1 00:00:00,472 --> 00:00:04,167 Those of you who have seen the film "Moneyball," 2 00:00:04,167 --> 00:00:06,151 or have read the book by Michael Lewis, 3 00:00:06,151 --> 00:00:09,287 will be familiar with the story of Billy Beane. 4 00:00:09,287 --> 00:00:13,975 Billy was supposed to be a tremendous ballplayer; all the scouts told him so. 5 00:00:13,975 --> 00:00:15,168 They told his parents that 6 00:00:15,168 --> 00:00:17,207 they predicted that he was going to be a star. 7 00:00:17,207 --> 00:00:22,159 But what actually happened when he signed the contract -- and by the way, he didn't 8 00:00:22,159 --> 00:00:24,583 want to sign that contract, he wanted to go to college -- 9 00:00:24,583 --> 00:00:27,240 which is what my mother, who actually does love me, 10 00:00:27,240 --> 00:00:30,104 said that I should do too, and I did -- 11 00:00:30,104 --> 00:00:33,178 well, he didn't do very well. He struggled mightily. 12 00:00:33,178 --> 00:00:37,711 He got traded a couple of times, he ended up in the Minors for most of his career, 13 00:00:37,711 --> 00:00:41,799 and he actually ended up in management. He ended up as a General Manager of the 14 00:00:41,799 --> 00:00:42,448 Oakland A's. 15 00:00:42,448 --> 00:00:46,872 Now for many of you in this room, ending up in management, which is also what I've done, 16 00:00:46,872 --> 00:00:48,568 is seen as a success. 17 00:00:48,568 --> 00:00:51,770 I can assure you that for a kid trying to make it in the Bigs, 18 00:00:51,770 --> 00:00:56,479 going into management ain't no success story. It's a failure. 19 00:00:56,479 --> 00:01:00,918 And what I want to talk to you about today, and share with you, is that our 20 00:01:00,918 --> 00:01:05,358 healthcare system, our medical system, is just as bad at predicting 21 00:01:05,358 --> 00:01:09,550 what happens to people in it -- patients, others -- 22 00:01:09,550 --> 00:01:14,163 as those scouts were at predicting what would happen to Billy Beane. 23 00:01:14,163 --> 00:01:16,844 And yet, every day 24 00:01:16,844 --> 00:01:18,805 thousands of people in this country 25 00:01:18,805 --> 00:01:22,731 are diagnosed with preconditions. 26 00:01:22,731 --> 00:01:26,971 We hear about pre-hypertension, we hear about pre-dementia, 27 00:01:26,971 --> 00:01:32,307 we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with 28 00:01:32,307 --> 00:01:33,684 that in the green room. 29 00:01:33,684 --> 00:01:38,037 We also refer to subclinical conditions. 30 00:01:38,037 --> 00:01:42,588 There's subclinical atherosclerosis, subclinical hardening of the arteries, 31 00:01:42,588 --> 00:01:46,123 obviously linked to heart attacks, potentially. 32 00:01:46,123 --> 00:01:49,556 One of my favorites is called subclinical acne. 33 00:01:49,556 --> 00:01:53,523 If you look up subclinical acne, you may find a website, which I did, 34 00:01:53,523 --> 00:01:57,652 which says that this is the easiest type of acne to treat. 35 00:01:57,652 --> 00:02:04,267 You don't have the pustules or the redness and inflammation. 36 00:02:04,267 --> 00:02:07,923 Maybe that's because you don't actually have acne. 37 00:02:07,923 --> 00:02:14,446 I have a name for all of these conditions, it's another precondition: 38 00:02:14,446 --> 00:02:16,301 I call them preposterous. 39 00:02:16,301 --> 00:02:22,360 In baseball, the game follows the pre-game. 40 00:02:22,360 --> 00:02:24,765 Season follows the pre-season. 41 00:02:24,765 --> 00:02:29,288 But with a lot of these conditions, that actually isn't the case, or at least it isn't the 42 00:02:29,288 --> 00:02:33,861 case all the time. It's as if there's a rain delay, every single time in many cases. 43 00:02:33,861 --> 00:02:35,679 We have pre-cancerous lesions, 44 00:02:35,679 --> 00:02:39,172 which often don't turn into cancer. 