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Daniel Levitin: How to stay calm when you know you'll be stressed
Deniels Levitins: Kā saglabāt mieru, ja zināt, ka būsiet satraukts.
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Stresa apstākļos jūs neesat labākajā formā. Smadzenes ir attīstījušās tūkstošiem gadu un stresa situācijās izdala kortizolu, kas bremzē racionālu, loģisku domāšanu, bet, iespējams, palīdz izdzīvot, ja uzbrūk, piemēram, lauva. Neirozinātnieks Deniels Levitins domā, ka pastāv veidi kā "pre mortem" izvairīties no kritiskām kļūdām stresa situācijās, kad domāšana aizmiglojas. "Mēs visi dažreiz kļūdāmies," viņš saka. "Svarīgi ir domāt uz priekšu un paredzēt, kādas šīs kļūdas varētu būt."
Daniel Levitin - Neuroscientist
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Daniel Levitin incorporates findings from neuroscience into everyday life. Full bio
Double-click the English transcript below to play the video.
00:13
A few years ago,
I broke into my own house.
I broke into my own house.
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Pirms dažiem gadiem
es ielauzos pats savā mājā.
es ielauzos pats savā mājā.
Biju tikko pārradies mājās,
00:16
I had just driven home,
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00:18
it was around midnight
in the dead of Montreal winter,
in the dead of Montreal winter,
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tā ap pusnakti Monreālas ziemas spelgonī,
00:20
I had been visiting my friend,
Jeff, across town,
Jeff, across town,
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no ciemošanās pie drauga Džefa
pilsētas otrā malā,
pilsētas otrā malā,
00:23
and the thermometer on the front porch
read minus 40 degrees --
read minus 40 degrees --
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un termometrs uz lieveņa rādīja mīnus 40,
00:27
and don't bother asking
if that's Celsius or Fahrenheit,
if that's Celsius or Fahrenheit,
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– nejautājiet, vai tas ir
pēc Celsija vai Fārenheita,
pēc Celsija vai Fārenheita,
00:30
minus 40 is where the two scales meet --
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jo pie mīnus 40 abas skalas satiekas, –
00:33
it was very cold.
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bija ļoti auksts.
00:34
And as I stood on the front porch
fumbling in my pockets,
fumbling in my pockets,
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Stāvēdams uz lieveņa,
taustīdamies pa kabatām,
taustīdamies pa kabatām,
00:37
I found I didn't have my keys.
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es sapratu, ka man nav atslēgu.
00:40
In fact, I could see them
through the window,
through the window,
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Patiesībā es tās varēju saskatīt caur logu
00:42
lying on the dining room table
where I had left them.
where I had left them.
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uz ēdamistabas galda,
kur biju tās atstājis.
kur biju tās atstājis.
00:45
So I quickly ran around
and tried all the other doors and windows,
and tried all the other doors and windows,
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Es veikli apskrēju ap māju un pārbaudīju
visas pārējās durvis un logus,
visas pārējās durvis un logus,
00:48
and they were locked tight.
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un tie visi bija cieši aizvērti.
00:50
I thought about calling a locksmith --
at least I had my cellphone,
at least I had my cellphone,
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Es apsvēru izsaukt atslēdznieku,
vismaz telefons man bija,
vismaz telefons man bija,
00:53
but at midnight, it could take a while
for a locksmith to show up,
for a locksmith to show up,
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bet ap pusnakti paietu krietns laiks,
līdz viņš ierastos,
līdz viņš ierastos,
00:56
and it was cold.
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un bija auksts.
01:00
I couldn't go back to my friend
Jeff's house for the night
Jeff's house for the night
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Es nevarēju doties atpakaļ
un pārnakšņot pie Džefa,
un pārnakšņot pie Džefa,
jo agri no rīta man bija jālido uz Eiropu
01:03
because I had an early flight
to Europe the next morning,
to Europe the next morning,
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un man vajadzēja pasi un ceļasomu.
01:05
and I needed to get
my passport and my suitcase.
my passport and my suitcase.
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01:08
So, desperate and freezing cold,
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Izmisis un pārsalis,
01:10
I found a large rock and I broke
through the basement window,
through the basement window,
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es uzmeklēju palielu akmeni
un izsitu pagraba logu,
un izsitu pagraba logu,
01:14
cleared out the shards of glass,
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novācu stikla lauskas,
01:16
I crawled through,
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ielīdu iekšā,
01:17
I found a piece of cardboard
and taped it up over the opening,
and taped it up over the opening,
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atradu kartona gabalu un aizlīmēju logu.
01:21
figuring that in the morning,
on the way to the airport,
on the way to the airport,
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Es nospriedu, ka no rīta ceļā uz lidostu
piezvanīšu apsaimniekotājam
un palūgšu logu iestiklot.
un palūgšu logu iestiklot.
01:24
I could call my contractor
and ask him to fix it.
and ask him to fix it.
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01:26
This was going to be expensive,
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Tas būs dārgi,
bet ne dārgāk kā pusnaktī
izsaukt atslēdznieku,
izsaukt atslēdznieku,
01:28
but probably no more expensive
than a middle-of-the-night locksmith,
than a middle-of-the-night locksmith,
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01:31
so I figured, under the circumstances,
I was coming out even.
