball.
Ivan Oransky - Health reporter
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions. Full bio
Ivan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions. Full bio
Double-click the English transcript below to play the video.
00:16
Those of you who have seen the film "Moneyball,"
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Cei care aţi văzut filmul "Moneyball",
00:20
or have read the book by Michael Lewis,
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sau aţi citit cartea lui Michael Lewis,
00:22
will be familiar with the story of Billy Beane.
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ştiţi povestea lui Billy Beane.
00:25
Billy was supposed to be a tremendous ballplayer; all the scouts told him so.
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Instructorii i-au spus că urma să devină un jucător fantastic.
00:29
They told his parents that
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Le-au spus părinţilor lui
00:31
they predicted that he was going to be a star.
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că prevedeau că va deveni un star.
00:33
But what actually happened when he signed the contract -- and by the way, he didn't
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Dar ce s-a întâmplat de fapt când a semnat contractul, pe care de fapt
00:38
want to sign that contract, he wanted to go to
college --
college --
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nu vroia să-l semneze, el dorea să meargă la universitate -
00:40
which is what my mother, who actually does
love me,
love me,
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ceea ce şi mama mea, care chiar mă iubeşte,
00:43
said that I should do too, and I did --
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mi-a spus că ar trebui să fac, şi am făcut.
00:46
well, he didn't do very well. He struggled
mightily.
mightily.
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Ei bine, n-a strălucit. S-a străduit din răsputeri.
00:49
He got traded a couple of times, he ended up in the Minors for most of his career,
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A prins contracte, dar mare parte a carierei a jucat în Liga Mică
00:53
and he actually ended up in management. He ended up as a General Manager of the
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şi a ajuns în management, manager general
00:57
Oakland A's.
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al echipei Oakland A.
00:58
Now for many of you in this room, ending up in management, which is also what I've done,
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Mulţi credeţi că a ajunge în management, ca şi mine,
01:02
is seen as a success.
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e un succes.
01:04
I can assure you that for a kid trying to make it in the Bigs,
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Pentru un tânăr care încearcă să intre în Liga Mare,
01:07
going into management ain't no success story. It's a failure.
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să ajungă în management nu e o poveste de succes. E un eşec.
01:12
And what I want to talk to you about today, and share with you, is that our
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Azi vreau să vă arăt
01:16
healthcare system, our medical system, is
just as bad at predicting
just as bad at predicting
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că sistemul nostru medical e la fel de slab în a prevedea
01:21
what happens to people in it -- patients,
others --
others --
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ce se întâmplă cu oamenii din el - pacienţi, alţii -
01:25
as those scouts were at predicting what would happen to Billy Beane.
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ca şi prospectorii care au prezis ce va ajunge Billy Beane.
01:30
And yet, every day
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Cu toate astea, zilnic,
01:32
thousands of people in this country
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mii de oameni din ţara asta
01:34
are diagnosed with preconditions.
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sunt diagnosticaţi cu predispoziţii.
01:38
We hear about pre-hypertension, we hear about pre-dementia,
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Auzim de pre-hipertensiune, pre-demenţă,
01:42
we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with
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pre-anxietate şi sunt sigur că m-am diagnosticat singur de asta
01:48
that in the green room.
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în camera verde.
01:49
We also refer to subclinical conditions.
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Vorbim și de stări medicale subclinice.
01:53
There's subclinical atherosclerosis, subclinical hardening of the arteries,
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Există ateroscleroză subclinică, artere indurate subclinic,
01:58
obviously linked to heart attacks, potentially.
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evident legate de potenţiale infarcte cardiace.
02:02
One of my favorites is called
subclinical acne.
subclinical acne.
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Una din favoritele mele e acneea subclinică.
02:05
If you look up subclinical acne, you may find a website, which I did,
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Căutând acneea subclinică găseşti un site, eu l-am găsit,
02:09
which says that this is the easiest type of acne to treat.
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care spune că asta e forma de acnee cea mai ușor de tratat.
02:13
You don't have the pustules or the redness and inflammation.
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Nu ai pustule, roşeaţă sau inflamaţie.
02:20
Maybe that's because you don't actually
have acne.
have acne.
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Poate e aşa pentru că de fapt nu ai acnee.
