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How big is a colonoscopy: What Should I Know Before Going Into a Colonoscopy?

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What Should I Know Before Going Into a Colonoscopy?

Colonoscopy: What to Know

 

If your doctor recommends you have a colonoscopy, don’t worry. You may think it’s going to be a terrible procedure, but it won’t be. Most likely you won’t even be awake to remember it. (Most people consider the preparation for the procedure to be the worst part.)

A colonoscopy is an exam your doctor uses to look inside your large intestine for possible causes of things like abdominal pain, rectal bleeding, or changes in bowel habits.

Colonoscopies are also used to prevent colorectal cancer, usually starting at age 45. During a colonoscopy abnormal growths, called polyps, can be removed before they transform into cancers.

What Do I Do Before Exam?

Before giving you a colonoscopy, your doctor will want to know about any special medical conditions you might have, including:

Also tell your doctor if you have diabetes or take drugs that could affect blood clotting. They may need to adjust to these medications before the procedure.

How Do I Prepare?

To have a successful colonoscopy, you must have a clean colon. That means you need to restrict your diet at least 24 hours before the procedure. Solid foods usually are off-limits, but your doctor will usually say it’s OK to have clear liquids, such as:

  • Coffee
  • Broth
  • Water
  • Sports drinks

The next step is to empty your bowel. Your doctor probably will ask you take care of this in one of a couple ways:

  • Drink a prescribed laxative — commonly polyethylene glycol — that makes you have to go
  • Supplement the laxative with a series of enemas

They might tell you to do it the night before your colonoscopy, or the night before and the morning of the procedure. Be sure to follow their directions exactly.

Make sure you arrange to have someone take you home after the colonoscopy. You will be sedated, meaning you won’t be awake for the procedure. It won’t be safe for you to drive or operate machinery for at least 8 hours afterward.

How Is a Colonoscopy Performed?

During your colonoscopy, you’ll lie on your left side on an exam table. You’ll get sedatives through an IV in your arm, and you’ll go to sleep.

During the procedure, the doctor puts a tube-like instrument called a colonoscope into your rectum. It’s long but only about a half-inch across. It has a light and video camera on the tip so the doctor can see the lining of your colon and tell if there is any problem.

The colonoscope also includes a tube that lets your doctor pump in air and inflate your colon. This will give them a better view of your colon and its lining.

During the exam, your doctor can use a small snare in the colonoscope to take tiny samples of your colon for testing, which is called a biopsy. They can also use it to take out abnormal growths called polyps.

What Happens After the Exam?

The entire procedure should take between 20 and 30 minutes. You’ll stay in a recovery room for about 30 minutes to an hour to wake up from the sedative.

Continued

You may have cramping or pass gas, but these are normal. You can eat regularly after you leave the doctor’s office.

Make sure you understand the instructions you get before you go home. You may need to avoid certain medicines, such as blood thinners, for a day or two if your doctor did a biopsy or removed any polyps.

Bleeding and puncture of the colon are rare but possible problems in a colonoscopy. Call your doctor right away if you have any of the following:

  • More than a little bleeding, or bleeding that lasts a long time
  • Severe abdominal pain, fever, or chills

Frequently Asked Questions about Colonoscopy

Important reminder: This general information is for educational purposes only – it is not a definitive basis for diagnosis or treatment. It is very important that you consult your doctor about your specific condition.

Q. Are there any videos about what to expect with a colonoscopy exam? Watch and learn: You can access a number of patient education videos about colonoscopy and other tests at the website for The American Society for Gastrointestinal Endoscopy (ASGE). Or view a video showing how a colonoscopy is performed demonstrated by U-M Dr. D. Kim Turgeon and Dr. Reena Salgia.

Q. What is a colonoscopy? A colonoscopy is an examination that enables your doctor to examine the lining of your colon (large intestine). The doctor will take a flexible tube about the size of a finger and slowly move it into the rectum and through the colon to look for signs of cancer or pre-cancerous lesions.

Q. What are the symptoms of colon cancer? Often, the early stages of colon cancer do not have symptoms. That is why preventive screening is very important. Every year, millions of adults help prevent the development of colon cancer by having a routine colonoscopy. During a colonoscopy, when doctors find pre-cancerous growths called “polyps,” they can easily remove the polyps – greatly lowering your risk of developing colon cancer. Symptoms can include rectal bleeding, anemia, a change in bowel habit, abdominal pain and weight loss, but these symptoms are common for other illnesses as well. When the symptoms are caused by cancer, the disease may be in a late stage.

Q: Are there different types of polyps? There are two types of polyp shapes and five types of polyps. Visit our Colon and Rectal Polyps page to learn more.

Q: What is a complex polyp? In general, a rectal or colon polyp is considered complex (also known as “defiant”) if it meets any of the following criteria:

  • Size greater than 2 centimeters
  • Located in a difficult area or is too flat (sessile) to be removed during a standard colonoscopy
  • When the doctor performing your colonoscopy does not feel they can safely remove the polyp(s) and decide to refer you to a specialist

Q: Is surgery the only option for complex polyp removal? If the complex polyp is benign, with no signs of cancer present, then the patient may choose non-surgical removal instead of surgery; however, this requires the expertise of a highly skilled physician who has performed a large volume of these procedures.

Q. Who is at risk of colon cancer? Age is the No. 1 risk factor – more than 90% of colon cancer cases occur in people (men and women equally) age 50 and older. There are other risk factors:

  • Family history of colorectal cancer or adenomas (polyps)
  • Cigarette smoking – which can increase the risk of colon cancer death by 30% – 40%, possibly accounting for up to 12% of colon cancer fatalities
  • Obesity
  • Sedentary lifestyle
  • High-fat diet, especially one from mostly animal sources
  • Heavy alcohol intake
  • Ulcerative colitis or Crohn’s colitis
  • Cancer of the uterus or ovaries before age 50
  • Past removal of the gall bladder
  • Past radiation therapy of the abdomen
  • Diabetes – which can increase the risk of developing colorectal cancer 30% – 40%

Q. Who should be screened and when? The American Cancer Society recommends that adults be screened for colon cancer beginning at age 50 – or even earlier if there is a family history of the disease.

Q. Will I receive sedation for the exam? You will receive “conscious sedation” for the exam, which means that an intravenous line is placed and medications are given intravenously. This is not general anesthesia, although almost all patients are comfortable during the procedure. Because of the sedation, you will need a driver to take you home.

Q. Do I need a referral? If you have an HMO type of health insurance, you will need a referral from your primary care provider. Check with your health insurance provider.

Q. Does my insurance cover this procedure? You should check with your health insurance provider to determine your colorectal cancer screening benefits. Most insurance providers cover colonoscopy for colon cancer screening; however, insurance coverage varies.

Q. What do I need to do to prepare for a colonoscopy? Preparation is a critically important part of the exam. If your bowel is not adequately cleaned out before the exam, the doctor will not be able to identify polyps, the pre-cancerous lesions. Before the procedure, you will have to take an oral laxative solution (called “a bowel prep” or “preparation”) to clean out your bowel. Specific prep instructions vary, but the prep usually begins 1 to 2 days before your procedure. Please read your prep instructions (given separately) to understand what you should do 1 day or 2 days before your colonoscopy.

