ste
those of you who have seen the film money ball
or read the book by michael lewis
will be similar with the story billy bean
billy was supposed to be a tremendous ballplayer all the scouts told them so
they told his parents that
they predicted that he was going to be a star
what actually happened when he signed the contract and by the way he didn't
want to sign a contract we want to go to college
which is not my mother who actually does love me
that i should do to you and i did
well he didn't do very well he struggled mightily
he got traded a couple times she ended up in the miners most of his career
and he actually ended up in management ended up as a general manager of the
open dates
now for many of you in this room ending up in management which is also what i've
done
is seen as a success
i can assure you that for a kid trying to make it in the base
mad going into management and a success story it's a failure
and what i want to talk to you that today and and share with you is that our
health care system our medical system is just a is bad at predicting
what happens to people in it patients others
those scouts were at predicting what would happen to billy being
everyday
thousands of people in this country
art diagnosed
preconditions
we share about tree hypertension we care about tree dementia
we care about free anxiety and i'm pretty sure that i'd agnes myself with
that in the green room
we also refer to subclinical conditions
there's subclinical atherosclerosis subclinical hardening of the arteries
obviously linked to heart attacks potentially
i'm one of my favorites is called subclinical acne
if you look up subclinical acne you may find a website which i did
which says that this is the easiest type of acne to treat
don't have the post rules are the redness inflammation
maybe that's because you don't actually have acted
i haven't the name for all these conditions it's another precondition
i call them preposterous
in baseball
the game
follows the pre-game
season
follows the preseason
with a lot of these conditions that actually isn't the case releases in the
case all the time it's as if there's a rain delay every single time in many
cases
we have pre-cancerous lesions
often don't turn into cancer
and yet
if you take for example subclinical osteoporosis or bone thinning disease
the precondition
otherwise known as ours to kenya
you'd have to treat two hundred seventy women for three years
notre prevent one broken bone
that's an awful lot of women
when you multiply by the number of women who were diagnosed
with this esther pina
and so is it any wonder
given all the costs and the side effects
of the drugs that were using the treat these preconditions that every year
we're spending more than two trillion dollars on health care and yet one
hundred thousand people a year and that's conservative estimate are dying
not because of the conditions they have
but because of the treatments or giving them and the complications of those
treatments
we've medical as everything
in this country
uh... women in the audience site have some
pretty bad news you already know
and that's that every aspect of your life
has been medical hottest
strike one is when you hit puberty
you'd now have something that happens you once a month that has been medical
institute condition
espy treats right too
is if you get pregnant
you half that's been medical arts as well
you have to have a high tech experience
of pregnancy otherwise something might go wrong
strike three
is menopause
we all know what happened when millions of women were given hormone replacement
therapy
for work for it
menopausal symptoms
for decades until all the suddenly realized because the state came at a big
one than h funded
it said
actually a lot of that commonplace in therapy may be doing more harm than good
of those women
just in case
i don't want to leave the men out
i am one after all
i have really bad news for all of you in this room
and for everyone
listening and watching elsewhere
you all have
a universally fatal condition
just take a moment
it's called pre death
every single one of you has it because you have the risk factor for it
which is being a lot
but i have some good news for you because
i'm a journalist elected and things and happy where forward-thinking way
and that's good news is that if you can survive to the end of my talk which
will see if that happens for everyone
you will be eight revive her
i made up three deaf
if i use someone else's freed up by apologizing
i think i made it up
i didn't make a provider
provider is what a particular cancer advocacy group would like everyone who
just has a risk factor
but hasn't actually had that cancer
to call themselves
your eight revival
is ready to be out here this morning morning if mark burnett is anyone the
audience i'd like to suggest
nellie reality tv show called revival
if you develop the disease you're off the island
the problem is we have a system
that is completely
basically promoted this
we've selected at every point in the system
to do what we do and to give everyone a precondition and then eventually
condition in some cases
start with the doctor patient relationship doctors most of them
in a few for service system they're basically incentivize to do more
procedures tests
prescribe medication
patients come to them
they want to do something where americans we have to we can't just stand
there we have to do something and so they want to be a drug
they wanted treatment they want to be told this is what you have this is how
you treat it let's keep the doctor doesn't give you that
you go somewhere else
that's not very good for doctors business
or even worse
if you are diagnosis something eventually and the a doctor didn't order
that test
you get sued
we have pharmaceutical companies are costly trying to expand
the indications expand the number of people who are eligible for a given
treatment
because that's the help survival money-back disagreements
like the one that's come up with provider
who want to make more and more people fill their at her regrets or might have
a condition
so that they can raise more funds
and raise visibility
etcetera
this is an actually
despite what journalist typically do this is not actually got blaming
particular players
we are all responsible
i'm responsible
i actually was for the yankees and talk about
being sort of rooting for the worst possible
offender when it comes to doing everything you can do
everyone who's responsible uh... hai
you know went to medical school
and high was by didn't have a course called had i think skeptically or
how not to order tests
we have this sort of system
where you know that's what you do
and actually took being a journalist
you know to understand all these incentives you know economists like to
say
down a bit people
there are just banned sentence
and that's actually true
here's what we've created as a sort of field of dreams when it comes to medical
technology
so when you put him another mri_ in every corner you put the robot
in every hospital saying that there's one has to have robotic surgery
well we've created system where if you build it they will come
but
you can actually traverse lee
tell people become tell convince them
that they have to come
it was when i became a journalist and i really realized how i was part of this
problem
and how we all or part of this problem
i was medical ising every risk factor as writing stories commissioning stories
everyday
trying to sort of
but mr lim people worried though that was what often happens
you know there are ways out
i someone internist last week
and
he said to me
you know and he told me something that
everyone in this audience could have told me for free
but i paid him for the privilege which is that
i need to lose some weight
well he's right i've had honest-to-goodness high blood pressure
for a dozen years now stand
age my father got it
and it's a real disease it's not pre hypertension is actual
hypertension high blood pressure
well he's right
and that's but he didn't say to me
well you have pre-opening city or
you have pre diabetes or anything like that he didn't say
better start taking this step mid to lower your cholesterol
they always have gotten some way come back and sing in a bit
we're just in a common higher doing
so that's to me
you know away for work
billy being by the way when the same thing
he learned
from watching this kid in the event rehired who's really successful form
it wasn't swing for the fences that wasn't sweeney at every pitch
like the sluggers do which is what all the expense of teams like the yankees
like to
they like to pick up those guys
this kid solvent you know you gotta watch the guys in depth go out and find
the guys who like to walk
is getting on this by a walk
is just as good and in our health care system
we need to figure out
is that really good pitch
or should we let it go by and not swing everything