02:23
I have a name for all of these conditions, it's another precondition:
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Am un nume pentru toate aceste predispoziţii:
02:30
I call them preposterous.
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la numesc "prea-absurde".
02:32
In baseball, the game follows the pre-game.
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În baseball, jocul e precedat de pre-joc.
02:38
Season follows the pre-season.
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Sezonul e precedat de pre-sezon.
02:40
But with a lot of these conditions, that actually isn't the case, or at least it isn't the
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Cu multe din aceste stări nu se întâmplă aşa, cel puţin nu mereu.
02:45
case all the time. It's as if there's a rain delay, every single time in many cases.
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E ca şi cum ploaia întârzie mai tot timpul.
02:49
We have pre-cancerous lesions,
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Avem leziuni pre-canceroase,
02:51
which often don't turn into cancer.
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care deseori nu se transformă în cancer.
02:55
And yet,
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Cu toate acestea,
02:56
if you take, for example, subclinical
osteoporosis, a bone thinning disease,
osteoporosis, a bone thinning disease,
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dacă iei osteoporoza subclinică, o boală care subţiază oasele,
03:00
the precondition,
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predispoziţia fiind numită
03:02
otherwise known as osteopenia,
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osteopenie,
03:04
you would have to treat 270
women for three years
women for three years
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ar trebui să tratezi 270 de femei timp de 3 ani
03:08
in order to prevent one broken bone.
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ca să previi un os fracturat.
03:10
That's an awful lot of women
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Sunt foarte multe femei
03:12
when you multiply by the number of women
who were diagnosed
who were diagnosed
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dacă înmulţeşti cu numărul femeilor diagnosticate
03:15
with this osteopenia.
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cu osteopenie.
03:17
And so is it any wonder,
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Vă mai miră,
03:19
given all of the costs and the side effects
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date fiind costurile şi efectele adverse ale medicamentelor
03:21
of the drugs that we're using to treat these preconditions, that every year
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cu care tratăm aceste predispoziţii,
03:25
we're spending more than two trillion dollars on healthcare and yet
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că anual risipim peste 3 trilioane dolari pe sănătate,
03:29
100,000 people a year -- and that's a conservative estimate -- are dying
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deşi cel puțin 100.000 de oameni mor anual,
03:32
not because of the conditions they have,
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nu din cauza predispoziţiilor pe care le au,
03:34
but because of the treatments that we're giving them and the complications of those treatments?
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ci din cauza tratamentelor şi a complicaţiilor acestora?
03:39
We've medicalized everything
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Am medicalizat totul
03:41
in this country.
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în ţara asta.
03:42
Women in the audience, I have
some
some
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Doamnelor din audienţă, am câteva veşti rele
03:46
pretty bad news that you already know,
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de care ştiţi deja,
03:48
and that's that every aspect of your
life
life
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anume că fiecare aspect al vieţii voastre
03:50
has been medicalized.
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a fost medicalizat.
03:52
Strike one is when you hit puberty.
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Prima treaptă e la pubertate.
03:54
You now have something that happens to you once a month that has been medicalized.
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Aveţi ceva ce vi se întâmplă lunar care a fost medicalizat.
03:59
It's a condition;
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E o stare medicală.
03:59
it has to be treated. Strike two
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Trebuie tratată. Faza a doua,
04:01
is if you get pregnant.
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dacă sunteți însărcinată,
04:03
That's been medicalized as
well.
well.
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și asta s-a medicalizat.
04:06
You have to have a high-tech experience
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Trebuie să faci teste supertehnologizate
04:08
of pregnancy, otherwise something might go wrong.
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pentru sarcină, altfel ceva poate să meargă prost.
04:10
Strike three is menopause.
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Treapta a treia e menopauza.
04:14
We all know what happened when millions of women were given hormone replacement therapy
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Toți știm ce s-a întâmplat când milioane de femei au făcut terapie hormonală
04:18
for menopausal symptoms
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pentru simptomele de menopauză, zeci de ani,
04:21
for decades until all of a sudden we realized, because a study came out, a big one,
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până când brusc ne-am dat seama, ca urmare a unui studiu subvenționat
04:26
NIH-funded.
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de Institutul Naţional de Sănătate,
04:27
It said,
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care spunea
04:28
actually, a lot of that hormone replacement therapy may be doing more harm than good
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că terapia hormonală de înlocuire face mai mult rău decât bine
04:32
for many of those women.
