Translator: Michele Gianella Reviewer: Nicoletta Pedrana
Good afternoon.
Today I want to talk about a dream: the dream of caring about healthy people.
Of course, when I say caring,
I don't mean therapy, quite the opposite.
But I mean it in the sense of Franco Battiato’s song:
I take care of, I take care of you, I am interested in something.
"I care", we would say in English.
But in fact, if we think about it, when we talk about this topic,
the institutional body that deals with the subject
is called "Ministry of Health",
not "Ministry of Diseases".
But despite this, when we think about our health,
we immediately imagine a pharmacy, the hospital,
the surgical room, the clinic.
And we think of diseases.
And we think that the diseases are all different:
cardiovascular diseases, tumors, neurodegenerative diseases.
We are in the situation where Ptolemy also was
when he thought that the Earth was at the center of the Universe,
and everything revolved around the Earth.
Then Copernicus came along,
and persuaded us all, the opposite was true,
and the Sun was at the center.
And so he did
what we still call a "Copernican Revolution".
So, today we find ourselves in medicine
with the need, with the desire, to make a Copernican revolution.
Instead of diseases,
we want to reassess medicine around the person, the man.
But when we think of man, we have such a tradition
that we immediately think of suffering, sick people.
Something like this hooded man at the Holy Thursday procession
that takes place in Lanciano, Abruzzo.
And we imagine
that this model of the sick man can give us useful informations
for a whole series of other people
who under the hood, as we see, all look the same,
and so the model of the sick man looks relatable.
In reality, if we catch the hooded men in a moment when they don't wear the hood,
we realize that they are all different from each other,
and therefore this model is not good.
I therefore want to quote here Don Milani,
who famously said: "Obedience is no longer a virtue".
Let me tell you, equality in medicine is no longer a virtue.
We are not all diabetics, we are not all hypertensive,
we want to see things in a different way.
Of course, if we all were alike, like these umbrellas in Rimini,
it would be something much simpler:
but in reality, our situation
is closer to what you see now, in this image.
But before this confusion,
before this complexity of the human condition,
what can we do?
Fifteen years ago, with my research group,
based in Molise,
we thought of changing the perspective a bit.
And we made a study
that from the name itself, from the very title of the project,
"Moli-sani", ["Sani" means healthy in Italian]
clearly underlines and indicates
that we are more interested in health than in disease.
And we are more interested in understanding what's before,
what's at the origin of human well-being.
We drew lots, as Brett said this morning,
we drew 30 municipalities, in Molise,
and we asked the mayors the list of their residents.
And in each town we took a number of people,
we drew a number of people in proportion of residents.
And at the end, we took 25,000 people.
It was a figure that at first really impressed me.
And we thought: now let's see how this population is.
But we immediately realized
that it was not worth knowing how many cancers there were,
how many cardiovascular diseases.
We thought we'd go a little deeper, to the roots.
And we figured out, all the diseases that seem so different to us,
in fact, if we dig underneath, they actually behave more like trees,
that have common roots or at least that intersect a lot.
So our interest has shifted from leaves and branches to roots.
Let me give you some examples of what we found in this investigation.
One of the roots underneath those "trees" we have seen,
is inflammation.
When one says inflammation, we imagine a very high fever,
a pain in the knees that keeps us from walking.
Arthritis, arthrosis and everything you can imagine.
But this is something that has happened already.
We do not want to do a medicine of “Guards and Thieves”,
where one first waits for thieves to carry out a theft,
and then the guards chase them.
We currently do the same: we first wait for a disease to develop,
the onset of inflammation.
And then we run after it, trying to cure it.
Not very smart.
We'd rather see something more like this image.
We are not interested in the visible tip of the iceberg:
sure, everyone sees it,
traditional medicine can see it.
We want to go further down, we want to study and understand
what is in the hidden part of the iceberg.
And this, I assure you, is a very fascinating undertaking.
A few examples: this inflammation -
which is not the pain, the fever -
can be measured by parameters
that we have developed in our laboratories
and we call it subclinical inflammation.
All of us here have subclinical inflammation;
but none of us know, not even me.
But if we check for those parameters, in a sample population like “Moli-sani”,
we realize that there is a diversity.
Nobody realizes this, but we have seen
that as long as this subclinical inflammation increases,
the very risk of dying also increases.
So we stroll around peacefully,
carrying within us a subclinical inflammation
that shapes, promotes what our risk of dying will be.
It's a really fascinating thing.
One might immediately say now, give me a drug to tame this inflammation.
No way: the drug comes later.
