Are you healthy if you're symptomless? | Duda Ernő | TEDxDanubia

While our cars are full of sensors for fuel levels, oil pressure and burnt-out bulbs, we only know about the processes in our bodies when our body signals it. With symptoms. According to Ernő Duda, health care needs to change: it should switch from a reactive illness-industry which deals with illnesses with huge costs and heroic struggle (97% of funding goes to healing and only 3% to prevention) to a preventive service which prefers prolongation of the healthy lifespan, and where appropriate, cooperates closely with the private sector.

During the past 20 years, Ernő Duda has founded 16 companies in different industries. He teaches at several universities thanks to his interest in science and his experience in numerous fields from business to biotechnology. He has held several positions at various foundations and non-governmental organizations. He is currently the President of the Hungarian Biotechnology Association and Vice President of the Hungarian Skeptical Society. He says that it is important to him to have a good work-life balance and he likes to talk about such topics as the future of human evolution or the convergence of different technologies while drinking wine.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

I'd like to introduce Béla.

Béla is a successful entrepreneur,

as we can see, he has a Rolex watch,

so he can even become a politician.

He earns a lot of money.

He spends a lot on himself,
he takes care of himself.

Among other things, he buys
a very expensive and safe car

packed full of sensors.

So Béla would know
immediately, in real time,

if there were any problems with his car.

For example, if the pressure
is lower in one of the tires,

or the lambda probe got dirty.

Although there aren't sensors on Béla,

he leads a very healthy,
conscious lifestyle.

He pays attention to his diet,

doesn't drink, doesn't smoke,

he makes an effort to exercise regularly.

He gets vaccinated.

In fact, three or four years ago,

he was even on a manager-screening test
at a private clinic.

So if we were to ask Béla,
"How are you, Béla?"

Béla would say, "I'm great, thanks."

But the truth is, unfortunately,

that Béla won't be among us for long.

Because his blood sugar level's been 12,

which is extremely high,

for at least two years.

In his eyes, kidneys, limbs,

the capillaries
are irreversibly damaged.

In addition, he suffers
from an extreme narrowing of arteries.

And he's got a genetic mutation as well,

which excessively increases
the risk of thrombosis.

Moreover, Béla has atrial fibrillation,

which is an abnormal
behavior of the heart,

that also forms thrombosis.

Unfortunately, it seems likely

that Béla will have an infarction
in the near future.

But if our Béla still survived it,

then there's still that benign tumor,

which has been growing
in his colon for 15 years,

and is beginning to transform
into tumorous tissue.

It could be cut out now
without any consequences

and our Béla could go home.

But by the time they recognize it,

it can be full of metastases,
and then it'll be too late.

How is this possible?

Well, it's possible

because Béla has no symptoms.

And in Hungary someone
can live without trouble

up to the age of 50

without ever getting an ECG,

without ever getting an ultrasound,

or without ever going for a blood test.

For many jobs,

even a compulsory medical examination
doesn't contain a simple blood count.

And what about our socialization?

What does it mean if you have no symptoms?

It must mean I'm healthy.

But that's not true.

Many diseases have been developing
for months, for years or for decades,

by the time they first cause symptoms.

Nature couldn't know
that we would have doctors.

If something goes wrong in the body,

the organism tries
to correct it, to fix it.

Then if it fails,

it'll try to delay the symptoms
as much as possible

because the symptoms
were evolutionary disadvantages.

Either the prehistoric man
didn't catch up with his prey

or couldn't run away from the lion

or simply couldn't pass on his genes.

How many of our friends
are proud of saying,

"I never go to see a doctor."

How many of them say,

"I'm not seeing the doc
because they could find something."

As if normally if we didn't know about it,

that disorder wouldn't exist.

Sure, there are things
that heal by themselves,

but there are a lot that don't.

For example, tumors rarely go away.

But let's admit it,

we all grew up with the notion,
it's always in our minds,

that if there is nothing wrong with me,
why should I see a doctor?

But if we consider

how many people die being fine

up until 10 minutes beforehand,

or at least thinking so,

it can be clearly deduced

that any one of us here and now

can die in 10 minutes
even though they're fine now.

I can see horror on your faces.

But I have some good news:
we can influence this.

It's up to us.

But our current systems
aren't developed for this.

What we now call health care

is in fact sickness care.

A late-reacting, crisis-driven,
reactive system,

where a specialist tries to treat

the isolated problems of patients
who are usually at an advanced stage

with methods meant for the masses,

while the patient
is a passive participant.

Yet, all diseases can be cured
more effectively and cheaply

if we recognize them as soon as possible.

In fact, it's best
not to let them develop.

During the onset of diabetes,

there is a 90% chance

that it can be reversed solely
with lifestyle changes.

90% of the early diagnosed
tumors can be cured,

while in late stages
this is obviously much worse.

Still, more than 97%
of our health expenditures

is devoted to healing,

and we spend less than 3%
for prevention and screening.

So what are we doing?

We are waiting for someone to be very ill.