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pentru multe femei.
04:34
Just in case,
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Pentru orice eventualitate
04:36
I don't want to leave the men out --
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nu vreau să-i omit pe bărbaţi -
04:38
I am one, after all --
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sunt și eu unul, la urma urmei.
04:40
I have really bad news for all of you in
this room,
this room,
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Am veşti foarte proaste pentru toţi din sală,
04:42
and for everyone
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şi pentru toţi
04:43
listening and watching elsewhere:
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cei ce urmăresc din altă parte:
04:45
You all have
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Toţi aveţi
04:46
a universally fatal condition.
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o boală universal fatală.
04:49
So, just take a moment.
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Așteptați o clipă.
04:52
It's called pre-death.
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Se numeşte pre-deces.
04:54
Every single one of you has it, because
you have the risk factor for it,
you have the risk factor for it,
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Fiecare o aveţi, pentru că aveţi un factor de risc pentru ea,
04:59
which is being alive.
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şi anume: trăiți.
05:01
But I have some good news for you,
because
because
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Dar am şi veşti bune, pentru că sunt jurnalist,
05:04
I'm a journalist, I like to end things in a happy way or a forward-thinking way.
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şi îmi place să închei optimist sau cu idei avangardiste.
05:08
And that good news is that if you can survive to the end of my talk, which
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Vestea bună e că dacă supravieţuiți prelegerii mele,
05:12
we'll see if that happens for everyone,
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vom vedea dacă e valabil pentru toţi,
05:14
you will be a pre-vivor.
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veţi fi un pre-vieţuitor.
05:17
I made up pre-death.
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Am inventat pre-decesul.
05:22
If I used someone else's pre-death, I apologize,
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Dacă l-am luat de la altcineva, îmi cer scuze,
05:26
I think I made it up.
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cred totuşi că eu l-am inventat.
05:28
I didn't make up pre-vivor.
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Nu am inventat pre-vieţuitor.
05:30
Pre-vivor is what a particular cancer advocacy group would like everyone who
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Pre-vieţuitor e ceea ce grupul care sprijină cancerul ar dori
05:35
just has a risk factor,
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ca cei ce prezintă un factor de risc,
05:36
but hasn't actually had that cancer,
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dar încă nu au cancer,
05:39
to call themselves.
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să se auto-numească.
05:40
You are a pre-vivor.
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Eşti un pre-vieţuitor.
05:42
We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the
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HBO a fost aici de dimineaţă. Mă întreb dacă Mark Burnett e în sală.
05:46
audience, I'd like to suggest
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Aș dori să-i sugerez
05:48
a reality TV show called "Pre-vivor."
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un reality-show intitulat "Pre-vieţuitorii".
05:52
If you develop a disease, you're off
the island.
the island.
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Dacă te îmbolnăvești eşti dat afară de pe insulă.
05:55
But the problem is, we have a system
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Problema e că avem un sistem
06:01
that is completely --
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care în esență
06:02
basically promoted this.
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a promovat asta.
06:04
We've selected, at every point in this system,
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Am ales în orice punct din sistem,
06:07
to do what we do, and to give everyone a
precondition and then eventually
precondition and then eventually
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să facem ce facem şi să dăm fiecăruia o predispoziţie
06:11
a condition, in some cases.
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și în final o boală, în anumite cazuri.
06:13
Start with the doctor-patient
relationship. Doctors, most of them,
relationship. Doctors, most of them,
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În relaţia doctor-pacient, majoritatea doctorilor
06:18
are in a fee-for-service system. They are
basically incentivized to do more --
basically incentivized to do more --
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consultă în sistem taxă pe tratament. Sunt stimulaţi să facă
06:23
procedures, tests,
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mai multe proceduri, teste,
06:24
prescribe medications.
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să prescrie medicamente.
06:26
Patients come to them,
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Pacienţii vin la consultație
06:27
they want to do something. We're
Americans, we can't just stand
Americans, we can't just stand
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şi vor să facă ceva. Suntem americani, nu putem sta,
06:31
there, we have to do something. And so
they want a drug.
they want a drug.
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trebuie să facem ceva. Aşa că vor un medicament.
06:34
They want a treatment. They want to be told, this is what you have and this is how
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Vor tratament. Vor să audă: asta ai, aşa te tratezi.