Q:  I am menstruating.  Can I still have a colonoscopy?  Yes, the procedure can still be performed while you have your period.  Tampons can be worn if preferred by the patient.

Q:  If a patient has a fever will a colonoscopy still be done? In general no.  A colonoscopy will not be performed if a patient has a temperature over 101 degrees.  Please contact your physician and let them know as soon as possible.

Q. Are there any complications or risks associated with having a colonoscopy? In general, colonoscopy is a safe procedure. As with any medical procedure, however, there are some risks associated with the procedure and with the sedation used. You should contact your doctor if you feel severe abdominal pain, dizziness, fever, chills or rectal bleeding after the colonoscopy. Perforation and bleeding are two of the major complications associated with colonoscopy. Perforation is a tear through the wall of the bowel that may allow leakage of intestinal fluids. Perforations are generally treated with hospitalization, antibiotics, and possible surgery. There may be bleeding at the site of a biopsy or polyp removal. Most cases of bleeding stop without treatment or can be controlled at the time of the procedure. Rarely, blood transfusions or other treatments may be required to stop the bleeding. There also is a risk of having a reaction to a sedative given during the exam. In most cases, medications are available to counteract this reaction. Although complications after colonoscopy are rare, they can be serious and life-threatening. It is important for you to be aware of early signs that something might be wrong.

Q. If I take medication, are there any risks? In general, most medications do not interfere with this procedure. However, if you are on insulin, your dosage may need to be adjusted – or changed – for the preparation period and the day of the exam. Also, if you take anti-coagulant or blood-thinning medicines, they will have to be stopped (and be possibly started on a bridge medication) before the procedure to allow for biopsy and/or polyp removal. Ask your physician about adjusting your medication.

Q. How long does the procedure take? How long will it take for me to recover? The procedure itself usually takes from 15 to 60 minutes, but you should plan on spending 2 to 3 hours total to account for preparation, waiting and recovery time.

Q. How many days do I need to take off work? You will need to take off work the day of the procedure. Some patients who work evenings also take off work the day before the procedure to do the bowel prep.

Q. Where can I get a colonoscopy at U-M? We have state-of-the-art colonoscopy facilities at:

Q. Are there different options for colon cancer screening? Currently, screening guidelines include a choice of four different tests:

  • Colonoscopy. Colonoscopy is the “gold standard test,” which means we believe it is most effective in detecting cancer and precancerous lesions. An instrument is inserted into the colon through the rectum. The rectum and entire colon are examined using a lighted instrument called a colonoscope. During colonoscopy, precancerous and cancerous growths throughout the colon can be found and either removed or biopsied. An advantage of having a colonoscopy is that growths in the upper part of the colon, where they would be missed by sigmoidoscopy, can be detected or found.
  • Fecal occult blood test (FOBT). This test checks for hidden blood in fecal material (stool). Currently, two types of FOBT are available. One type, called guaiac FOBT, uses the chemical guaiac to detect heme in stool. Heme is the iron-containing component of the blood protein hemoglobin. The other type of FOBT, called immunochemical FOBT, uses antibodies to detect human hemoglobin protein in stool. Studies have shown that FOBT, when performed every 1 to 2 years in people ages 50 to 80, can help reduce the number of deaths due to colorectal cancer by 15 to 33 percent. The problem with this test is that it misses many polyps and cancers. It has the advantage of low cost and safety.  If the test yields a positive result, a follow-up colonoscopy will be scheduled.
  • Stool DNA testing (Cologuard). This test identifies DNA mutations from colon cells that are excreted in stool samples. As part of the stool DNA testing, a fecal immunochemical test is also routinely performed.  Stool DNA testing will detect colorectal cancer approximately 92 percent of the time and advanced polyps approximately 42 percent of the time.  A follow-up colonoscopy will be scheduled if the test yields a positive result.  Stool DNA testing should be repeated every 3 years.   
  • Flexible sigmoidoscopy. In this test, the physician examines the rectum and lower colon using a lighted instrument called a “sigmoidoscope.” During sigmoidoscopy, precancerous and cancerous growths in the rectum and lower colon can be found and biopsied. If the physician discovers a polyp, the patient will need to have a colonoscopy at a later date. Studies suggest that regular screening with sigmoidoscopy after age 50 can help reduce the number of deaths from colorectal cancer. A thorough cleansing of the lower colon is necessary for this test.  If the test yields a positive result, a follow-up colonoscopy will be scheduled

Q. Is there anyone who should not have the procedure? Colonoscopy is not recommended in pregnant patients, patients 75 years or older, patients with limited life expectancy, or in patients with severe medical problems making them high risk for sedation.

Colonoscopy



Overview


Tips to Prepare for Your Colonoscopy

What is a colonoscopy?

A colonoscopy is an outpatient procedure that is done to examine the inside of the large intestine (colon and rectum). The examination uses an instrument called a colonoscope (sometimes called a scope). This flexible instrument, is very long and includes a camera and the ability to remove tissue (you do not feel tissue being removed). A colonoscopy is commonly used to evaluate gastrointestinal symptoms, such as bleeding, abdominal pain or changes in bowel habits (how often you poop, how easily you poop, and the color and consistency of your poop).

A colonoscopy can be used to detect many different types of conditions.

Some people may avoid the procedure due to embarrassment or a reluctance to do the preparation. There are many bowel preparations available, and they come in different sizes and tastes. Also, the colonoscopy team respects your privacy during the entire procedure. Colonoscopies are done to check for colorectal polyps or cancer. Removing polyps early means they can’t turn into cancer.

The medical community recommends that anyone who does not have risk factors for colorectal cancer should get a screening colonoscopy starting at age 50. The American Cancer Society has recommended that the screening start at age 45, and the Multi Society Task Force recommends that African Americans start screening at 45 (this is due to an increased risk of cancer). The timing of your colonoscopies varies depending on the findings of your test. You may need to have a colonoscopy at a younger age if you have an increased risk of colon cancer. These risk factors can include:

  • Having familial polyposis syndrome (a condition that runs in your family and is linked to an increased risk of forming polyps).
  • Having a genetic condition associated with colon cancer.
  • Having inflammatory bowel disease, such as Crohn’s disease and ulcerative colitis.
  • Having first-degree relatives with colon cancer (that is, your mother or father, brother or sister, or child).
  • Having multiple relatives with colon cancer.



Test Details

Large intestine, rectum & anus

What should I know or tell my doctor before a colonoscopy?

Be sure to tell your doctor exactly what medicines you take on a daily basis. This includes prescription and over-the-counter products like supplements. Your doctor can tell you which medications to avoid and what changes might be necessary. It is possible that you might have to reschedule your medications if you have diabetes or need blood thinners.

You will need a driver. Most facilities will not let you check in or perform the exam at all if you do not bring a responsible driver with you.

To have a successful colonoscopy, you will have to do your part. This means following all the instructions about what to eat and drink in the days before the procedure. It also means making sure that your colon is empty so your doctor can see clearly when the scope is inside the colon. This involves what is known as ‘bowel preparation.’

Bowel preparation. Colonoscopy prep. Cleaning out your colon. What does this mean?

