WEBVTT 00:00:00.472 --> 00:00:04.167 Those of you who have seen the film "Moneyball," 00:00:04.167 --> 00:00:06.151 or have read the book by Michael Lewis, 00:00:06.151 --> 00:00:09.287 will be familiar with the story of Billy Beane. 00:00:09.287 --> 00:00:13.975 Billy was supposed to be a tremendous ballplayer; all the scouts told him so. 00:00:13.975 --> 00:00:15.168 They told his parents that 00:00:15.168 --> 00:00:17.207 they predicted that he was going to be a star. NOTE Paragraph 00:00:17.207 --> 00:00:22.159 But what actually happened when he signed the contract -- and by the way, he didn't 00:00:22.159 --> 00:00:24.583 want to sign that contract, he wanted to go to college -- 00:00:24.583 --> 00:00:27.240 which is what my mother, who actually does love me, 00:00:27.240 --> 00:00:30.104 said that I should do too, and I did -- 00:00:30.104 --> 00:00:33.178 well, he didn't do very well. He struggled mightily. 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, 00:00:37.711 --> 00:00:41.799 and he actually ended up in management. He ended up as a General Manager of the 00:00:41.799 --> 00:00:42.448 Oakland A's. NOTE Paragraph 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, 00:00:46.872 --> 00:00:48.568 is seen as a success. 00:00:48.568 --> 00:00:51.770 I can assure you that for a kid trying to make it in the Bigs, 00:00:51.770 --> 00:00:56.479 going into management ain't no success story. It's a failure. NOTE Paragraph 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 00:01:00.918 --> 00:01:05.358 healthcare system, our medical system, is just as bad at predicting 00:01:05.358 --> 00:01:09.550 what happens to people in it -- patients, others -- 00:01:09.550 --> 00:01:14.163 as those scouts were at predicting what would happen to Billy Beane. 00:01:14.163 --> 00:01:16.844 And yet, every day 00:01:16.844 --> 00:01:18.805 thousands of people in this country 00:01:18.805 --> 00:01:22.731 are diagnosed with preconditions. NOTE Paragraph 00:01:22.731 --> 00:01:26.971 We hear about pre-hypertension, we hear about pre-dementia, 00:01:26.971 --> 00:01:32.307 we hear about pre-anxiety, and I'm pretty sure that I diagnosed myself with 00:01:32.307 --> 00:01:33.684 that in the green room. NOTE Paragraph 00:01:33.684 --> 00:01:38.037 We also refer to subclinical conditions. 00:01:38.037 --> 00:01:42.588 There's subclinical atherosclerosis, subclinical hardening of the arteries, 00:01:42.588 --> 00:01:46.123 obviously linked to heart attacks, potentially. 00:01:46.123 --> 00:01:49.556 One of my favorites is called subclinical acne. 00:01:49.556 --> 00:01:53.523 If you look up subclinical acne, you may find a website, which I did, 00:01:53.523 --> 00:01:57.652 which says that this is the easiest type of acne to treat. 00:01:57.652 --> 00:02:04.267 You don't have the pustules or the redness and inflammation. 00:02:04.267 --> 00:02:07.923 Maybe that's because you don't actually have acne. NOTE Paragraph 00:02:07.923 --> 00:02:14.446 I have a name for all of these conditions, it's another precondition: 00:02:14.446 --> 00:02:16.301 I call them preposterous. 00:02:16.301 --> 00:02:22.360 In baseball, the game follows the pre-game. 00:02:22.360 --> 00:02:24.765 Season follows the pre-season. 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 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. NOTE Paragraph 00:02:33.861 --> 00:02:35.679 We have pre-cancerous lesions, 00:02:35.679 --> 00:02:39.172 which often don't turn into cancer. 