0:00:00.472,0:00:04.167 Those of you who have seen the film "Moneyball," 0:00:04.167,0:00:06.151 or have read the book by Michael Lewis, 0:00:06.151,0:00:09.287 will be familiar with the story of Billy Beane. 0:00:09.287,0:00:13.975 Billy was supposed to be a tremendous ballplayer; all the scouts told him so. 0:00:13.975,0:00:15.168 They told his parents that 0:00:15.168,0:00:17.207 they predicted that he was going to be a star. 0:00:17.207,0:00:22.159 But what actually happened when he signed the contract -- and by the way, he didn't 0:00:22.159,0:00:24.583 want to sign that contract, he wanted to go to[br]college -- 0:00:24.583,0:00:27.240 which is what my mother, who actually does[br]love me, 0:00:27.240,0:00:30.104 said that I should do too, and I did -- 0:00:30.104,0:00:33.178 well, he didn't do very well. He struggled[br]mightily. 0:00:33.178,0:00:37.711 He got traded a couple of times, he ended up in the Minors for most of his career, 0:00:37.711,0:00:41.799 and he actually ended up in management. He ended up as a General Manager of the 0:00:41.799,0:00:42.448 Oakland A's. 0:00:42.448,0:00:46.872 Now for many of you in this room, ending[br]up in management, which is also what I've done, 0:00:46.872,0:00:48.568 is seen as a success. 0:00:48.568,0:00:51.770 I can assure you that for a kid trying[br]to make it in the Bigs, 0:00:51.770,0:00:56.479 going into management ain't no success story. It's a failure. 0:00:56.479,0:01:00.918 And what I want to talk to you about today, and share with you, is that our 0:01:00.918,0:01:05.358 healthcare system, our medical system, is[br]just as bad at predicting 0:01:05.358,0:01:09.550 what happens to people in it -- patients,[br]others -- 0:01:09.550,0:01:14.163 as those scouts were at predicting what would happen to Billy Beane. 0:01:14.163,0:01:16.844 And yet, every day 0:01:16.844,0:01:18.805 thousands of people in this country 0:01:18.805,0:01:22.731 are diagnosed with preconditions. 0:01:22.731,0:01:26.971 We hear about pre-hypertension, we hear about pre-dementia, 0:01:26.971,0:01:32.307 we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with 0:01:32.307,0:01:33.684 that in the green room. 0:01:33.684,0:01:38.037 We also refer to subclinical conditions. 0:01:38.037,0:01:42.588 There's subclinical atherosclerosis, subclinical hardening of the arteries, 0:01:42.588,0:01:46.123 obviously linked to heart attacks,[br]potentially. 0:01:46.123,0:01:49.556 One of my favorites is called[br]subclinical acne. 0:01:49.556,0:01:53.523 If you look up subclinical acne, you may find a website, which I did, 0:01:53.523,0:01:57.652 which says that this is the easiest type of acne to treat. 0:01:57.652,0:02:04.267 You don't have the pustules or the redness and inflammation. 0:02:04.267,0:02:07.923 Maybe that's because you don't actually[br]have acne. 0:02:07.923,0:02:14.446 I have a name for all of these conditions, it's another precondition: 0:02:14.446,0:02:16.301 I call them preposterous. 0:02:16.301,0:02:22.360 In baseball, the game follows the pre-game. 0:02:22.360,0:02:24.765 Season follows the pre-season. 0:02:24.765,0:02:29.288 But with a lot of these conditions, that actually isn't the case, or at least it isn't the 0:02:29.288,0:02:33.861 case all the time. It's as if there's a rain delay, every single time in many cases. 0:02:33.861,0:02:35.679 We have pre-cancerous lesions, 0:02:35.679,0:02:39.172 which often don't turn into cancer. 