45 00:02:39,172 --> 00:02:41,028 And yet, 46 00:02:41,028 --> 00:02:44,954 if you take, for example, subclinical osteoporosis, a bone thinning disease, 47 00:02:44,954 --> 00:02:46,607 the precondition, 48 00:02:46,607 --> 00:02:49,014 otherwise known as osteopenia, 49 00:02:49,014 --> 00:02:52,684 you would have to treat 270 women for three years 50 00:02:52,684 --> 00:02:54,884 in order to prevent one broken bone. 51 00:02:54,884 --> 00:02:56,493 That's an awful lot of women 52 00:02:56,493 --> 00:02:59,420 when you multiply by the number of women who were diagnosed 53 00:02:59,420 --> 00:03:01,309 with this osteopenia. 54 00:03:01,309 --> 00:03:03,365 And so is it any wonder, 55 00:03:03,365 --> 00:03:05,895 given all of the costs and the side effects 56 00:03:05,895 --> 00:03:10,099 of the drugs that we're using to treat these preconditions, that every year 57 00:03:10,099 --> 00:03:13,772 we're spending more than two trillion dollars on healthcare and yet 58 00:03:13,772 --> 00:03:17,059 100,000 people a year -- and that's a conservative estimate -- are dying 59 00:03:17,059 --> 00:03:18,972 not because of the conditions they have, 60 00:03:18,972 --> 00:03:23,259 but because of the treatments that we're giving them and the complications of those treatments? 61 00:03:23,259 --> 00:03:26,071 We've medicalized everything 62 00:03:26,071 --> 00:03:27,040 in this country. 63 00:03:27,040 --> 00:03:30,423 Women in the audience, I have some 64 00:03:30,423 --> 00:03:32,422 pretty bad news that you already know, 65 00:03:32,422 --> 00:03:35,079 and that's that every aspect of your life 66 00:03:35,079 --> 00:03:36,487 has been medicalized. 67 00:03:36,487 --> 00:03:38,911 Strike one is when you hit puberty. 68 00:03:38,911 --> 00:03:43,247 You now have something that happens to you once a month that has been medicalized. 69 00:03:43,247 --> 00:03:44,063 It's a condition; 70 00:03:44,063 --> 00:03:45,623 it has to be treated. Strike two 71 00:03:45,623 --> 00:03:47,223 is if you get pregnant. 72 00:03:47,223 --> 00:03:50,319 That's been medicalized as well. 73 00:03:50,319 --> 00:03:52,239 You have to have a high-tech experience 74 00:03:52,239 --> 00:03:54,967 of pregnancy, otherwise something might go wrong. 75 00:03:54,967 --> 00:03:58,574 Strike three is menopause. 76 00:03:58,574 --> 00:04:02,911 We all know what happened when millions of women were given hormone replacement therapy 77 00:04:02,911 --> 00:04:05,957 for menopausal symptoms 78 00:04:05,957 --> 00:04:10,387 for decades until all of a sudden we realized, because a study came out, a big one, 79 00:04:10,387 --> 00:04:11,395 NIH-funded. 80 00:04:11,395 --> 00:04:12,323 It said, 81 00:04:12,323 --> 00:04:16,908 actually, a lot of that hormone replacement therapy may be doing more harm than good 82 00:04:16,908 --> 00:04:18,692 for many of those women. 83 00:04:18,692 --> 00:04:20,940 Just in case, 84 00:04:20,940 --> 00:04:22,572 I don't want to leave the men out -- 85 00:04:22,572 --> 00:04:24,188 I am one, after all -- 86 00:04:24,188 --> 00:04:26,877 I have really bad news for all of you in this room, 87 00:04:26,877 --> 00:04:27,837 and for everyone 88 00:04:27,837 --> 00:04:29,583 listening and watching elsewhere: 89 00:04:29,583 --> 00:04:30,796 You all have 90 00:04:30,796 --> 00:04:33,732 a universally fatal condition. 91 00:04:33,732 --> 00:04:37,040 So, just take a moment. 92 00:04:37,040 --> 00:04:38,372 It's called pre-death. 93 00:04:38,372 --> 00:04:43,444 Every single one of you has it, because you have the risk factor for it, 94 00:04:43,444 --> 00:04:45,188 which is being alive. 95 00:04:45,188 --> 00:04:48,246 But I have some good news for you, because 96 00:04:48,246 --> 00:04:52,276 I'm a journalist, I like to end things in a happy way or a forward-thinking way. 97 00:04:52,276 --> 00:04:56,205 And that good news is that if you can survive to the end of my talk, which 98 00:04:56,205 --> 00:04:58,797 we'll see if that happens for everyone, 99 00:04:58,797 --> 00:05:02,092 you will be a pre-vivor. 100 00:05:02,092 --> 00:05:06,908 I made up pre-death. 101 00:05:06,908 --> 00:05:11,020 If I used someone else's pre-death, I apologize, 102 00:05:11,020 --> 00:05:12,605 I think I made it up. 103 00:05:12,605 --> 00:05:14,172 I didn't make up pre-vivor. 