00:02:39.172 --> 00:02:41.028 And yet, 00:02:41.028 --> 00:02:44.954 if you take, for example, subclinical osteoporosis, a bone thinning disease, 00:02:44.954 --> 00:02:46.607 the precondition, 00:02:46.607 --> 00:02:49.014 otherwise known as osteopenia, 00:02:49.014 --> 00:02:52.684 you would have to treat 270 women for three years 00:02:52.684 --> 00:02:54.884 in order to prevent one broken bone. 00:02:54.884 --> 00:02:56.493 That's an awful lot of women 00:02:56.493 --> 00:02:59.420 when you multiply by the number of women who were diagnosed 00:02:59.420 --> 00:03:01.309 with this osteopenia. NOTE Paragraph 00:03:01.309 --> 00:03:03.365 And so is it any wonder, 00:03:03.365 --> 00:03:05.895 given all of the costs and the side effects 00:03:05.895 --> 00:03:10.099 of the drugs that we're using to treat these preconditions, that every year 00:03:10.099 --> 00:03:13.772 we're spending more than two trillion dollars on healthcare and yet 00:03:13.772 --> 00:03:17.059 100,000 people a year -- and that's a conservative estimate -- are dying 00:03:17.059 --> 00:03:18.972 not because of the conditions they have, 00:03:18.972 --> 00:03:23.259 but because of the treatments that we're giving them and the complications of those treatments? NOTE Paragraph 00:03:23.259 --> 00:03:26.071 We've medicalized everything 00:03:26.071 --> 00:03:27.040 in this country. 00:03:27.040 --> 00:03:30.423 Women in the audience, I have some 00:03:30.423 --> 00:03:32.422 pretty bad news that you already know, 00:03:32.422 --> 00:03:35.079 and that's that every aspect of your life NOTE Paragraph 00:03:35.079 --> 00:03:36.487 has been medicalized. 00:03:36.487 --> 00:03:38.911 Strike one is when you hit puberty. 00:03:38.911 --> 00:03:43.247 You now have something that happens to you once a month that has been medicalized. 00:03:43.247 --> 00:03:44.063 It's a condition; 00:03:44.063 --> 00:03:45.623 it has to be treated. Strike two 00:03:45.623 --> 00:03:47.223 is if you get pregnant. 00:03:47.223 --> 00:03:50.319 That's been medicalized as well. 00:03:50.319 --> 00:03:52.239 You have to have a high-tech experience 00:03:52.239 --> 00:03:54.967 of pregnancy, otherwise something might go wrong. NOTE Paragraph 00:03:54.967 --> 00:03:58.574 Strike three is menopause. 00:03:58.574 --> 00:04:02.911 We all know what happened when millions of women were given hormone replacement therapy 00:04:02.911 --> 00:04:05.957 for menopausal symptoms 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, 00:04:10.387 --> 00:04:11.395 NIH-funded. 00:04:11.395 --> 00:04:12.323 It said, 00:04:12.323 --> 00:04:16.908 actually, a lot of that hormone replacement therapy may be doing more harm than good 00:04:16.908 --> 00:04:18.692 for many of those women. NOTE Paragraph 00:04:18.692 --> 00:04:20.940 Just in case, 00:04:20.940 --> 00:04:22.572 I don't want to leave the men out -- 00:04:22.572 --> 00:04:24.188 I am one, after all -- 00:04:24.188 --> 00:04:26.877 I have really bad news for all of you in this room, 00:04:26.877 --> 00:04:27.837 and for everyone 00:04:27.837 --> 00:04:29.583 listening and watching elsewhere: 00:04:29.583 --> 00:04:30.796 You all have 00:04:30.796 --> 00:04:33.732 a universally fatal condition. 00:04:33.732 --> 00:04:37.040 So, just take a moment. 00:04:37.040 --> 00:04:38.372 It's called pre-death. 00:04:38.372 --> 00:04:43.444 Every single one of you has it, because you have the risk factor for it, 00:04:43.444 --> 00:04:45.188 which is being alive. NOTE Paragraph 00:04:45.188 --> 00:04:48.246 But I have some good news for you, because 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. 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 00:04:56.205 --> 00:04:58.797 we'll see if that happens for everyone, 00:04:58.797 --> 00:05:02.092 you will be a pre-vivor. NOTE Paragraph 00:05:02.092 --> 00:05:06.908 I made up pre-death. 00:05:06.908 --> 00:05:11.020 If I used someone else's pre-death, I apologize, 00:05:11.020 --> 00:05:12.605 I think I made it up. 00:05:12.605 --> 00:05:14.172 I didn't make up pre-vivor. 