I was coming out even.
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tāpēc es nospriedu, ka šajos apstākļos
izmaksas būs līdzīgas.
izmaksas būs līdzīgas.
01:36
Now, I'm a neuroscientist by training
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Es pēc izglītības esmu neirozinātnieks
01:39
and I know a little bit
about how the brain performs under stress.
about how the brain performs under stress.
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un mazliet zinu, kā smadzenes
strādā stresa apstākļos.
strādā stresa apstākļos.
01:43
It releases cortisol
that raises your heart rate,
that raises your heart rate,
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Tās izdala kortizolu,
kas paātrina sirdsdarbību.
kas paātrina sirdsdarbību.
01:46
it modulates adrenaline levels
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Tās paaugstina adrenalīna līmeni
01:49
and it clouds your thinking.
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un aizmiglo domāšanu.
01:51
So the next morning,
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Tāpēc nākamajā rītā,
01:53
when I woke up on too little sleep,
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kad pamodos neizgulējies,
01:55
worrying about the hole in the window,
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noraizējies par izsisto logu,
01:58
and a mental note
that I had to call my contractor,
that I had to call my contractor,
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ar domām par zvanu apsaimniekotājam
02:01
and the freezing temperatures,
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un lielo aukstumu,
02:02
and the meetings I had upcoming in Europe,
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un gaidāmajām sanāksmēm Eiropā,
02:05
and, you know, with all
the cortisol in my brain,
the cortisol in my brain,
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un ar to visu kortizolu smadzenēs,
02:08
my thinking was cloudy,
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mana domāšana bija miglaina,
02:10
but I didn't know it was cloudy
because my thinking was cloudy.
because my thinking was cloudy.
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bet es nezināju, ka tā bija miglaina,
jo mana domāšana bija miglaina.
jo mana domāšana bija miglaina.
02:13
(Laughter)
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(Smiekli)
02:15
And it wasn't until I got
to the airport check-in counter,
to the airport check-in counter,
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Un tikai tajā brīdī, kad nonācu
pie lidostas reģistrācijas,
pie lidostas reģistrācijas,
02:18
that I realized I didn't have my passport.
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es aptvēru, ka man nav līdzi pases.
02:20
(Laughter)
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(Smiekli)
02:22
So I raced home in the snow
and ice, 40 minutes,
and ice, 40 minutes,
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Tā nu es pa sniegu un ledu
traucos mājup, 40 minūtes,
traucos mājup, 40 minūtes,
02:26
got my passport,
raced back to the airport,
raced back to the airport,
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paņēmu pasi un traucos atpakaļ uz lidostu.
02:28
I made it just in time,
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Es paspēju pēdējā brīdī,
02:30
but they had given away
my seat to someone else,
my seat to someone else,
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bet mana sēdvieta
bija atdota kādam citam,
bija atdota kādam citam,
02:32
so I got stuck in the back of the plane,
next to the bathrooms,
next to the bathrooms,
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tāpec mani nosēdināja
lidmašīnas aizmugurē pie tualetēm,
lidmašīnas aizmugurē pie tualetēm,
02:35
in a seat that wouldn't recline,
on an eight-hour flight.
on an eight-hour flight.
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krēslā, kuru nevarēja atlocīt,
un jālido bija astoņas stundas.
un jālido bija astoņas stundas.
02:39
Well, I had a lot of time to think
during those eight hours and no sleep.
during those eight hours and no sleep.
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Man bija daudz laika pārdomām
šo astoņu bezmiega stundu laikā.
šo astoņu bezmiega stundu laikā.
(Smiekli)
02:43
(Laughter)
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Un es sāku prātot,
vai kaut ko var darīt citādāk,
vai kaut ko var darīt citādāk,
02:44
And I started wondering,
are there things that I can do,
are there things that I can do,
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02:47
systems that I can put into place,
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izveidot kādu sistēmu,
02:49
that will prevent bad things
from happening?
from happening?
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kas novērstu šādus negadījumus.
02:51
Or at least if bad things happen,
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Vai vismaz, ja negadījumi notiek,
02:53
will minimize the likelihood
of it being a total catastrophe.
of it being a total catastrophe.
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varētu minimizēt
totālas katastrofas iespējamību.
totālas katastrofas iespējamību.
Es sāku par to domāt,
02:59
So I started thinking about that,
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bet manas domas izkristalizējās
tikai pēc aptuveni mēneša.
tikai pēc aptuveni mēneša.
03:00
but my thoughts didn't crystallize
until about a month later.
until about a month later.
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Es vakariņoju ar kolēģi Deniju Kānemanu,
Nobela prēmijas ieguvēju,
Nobela prēmijas ieguvēju,
03:03
I was having dinner with my colleague,
Danny Kahneman, the Nobel Prize winner,
Danny Kahneman, the Nobel Prize winner,
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un nedaudz kaunīgi
pastāstīju par izsisto logu
pastāstīju par izsisto logu
03:07
and I somewhat embarrassedly told him
about having broken my window,
about having broken my window,
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03:10
and, you know, forgotten my passport,
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un aizmirsto pasi,
03:13
and Danny shared with me
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un Denijs man pastāstīja,
03:14
that he'd been practicing
something called prospective hindsight.
something called prospective hindsight.