Your healthcare team will give you plenty of time to prepare. You will get instructions at least two weeks before the procedure. It is important to read and follow all of the instructions given to you. If your bowel is not empty, your colonoscopy will not be successful and may have to be repeated. The cleaner your colon, the better chance your provider will have at finding all of your polyps and cancer, which sometimes can be small or hidden.

What can you eat and drink in the days before a colonoscopy?

Some providers may ask you to avoid corn, nuts, seeds and popcorn for at least three days before the procedure. Others might suggest a low-fiber diet for two days before the colonoscopy. The day before the procedure you will not be able to eat solid food or drink alcohol

You will be able to drink clear liquids, including water, black coffee, tea, ginger ale, apple juice, white grape juice and clear broths. You can have JELL-O® and Popsicles®, but only those that are not red, blue or purple. Drinking extra fluid will help you not become severely dehydrated.

You should not drink or eat anything at all for at least four hours before the colonoscopy. Be sure to drink plenty of fluids the day before while you are doing your bowel prep. If you are having your colonoscopy with general anesthesia, then you cannot drink anything after midnight on the night preceding your test.

What exactly does bowel preparation mean?

There are a few different kinds of bowel preparations, almost all of them liquid. Your doctor will tell you what kind is best for you based on your medical history and their particular preference. Some of these products are prescription-only, while others are available over-the-counter. They all have the same goal—to get rid of everything in your colon by causing watery diarrhea.

The time of day or night that you will have to start drinking the solution will depend on when your procedure is scheduled. You will be asked to consume the entire amount of liquid within a specific time period. There is also something called “split-dosing.” In split dosing, you will be asked to drink half of the bowel preparation the night before and then stop. You will get up in the morning and do the other half of the dose in the morning, finishing up at least four hours before the procedure itself. In general, split dosing results in cleaner bowel preparations. If you are having a colonoscopy with conscious sedation or twilight, and you have not been given split dosing instructions, ask your provider if you can do the split dosing.

What can you do to make a colonoscopy preparation easier?

There are things that might help you to drink the solution more easily. These include using a straw to drink the liquid and cooling the solution in the refrigerator before drinking it. You can add lemon drops or chew ginger candy. You will need to stay close to the bathroom during bowel preparation period. A split-dose might make the preparation easier. You will know you have done a good job when your diarrhea looks clear and yellowish, like urine.

You may experience skin irritation around the anus due to the passage of liquid stools. To prevent and treat skin irritation, you should:

  • Apply Vaseline® or Desitin® ointment to the skin around the anus before drinking the bowel preparation medications. These products can be purchased at any drug store.
  • Wipe the skin after each bowel movement with disposable wet wipes instead of toilet paper. These are found in the toilet paper area of the store.
  • Sit in a bathtub filled with warm water for 10 to 15 minutes after you finish passing a stool. After soaking, blot the skin dry with a soft cloth. Then apply Vaseline or Desitin ointment to the anal area, and place a cotton ball just outside your anus to absorb leaking fluid.

What happens on the day of a colonoscopy?

Take a shower in the morning if you like, but do not use lotions, perfumes, or deodorants. Leave your jewelry, other valuables and contact lenses at home.

During the procedure itself:

  • You are asked to wear a hospital gown and an IV will be started.
  • The procedure can be done with conscious sedation, often referred to as “twilight,” or deeper sedation referred to as “general anesthesia.” You are given a pain reliever and a sedative intravenously (in your vein). You will feel relaxed and somewhat drowsy. This step means that the colonoscopy will not hurt.
  • You will lie on your left side, with your knees drawn up towards your chest.
  • A small amount of air is used to expand the colon so the doctor can see the colon walls.
  • You may feel mild cramping during the procedure. Cramping can be reduced by taking slow, deep breaths.
  • The colonoscope is slowly withdrawn while the lining of your bowel is carefully examined.
  • The procedure lasts about 30 minutes. It takes about 12 minutes to move the scope five or six feet and another 12 minutes to take it out. If there are polyps to remove, the procedure will take longer.

What happens after a colonoscopy?

  • You will stay in a recovery room for observation until you are ready for discharge. The amount of time that you are in recovery depends on whether or not you were sedated and what type of pain management medication you received.
  • You may feel some cramping or a sensation of having gas, but this should pass quickly.
  • Your responsible family member or friend will drive you home.
  • Avoid alcohol, driving and operating machinery for 24 hours following the procedure.
  • Unless otherwise instructed, you may immediately return to your normal diet. It’s recommended that you wait until the day after your procedure to resume normal activities.
  • The doctor performing your colonoscopy will tell you when it’s safe to resume taking your blood thinners or any other medications you might have stopped.
  • If polyps were removed or a biopsy was done, you may notice light rectal bleeding for one to two days after the procedure.

NOTE: If you have a large amount of rectal bleeding, high or persistent fevers, or severe abdominal pain within the next two weeks, go to your local emergency room and call the doctor who performed your exam.

How long will it be before my next bowel movement?

It might take a few days before you have a bowel movement because your colon is empty. It also depends on how much roughage (fibrous foods) you eat.



Results and Follow-Up

When will I know the results of the colonoscopy?

Usually, your doctor will speak with you after the procedure to explain what was done. The doctor will tell you if you did have polyps and if any tissue was removed. They will also go over when you are able to start taking your medications again if you had to stop taking something before the colonoscopy.

Also, usually you will get a formal report either mailed to you or sent to you and your primary care provider in your electronic medical record. Your healthcare team will let you know if any follow-up is needed based on the results of your colonoscopy.



Additional Details

Are there alternatives to colonoscopies?

There are other ways to screen for colon cancer. These include:

  • Stool tests, such as the fecal immunochemical test (FIT), fecal occult blood test (FOBT), stool DNA tests (like Cologuard®). These tests let you collect your stool samples at home and then return them to your healthcare provider or mail them to a lab. You will have to do these more often than a colonoscopy.
  • CT colonoscopy (also called a virtual colonoscopy).
  • Flexible sigmoidoscopy, a test similar to the colonoscopy but covering a smaller part of the colon and the anus. It does not visualize the first part of the colon.

You and your healthcare provider should discuss the type of colon cancer screening that you should have. The choice will be based on your overall risk of colon cancer, general health, any symptoms you might be having and your personal preference. You should contact your health insurer about the costs of these less conventional tests.

You should know that some of the options that are not actual colonoscopies still call for the same type of preparation (cleaning out the colon by causing diarrhea). If polyps or other abnormalities are found on the alternative testing, they cannot be removed or treated. So it is likely that you will still have to have a colonoscopy. In addition, the costs of a screening colonoscopy may be less than of a colonoscopy completed after another, positive screening test other than colonoscopy.

Can you swallow a camera in a pill to take pictures of your colon?

Currently, the pill camera test is used to view the small intestine because the small intestine is easier to clean (for visibility) (the part of your bowel between your stomach and colon). Also, the camera passes through the small intestine in two to three hours.

The pill camera is being studied for colonoscopy. There are issues, though:

  • The large intestine (colon) is wide and has folds and creases.
  • It can take as long as 36 hours to pass the pill camera through the colon.
  • The colon is not as easy to get and keep as clean as the small intestine.