06:38
you treat it. If the doctor
doesn't give you that,
doesn't give you that,
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Dacă doctorul nu-ţi dă asta,
06:40
you go somewhere else.
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te duci în altă parte.
06:42
That's not very good for doctors'
business.
business.
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Asta nu e bine pentru doctor.
06:44
Or even worse,
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Sau şi mai rău,
06:46
if you are diagnosed with something
eventually, and the doctor didn't order that test,
eventually, and the doctor didn't order that test,
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dacă eşti diagnosticat cu ceva şi doctorul nu a cerut
06:50
you get sued.
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acea analiză, ești dat în judecată.
06:52
We have pharmaceutical companies that are
constantly trying to expand
constantly trying to expand
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Companiile farmaceutice încearcă să extindă indicaţiile,
06:55
the indications, expand the number of people who are eligible for a given treatment,
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numărul celor eligibili pentru un anumit tratament,
07:00
because that obviously helps their bottom line.
We have advocacy groups,
We have advocacy groups,
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pentru că evident îi avantajează.
07:03
like the one that's come up with
pre-vivor,
pre-vivor,
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Grupuri de susţinători ca cel care a inventat pre-vieţuitorul,
07:05
who want to make more and more people feel they are at risk, or might have a condition,
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vor să facă tot mai mulţi să se simtă în pericol că ar avea o boală,
07:10
so that they can raise more funds
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ca să strângă mai multe fonduri
07:12
and raise visibility, et cetera.
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să-şi mărească vizibilitatea, etc.
07:14
But this isn't actually,
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Dar nu asta fac jurnaliștii de fapt,
07:16
despite what journalists typically do,
this isn't actually about blaming
this isn't actually about blaming
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nu dau vina pe anumiți
07:19
particular players.
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factori decisivi.
07:21
We are all responsible.
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Suntem toți responsabili.
07:22
I'm responsible.
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Eu sunt responsabil.
07:24
I actually root for the Yankees, I mean talk
about
about
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Eu de fapt țin cu Yankees.
07:27
rooting for the worst
possible
possible
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Să mă vedeți cum susțin și pe cel mai rău faultist
07:30
offender when it comes to doing
everything you can do.
everything you can do.
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când e vorba să fac tot ce pot.
07:33
Thank you.
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Vă mulţumesc.
07:34
But everyone is responsible.
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Dar toţi suntem răspunzători.
07:38
I went to medical school,
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Am absolvit o şcoală medicală,
07:41
and I didn't have a course called How to Think Skeptically,
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şi n-am avut niciun curs despre "Cum să gândeşti sceptic"
07:46
or How Not to Order Tests.
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sau "Cum să nu ceri analize".
07:48
We have this system
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Avem acest sistem
07:50
where that's what you do.
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în care asta facem.
07:53
And it actually took being a journalist
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Şi a trebuit să mă fac jurnalist
07:55
to understand all these incentives. You know, economists like to say,
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ca să înţeleg aceste stimulente. Economiştii afirmă că
07:59
there are no bad people,
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nu există oameni răi,
08:00
there are just bad incentives.
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doar stimulente rele.
08:02
And that's actually true.
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E adevărat.
08:04
Because what we've created is a sort of Field of Dreams, when it comes to medical technology.
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Tehnologia medicală a devenit un "Câmp al Visurilor".
08:07
So when you put another MRI in
every corner, you put a robot
every corner, you put a robot
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Când pui un RMN în fiecare colţ, pui un robot în fiecare spital,
08:13
in every hospital saying that everyone has to have robotic surgery.
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spui că toţi ar trebui să-și facă operație robotică.
08:16
Well, we've created a system where if you
build it, they will come.
build it, they will come.
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Am creat un sistem în care "dacă-l faci, vor veni".
08:20
But you can actually perversely
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Dar poţi , abuziv,
08:24
tell people to come, convince them
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să spui oamenilor să vină, să-i convingi
08:26
that they have to come.
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că trebuie să vină.
08:28
It was when I became a journalist that I really realized how I was part of this problem,
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Devenind jurnalist am realizat că şi eu eram parte a problemei,
08:33
and how we all are part of this problem.
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şi că toţi suntem parte a problemei.