And when it happens,

we try to fix it with a heroic struggle

and huge costs.

And many times we do succeed.

And what are we doing afterward?

We let them go home.

And we usually wait,
wait until they become ill again.

Also, the core of our doctors' training

is not to keep someone healthy
for as long as possible

and to prevent illnesses.

Doctors learn for many, many years
and through thousands of pages

how to fix something when it goes wrong.

And their material interest
is also not in health

because nobody gets money
if someone is healthy.

The doctor gets money for healing;
the insurer pays for sickness.

Not for health.

If we think it over like this,
how could such a system have developed?

Actually, it's very simple.

Because apart from the recent past,
for thousands of years,

doctors had only two ways to learn

whether the patient had any problems:

either the patient
had visible signs on themselves,

or they said,

"I have something wrong with me."

There weren't any other
possibilities. Nothing.

But it's not the case today.

Not only have doctors
other tools, but we do too.

Nowadays anyone can choose
to have a genetic screening test

for a few tens of thousands of forints.

Not only for themselves,
but even for their entire intestinal flora

of which a lot of illnesses
can be predicted.

For a few tens of thousands of forints,
anyone can buy portable devices

that measure their pulse or ECG
throughout the day,

or their blood oxygen levels, breathing,
brain functions, sleep cycles,

or they measure the exact blood pressure
just by touching them to the forehead.

Anyone can buy a smart toilet,
that analyzes end-products,

and sends the results
to their mobile phone.

We will soon test blood sugar and other
blood components without pricking.

What kind of screening I go for
is solely my decision.

Yeah, but I hear from some
of my smart doctor friends:

"It's not so good because a lot of
screenings aren't accurate enough."

And they're absolutely right.

We have some tests
which aren't accurate enough,

especially if we study the test results,
separately, in themselves.

One hundred years ago
it was super dangerous to fly.

However, we didn't choose the option
to travel to America by boat,

but we made air travel safer.

That is to say our methods
will become more accurate,

but until then we can do more tests,

from which we get
much more accurate results.

My doctor friends say about this:

"Not all screening tests are worth it."

Namely, a colon examination -

that our poor Béla would need too -

costs 6,000 forints, at least
the institutions get that much for it,

and no more than a few tens of thousands
of forints privately.

This must be contrasted, let's say,

with treatment of a colon tumor
recognized at a late stage,

which can cost
from 10 to 20 million forints.

Obviously, it's also
worth it on a social level.

But many tests aren't worth it
on the population level.

They're absolutely right.

But I'm not the population.

My mother, my brother or my child
aren't the population either.

What is worth it for the insurer
and what I choose

are two completely different questions.

Currently, the most sensitive way
to recognize early-stage tumors

is the so-called PET CT scan.

It's a very expensive test.

It's totally unsuitable for testing
on a societal level, that's for sure.

A couple of years ago,
an elderly couple decided

that they would pay for such a test
for each other for Christmas

from their saved money.

The results were shocking.

Both turned out to have tumors.

In addition, they had different
but aggressive tumors with poor prognoses.

Since being recognized early
and managed in time,

both were cured
and are still healthy today.

If they'd started to treat them
when the first symptoms occurred,

it's sure neither of them
would have survived.

What we're doing now

is a bit like if we had developed
a supercar with tremendous effort,

driven by a very professional
driver at night without any lights.

And when the obstacles come,

we would try to avoid them
with incredible feats

or at least minimize the losses,

instead of turning on the headlights,

so that we could see the obstacles
as they come and avoid them.

We would go much farther,
with much less damage.

We have to transform this system not just
because of the development of technology

but because it's untenable.

In all developed countries of the world,

health expenditures increase
about 2-3% faster than the GDP.

In addition, patients want to participate
more actively in their own health care.

Science, our tools, our sensors, and
the development of artificial intelligence

combined with the explosive growth

of genetic and other
biological information

will soon enable us to always drive
with our headlights on.

Health will be more about health,

disease prevention,

and it'll be a proactive,
not a reactive system.

And when necessary,
healing will be personalized

with individual treatment,

the patient won't be treated
with methods for the masses.

They'll be an active participant
in the process.

In addition, our health care,
especially diagnostics,

will move into our homes very soon.

I know it sounds a bit futuristic,

but think about it this way:
it wasn't so long ago,

when the computer
was a roomful of equipment.

Nobody would have thought that such
a thing would ever be in our apartments.

And nowadays we carry the knowledge
of 100,000 such devices

in our pockets or even our watches,

which are the perfect devices

to collect and process
information about our health.

Fortunately, the culture
of screenings and prevention

is starting to integrate
into our lives in Hungary.

But, in truth, we aren't ready for it yet

either in terms
of instrumentation or personnel.

We still need to redesign
our financial system,

supply system, education,
but most of all our thinking.

But until these changes happen,

we can decide if we want to be
passive participants in sick-care,

and see if we survive the next obstacle,

or if we take our health and the health
of our loved ones into our own hands.

Thank you.

(Applause)