Can you have a colonoscopy while you have your period?

The answer to this question is yes. You might want to wear a tampon if you have your period.

Can you have colonoscopy when you are pregnant?

A pregnant woman should always consult her obstetrician before having any kind of procedure. If you are having a colonoscopy for screening, it is best to wait after pregnancy. However, colonoscopy is generally believed to be safe during pregnancy.

What are the recommendations for scheduling your first and later colonoscopies?

If you are a person of average risk for colorectal cancer, the recommendation is to get your first screening test at 50, unless you are African American, which means you should start at age 45. This might be a colonoscopy or a stool test. If your risk is higher or you have certain symptoms, your healthcare provider might suggest a colonoscopy or other screening test earlier than age 45. The incidence of colorectal cancer in African Americans has been increasing, and survival rates in those with colon cancer are worse than those for other groups.

You should discuss when to start screening with your healthcare provider. There are other sets of guidelines. For instance, the American Cancer Society suggests that screening for average risk people and African Americans start at age 45.

Follow-up colonoscopies will depend on the results of the first one. If you have no polyps and low risk, you might be able to wait 10 years before having another one. If you do have polyps and are considered high-risk, you might have to have a yearly procedure. (A colonoscopy every 10 years is the general rule for people who are not at high risk.)

Regular screening should be done through the age of 75. After that, you and your healthcare provider can decide on further screening needs.

Can a colonoscopy find parasites?

In the case of some parasites, like whipworms, the answer is yes. However, a colonoscopy is not the usual way to diagnose parasites.

Can a colonoscopy be used to diagnose endometriosis?

If you are a woman with endometriosis, you may have symptoms that affect your bowel, such as pain or bouts of constipation mixed with diarrhea. Your gynecologist might suggest a colonoscopy to rule out bowel problems. Usually, the endometrial tissue does not protrude through the bowel so it cannot be seen on a colonoscopy. Such tissue often sticks to the outside of the bowel or to other tissue in the area.

Can a colonoscopy be used to diagnose prostate cancer?

No. A colonoscopy is not designed to find prostate cancer. However, some doctors may choose to perform a digital rectal examination and a prostate examination before inserting the colonoscope. Men may believe that that their prostates have been examined, but this might not be true. It is a good topic to bring up with your doctor before a colonoscopy.

Here is a final thought about colonoscopies. Many people avoid them because they find the idea embarrassing and the preparation to be unpleasant. However, people often ask themselves and their care providers how we can prevent something from happening. Here is one way: colonoscopies can stop colon cancer before it starts.



Resources

Cleveland Clinic’s Bowel Preparation Instructions

They found colon polyps: Now what?

Follow-up exams at the right time are essential to prevent cancer from developing.

Colorectal cancer is one of the most preventable forms of cancer—if you are screened for hidden warning signs while you are still healthy. Screening finds precancerous growths on the colon wall, called polyps, which the doctor can then remove.

“They are not cancer, and most of them have not started to change into cancer,” says Dr. John Saltzman, associate professor at Harvard Medical School and director of endoscopy at Brigham and Women’s Hospital in Boston. “If you get them at the precancerous phase, they don’t have a chance to grow and turn into cancer.”

But you will need to come back for follow-up testing to see if more polyps turn up in the future. Here is what to expect.

What are polyps?

A colonoscope, the flexible device used to inspect the colon, can grab and snip off polyps if they are relatively small. The timing of follow-up depends on what kind of polyps the doctor finds, how many, and how big they are.

Hyperplastic polyps: These polyps are not precancerous. Doctors generally remove them anyway, just to be safe.

Adenomas: Two-thirds of colon polyps are the precancerous type, called adenomas. It can take seven to 10 or more years for an adenoma to evolve into cancer—if it ever does. Overall, only 5% of adenomas progress to cancer, but your individual risk is hard to predict. Doctors remove all the adenomas they find.

Sessile serrated polyps: Once thought harmless, this type of adenoma is now known to be risky. These are also removed.

When to return for follow-up

After polyps are removed, you will need to return for an additional colonoscopy. There is a 25% to 30% chance that a repeat colonoscopy will find additional polyps. How soon you need to return for follow-up depends largely on the size of the polyps found in the first exam.

  • If the colonoscopy finds one or two small polyps (5 mm in diameter or smaller), you are considered at relatively low risk. Most people will not have to return for a follow-up colonoscopy for at least five years, and possibly longer.
  • If the polyps are larger (10 mm or larger), more numerous, or abnormal in appearance under a microscope, you may have to return in three years or sooner.
  • If the exam finds no polyps, “your cancer risk is essentially the average for the population, and you can wait 10 years for the next screening,” Dr. Saltzman says.

How a colon polyp progresses to cancer

Get the best exam you can

Whenever you have a colonoscopy, you should have the highest quality exam possible so the doctor can find all the polyps. During the colon-cleansing “prep” before the colonoscopy, follow the instructions to the letter. Eating a low-fiber diet for four to five days may improve the quality of the prep, Dr. Saltzman says. That’s because fiber gets stuck in the nooks and crannies of the colon wall, and can block the doctor’s view. For colonoscopy to prevent cancer, the doctor must find and remove as many precancerous growths as possible.

Reducing your risk

After polyp removal, certain steps may lower your risk of colon cancer:

  • Eat less meat: Eat a healthy diet, with minimal red meat—especially processed or cured meats. Studies suggest that people with meat-rich diets tend to have higher rates of colon cancer.
  • Aspirin: Some research suggests that taking aspirin may reduce overall colon cancer risk, but the evidence is not definite. If you need to take aspirin for your heart, then it may offer some protection for the colon.
  • Calcium: Research has also linked a calcium-rich diet to lower colon cancer risk, but this, too, is uncertain. If you are already eat a healthy calcium rich diet to preserve bone health, you might get an extra “bump” of cancer prevention.

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ASGE | Understanding Colonoscopy

What is a colonoscopy?

Colonoscopy lets your doctor examine the lining of your large intestine (colon) for abnormalities by inserting a thin flexible tube, as thick as your finger, into your anus and slowly advancing it into the rectum and colon. This instrument, called a colonoscope, has its own lens and light source and it allows your doctor to view images on a video monitor.

Why is colonoscopy recommended?

Colonoscopy may be recommended as a screening test for colorectal cancer. Colorectal cancer is the third leading cause of cancer deaths in the United States. Annually, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States and 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year. Colonoscopy may also be recommended by your doctor to evaluate for symptoms such as bleeding and chronic diarrhea.

What preparations are required?

Your doctor will tell you what dietary restrictions to follow and what cleansing routine to use. In general, the preparation consists of limiting your diet to clear liquids the day before and consuming either a large volume of a special cleansing solution or special oral laxatives. The colon must be completely clean for the procedure to be accurate and comprehensive, so be sure to follow your doctor’s instructions carefully.

Can I take my current medications?

Most medications can be continued as usual, but some medications can interfere with the preparation or the examination. Inform your doctor about medications you’re taking, particularly aspirin products, arthritis medications, anticoagulants (blood thinners such as warfarin or heparin), clopidogrel, insulin or iron products. Also, be sure to mention allergies you have to medications.