00:05:14.172 --> 00:05:19.644 Pre-vivor is what a particular cancer advocacy group would like everyone who 00:05:19.644 --> 00:05:20.916 just has a risk factor, 00:05:20.916 --> 00:05:23.438 but hasn't actually had that cancer, 00:05:23.438 --> 00:05:24.812 to call themselves. 00:05:24.812 --> 00:05:26.387 You are a pre-vivor. NOTE Paragraph 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 00:05:30.860 --> 00:05:32.365 audience, I'd like to suggest 00:05:32.365 --> 00:05:36.572 a reality TV show called "Pre-vivor." 00:05:36.572 --> 00:05:40.073 If you develop a disease, you're off the island. NOTE Paragraph 00:05:40.073 --> 00:05:45.208 But the problem is, we have a system 00:05:45.208 --> 00:05:47.080 that is completely -- 00:05:47.080 --> 00:05:49.007 basically promoted this. 00:05:49.007 --> 00:05:51.873 We've selected, at every point in this system, 00:05:51.873 --> 00:05:55.860 to do what we do, and to give everyone a precondition and then eventually 00:05:55.860 --> 00:05:57.839 a condition, in some cases. 00:05:57.839 --> 00:06:02.332 Start with the doctor-patient relationship. Doctors, most of them, 00:06:02.332 --> 00:06:07.358 are in a fee-for-service system. They are basically incentivized to do more -- 00:06:07.358 --> 00:06:09.015 procedures, tests, 00:06:09.015 --> 00:06:10.681 prescribe medications. NOTE Paragraph 00:06:10.681 --> 00:06:12.046 Patients come to them, 00:06:12.046 --> 00:06:16.046 they want to do something. We're Americans, we can't just stand 00:06:16.046 --> 00:06:18.927 there, we have to do something. And so they want a drug. 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 00:06:22.702 --> 00:06:25.022 you treat it. If the doctor doesn't give you that, 00:06:25.022 --> 00:06:26.846 you go somewhere else. 00:06:26.846 --> 00:06:28.726 That's not very good for doctors' business. 00:06:28.726 --> 00:06:30.414 Or even worse, 00:06:30.414 --> 00:06:34.373 if you are diagnosed with something eventually, and the doctor didn't order that test, 00:06:34.373 --> 00:06:36.597 you get sued. NOTE Paragraph 00:06:36.597 --> 00:06:39.629 We have pharmaceutical companies that are constantly trying to expand 00:06:39.629 --> 00:06:44.973 the indications, expand the number of people who are eligible for a given treatment, 00:06:44.973 --> 00:06:47.766 because that obviously helps their bottom line. We have advocacy groups, 00:06:47.766 --> 00:06:50.021 like the one that's come up with pre-vivor, 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, 00:06:54.261 --> 00:06:56.390 so that they can raise more funds 00:06:56.390 --> 00:06:59.005 and raise visibility, et cetera. NOTE Paragraph 00:06:59.005 --> 00:07:00.845 But this isn't actually, 00:07:00.845 --> 00:07:03.941 despite what journalists typically do, this isn't actually about blaming 00:07:03.941 --> 00:07:05.229 particular players. 00:07:05.229 --> 00:07:07.030 We are all responsible. 00:07:07.030 --> 00:07:08.472 I'm responsible. 00:07:08.472 --> 00:07:11.510 I actually root for the Yankees, I mean talk about 00:07:11.510 --> 00:07:14.702 rooting for the worst possible 00:07:14.702 --> 00:07:17.312 offender when it comes to doing everything you can do. 00:07:17.312 --> 00:07:18.849 Thank you. 00:07:18.849 --> 00:07:22.813 But everyone is responsible. NOTE Paragraph 00:07:22.813 --> 00:07:25.718 I went to medical school, 00:07:25.718 --> 00:07:30.470 and I didn't have a course called How to Think Skeptically, 00:07:30.470 --> 00:07:32.133 or How Not to Order Tests. 