0:02:39.172,0:02:41.028 And yet, 0:02:41.028,0:02:44.954 if you take, for example, subclinical[br]osteoporosis, a bone thinning disease, 0:02:44.954,0:02:46.607 the precondition, 0:02:46.607,0:02:49.014 otherwise known as osteopenia, 0:02:49.014,0:02:52.684 you would have to treat 270[br]women for three years 0:02:52.684,0:02:54.884 in order to prevent one broken bone. 0:02:54.884,0:02:56.493 That's an awful lot of women 0:02:56.493,0:02:59.420 when you multiply by the number of women[br]who were diagnosed 0:02:59.420,0:03:01.309 with this osteopenia. 0:03:01.309,0:03:03.365 And so is it any wonder, 0:03:03.365,0:03:05.895 given all of the costs and the side effects 0:03:05.895,0:03:10.099 of the drugs that we're using to treat these preconditions, that every year 0:03:10.099,0:03:13.772 we're spending more than two trillion dollars on healthcare and yet 0:03:13.772,0:03:17.059 100,000 people a year -- and that's a conservative estimate -- are dying 0:03:17.059,0:03:18.972 not because of the conditions they have, 0:03:18.972,0:03:23.259 but because of the treatments that we're giving them and the complications of those treatments? 0:03:23.259,0:03:26.071 We've medicalized everything 0:03:26.071,0:03:27.040 in this country. 0:03:27.040,0:03:30.423 Women in the audience, I have[br]some 0:03:30.423,0:03:32.422 pretty bad news that you already know, 0:03:32.422,0:03:35.079 and that's that every aspect of your[br]life 0:03:35.079,0:03:36.487 has been medicalized. 0:03:36.487,0:03:38.911 Strike one is when you hit puberty. 0:03:38.911,0:03:43.247 You now have something that happens to you once a month that has been medicalized. 0:03:43.247,0:03:44.063 It's a condition; 0:03:44.063,0:03:45.623 it has to be treated. Strike two 0:03:45.623,0:03:47.223 is if you get pregnant. 0:03:47.223,0:03:50.319 That's been medicalized as[br]well. 0:03:50.319,0:03:52.239 You have to have a high-tech experience 0:03:52.239,0:03:54.967 of pregnancy, otherwise something might[br]go wrong. 0:03:54.967,0:03:58.574 Strike three is menopause. 0:03:58.574,0:04:02.911 We all know what happened when millions[br]of women were given hormone replacement therapy 0:04:02.911,0:04:05.957 for menopausal symptoms 0:04:05.957,0:04:10.387 for decades until all of a sudden we realized, because a study came out, a big one, 0:04:10.387,0:04:11.395 NIH-funded. 0:04:11.395,0:04:12.323 It said, 0:04:12.323,0:04:16.908 actually, a lot of that hormone replacement therapy may be doing more harm than good 0:04:16.908,0:04:18.692 for many of those women. 0:04:18.692,0:04:20.940 Just in case, 0:04:20.940,0:04:22.572 I don't want to leave the men out -- 0:04:22.572,0:04:24.188 I am one, after all -- 0:04:24.188,0:04:26.877 I have really bad news for all of you in[br]this room, 0:04:26.877,0:04:27.837 and for everyone 0:04:27.837,0:04:29.583 listening and watching elsewhere: 0:04:29.583,0:04:30.796 You all have 0:04:30.796,0:04:33.732 a universally fatal condition. 0:04:33.732,0:04:37.040 So, just take a moment. 0:04:37.040,0:04:38.372 It's called pre-death. 0:04:38.372,0:04:43.444 Every single one of you has it, because[br]you have the risk factor for it, 0:04:43.444,0:04:45.188 which is being alive. 0:04:45.188,0:04:48.246 But I have some good news for you,[br]because 0:04:48.246,0:04:52.276 I'm a journalist, I like to end things in a happy way or a forward-thinking way. 0:04:52.276,0:04:56.205 And that good news is that if you can survive to the end of my talk, which 0:04:56.205,0:04:58.797 we'll see if that happens for everyone, 0:04:58.797,0:05:02.092 you will be a pre-vivor. 0:05:02.092,0:05:06.908 I made up pre-death. 0:05:06.908,0:05:11.020 If I used someone else's pre-death, I apologize, 0:05:11.020,0:05:12.605 I think I made it up. 0:05:12.605,0:05:14.172 I didn't make up pre-vivor. 