Prescribing Knowledge | Erney Mattsson | TEDxTrondheim


Translator: assia elaouam
Reviewer: Peter van de Ven Hi. Have you noticed that knowledge is almost forgotten. Even if it has been the base for human
progress for many many generations. Have we come to a stage where hidden interests, feelings
should steer our choices? Because knowledge is huge, it’s complex, we store it into computers, and from there,
perhaps use it when needed. Just go to your own working place: how important is knowledge
in your decision making ? And how much do other factors
influence what you do ? For those of you that might have
forgotten the use of knowledge, I would then like, as introduced, to give you an illustrative
dancing lesson to show you what it is all about. So this is it, just follow now. You use the existing
knowledge in your back, and that will push you forward, and then, almost immediately,
you challenge that existing knowledge to go, perhaps, a little bit further, in a slightly different direction, and thereby, give progress a possibility. That’s it ! Did you get it ? Good ! So, I now go back in this dance to medecine, which is my field, to show you how existing
knowledge is used today. Aortic aneurysm is a widening
of the biggest vessel we have in our body. It can be like a balloon,
here in the abdomen, and it can suddenly just rapture. And if so, you can die. But there is solid global knowledge saying that this disease should be operated upon
at a diameter of 55 millimeters, because then the risk with the disease is
higher then the risk with the operation. If you operate upon it at a smaller size, the risk with the operation is higher, and then you shouldn’t do it ! You got it ? In a recent publication from Shanzer, covering more than 10 000 patients
in the United States, 59% were operated upon
at a size lower than 55 millimeters. And not only that. Over 30% of the patients
had to face a technique that was outside the instructions for use for the device implanted. Why ? What is steering us ? Another example: Tonsillectomy – that is to remove
the tonsils from the throat. It has a knowledge based indication, but the variation in frequency
between our Nordic countries is over 370%. And that is even reflected here in Norway. Just to the south of us, we have a county called Møre og Romsdal – there are certainly people
from there here – and that’s divided
into 26 minor municipalities. And the variation is 480%! That is to say, almost a five fold
difference in this operation. Again: why? And the thing is that we can
pick any type of disease in any type of geography, and you will see a similiar situation. So in summery, if we do not apply the existing knowledge, some patients they will not get
the operation they need; others, they will actually be
operated upon unnecessary, and sometimes even with techniques outside written and tested instructions. Surprised, hey? Now for the next little step – that’s the advanced one, the sidestep. The challenging of the existing. That is to say that … knowledge is alive! It is continuously changing. That is to say that me and you, we are the only ones
that can change knowledge. The computer here, thereby, does not have the ability
to cover all aspects of knowledge. It has to be with us, used by us, and challenged by us. So, may I ask you a small question: Are you welcome to challenge
the environment where you are, where you work? Are you allowed to ask the question “why?” And if so, if you do that, will you then be regarded
as a representative of progress or a troublebmaker ? My task here is not to challenge you; it is from an academic standpoint
always better to challenge yourself. So I would then like to challenge
the existing knowledge in medicine; is that necessary as part of this dance? In 1949, Antonio Moniz
got the Nobel Prize for an operation: lobotomy. And that is a nerve surgery where you cut off the nerves
to the frontal lobe. It was good against psychosis, but it left behind
emotionally blunt people, reduced intellectual capacity, and mental invalids. I want you to think: Would it have been possible to save
some people from this operation if we had been able to challenge
the existing knowledge? 2 500 people were operated
here in Norway until 1957. So would that have been
good for these individuals? Then some of you would say – there are a lot of young people here – you would say, “Well,
that was 60 years ago. I don’t care.” But, you know, if you look
at the causes of death, what is on the 3rd place ? After cardiovascular disease and cancer, it is actually the use – or I would say, rather –
the misuse of medicine. So even today in my field, and you could consider your fields, it is necessary to challenge the existing. And how can we create an atmosphere
where that is allowed? We have to welcome diversity because it’s only in discussions
with people having different opinions that knowledge can propel, get on further. And these individuals
must have the ability to make a difference
between subject and person. So, I stand here, I stand here for a call for the ongoing
development of knowledge to be applied in all fields of humanity. I urge you to learn
these two steps of dancing; I urge you to apply the question “why?” And let the hidden interests, the feelings a little bit be reduced
in decision-making, because if you follow my recipe, you will bring mankind, societies, fields like medicine back to a prosperous
knowledge-based future. Let’s go for a “Why revolution.” (Applause)

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