00:07:32.133 --> 00:07:34.784 We have this system 00:07:34.784 --> 00:07:37.301 where that's what you do. 00:07:37.301 --> 00:07:39.926 And it actually took being a journalist 00:07:39.926 --> 00:07:43.829 to understand all these incentives. You know, economists like to say, 00:07:43.829 --> 00:07:45.048 there are no bad people, 00:07:45.048 --> 00:07:46.925 there are just bad incentives. NOTE Paragraph 00:07:46.925 --> 00:07:48.533 And that's actually true. 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. 00:07:52.000 --> 00:07:57.300 So when you put another MRI in every corner, you put a robot 00:07:57.300 --> 00:08:00.838 in every hospital saying that everyone has to have robotic surgery. 00:08:00.838 --> 00:08:04.654 Well, we've created a system where if you build it, they will come. 00:08:04.654 --> 00:08:08.181 But you can actually perversely 00:08:08.181 --> 00:08:10.965 tell people to come, convince them 00:08:10.965 --> 00:08:12.654 that they have to come. NOTE Paragraph 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, 00:08:17.462 --> 00:08:19.486 and how we all are part of this problem. 00:08:19.486 --> 00:08:23.142 I was medicalizing every risk factor, I was writing stories, commissioning stories, 00:08:23.142 --> 00:08:26.535 every day, that were trying to, 00:08:26.535 --> 00:08:29.532 not necessarily make people worried, although that was what often happened. NOTE Paragraph 00:08:29.532 --> 00:08:32.555 But, you know, there are ways out. 00:08:32.555 --> 00:08:34.427 I saw my own internist last week, 00:08:34.427 --> 00:08:36.959 and he said to me, 00:08:36.959 --> 00:08:39.476 "You know," and he told me something that 00:08:39.476 --> 00:08:41.950 everyone in this audience could have told me for free, 00:08:41.950 --> 00:08:44.438 but I paid him for the privilege, which is that 00:08:44.438 --> 00:08:46.107 I need to lose some weight. 00:08:46.107 --> 00:08:50.564 Well, he's right. I've had honest-to-goodness high blood pressure 00:08:50.564 --> 00:08:52.277 for a dozen years now, same 00:08:52.277 --> 00:08:54.051 age my father got it, 00:08:54.051 --> 00:08:57.838 and it's a real disease. It's not pre-hypertension, it's actual 00:08:57.838 --> 00:08:59.811 hypertension, high blood pressure. NOTE Paragraph 00:08:59.811 --> 00:09:00.796 Well, he's right, 00:09:00.796 --> 00:09:03.876 but he didn't say to me, 00:09:03.876 --> 00:09:05.563 well, you have pre-obesity or 00:09:05.563 --> 00:09:08.908 you have pre-diabetes, or anything like that. He didn't say, 00:09:08.908 --> 00:09:12.284 better start taking this Statin, you need to lower your cholesterol. 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, 00:09:15.443 --> 00:09:17.444 or just give me a call and let me know how you're doing." NOTE Paragraph 00:09:17.444 --> 00:09:19.484 So that's, to me, 00:09:19.484 --> 00:09:21.115 a way forward. 00:09:21.115 --> 00:09:23.479 Billy Beane, by the way, learned the same thing. 00:09:23.479 --> 00:09:25.015 He learned, 00:09:25.015 --> 00:09:28.532 from watching this kid who he eventually hired, who was really successful for him, 00:09:28.532 --> 00:09:33.407 that it wasn't swinging for the fences, it wasn't swinging at every pitch 00:09:33.407 --> 00:09:38.167 like the sluggers do, which is what all the expensive teams like the Yankees like to -- 00:09:38.176 --> 00:09:39.516 they like to pick up those guys. 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 00:09:44.105 --> 00:09:45.344 the guys who like to walk, 00:09:45.344 --> 00:09:47.048 because getting on base by a walk 00:09:47.048 --> 00:09:49.816 is just as good, and in our healthcare system 00:09:49.816 --> 00:09:51.256 we need to figure out, 00:09:51.256 --> 00:09:52.832 is that really a good pitch 00:09:52.832 --> 00:09:55.750 or should we let it go by and not swing at everything? 00:09:55.750 --> 00:09:57.525 Thanks.