What happens during colonoscopy?  

Colonoscopy is well-tolerated and rarely causes much pain. You might feel pressure, bloating or cramping during the procedure. Typically, your doctor will give you a sedative or painkiller to help you relax and better tolerate any discomfort. You will lie on your side or back while your doctor slowly advances a colonoscope along your large intestine to examine the lining. Your doctor will examine the lining again as he or she slowly withdraws the colonoscope. The procedure itself usually takes less than 45 minutes, although you should plan on two to three hours for waiting, preparation and recovery. In some cases, the doctor cannot pass the colonoscope through the entire colon to where it meets the small intestine. Your doctor will advise you whether any additional testing is necessary.

What if the colonoscopy shows something abnormal?

If your doctor thinks an area needs further evaluation, he or she might pass an instrument through the colonoscope to obtain a biopsy (a small sample of the colon lining) to be analyzed. Biopsies are used to identify many conditions, and your doctor will often take a biopsy even if he or she doesn’t suspect cancer. If colonoscopy is being performed to identify sites of bleeding, your doctor might control the bleeding through the colonoscope by injecting medications or by cauterization (sealing off bleeding vessels with heat treatment) or by use of small clips. Your doctor might also find polyps during colonoscopy, and he or she will most likely remove them during the examination. These procedures don’t usually cause any pain.

What are polyps and why are they removed?

Polyps are abnormal growths in the colon lining that are usually benign (noncancerous). They vary in size from a tiny dot to several inches. Your doctor can’t always tell a benign polyp from a malignant (cancerous) polyp by its outer appearance, so he or she will usually remove polyps for analysis. Because cancer begins in polyps, removing them is an important means of preventing colorectal cancer.

How are polyps removed?

Your doctor may destroy tiny polyps by fulguration (burning) or by removing them with wire loops called snares or with biopsy instruments. Your doctor will use a technique called “snare polypectomy” to remove larger polyps. Your doctor will pass a wire loop through the colonoscope and remove the polyp from the intestinal wall using an electrical current. You should feel no pain during them polypectomy.

What happens after a colonoscopy?

You will be monitored until most of the effects of the sedatives have worn off. You might have some cramping or bloating because of the air introduced into the colon during the examination. This should disappear quickly when you pass gas. Your physician will explain the results of the examination to you, although you’ll probably have to wait for the results of any biopsies performed. If you have been given sedatives during the procedure, someone must drive you home and stay with you. Even if you feel alert after the procedure, your judgment and reflexes could be impaired for the rest of the day. You should be able to eat after the examination, but your doctor might restrict your diet and activities, especially after polypectomy. Your doctor will advise you on this.

What are the possible complications of colonoscopy?

Colonoscopy and polypectomy are generally safe when performed by doctors who have been specially trained and are experienced in these procedures. One possible complication is a perforation, or tear, through the bowel wall that could require surgery. Bleeding might occur at the site of biopsy or polypectomy, but it’s usually minor. Bleeding can stop on its own or be controlled through the colonoscope; it rarely requires follow-up treatment. Some patients might have a reaction to the sedatives or complications from heart or lung disease. Although complications after colonoscopy are uncommon, it’s important to recognize early signs of possible complications. Contact your doctor if you notice severe abdominal pain, fever and chills, or rectal bleeding. Note that bleeding can occur several days after the procedure.

Reviewed and updated August 2009

IMPORTANT REMINDER:
The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

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Colonoscopy

What is colonoscopy?

Colonoscopy is a procedure a doctor uses to look at the inside of the colon and rectum with a colonoscope, which is a long, flexible tube about the width of a finger with a light and small video camera on the end. It’s put in through the anus and into the rectum and colon. Special instruments can be passed through the colonoscope to biopsy (sample) or remove any suspicious-looking areas such as polyps, if needed.

(Note: This test is different from a virtual colonoscopy (also known as CT colonography), which is a type of CT scan.)

Why do you need a colonoscopy?

There are a few reasons you might need a colonoscopy:

To check for polyps or cancer in the colon and rectum

This test can be used to screen for colorectal cancer. Screening is looking for cancer in people who don’t have symptoms. If abnormal areas are seen during the colonoscopy, they can be removed (biopsied) and tested for cancer. This is done by passing long, thin instruments down the colonoscope, such as small forceps (tweezers) to collect the samples. A screening colonoscopy can also prevent some colorectal cancers, by finding and removing polyps (growths on the inner lining) before they turn into cancer.

If you have had colon or rectal cancer, colonoscopy can also be used to look for new tumors.

Because you are having problems in the colon or rectum

Colonoscopy can also be used to look for the causes of signs or symptoms that might be from colon or rectal cancer (such as changes in bowel movements, bleeding from the rectum, or unexplained weight loss).

You have a problem in the colon or rectum that needs treatment

Colonoscopy can be used to treat some problems in the colon or rectum. For example, instruments can be passed down a colonoscope to remove polyps or other small tumors (growths) in the colon or rectum.

For some advanced cancers that can’t be removed (because they are too big or have spread), a colonoscope can be used to place a rigid tube called a stent into part of the colon or rectum to help keep it open.

What’s it like to have a colonoscopy?

This is a general outline of what typically happens before, during, and after a colonoscopy. But your experience might be a little different, depending on why you’re having it, where you’re having it done, and your overall health. Be sure to talk to your health care provider before having this test so you understand what to expect, and ask questions if there’s anything you’re not sure about.

Before the test

Be sure your health care provider knows about any medicines you are taking, including vitamins, herbs, and supplements, as well as if you have allergies to any medicines (including any type of anesthesia).

You may be asked to stop taking blood-thinning medicines (including aspirin) or some other medicines for several days before the test.

The colon and rectum must be empty and clean so your doctor can see the entire inner lining during the test. You might hear this referred to as a “bowel prep.” There are different ways to do this, including pills, fluids, and enemas (or combinations of these). For example, you might need to drink large amounts of a liquid laxative solution the evening before the procedure. This can often result in spending a lot of time in the bathroom. Because the process of cleaning out the colon and rectum can be unpleasant, it might keep some people from getting this test done. However, newer kits are available to clean out the bowel that might make it easier. Talk to your health care provider about all of your options for the bowel prep.

Your health care provider will give you specific instructions. It’s important to read them carefully a few days ahead of time, since you may need to shop for supplies and laxatives and follow a special liquid diet for at least a day before the test. If you’re not sure about any of the instructions, call the health care provider’s office and get your questions answered.

You will probably also be told not to eat or drink anything after a certain time the night before your test. If you normally take prescription medicines in the morning, talk with your doctor or nurse about how to manage them for that day.

Because a sedative is used to help keep you more comfortable during the test, you will most likely need to arrange for a ride home after the test. You might need someone to help you get home if you are sleepy or dizzy, so many centers that do colonoscopies will not discharge people to go home in a cab or a ridesharing service. If transportation might be a problem, talk with your health care provider about the policy at your hospital or surgery center for using one of these services. There may be other resources available for getting home, depending on the situation.

Getting the test

Colonoscopy can usually be done as an outpatient procedure (where you don’t need to stay overnight in a hospital).