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ka viņš praktizē tā saucamo
perspektīvo atpakaļskatu.
perspektīvo atpakaļskatu.
03:19
(Laughter)
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(Smiekli)
03:20
It's something that he had gotten
from the psychologist Gary Klein,
from the psychologist Gary Klein,
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Viņš to esot aizguvis
no psihologa Gerija Kleina,
no psihologa Gerija Kleina,
03:24
who had written about it
a few years before,
a few years before,
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kas par to rakstījis pirms dažiem gadiem,
03:26
also called the pre-mortem.
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to dēvē arī par pre mortem.
03:28
Now, you all know what the postmortem is.
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Jūs droši vien zināt, kas ir post mortem.
03:30
Whenever there's a disaster,
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Kad notiek nelaime,
03:31
a team of experts come in and they try
to figure out what went wrong, right?
to figure out what went wrong, right?
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ekspertu komanda mēģina izzināt,
kas nogāja greizi, vai ne?
kas nogāja greizi, vai ne?
03:36
Well, in the pre-mortem, Danny explained,
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Savukārt, veicot pre mortem,
kā skaidroja Denijs,
kā skaidroja Denijs,
03:38
you look ahead and you try to figure out
all the things that could go wrong,
all the things that could go wrong,
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jūs skatāties nākotnē un mēģināt
paredzēt visu, kas varētu noiet greizi,
paredzēt visu, kas varētu noiet greizi,
03:42
and then you try to figure out
what you can do
what you can do
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un tad jūs mēģināt izdomāt,
ko varētu darīt,
ko varētu darīt,
lai šīs lietas novērstu
un minimizētu zaudējumus.
un minimizētu zaudējumus.
03:45
to prevent those things from happening,
or to minimize the damage.
or to minimize the damage.
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03:48
So what I want to talk to you about today
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Tātad šodien es vēlos ar jums runāt
03:51
are some of the things we can do
in the form of a pre-mortem.
in the form of a pre-mortem.
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par lietām, ko mēs varam veikt
pre mortem formā.
pre mortem formā.
03:55
Some of them are obvious,
some of them are not so obvious.
some of them are not so obvious.
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Dažas no tām ir acīmredzamas,
dažas ne tik acīmredzamas.
dažas ne tik acīmredzamas.
03:58
I'll start with the obvious ones.
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Sākšu ar acīmredzamajām.
03:59
Around the home, designate a place
for things that are easily lost.
for things that are easily lost.
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Nozīmējiet mājas tuvumā vietu lietām,
kas var viegli pazust.
kas var viegli pazust.
04:05
Now, this sounds
like common sense, and it is,
like common sense, and it is,
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Tas izklausās pats par sevi saprotams,
04:09
but there's a lot of science
to back this up,
to back this up,
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bet tam ir daudz zinātnisku pamatojumu,
04:12
based on the way our spatial memory works.
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kas balstās tajā, kā darbojas
mūsu telpiskā atmiņa.
mūsu telpiskā atmiņa.
04:15
There's a structure in the brain
called the hippocampus,
called the hippocampus,
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Smadzenēs ir tāda struktūra hipokamps,
04:18
that evolved over tens
of thousands of years,
of thousands of years,
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kas veidojusies tūkstošiem gadu,
04:21
to keep track of the locations
of important things --
of important things --
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un tā ielāgo, kur atrodas svarīgākais –
04:25
where the well is,
where fish can be found,
where fish can be found,
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kur ir ūdens avots, kur var noķert zivis,
04:27
that stand of fruit trees,
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kur aug augļu koki,
04:30
where the friendly and enemy tribes live.
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kur dzīvo draudzīgās ciltis
un kur – naidīgās.
un kur – naidīgās.
04:32
The hippocampus is the part of the brain
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Hipokamps ir smadzeņu daļa,
kas Londonas taksometru
vadītājiem kļūst milzīga.
vadītājiem kļūst milzīga.
04:34
that in London taxicab drivers
becomes enlarged.
becomes enlarged.
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04:38
It's the part of the brain
that allows squirrels to find their nuts.
that allows squirrels to find their nuts.
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Tā ir tā smadzeņu daļa,
kas vāverēm ļauj atrast riekstus.
kas vāverēm ļauj atrast riekstus.
04:41
And if you're wondering,
somebody actually did the experiment
somebody actually did the experiment
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Ja gribat zināt, šāds eksperiments
patiešām ir veikts –
patiešām ir veikts –
vāverēm tika atņemtas ožas spējas,
04:44
where they cut off
the olfactory sense of the squirrels,
the olfactory sense of the squirrels,
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04:47
and they could still find their nuts.
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un tās tik un tā spēja atrast riekstus.