104 00:05:14,172 --> 00:05:19,644 Pre-vivor is what a particular cancer advocacy group would like everyone who 105 00:05:19,644 --> 00:05:20,916 just has a risk factor, 106 00:05:20,916 --> 00:05:23,438 but hasn't actually had that cancer, 107 00:05:23,438 --> 00:05:24,812 to call themselves. 108 00:05:24,812 --> 00:05:26,387 You are a pre-vivor. 109 00:05:26,387 --> 00:05:30,860 We've had HBO here this morning. I'm wondering if Mark Burnett is anywhere in the 110 00:05:30,860 --> 00:05:32,365 audience, I'd like to suggest 111 00:05:32,365 --> 00:05:36,572 a reality TV show called "Pre-vivor." 112 00:05:36,572 --> 00:05:40,073 If you develop a disease, you're off the island. 113 00:05:40,073 --> 00:05:45,208 But the problem is, we have a system 114 00:05:45,208 --> 00:05:47,080 that is completely -- 115 00:05:47,080 --> 00:05:49,007 basically promoted this. 116 00:05:49,007 --> 00:05:51,873 We've selected, at every point in this system, 117 00:05:51,873 --> 00:05:55,860 to do what we do, and to give everyone a precondition and then eventually 118 00:05:55,860 --> 00:05:57,839 a condition, in some cases. 119 00:05:57,839 --> 00:06:02,332 Start with the doctor-patient relationship. Doctors, most of them, 120 00:06:02,332 --> 00:06:07,358 are in a fee-for-service system. They are basically incentivized to do more -- 121 00:06:07,358 --> 00:06:09,015 procedures, tests, 122 00:06:09,015 --> 00:06:10,681 prescribe medications. 123 00:06:10,681 --> 00:06:12,046 Patients come to them, 124 00:06:12,046 --> 00:06:16,046 they want to do something. We're Americans, we can't just stand 125 00:06:16,046 --> 00:06:18,927 there, we have to do something. And so they want a drug. 126 00:06:18,927 --> 00:06:22,702 They want a treatment. They want to be told, this is what you have and this is how 127 00:06:22,702 --> 00:06:25,022 you treat it. If the doctor doesn't give you that, 128 00:06:25,022 --> 00:06:26,846 you go somewhere else. 129 00:06:26,846 --> 00:06:28,726 That's not very good for doctors' business. 130 00:06:28,726 --> 00:06:30,414 Or even worse, 131 00:06:30,414 --> 00:06:34,373 if you are diagnosed with something eventually, and the doctor didn't order that test, 132 00:06:34,373 --> 00:06:36,597 you get sued. 133 00:06:36,597 --> 00:06:39,629 We have pharmaceutical companies that are constantly trying to expand 134 00:06:39,629 --> 00:06:44,973 the indications, expand the number of people who are eligible for a given treatment, 135 00:06:44,973 --> 00:06:47,766 because that obviously helps their bottom line. We have advocacy groups, 136 00:06:47,766 --> 00:06:50,021 like the one that's come up with pre-vivor, 137 00:06:50,021 --> 00:06:54,261 who want to make more and more people feel they are at risk, or might have a condition, 138 00:06:54,261 --> 00:06:56,390 so that they can raise more funds 139 00:06:56,390 --> 00:06:59,005 and raise visibility, et cetera. 140 00:06:59,005 --> 00:07:00,845 But this isn't actually, 141 00:07:00,845 --> 00:07:03,941 despite what journalists typically do, this isn't actually about blaming 142 00:07:03,941 --> 00:07:05,229 particular players. 143 00:07:05,229 --> 00:07:07,030 We are all responsible. 144 00:07:07,030 --> 00:07:08,472 I'm responsible. 145 00:07:08,472 --> 00:07:11,510 I actually root for the Yankees, I mean talk about 146 00:07:11,510 --> 00:07:14,702 rooting for the worst possible 147 00:07:14,702 --> 00:07:17,312 offender when it comes to doing everything you can do. 148 00:07:17,312 --> 00:07:18,849 Thank you. 149 00:07:18,849 --> 00:07:22,813 But everyone is responsible. 150 00:07:22,813 --> 00:07:25,718 I went to medical school, 151 00:07:25,718 --> 00:07:30,470 and I didn't have a course called How to Think Skeptically, 152 00:07:30,470 --> 00:07:32,133 or How Not to Order Tests. 153 00:07:32,133 --> 00:07:34,784 We have this system 154 00:07:34,784 --> 00:07:37,301 where that's what you do. 155 00:07:37,301 --> 00:07:39,926 And it actually took being a journalist 156 00:07:39,926 --> 00:07:43,829 to understand all these incentives. You know, economists like to say, 157 00:07:43,829 --> 00:07:45,048 there are no bad people, 158 00:07:45,048 --> 00:07:46,925 there are just bad incentives. 