It's a staple component of that medicine we don't want to do.
What can we do to reduce this inflammation in our lives of healthy people?
So we were able to study and understand
that eating in the Mediterranean way - it is commonplace here -
sticking with the Mediterranean diet reduces this inflammation,
that nobody notices;
but not even us, when eating the Mediterranean diet:
fruit, vegetables, olive oil, a little fish and so on -
nobody notices that eating in such a way reduces the inflammation.
These are all phenomena that go under the iceberg:
but they make an important difference in our current health status
and what may be, tomorrow,
the risk of getting sick or even dying.
So we wanted to verify:
if the Mediterranean diet reduces this subclinical inflammation,
what does it do in reality?
And as you can see, it reduces mortality from cardiovascular diseases,
but also total mortality, for all possible causes.
Therefore, an interesting finding
is that if one follows this type of nutrition
they reduce something that we do not see,
but also reduces something that we can experience
such as mortality from today's most common diseases,
which are cardiovascular diseases.
However, apparently, there isn't just the Mediterranean diet:
we all know it is good not to smoke,
it is good to walk, to do physical activity,
to control our weight.
If we put together all these good habits,
and then we go to measure, in the ten years of observation,
that we are running on this population of “Moli-sani”,
we see that the “Moli-sani” who do not follow these lifestyles
have a mortality curve, the red one at the top,
much higher, much more dangerous
than those in the same environment -
all else being comparable, of course: the variation, here, are only lifestyles -
who follow a healthy lifestyle: their mortality curve is much lower.
So there is no need to go to hospital,
no need to think about pharmacies, no need to think about drugs.
We can control our health,
and also predict and prevent all the things we fear,
in a way that gets much closer to health than sickness.
Then, after seeing these things,
we were very happy and very satisfied.
Then we went to look a little closer,
and we realized
that the Mediterranean diet is not the same for everyone.
It's not good for everyone indistinctly.
The more educated you are, for example,
the more advantage you take of the Mediterranean diet.
You will wonder why, and we still can't state for sure:
but we know, because we have studied it,
that those who have a higher level of education
read labels better, their analytic abilities are sharper,
and are less prone to believe the fake news
that newspapers and television tell us about health every day.
Every day there are also people who have television channels
that say a lot of nonsense.
But the more educated one is, the stronger the critical system
to resist this type of bad informations.
Plus, we also realized
that not only the doctor, but the Internal Revenue Service
plays an important role in our health.
Most “Moli-sani”
answered the question about family income -
looking closely at whether we could be
tax agents disguised by a scrub.
And so we were able to study and assess
that income is more important than cholesterol.
We all want to check cholesterol;
but family income, personal income is extremely important also.
Why is that? Let me give you a simple example.
The Mediterranean diet is characterized, among many different things,
by extra virgin olive oil.
Then, in our questionnaires, we asked: do you consume extra virgin olive oil?
Yes, yes. OK, a plus for you.
And you, do you consume extra virgin olive oil?
Yes. OK, a plus for you.
Then, second question:
how much does a bottle of oil cost to you on average?
14 euros.
How much does a bottle cost to you on average?
Four euros.
So it's true that both participants follow the Mediterranean diet.
Both of them season salads with extra virgin olive oil.
But you easily get how huge the difference is:
therefore, even within the Mediterranean diet,
equality is no longer a virtue.
And it is no longer enough to say the Mediterranean diet is good for us:
one must precisely define origin, quality, and understand all these things
in order to have a better idea of how our health is going, and can go on,
or the risk of getting sick.
And the last thing we have seen, and is of great interest to us -
we are in an ageing society, so we are all getting older.
Let's face it: ageing is an issue we all certainly care about very much.
We have discovered in “Moli-sani”
we shouldn't care much about the age declared in our passports,
and in our identity cards.
The biological age, metered by a series of parameters -
that we are trying to define better, matters much more.
What is this biological age?
The biological age corresponds better to the risk of getting sick
and our chances to keep ourselves in good shape.
Enough, therefore, with a medicine
that settles down with checking pressure,
cholesterol, blood sugar, urine examination.
We want a medicine that investigates men,
that investigates people in all their facets.
Their passions, readings, where they live, how and where they travel.
their socio-economic situation.
And so, like Diogenes,
I also go around, among the people, looking for man, looking for the person,
looking for the individual.
Truth be told, I don't care much
whether they're healthier or just less sick.
I'm interested in making them happier.
And I'm interested that they've found meaning
in his life and his death.
The research goes on.
Thank you.
(Applause)