04:49
They weren't using smell,
they were using the hippocampus,
they were using the hippocampus,
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Tās neizmantoja ožu,
tās izmantoja hipokampu,
tās izmantoja hipokampu,
šo īpašo mehānismu, kas izstrādājies
smadzenēs, lai atrastu lietas.
smadzenēs, lai atrastu lietas.
04:52
this exquisitely evolved mechanism
in the brain for finding things.
in the brain for finding things.
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04:57
But it's really good for things
that don't move around much,
that don't move around much,
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Tas ir tiešām labs lietām,
kas nemaina savu atrašanos,
kas nemaina savu atrašanos,
05:01
not so good for things that move around.
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bet ne tik labs tādām, kas kustas.
05:03
So this is why we lose car keys
and reading glasses and passports.
and reading glasses and passports.
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Tāpēc mēs arvien zaudējam
mašīnas atslēgas, lasāmbrilles un pasi.
mašīnas atslēgas, lasāmbrilles un pasi.
05:07
So in the home,
designate a spot for your keys --
designate a spot for your keys --
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Tāpēc mājās paredziet vietu jūsu atslēgām,
05:10
a hook by the door,
maybe a decorative bowl.
maybe a decorative bowl.
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kādu āķi pie durvīm vai dekoratīvu trauku.
05:13
For your passport, a particular drawer.
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Pasei nozīmējiet noteiktu atvilktni,
05:15
For your reading glasses,
a particular table.
a particular table.
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lasāmbrillēm – noteiktu galdu.
05:18
If you designate a spot
and you're scrupulous about it,
and you're scrupulous about it,
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Ja nozīmējat kādu vietu
un to stingri ievērojat,
un to stingri ievērojat,
05:21
your things will always be there
when you look for them.
when you look for them.
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lietas būs vienmēr tur, kur tās meklējat.
05:24
What about travel?
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Kā tad ar ceļojumiem?
05:25
Take a cell phone picture
of your credit cards,
of your credit cards,
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Saglabājiet telefonā
savu kredītkaršu foto,
savu kredītkaršu foto,
05:28
your driver's license, your passport,
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autovadītāja apliecību, pasi,
05:30
mail it to yourself so it's in the cloud.
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nosūtiet tos sev mākonī.
05:32
If these things are lost or stolen,
you can facilitate replacement.
you can facilitate replacement.
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Ja šīs lietas pazūd vai nozog,
jums būs vieglāk tās atgūt.
jums būs vieglāk tās atgūt.
05:37
Now these are some rather obvious things.
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Šīs ir visai acīmredzamas lietas.
05:39
Remember, when you're under stress,
the brain releases cortisol.
the brain releases cortisol.
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Atcerieties, ka stresa apstākļos,
smadzenes izdala kortizolu.
smadzenes izdala kortizolu.
05:43
Cortisol is toxic,
and it causes cloudy thinking.
and it causes cloudy thinking.
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Kortizols ir toksisks
un aizmiglo domāšanu.
un aizmiglo domāšanu.
05:46
So part of the practice of the pre-mortem
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Daļa no pre mortem prakses
05:49
is to recognize that under stress
you're not going to be at your best,
you're not going to be at your best,
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ir atzīt, ka stresa apstākļos
jūsu lemtspēja pasliktināsies
jūsu lemtspēja pasliktināsies
05:53
and you should put systems in place.
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un ir jāievieš sistēmas.
05:55
And there's perhaps
no more stressful a situation
no more stressful a situation
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Un droši vien
nav lielākas stresa situācijas
nav lielākas stresa situācijas
05:58
than when you're confronted
with a medical decision to make.
with a medical decision to make.
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kā medicīnisku lēmumu pieņemšana.
06:02
And at some point, all of us
are going to be in that position,
are going to be in that position,
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Kādā dzīves brīdī mēs visi
nonāksim šādā situācijā,
nonāksim šādā situācijā,
06:05
where we have to make
a very important decision
a very important decision
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kad jāpieņem kāds svarīgs lēmums
06:07
about the future of our medical care
or that of a loved one,
or that of a loved one,
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par medicīnisku aprūpi
sev vai sev tuvajiem,
sev vai sev tuvajiem,
06:11
to help them with a decision.
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palīdzot tiem pieņemt lēmumu.
06:12
And so I want to talk about that.
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Tāpēc es vēlos runāt par to.
Es runāšu par pavisam
noteiktu medicīnisku situāciju,
noteiktu medicīnisku situāciju,
06:14
And I'm going to talk about
a very particular medical condition.
a very particular medical condition.
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06:17
But this stands as a proxy for all kinds
of medical decision-making,
of medical decision-making,
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bet tā ir līdzīga visa veida
medicīnisku lēmumu pieņemšanai
medicīnisku lēmumu pieņemšanai
06:21
and indeed for financial decision-making,
and social decision-making --
and social decision-making --
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un pat finanšu lēmumu pieņemšanai,
un sociāla rakstura lēmumiem,
un sociāla rakstura lēmumiem,
06:25
any kind of decision you have to make
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jebkāda veida lēmumiem, kas jāpieņem,
06:27
that would benefit from a rational
assessment of the facts.
assessment of the facts.