Before the test starts, you’ll likely be given a sedative (into a vein, or IV) to make you feel relaxed and sleepy during the procedure. For most people, this medicine makes them unable to remember the procedure afterward.

During the test, you’ll be asked to lie on your side with your knees pulled up. Your doctor might insert a gloved finger into the rectum to examine it before putting in the colonoscope. The colonoscope is lubricated with gel so it can be inserted easily into the rectum. It is then passed all the way up to the beginning of the colon, called the cecum. If you’re awake, you might feel an urge to have a bowel movement when the colonoscope is inserted or pushed further up the colon. The doctor also puts air into the colon through the colonoscope to make it easier to see the lining and to perform the test. To ease any discomfort, it may help to breathe deeply and slowly through your mouth. The doctor will look carefully at the inner walls of the colon and rectum as the colonoscope is slowly removed.

If a small polyp is found, it may be removed and then sent to a lab to check if it has any areas that have cancer. This is because some small polyps may become cancer over time. If your doctor sees a larger polyp or tumor, or anything else abnormal, a small piece of it will be removed (biopsied) through the colonoscope. It will be checked in the lab to see if it’s cancer, a benign (non-cancerous) growth, or something else.

The test itself usually takes about 30 minutes, but it may take longer if one or more polyps is found and removed.

After the test

After the procedure, you will be watched closely for a while to make sure you don’t have any complications. You might need to stay at the center for about an hour before you are able to go home, and will need a ride home because of the medicines or anesthesia you received. Your doctor or nurse should give you specific instructions on what you can and can’t do in the hours after the test.

Because air is pumped into the colon and rectum during the test, you might feel bloated, have gas pains, or have cramping for a while after the test until the air passes out.

If biopsies were done as part of the procedure, the results will typically be available within a few days, although some tests on the biopsy samples might take longer. You will need to follow up with your doctor after the procedure to get your results.

Possible complications of colonoscopy

Colonoscopy is usually safe, but there is a risk of:

  • Bleeding. If a polyp is removed or a biopsy is done during the colonoscopy, you might notice some blood in your stool for a day or two after the test. Serious bleeding is uncommon, but in rare cases, bleeding might need to be treated or can even be life-threatening.
  • Perforation (puncture the wall of the colon or rectum). This is rare, but it can be a life-threatening complication, and the hole may need to be repaired with surgery.
  • Reactions to anesthesia

Your doctor or nurse should give you specific instructions on what types of problems might require you to call the doctor’s office or seek medical help right away. Be sure you understand these instructions.

Colonoscopy Procedure – Jersey Shore University Medical Center

What is a Colonoscopy?

A Colonoscopy is the visual examination of the inside of the rectum and colon. The procedure is performed using a lighted, flexible tube connected to an eyepiece or video screen for viewing called a colonoscope. The colon (large intestine) is 5 to 6 feet long. A complete colonoscopy requires the physician to pass the colonoscope to the end of the large intestine or colon to the rectum.

Equipment

The flexible endoscope is a remarkable piece of equipment that can be directed and moved around the bends in the colon and rectum. The image in the bowel is transmitted through the endoscope either to the eyepiece or a video screen. An open channel in the scope allows other instruments to be passed through it to take tissue samples (biopsies) or to remove polyps.

Reasons for the Exam

A colonoscopy is performed to diagnose the cause of certain symptoms. It is also used as a preventative measure to detect problems at an early stage, even before the patient recognizes symptoms.

The following are some reasons for performing a colonoscopy:

  • Bleeding – Rectal bleeding is very common. It often is caused by hemorrhoids or by a small tear in the anus, called a fissure. However, more serious problems can cause bleeding. Benign polyps can bleed. It is important to identify and remove polyps at an early stage before they can become cancerous. Rectal and colon cancers bleed and require immediate diagnosis and treatment. Finally, various forms of colitis and inflammation can cause bleeding.
  • Diarrhea – Persistent diarrhea should always be evaluated. There are many causes of diarrhea and the exam is of great help in tracking down the specific cause.
  • Pain – Hemorrhoids and fissures are some causes of pain around the anus or the rectum. Discomfort in the lower abdomen can be caused by tumors. Diverticulosis can occur in the lower bowel. With this condition, small pockets or sacks project from the bowel.
  • X-Ray Findings – A barium enema x-ray may show abnormalities that need to be confirmed or treated by a colonoscopy.
  • Detection – Colon cancer is one of the most common cancers in the country. It is highly curable if it is found early. This cancer usually begins in the colon as a polyp that remains benign for many years. Therefore, it is generally advisable to have a colonoscopy after age 40 or 50. If parents, brothers, or sisters have had colon polyps or colon cancer, it is even more critical to have this exam. The tendency to develop colon cancer and polyps can be inherited.

Preparation for the Test

To obtain the full benefit of the exam and allow a thorough inspection, the rectum and the entire colon must be clean. Preparation usually involves drinking clear liquids the day before along with taking laxatives or an enema. Specific instructions for preparation are provided beforehand.

The Procedure

Colonoscopy is usually performed on an outpatient basis. It is performed with the patient lying on the left side with the legs drawn up. A sheet is placed over the lower body. A finger or digital exam of the anus and rectum is performed. The patient will be sedated. Then the endoscope is gently inserted in to the rectum. Air is inflated into the bowel to expand it and allow for careful examination. The endoscope is advanced under direct vision and moved around the various bends in the lower bowel.

Benefits

The benefits of a colonoscopy can include the following: It is often possible to determine the specific cause of symptoms. Conditions such as colitis and diverticulosis can be monitored to determine effectiveness of treatment. Polyps and tumors can be discovered at an early stage.

Alternative Testing

Alternative testing includes barium enema x-ray exams. Additionally, the stools can be examined in a variety of ways to uncover or study certain bowel conditions. However, a direct look at the lower rectum and colon by colonoscopy is by far the best method of examining this area.

Side Effects and Risks

Bloating and bowel distension are common due to air inflated into the bowel. This usually lasts only 30 to 60 minutes. If biopsies are done or if a polyp is removed, there may be some spotting of blood. However, this is rarely serious. Other uncommon risks include a diagnostic error or oversight, or tear (perforation) of the wall of the colon which might require surgery. Due to sedation, the patient should not drive or operate machinery for the remainder of the day following the exam.

Summary

Colonoscopy is a simple outpatient exam which can uncover a serious medical problem. Specific diagnoses can be made. Treatment programs can be evaluated, or reassurance can be provided when the exam is normal. It is one of the most useful and simple exams in medicine.

(PDF) Japan high-tech health care system

Current interview

Therapia # 10 (113) 2016 5

with extension cord. Caring for the quality of life of patients is noticeable

also in special shops, where various necessary goods for them are presented

. For example, a variety of

bright cotton and knitted hats (to cover

alopecia that developed after chemotherapy), scarves and glasses,

various devices for fixing the cane, brightly colored

drinking bowls and spittoon bowls.Here, in the cafe of the clinic, there is a

opportunity to have a very varied and tasty lunch. Immediately

you understand that these difficult patients are not left to themselves and their relatives

, they are taken care of.

– Have you noticed any peculiarities of preparing

patients for colonoscopy?

– As an endoscopic surgeon, the

system of preparing patients for colonoscopy was very interesting to me.