159 00:07:46,925 --> 00:07:48,533 And that's actually true. 160 00:07:48,533 --> 00:07:51,990 Because what we've created is a sort of Field of Dreams, when it comes to medical technology. 161 00:07:52,000 --> 00:07:57,300 So when you put another MRI in every corner, you put a robot 162 00:07:57,300 --> 00:08:00,838 in every hospital saying that everyone has to have robotic surgery. 163 00:08:00,838 --> 00:08:04,654 Well, we've created a system where if you build it, they will come. 164 00:08:04,654 --> 00:08:08,181 But you can actually perversely 165 00:08:08,181 --> 00:08:10,965 tell people to come, convince them 166 00:08:10,965 --> 00:08:12,654 that they have to come. 167 00:08:12,654 --> 00:08:17,279 It was when I became a journalist that I really realized how I was part of this problem, 168 00:08:17,462 --> 00:08:19,486 and how we all are part of this problem. 169 00:08:19,486 --> 00:08:23,142 I was medicalizing every risk factor, I was writing stories, commissioning stories, 170 00:08:23,142 --> 00:08:26,535 every day, that were trying to, 171 00:08:26,535 --> 00:08:29,532 not necessarily make people worried, although that was what often happened. 172 00:08:29,532 --> 00:08:32,555 But, you know, there are ways out. 173 00:08:32,555 --> 00:08:34,427 I saw my own internist last week, 174 00:08:34,427 --> 00:08:36,959 and he said to me, 175 00:08:36,959 --> 00:08:39,476 "You know," and he told me something that 176 00:08:39,476 --> 00:08:41,950 everyone in this audience could have told me for free, 177 00:08:41,950 --> 00:08:44,438 but I paid him for the privilege, which is that 178 00:08:44,438 --> 00:08:46,107 I need to lose some weight. 179 00:08:46,107 --> 00:08:50,564 Well, he's right. I've had honest-to-goodness high blood pressure 180 00:08:50,564 --> 00:08:52,277 for a dozen years now, same 181 00:08:52,277 --> 00:08:54,051 age my father got it, 182 00:08:54,051 --> 00:08:57,838 and it's a real disease. It's not pre-hypertension, it's actual 183 00:08:57,838 --> 00:08:59,811 hypertension, high blood pressure. 184 00:08:59,811 --> 00:09:00,796 Well, he's right, 185 00:09:00,796 --> 00:09:03,876 but he didn't say to me, 186 00:09:03,876 --> 00:09:05,563 well, you have pre-obesity or 187 00:09:05,563 --> 00:09:08,908 you have pre-diabetes, or anything like that. He didn't say, 188 00:09:08,908 --> 00:09:12,284 better start taking this Statin, you need to lower your cholesterol. 189 00:09:12,284 --> 00:09:15,443 No, he said, "Go out and lose some weight. Come back and see me in a bit, 190 00:09:15,443 --> 00:09:17,444 or just give me a call and let me know how you're doing." 191 00:09:17,444 --> 00:09:19,484 So that's, to me, 192 00:09:19,484 --> 00:09:21,115 a way forward. 193 00:09:21,115 --> 00:09:23,479 Billy Beane, by the way, learned the same thing. 194 00:09:23,479 --> 00:09:25,015 He learned, 195 00:09:25,015 --> 00:09:28,532 from watching this kid who he eventually hired, who was really successful for him, 196 00:09:28,532 --> 00:09:33,407 that it wasn't swinging for the fences, it wasn't swinging at every pitch 197 00:09:33,407 --> 00:09:38,167 like the sluggers do, which is what all the expensive teams like the Yankees like to -- 198 00:09:38,176 --> 00:09:39,516 they like to pick up those guys. 199 00:09:39,516 --> 00:09:44,105 This kid told him, you know, you gotta watch the guys, and you gotta go out and find 200 00:09:44,105 --> 00:09:45,344 the guys who like to walk, 201 00:09:45,344 --> 00:09:47,048 because getting on base by a walk 202 00:09:47,048 --> 00:09:49,816 is just as good, and in our healthcare system 203 00:09:49,816 --> 00:09:51,256 we need to figure out, 204 00:09:51,256 --> 00:09:52,832 is that really a good pitch 205 00:09:52,832 --> 00:09:55,750 or should we let it go by and not swing at everything? 206 00:09:55,750 --> 00:09:57,525 Thanks.