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liekot lietā racionālu faktu apsvēršanu.
06:31
So suppose you go to your doctor
and the doctor says,
and the doctor says,
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Pieņemsim, ka dodaties
pie ārsta un ārsts saka:
pie ārsta un ārsts saka:
06:34
"I just got your lab work back,
your cholesterol's a little high."
your cholesterol's a little high."
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"Es tikko saņēmu jūsu analīzes,
holesterīna līmenis
ir mazliet paaugstināts."
ir mazliet paaugstināts."
06:39
Now, you all know that high cholesterol
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Jūs visi zināt, ka augsts
holesterīna līmenis
holesterīna līmenis
06:42
is associated with an increased risk
of cardiovascular disease,
of cardiovascular disease,
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nozīmē augstu kardiovaskulāro slimību,
sirdstriekas un insulta risku.
sirdstriekas un insulta risku.
06:46
heart attack, stroke.
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06:47
And so you're thinking
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Tāpēc jūs domājat,
ka augsts holesterīna līmenis
nav nekas labs, un ārsts saka:
nav nekas labs, un ārsts saka:
06:49
having high cholesterol
isn't the best thing,
isn't the best thing,
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06:51
and so the doctor says,
"You know, I'd like to give you a drug
"You know, I'd like to give you a drug
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"Ziniet, es gribētu jums izrakstīt zāles,
06:54
that will help you
lower your cholesterol, a statin."
lower your cholesterol, a statin."
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kas palīdzēs pazemināt
holesterīna līmeni – statīnu."
holesterīna līmeni – statīnu."
06:57
And you've probably heard of statins,
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Droši vien esat dzirdējuši,
ka statīni ir vienas no visvairāk
izrakstītajām zālēm mūsdienu pasaulē,
izrakstītajām zālēm mūsdienu pasaulē,
06:59
you know that they're among
the most widely prescribed drugs
the most widely prescribed drugs
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07:01
in the world today,
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jūs varbūt pat pazīstat
cilvēkus, kas to lieto.
cilvēkus, kas to lieto.
07:03
you probably even know
people who take them.
people who take them.
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Un jūs nospriežat:
"Jā! Dodiet man statīnu."
"Jā! Dodiet man statīnu."
07:05
And so you're thinking,
"Yeah! Give me the statin."
"Yeah! Give me the statin."
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Bet tajā brīdī jums jāuzdod jautājums,
07:07
But there's a question
you should ask at this point,
you should ask at this point,
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07:10
a statistic you should ask for
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jānoskaidro kāds statistisks rādītājs,
07:11
that most doctors
don't like talking about,
don't like talking about,
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par ko vairums ārstu negrib runāt
07:14
and pharmaceutical companies
like talking about even less.
like talking about even less.
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un farmācijas uzņēmumi vēl jo mazāk.
07:18
It's for the number needed to treat.
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Tas ir ārstēto skaits uz vienu izārstēto.
07:21
Now, what is this, the NNT?
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Kas ir šis NNT indekss?
07:23
It's the number of people
that need to take a drug
that need to take a drug
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Tas ir cilvēku skaits,
kuriem jālieto šīs zāles
kuriem jālieto šīs zāles
07:26
or undergo a surgery
or any medical procedure
or any medical procedure
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vai jāveic operācija
vai medicīniska procedūra,
vai medicīniska procedūra,
07:29
before one person is helped.
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lai vienam cilvēkam kļūtu labāk.
07:31
And you're thinking,
what kind of crazy statistic is that?
what kind of crazy statistic is that?
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Un jūs nodomāsiet:
kas tad tā par tādu dīvainu statistiku?
kas tad tā par tādu dīvainu statistiku?
07:34
The number should be one.
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Indeksam jābūt 1.
Mans ārsts man neizrakstītu
neko tādu, kas nelīdz.
neko tādu, kas nelīdz.
07:35
My doctor wouldn't prescribe
something to me
something to me
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07:37
if it's not going to help.
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07:39
But actually, medical practice
doesn't work that way.
doesn't work that way.
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Īstenībā medicīna tā nestrādā.
07:41
And it's not the doctor's fault,
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Un tā nav ārsta vaina,
ja vispār kāds jāvaino,
vainojiet zinātniekus, ieskaitot mani.
vainojiet zinātniekus, ieskaitot mani.
07:43
if it's anybody's fault,
it's the fault of scientists like me.
it's the fault of scientists like me.
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Mēs neesam gana labi izpratuši
pamatā esošos mehānismus.
pamatā esošos mehānismus.
07:46
We haven't figured out
the underlying mechanisms well enough.
the underlying mechanisms well enough.
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07:48
But GlaxoSmithKline estimates
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But GlaxoSmithKline lēš,
07:51
that 90 percent of the drugs work
in only 30 to 50 percent of the people.
in only 30 to 50 percent of the people.
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ka 90 procenti zāļu palīdz
tikai 30 līdz 50 procentiem cilvēku.
tikai 30 līdz 50 procentiem cilvēku.