The pathology detected

and the possibility of its elimination directly depend on the quality of bowel preparation.In the hospital at the same time

up to 7-10 colonoscopic examinations

or operations are performed. The flow of patients is very large. Three to four

days before the study, the attending physician (he is also a gastroenterologist, he is

an endoscopist) explains to the patient the peculiarities of the diet for

preparation of the colon, accompanies him to the office of information

, where in slides, posters, visual aids

biys and atlases collected all information about the upcoming procedure

fool, its features, benefits and risks.In a calm

environment, patients have the opportunity to scrupulously study the

technology and ask questions of interest. Then they receive

a colored flyer with a recommended diet.

On the day of colonoscopy, starting at 5 a.m., patients come to the

clinic in groups, enter a special department for

preparation for colonoscopy, where, under the guidance of a trained

nurse, they take the required amount of

polyethylene glycol solution.And all this happens in the

group, in a relaxed atmosphere. Each patient receives

a key to a personal locker room with a toilet. Then the entire

group begins to take the drug solution, performing simple personal exercises under the guidance of an instructor.

From time to time, one of the group members goes to the toilet,

rotates and continues to take the drug. When the patient thinks that

melts that he is sufficiently ready to conduct the study, comparing the color of the wash water with the color shown in the color picture,

he calls the nurse, who monitors the result

and decides whether to continue taking the drug or you can

already go to research.The next

patients gradually arrive. Such a system of personalized, group,

controlled training is the basis of the highest quality

colon preparation. At the same time, each patient

in sufficiently comfortable conditions receives the necessary

amount of the drug, and the doctor sees an absolutely clean colon

, ready for intravital microscopic examination, staining and operation.

– And what are the features of the endoscopic examinations themselves

?

– In Japan, as, indeed, everywhere in the civilized world,

it is customary to carry out uncomfortable procedures under anesthesia and sedation. Even an intravenous catheter is placed

after local anesthesia of the injection site. There is no need to talk about endoscopic

studies, all of them are performed

under sedation. In uncomplicated cases, which are the majority in the clinic, sedation with propofol is performed by the second

gastroenterologist (endoscopist), who has completed a special

six-month internship in intensive care

and sedation, has a separate license to perform sedation.

tions in non-severe patients, that is, it has the appropriate

competence and certain skills.German doctors

, in contrast to Japanese, carry out sedation on their own

. And this despite the fact that in Japan, as in Germany, all

severe cases and long-term operations are necessarily accompanied by an anesthesiologist. All endoscopic cabins

nets are equipped with oxygen supply, cardiomonitor –

mi, pulse oximeters. The introduction of the drug is carried out

using a syringe or pump. There is also a possibility (

) (at the patient’s choice) of self-administration of the pre-

paratha by the patient under the supervision of an endoscopist.This

method allows you to achieve the desired depth of sedation with

administration of the drug in the minimum dose. For colonoscopy,

for example, it is normal for the patient to be stunned. He

seems to be asleep, but at the same time, if necessary, through sleep

can hear and execute the doctor’s commands (turn from

side to side, throw one leg over the other, etc.). All this is achieved

also due to the minimum dosage of the drug.

If an endoscopic examination or operation lasts

more than 2 hours, then the operation is interrupted, the patient is awakened, transferred

, forced to move and after a slight

break, sedation is continued. This type of anesthesiologist is practically not used in Ukrainian

patients who are not used to controlling themselves during the

time of anesthesia, they may experience unforeseen

subcortical motor and conversational reactions.

Themselves endoscopic examinations are more screen-

ning in nature, suggest a leisurely, detailed study of the mucous membrane of the digestive tract

with mandatory detailed photo and video recording of the study,

superficial formations

. Beginning such studies as, as a rule,

vilo, in patients over the age of 50 and in the absence of

pathology is carried out every 10 years.For the study of the small

intestine, in addition to the well-known one- and two-balloon

enteroscopes, the latest development is used – motorized spiro

enteroscopy, which allows in some cases

to examine almost the entire small intestine through the mouth.

– How are the offices and operating rooms in Japanese

clinics equipped?

– The furnishings and equipment of the offices are excellent, the apparatus –

– the latest, tools and consumables –

in excess.The doctor does not think about where,

, how and what kind of instrument should be purchased.

This is very important due to the fact that endoscopic

instruments are very expensive and, as a rule, disposable

. A characteristic feature of Japanese university

clinics is close collaboration with engineering departments

departments of equipment and instruments manufacturing companies

mentaries. The faculty at Kitasato Hospital develops a range of instruments and apparatus, and

is testing prototype endoscopes.Interestingly,

that fiber endoscopes have not been used in Japan

for over 20 years, and conventional video systems are no longer “

in use.” The standard endoscopic equipment is

technology with high resolution and the ability to conduct a narrow-band examination.

Prepared by the editors of Therapia

Pass tests for STIs (sexually transmitted infections) in Nizhny Novgorod at the Tonus clinic, STI testing

Sexually transmitted infections are diseases that are transmitted during intercourse.It is possible for the baby to become infected when it passes through the birth canal.

In order to protect your partner or unborn child, it is necessary to pass tests for STIs .

The causative agents are various bacteria and viruses (for example, such as herpes simplex virus, chlamydia, mycoplasma, ureaplasma and others). Their determination is the main task of the analysis for STIs.

How is STI infection manifested? What do you need to know to get an STI test?

Carriage of STIs is very often asymptomatic, which complicates their diagnosis.You cannot think that the infection will heal by itself and let everything take its course. If the clinical symptoms of the disease suddenly disappeared during treatment, this may indicate not only a cure, but also that the process has passed into a latent form. In this case, control examination for STI will help to resolve the issue.

What does an STI screening include?

In total, there are several groups of analyzes for STIs:

  • Flora swab
    This is one of the most common methods of testing for STIs.A smear is taken from the vagina and sent to the laboratory. To pass an STI test, you need to prepare. Do not go to the toilet in two hours, and also get an STI test immediately after menstruation
  • ELISA analysis (enzyme-linked immunosorbent assay for STIs)
    Allows you to determine the body’s response to finding the pathogen. With the help of it, the amount of antibodies that are produced in response to the presence of a particular bacterium or virus in it is revealed. Antibodies are of various classes (they look at IgG, IgM – depending on the presence of a particular class, one can judge whether an infection is present in a given organism and how much its activity is)
  • PCR (polymerase chain reaction)
    The DNA of the pathogen in the biological material is determined (the test material can be, for example, vaginal discharge).With this method, a specific infection can be identified. Other advantages of this sexually transmitted infection test are that it is fast and versatile
  • Bacterial culture
    Determines the sensitivity of microorganisms to various drugs. This PPI test allows further prescribing the most adequate therapy

There is no need to delay STI treatment. It is not difficult to pass such an analysis, the procedure is painless.Many people get sick, although the diagnosis is varied and accurate.

We must not forget about prevention. Remember that self-medication can only worsen the condition.

GBUZ SO “Togliatti City Clinical Hospital No. 5”

The first in Togliatti 64-slice multipurpose computed tomograph has been installed and has already been successfully tested in our hospital.