0:05:14.172,0:05:19.644 Pre-vivor is what a particular cancer advocacy group would like everyone who 0:05:19.644,0:05:20.916 just has a risk factor, 0:05:20.916,0:05:23.438 but hasn't actually had that cancer, 0:05:23.438,0:05:24.812 to call themselves. 0:05:24.812,0:05:26.387 You are a pre-vivor. 0:05:26.387,0:05:30.860 We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the 0:05:30.860,0:05:32.365 audience, I'd like to suggest 0:05:32.365,0:05:36.572 a reality TV show called "Pre-vivor." 0:05:36.572,0:05:40.073 If you develop a disease, you're off[br]the island. 0:05:40.073,0:05:45.208 But the problem is, we have a system 0:05:45.208,0:05:47.080 that is completely -- 0:05:47.080,0:05:49.007 basically promoted this. 0:05:49.007,0:05:51.873 We've selected, at every point in this system, 0:05:51.873,0:05:55.860 to do what we do, and to give everyone a[br]precondition and then eventually 0:05:55.860,0:05:57.839 a condition, in some cases. 0:05:57.839,0:06:02.332 Start with the doctor-patient[br]relationship. Doctors, most of them, 0:06:02.332,0:06:07.358 are in a fee-for-service system. They are[br]basically incentivized to do more -- 0:06:07.358,0:06:09.015 procedures, tests, 0:06:09.015,0:06:10.681 prescribe medications. 0:06:10.681,0:06:12.046 Patients come to them, 0:06:12.046,0:06:16.046 they want to do something. We're[br]Americans, we can't just stand 0:06:16.046,0:06:18.927 there, we have to do something. And so[br]they want a drug. 0:06:18.927,0:06:22.702 They want a treatment. They want to be told, this is what you have and this is how 0:06:22.702,0:06:25.022 you treat it. If the doctor[br]doesn't give you that, 0:06:25.022,0:06:26.846 you go somewhere else. 0:06:26.846,0:06:28.726 That's not very good for doctors'[br]business. 0:06:28.726,0:06:30.414 Or even worse, 0:06:30.414,0:06:34.373 if you are diagnosed with something[br]eventually, and the doctor didn't order that test, 0:06:34.373,0:06:36.597 you get sued. 0:06:36.597,0:06:39.629 We have pharmaceutical companies that are[br]constantly trying to expand 0:06:39.629,0:06:44.973 the indications, expand the number of people who are eligible for a given treatment, 0:06:44.973,0:06:47.766 because that obviously helps their bottom line.[br]We have advocacy groups, 0:06:47.766,0:06:50.021 like the one that's come up with[br]pre-vivor, 0:06:50.021,0:06:54.261 who want to make more and more people feel they are at risk, or might have a condition, 0:06:54.261,0:06:56.390 so that they can raise more funds 0:06:56.390,0:06:59.005 and raise visibility, et cetera. 0:06:59.005,0:07:00.845 But this isn't actually, 0:07:00.845,0:07:03.941 despite what journalists typically do,[br]this isn't actually about blaming 0:07:03.941,0:07:05.229 particular players. 0:07:05.229,0:07:07.030 We are all responsible. 0:07:07.030,0:07:08.472 I'm responsible. 0:07:08.472,0:07:11.510 I actually root for the Yankees, I mean talk[br]about 0:07:11.510,0:07:14.702 rooting for the worst[br]possible 0:07:14.702,0:07:17.312 offender when it comes to doing[br]everything you can do. 0:07:17.312,0:07:18.849 Thank you. 0:07:18.849,0:07:22.813 But everyone is responsible. 0:07:22.813,0:07:25.718 I went to medical school, 0:07:25.718,0:07:30.470 and I didn't have a course called How to Think Skeptically, 0:07:30.470,0:07:32.133 or How Not to Order Tests. 