07:56
So the number needed to treat
for the most widely prescribed statin,
for the most widely prescribed statin,
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Tātad NNT indekss
visvairāk izrakstītajam statīnam,
visvairāk izrakstītajam statīnam,
08:00
what do you suppose it is?
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kā jūs domājat, cik tas ir?
08:02
How many people have to take it
before one person is helped?
before one person is helped?
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Cik cilvēkiem tas jālieto,
lai palīdzētu vienam no tiem?
lai palīdzētu vienam no tiem?
08:05
300.
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1200
300.
08:07
This is according to research
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Tas ir balstīts pētījumos,
08:08
by research practitioners
Jerome Groopman and Pamela Hartzband,
Jerome Groopman and Pamela Hartzband,
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ko veikuši pētnieki Džeroms Grūpmens
un Pamela Harcbenda
un Pamela Harcbenda
08:12
independently confirmed by Bloomberg.com.
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un neatkarīgi apstiprinājis Bloomberg.com.
08:14
I ran through the numbers myself.
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Es pats pārskatīju šos skaitļus.
08:17
300 people have to
take the drug for a year
take the drug for a year
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300 cilvēkiem gadu jālieto šīs zāles,
08:20
before one heart attack, stroke
or other adverse event is prevented.
or other adverse event is prevented.
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lai novērstu vienu sirdstrieku, insultu
vai citu ļaundabīgu iznākumu.
vai citu ļaundabīgu iznākumu.
Jūs droši vien nodomāsiet:
08:24
Now you're probably thinking,
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"Labs ir, iespēja ir 1 pret 300,
ka mans holesterīns pazemināsies.
ka mans holesterīns pazemināsies.
08:25
"Well, OK, one in 300 chance
of lowering my cholesterol.
of lowering my cholesterol.
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08:28
Why not, doc? Give me
the prescription anyway."
the prescription anyway."
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Kāpēc nepamēģināt?
Dakter, raksti tik ārā!"
Dakter, raksti tik ārā!"
08:30
But you should ask at this point
for another statistic,
for another statistic,
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Bet tobrīd vajadzētu taujāt
pēc vēl kāda statistikas rādītāja,
pēc vēl kāda statistikas rādītāja,
08:33
and that is, "Tell me
about the side effects." Right?
about the side effects." Right?
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proti, blaknēm, vai ne?
08:36
So for this particular drug,
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Šīm konkrētajām zālēm
08:37
the side effects occur
in five percent of the patients.
in five percent of the patients.
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blaknes vērojamas 5% pacientu.
08:41
And they include terrible things --
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Un dažas no tām ir briesmīgas
08:43
debilitating muscle and joint pain,
gastrointestinal distress --
gastrointestinal distress --
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– vājinošas muskuļu un locītavu sāpes,
gastroenteroloģiskas problēmas, –
gastroenteroloģiskas problēmas, –
08:47
but now you're thinking, "Five percent,
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bet jūs nospriežat: "Pieci procenti,
diez vai es būšu to vidū,
diez vai es būšu to vidū,
08:49
not very likely
it's going to happen to me,
it's going to happen to me,
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ņemšu tās zāles tik un tā."
08:51
I'll still take the drug."
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Bet pagaidiet – atcerieties,
ka stresa apstākļos nedomājat skaidri.
ka stresa apstākļos nedomājat skaidri.
08:52
But wait a minute.
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08:54
Remember under stress
you're not thinking clearly.
you're not thinking clearly.
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Tāpēc apdomājiet priekšlaikus,
kā iesiet tam cauri,
kā iesiet tam cauri,
08:56
So think about how you're going
to work through this ahead of time,
to work through this ahead of time,
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lai šī spriedumu ķēde
nebūtu jāveic uz vietas.
nebūtu jāveic uz vietas.
08:59
so you don't have to manufacture
the chain of reasoning on the spot.
the chain of reasoning on the spot.
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300 cilvēku lieto šīs zāles, vai ne?
09:02
300 people take the drug, right?
One person's helped,
One person's helped,
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Vienam cilvēkam tās palīdz,
5% no 300 ir blaknes,
5% no 300 ir blaknes,
09:05
five percent of those 300
have side effects,
have side effects,
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09:07
that's 15 people.
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tie ir 15 cilvēki.
09:09
You're 15 times more likely
to be harmed by the drug
to be harmed by the drug
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Ir 15 reizes lielāka iespējamība,
ka zāles jums kaitēs,
ka zāles jums kaitēs,
09:13
than you are to be helped by the drug.
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nekā ka tās jums palīdzēs.
09:16
Now, I'm not saying whether you
should take the statin or not.
should take the statin or not.
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Es nesaku, ka jums būtu
vai nebūtu jālieto statīns.
vai nebūtu jālieto statīns.
Es tikai saku, ka jums
ar ārstu tas jāpārrunā.
ar ārstu tas jāpārrunā.
09:19
I'm just saying you should have
this conversation with your doctor.
this conversation with your doctor.
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To prasa medicīnas ētika,
09:22
Medical ethics requires it,
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09:24
it's part of the principle
of informed consent.
of informed consent.