08:35
I was medicalizing every risk factor, I was writing stories, commissioning stories,
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Medicalizam orice factor de risc, scriam şi spuneam poveşti
08:39
every day, that were trying to,
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în fiecare zi, prin care nu încercam neapărat
08:42
not necessarily make people worried, although that was what often happened.
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să îngrijorez oamenii, deşi asta se întâmpla deseori.
08:45
But, you know, there are ways out.
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Dar există căi de ieşire.
08:48
I saw my own internist last week,
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Am fost la internistul meu săptămâna trecută,
08:50
and he said to me,
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şi mi-a spus ceva
08:52
"You know," and he told me something that
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ce oricine din sală
08:55
everyone in this audience could have
told me for free,
told me for free,
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mi-ar fi putut spune gratuit,
08:57
but I paid him for the privilege, which
is that
is that
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dar am plătit pentru privilegiu,
09:00
I need to lose some weight.
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anume că trebuie să slăbesc.
09:02
Well, he's right. I've had honest-to-goodness high blood pressure
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Are dreptate. Am tensiune crescută
09:06
for a dozen years now, same
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de vreo 12 ani deja,
09:08
age my father got it,
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la vârsta la care o avea şi tatăl meu,
09:09
and it's a real disease. It's not pre-hypertension, it's actual
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şi e o boală reală. Nu e pre-hipertensiune,
09:13
hypertension, high blood pressure.
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e chiar hipertensiune mare.
09:15
Well, he's right,
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Are dreptate,
09:16
but he didn't say to me,
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dar nu mi-a spus,
09:19
well, you have pre-obesity or
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ai pre-obezitate
09:21
you have pre-diabetes, or anything like that. He didn't say,
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sau pre-diabet sau ceva asemănător. Nu mi-a spus:
09:24
better start taking this Statin, you need to lower your cholesterol.
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ar fi cazul să iei Statin să-ți reduci colesterolul.
09:28
No, he said, "Go out and lose some weight. Come back and see me in a bit,
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Nu, mi-a spus: "Du-te slăbeşte puţin şi revino
09:31
or just give me a call and let me know how you're doing."
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sau sună-mă să ştiu cum te mai simţi."
09:33
So that's, to me,
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Asta pentru mine
09:35
a way forward.
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e o veste bună.
09:37
Billy Beane, by the way, learned the same
thing.
thing.
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Billy Beane a învăţat acelaşi lucru.
09:39
He learned,
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A învăţat, privind acest puşti
09:40
from watching this kid who he eventually hired, who was really successful for him,
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pe care l-a şi angajat, şi a meritat,
09:44
that it wasn't swinging for the fences, it
wasn't swinging at every pitch
wasn't swinging at every pitch
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că nu trebuia să te arunci în garduri, să te năpustești la fiecare azvârlire
09:49
like the sluggers do, which is what all the expensive teams like the Yankees like to --
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ca boxerii, cum fac toate echipele ca Yankees -
09:54
they like to pick up those guys.
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le place să-i culeagă pe acei tipi.
09:55
This kid told him, you know, you gotta watch the guys, and you gotta go out and find
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Puştiul i-a spus, caută băieţii cărora le place
10:00
the guys who like to walk,
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să se plimbe,
10:01
because getting on base by a walk
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pentru că atingând baza în plimbare
10:02
is just as good, and in our healthcare
system
system
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e la fel de bine, iar în sănătate
10:05
we need to figure out,
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trebuie să discernem
10:07
is that really a good pitch
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dacă asta-i o mişcare bună
10:08
or should we let it go by and not swing at everything?
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sau o putem ignora fără să ne agităm pentru orice.
10:11
Thanks.
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Vă mulţumesc.
ABOUT THE SPEAKER
Ivan Oransky - Health reporterIvan Oransky is the executive editor of Reuters Health, and has done pioneering work in covering scientific retractions.
Why you should listen
Ivan Oransky is a doctor-turned reporter. With an MD and an internship completed, he left to cover heath and health care, bringing the insight of a trained doctor to the beat. He is now executive editor of Reuters Health, and also teaches journalism and medicine at New York University.
He is also the co-founder of Retraction Watch a blog that tracks and investigates retractions in scientific journals, and it's sister-site, Embargo Watch, doing the same for reporting on scientific papers.
Ivan Oransky | Speaker | TED.com