0:07:32.133,0:07:34.784 We have this system 0:07:34.784,0:07:37.301 where that's what you do. 0:07:37.301,0:07:39.926 And it actually took being a journalist 0:07:39.926,0:07:43.829 to understand all these incentives. You know, economists like to say, 0:07:43.829,0:07:45.048 there are no bad people, 0:07:45.048,0:07:46.925 there are just bad incentives. 0:07:46.925,0:07:48.533 And that's actually true. 0:07:48.533,0:07:51.990 Because what we've created is a sort of Field of Dreams, when it comes to medical technology. 0:07:52.000,0:07:57.300 So when you put another MRI in[br]every corner, you put a robot 0:07:57.300,0:08:00.838 in every hospital saying that everyone has to have robotic surgery. 0:08:00.838,0:08:04.654 Well, we've created a system where if you[br]build it, they will come. 0:08:04.654,0:08:08.181 But you can actually perversely 0:08:08.181,0:08:10.965 tell people to come, convince them 0:08:10.965,0:08:12.654 that they have to come. 0:08:12.654,0:08:17.279 It was when I became a journalist that I really realized how I was part of this problem, 0:08:17.462,0:08:19.486 and how we all are part of this problem. 0:08:19.486,0:08:23.142 I was medicalizing every risk factor, I was writing stories, commissioning stories, 0:08:23.142,0:08:26.535 every day, that were trying to, 0:08:26.535,0:08:29.532 not necessarily make people worried, although that was what often happened. 0:08:29.532,0:08:32.555 But, you know, there are ways out. 0:08:32.555,0:08:34.427 I saw my own internist last week, 0:08:34.427,0:08:36.959 and he said to me, 0:08:36.959,0:08:39.476 "You know," and he told me something that 0:08:39.476,0:08:41.950 everyone in this audience could have[br]told me for free, 0:08:41.950,0:08:44.438 but I paid him for the privilege, which[br]is that 0:08:44.438,0:08:46.107 I need to lose some weight. 0:08:46.107,0:08:50.564 Well, he's right. I've had honest-to-goodness high blood pressure 0:08:50.564,0:08:52.277 for a dozen years now, same 0:08:52.277,0:08:54.051 age my father got it, 0:08:54.051,0:08:57.838 and it's a real disease. It's not pre-hypertension, it's actual 0:08:57.838,0:08:59.811 hypertension, high blood pressure. 0:08:59.811,0:09:00.796 Well, he's right, 0:09:00.796,0:09:03.876 but he didn't say to me, 0:09:03.876,0:09:05.563 well, you have pre-obesity or 0:09:05.563,0:09:08.908 you have pre-diabetes, or anything like[br]that. He didn't say, 0:09:08.908,0:09:12.284 better start taking this Statin, you need to lower your cholesterol. 0:09:12.284,0:09:15.443 No, he said, "Go out and lose some weight. Come back and see me in a bit, 0:09:15.443,0:09:17.444 or just give me a call and let me know how you're doing." 0:09:17.444,0:09:19.484 So that's, to me, 0:09:19.484,0:09:21.115 a way forward. 0:09:21.115,0:09:23.479 Billy Beane, by the way, learned the same[br]thing. 0:09:23.479,0:09:25.015 He learned, 0:09:25.015,0:09:28.532 from watching this kid who he eventually hired, who was really successful for him, 0:09:28.532,0:09:33.407 that it wasn't swinging for the fences, it[br]wasn't swinging at every pitch 0:09:33.407,0:09:38.167 like the sluggers do, which is what all the expensive teams like the Yankees like to -- 0:09:38.176,0:09:39.516 they like to pick up those guys. 0:09:39.516,0:09:44.105 This kid told him, you know, you gotta watch the guys, and you gotta go out and find 0:09:44.105,0:09:45.344 the guys who like to walk, 0:09:45.344,0:09:47.048 because getting on base by a walk 0:09:47.048,0:09:49.816 is just as good, and in our healthcare[br]system 0:09:49.816,0:09:51.256 we need to figure out, 0:09:51.256,0:09:52.832 is that really a good pitch 0:09:52.832,0:09:55.750 or should we let it go by and not swing at everything? 0:09:55.750,9:59:59.000 Thanks.