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tā ir daļa no informēta lēmuma
pieņemšanas principa.
pieņemšanas principa.
09:26
You have the right to have access
to this kind of information
to this kind of information
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Jums ir tiesības
piekļūt šādai informācijai,
piekļūt šādai informācijai,
09:29
to begin the conversation about whether
you want to take the risks or not.
you want to take the risks or not.
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lai uzsāktu sarunu par to,
vai vēlaties uzņemties risku.
vai vēlaties uzņemties risku.
09:33
Now you might be thinking
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Jūs varētu nodomāt,
09:34
I've pulled this number
out of the air for shock value,
out of the air for shock value,
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ka es šo skaitli pagrābu
no gaisa, lai jūs šokētu,
no gaisa, lai jūs šokētu,
09:37
but in fact it's rather typical,
this number needed to treat.
this number needed to treat.
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bet īstenībā tas ir
visai tipisks NNT indekss.
visai tipisks NNT indekss.
09:40
For the most widely performed surgery
on men over the age of 50,
on men over the age of 50,
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Visvairāk veiktajai operācijai
vīriešiem pēc 50 gadu vecuma,
vīriešiem pēc 50 gadu vecuma,
09:45
removal of the prostate for cancer,
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prostatas vēža izņemšanai,
09:47
the number needed to treat is 49.
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NNT indekss ir 49.
09:50
That's right, 49 surgeries are done
for every one person who's helped.
for every one person who's helped.
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Tieši tā! Ir vajadzīgas 49 operācijas,
lai vienam cilvēkam tas palīdzētu.
lai vienam cilvēkam tas palīdzētu.
09:54
And the side effects in that case
occur in 50 percent of the patients.
occur in 50 percent of the patients.
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Un blaknes šajā gadījumā ir 50% pacientu.
09:59
They include impotence,
erectile dysfunction,
erectile dysfunction,
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To skaitā ir impotence,
erekcijas disfunkcija,
erekcijas disfunkcija,
10:01
urinary incontinence, rectal tearing,
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urīna nesaturēšana, anālā plaisāšana,
10:04
fecal incontinence.
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fekālā nesaturēšana.
10:06
And if you're lucky, and you're one
of the 50 percent who has these,
of the 50 percent who has these,
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Ja jums paveicas
un jūs esat šo 50% skaitā,
un jūs esat šo 50% skaitā,
10:09
they'll only last for a year or two.
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tās ilgs tikai gadu vai divus.
10:12
So the idea of the pre-mortem
is to think ahead of time
is to think ahead of time
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Tātad pre mortem nozīmē domāt uz priekšu
10:16
to the questions
that you might be able to ask
that you might be able to ask
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par jautājumiem,
kas jums varētu būt jāuzdod,
kas jums varētu būt jāuzdod,
10:19
that will push the conversation forward.
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lai uzturētu sarunu pareizā gultnē,
10:21
You don't want to have to manufacture
all of this on the spot.
all of this on the spot.
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lai nevajadzētu šos jautājumus
izdomāt uz vietas.
izdomāt uz vietas.
10:24
And you also want to think
about things like quality of life.
about things like quality of life.
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Un jums arī būtu jādomā
par tādām lietām kā dzīves kvalitāte.
par tādām lietām kā dzīves kvalitāte.
10:27
Because you have a choice oftentimes,
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Jo jums bieži vien ir izvēle,
10:29
do you I want a shorter life
that's pain-free,
that's pain-free,
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vai vēlaties īsāku dzīvi bez sāpēm
10:31
or a longer life that might have
a great deal of pain towards the end?
a great deal of pain towards the end?
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vai garāku dzīvi, kuras beigas
būs diezgan sāpīgas.
būs diezgan sāpīgas.
10:35
These are things to talk about
and think about now,
and think about now,
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Par to ir jārunā un jādomā tagad
kopā ar ģimeni un tuviniekiem.
kopā ar ģimeni un tuviniekiem.
10:37
with your family and your loved ones.
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Jūs varat pārdomāt mirkļa karstumā,
10:39
You might change your mind
in the heat of the moment,
in the heat of the moment,
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bet vismaz jūs būsiet izmēģinājuši
šāda veida domāšanu.
šāda veida domāšanu.
10:42
but at least you're practiced
with this kind of thinking.
with this kind of thinking.
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10:45
Remember, our brain under stress
releases cortisol,
releases cortisol,
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Atcerieties, ka stresa apstākļos
smadzenes izdala kortizolu,
smadzenes izdala kortizolu,
10:49
and one of the things
that happens at that moment
that happens at that moment
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un viena no lietām, kas tajā brīdī notiek,
10:52
is a whole bunch on systems shut down.
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ir tas, ka daudzas sistēmas aizveras.
10:54
There's an evolutionary reason for this.
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1905
Tam ir evolucionārs iemesls.
10:56
Face-to-face with a predator,
you don't need your digestive system,
you don't need your digestive system,
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Sastopoties ar plēsēju,
nav vajadzīga gremošanas sistēma
nav vajadzīga gremošanas sistēma
10:59
or your libido, or your immune system,
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vai libido, vai imūnsistēma,
11:02
because if you're body is expending
metabolism on those things
metabolism on those things
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jo, ja ķermenis tērē vielmaiņu šīm lietām
11:05
and you don't react quickly,
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un jūs nespējāat reaģēt ātri,
11:07
you might become the lion's lunch,
and then none of those things matter.
and then none of those things matter.
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jūs varat kļūt par lauvas pusdienām
un tad visam pārējam nav nozīmes.
un tad visam pārējam nav nozīmes.
11:11
Unfortunately,
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Diemžēl viena no lietām,
kas stresa laikā paliek novārtā,
kas stresa laikā paliek novārtā,
11:12
one of the things that goes out the window
during those times of stress
during those times of stress
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11:16
is rational, logical thinking,
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ir racionāla, loģiska domāšana,
11:18
as Danny Kahneman
and his colleagues have shown.
and his colleagues have shown.
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kā pierādījuši Denijs Kānemans
un viņa kolēģi.
un viņa kolēģi.
11:22
So we need to train ourselves
to think ahead
to think ahead
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Tāpēc jātrenējas domāt uz priekšu
11:25
to these kinds of situations.
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un paredzēt šādas situācijas.
11:27
I think the important point here
is recognizing that all of us are flawed.
is recognizing that all of us are flawed.
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Es domāju, ka svarīgi šeit ir apzināties,
ka mēs visi esam nepilnīgi.
ka mēs visi esam nepilnīgi.
11:33
We all are going to fail now and then.
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Mēs visi šad tad kļūdāmies.
11:36
The idea is to think ahead
to what those failures might be,
to what those failures might be,
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Galvenais ir domāt uz priekšu,
kādas šīs kļūdas varētu būt,
kādas šīs kļūdas varētu būt,
11:40
to put systems in place
that will help minimize the damage,
that will help minimize the damage,
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un iedibināt sistēmas,
kas palīdz minimizēt zaudējumus
kas palīdz minimizēt zaudējumus
11:44
or to prevent the bad things
from happening in the first place.
from happening in the first place.
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vai novērš negadījumus,
pirms tie notikuši.
pirms tie notikuši.
11:48
Getting back to that
snowy night in Montreal,
snowy night in Montreal,
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Atgriežoties tajā
sniegainajā naktī Monreālā –
sniegainajā naktī Monreālā –
11:50
when I got back from my trip,
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kad atgriezos no ceļojuma,
11:52
I had my contractor install
a combination lock next to the door,
a combination lock next to the door,
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es liku apsaimniekotājam uzlikt
kombināciju atslēgu blakus durvīm,
kombināciju atslēgu blakus durvīm,
11:56
with a key to the front door in it,
an easy to remember combination.
an easy to remember combination.
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kurā es turu ārdurvju atslēgas,
un ciparu kombināciju ir viegla.
un ciparu kombināciju ir viegla.
12:00
And I have to admit,
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Jāatzīst gan,
12:01
I still have piles of mail
that haven't been sorted,
that haven't been sorted,
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man vēl arvien ir kaudzēm
neizskatītu vēstuļu
neizskatītu vēstuļu
12:04
and piles of emails
that I haven't gone through.
that I haven't gone through.
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un kaudzēm neskartu e-pasta vēstuļu.
Tā ka viss man vēl nav pilnīgā kārtībā,
12:07
So I'm not completely organized,
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12:09
but I see organization
as a gradual process,
as a gradual process,
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bet sakārtošanu es uzskatu
par pakāpenisku procesu,
par pakāpenisku procesu,
12:12
and I'm getting there.
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un es pie tā strādāju.
12:13
Thank you very much.
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Liels paldies.
12:14
(Applause)
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(Aplausi)
ABOUT THE SPEAKER
Daniel Levitin - NeuroscientistDaniel Levitin incorporates findings from neuroscience into everyday life.
Why you should listen
Dr. Daniel Levitin is a neuroscientist at McGill University in Montreal, dean at Minerva Schools in San Francisco and a musician. His research focuses on pattern processing in the brain.
His three books This Is Your Brain on Music, The World in Six Songs, and the recent The Organized Mind are all bestsellers. A polymath at heart, he has performed with top musicians and holds a few gold and platinum records.
Levitin earned his B.A. in Cognitive Psychology and Cognitive Science at Stanford University, and went on to earn his Ph.D. in Psychology from the University of Oregon, researching complex auditory patterns and pattern processing in expert and non-expert populations. He completed post-doctoral training at Stanford University Medical School (in Neuroimaging) and at UC Berkeley (in Cognitive Psychology). He has consulted on audio sound source separation for the U.S. Navy, and on audio quality for several rock bands and record labels (including the Grateful Dead and Steely Dan), and served as one of the “Golden Ears” expert listeners in the original Dolby AC3 compression tests. He worked for two years at the Silicon Valley think tank Interval Research Corporation.
He taught at Stanford University in the Department of Computer Science, the Program in Human-Computer Interaction, and the Departments of Psychology, Anthropology, Computer Music, and History of Science.
Daniel Levitin | Speaker | TED.com