Philips Ingenuity 64 multipurpose CT scanner delivers low dose, high quality images and coatings, patient personalization, artifact reduction features and industry leading low contrast resolution.
Thanks to innovative technologies that expand the visualization of small details, the modern Philips Ingenuity Core 64 CT scanner creates a lower radiation exposure (by about 60-80%), and at the same time increases the detection rate of objects, pathologies with low contrast by 43-80% …
The system provides 64-slice shooting for exceptional image quality at high spatial resolution. The modern X-ray tube is equipped with a special air cooling system, which allows even the most complex and time-consuming manipulations to be carried out continuously.The Ingenuity 64 Philips computed tomograph has a spatial matrix from 512×512 to 1024×1024, which visualizes the most complex organs from this point of view with the highest quality.

The deputy chief physician of TGKB 5 on consultative and diagnostic issues tells
Alexey Nikolaevich Kirsanov:

– The device was purchased under the program of the National Healthcare Project in the field of combating cancer, federal funding.And the focus of the work of this office is precisely to increase the number of studies performed in the interests of patients with cancer. These are patients who are registered in our oncological clinic, in the in-patient department of our hospital. Naturally, these studies are carried out within the framework of compulsory health insurance. If there is a referral from the outpatient clinic – also under compulsory medical insurance. That is, absolutely free.
The device is fully equipped with all the necessary instruments for the introduction of contrast, equipped with all the necessary number of mounts, support devices, etc.as well as an ECG synchronizer – this is a special device that allows scanning at certain phases of the cardiac cycle. This device is a very serious help for cardiological research. In particular, studies of the ascending aortic arch to exclude aneurysm, studies of the coronary arteries or heart vessels. And with the images obtained on the new apparatus, we can work at those analysis stations that we already have.

This scanner has a program for finding so-called pulmonary nodules.There is a virtual colonoscopy screening program. The Calcium Index Program is, again, very interesting for cardiologists. In addition, the device has the ability to perfuse the brain – this is very important for neurosurgeons when determining the size of the tumor and for neurologists in the early phase of ischemic stroke, when it is not yet clear how large the affected area and border zone, which is called the medical term “penumbra”. That is, a study on this device allows you to determine how much brain tissue has died, and how much is in a conditionally living state – based on this, it is possible to most correctly determine the treatment tactics.This, together with the appearance of an angiograph at the next stage, which is now being installed, with angiosurgery, will significantly improve the prognosis of patients with ischemic stroke, and will definitely increase the survival rate.
We also have other similar equipment from the “Philipps” company, therefore, it was not difficult for the staff of the department of radiation diagnostics to study the peculiarities of operating a new tomograph. We have already carried out the first scans and studies for our patients – we have convincingly obtained high-quality results in all anatomical areas, which allows us to look to the future with optimism.

The device has been technically put into operation, the technical documentation, the office passport is being finalized, and we are submitting these documents for issuing a sanitary and epidemiological permit. It will take some time, about one and a half to two months, during which we will receive patients on the new tomograph in a very limited volume. First of all, there will be studies for patients of our hospital and oncopolyclinic, then – by referral from the polyclinic at the place of residence.And now, if they do not give directions there (a quota is selected), then you can go for a fee, but this is only on a leftover basis, after all the mandatory studies have been completed. There is a framework for radiation safety, only a certain number of patients can be accepted per shift.

Daniel Kahneman: The riddle of the experience-memory dichotomy

Now everyone is talking about happiness. Once I asked one person to count all the books with the word “happiness” in the title, published in the last 5 years, and he gave up after the 40th, but of course there were even more of them.The rise in interest in happiness is enormous among researchers. There are many trainings on this topic. Everyone wants to make people happier. But despite such an abundance of literature, there are some cognitive traps that practically prevent you from thinking correctly about happiness.

And my talk today will mainly focus on these cognitive traps. This also applies to ordinary people who think about their happiness, and to the same extent to scientists who think about happiness, since it turns out that we are all equally confused.The first of these pitfalls is a reluctance to admit how complex the concept is. It turns out that the word “happiness” is no longer considered such a useful word, because we use it in relation to too different things. I think there is one specific meaning that we should limit ourselves to, but in general, this is something that we will have to forget about and develop a more comprehensive view of what well-being is. The second trap is the confusion of experience and memory: that is, between being happy in life and feeling happy about your life or feeling that life suits you.These are two completely different concepts, but both of them are usually combined into one concept of happiness. And the third is the illusion of focus, and it is a sad fact that we cannot think of any circumstance that affects our well-being without distorting its significance. This is a real cognitive trap. And there is simply no way to get it all right.

I would like to start with an example of a person who took part in a Q&A session after one of my lectures and told a story (inaudible).He told how he once listened to a symphony, and it was just amazing music, but at the very end of the recording, there was a terrible grinding sound. And then he added, quite emotionally, that it ruined the whole experience. But this is not the case. This spoiled the memory of the experience. He experienced this experience. He experienced 20 minutes of wonderful music. But they didn’t matter, because all that was left was his memory. The memory was tainted, and the memory was the only thing he had left.

And the conclusion from this, in fact, is that we, perhaps, perceive ourselves and others through the prism of two selves. One is our experiencing self, the one who lives in the present moment and knows only the present, and can relive past experiences, but, in fact, has only the present. This is the experiencing self that the doctor turns to, you know, when he asks, “Does it hurt when I touch here?” And there is a remembering self, and a remembering self – this is the one that keeps track and keeps the history of our life, and this is the one to which the doctor addresses the question: “How are you feeling lately?” or “How was your trip to Albania?” or something like that.They are two completely different entities, the experiencing self and the remembering self, and the confusion between the two creates confusion with the concept of happiness.

The remembering self is the storyteller. And it starts with the basic response of our memories – it starts right away. We tell stories not only when we intend to tell them. Our memory tells us stories, everything that we get out of our experience is history. And let me give you one example. This is one longstanding study. Real patients undergo a painful procedure.I will not go into details. It is painless these days, but then, in the 1990s, it was different. They were asked to share their feelings every minute. Here are two patients. And their data. And they ask you: “Which of them suffered the most?” And this is a very simple question. It is clear that patient B suffered more. His colonoscopy took longer, and every minute of pain that patient A suffered, patient B also suffered, plus additional time.

But another question arises: “How badly, according to the patients themselves, did they suffer?” And here a surprise awaits us.It consists in the fact that patient A’s memories of the colonoscopy are much worse than those of patient B. The histories of these procedures were different, and since a very important part of them is how they end, and none of them is particularly encouraging – but one one of them is definitely worse than the other. And the one that is worse is the one in which the pain was most severe at the end of the procedure. This is a bad story. How do we know this? Because we asked people after the colonoscopy and also much later. “How bad was it, overall?” And for A, according to recollections, it was much worse than for B.

And there is a direct conflict between the experiencing and the remembering self. From the point of view of the experiencing self, it is clear that patient B had a more difficult experience. And now what to try with patient A, and we actually did clinical research and it worked, you can extend patient A’s colonoscopy by leaving the tube inside but not moving it too much. This will give the patient unpleasant sensations, but not severe pain, much less than before. And if you do this for a couple of minutes, you put patient A’s experiencing self in a worse position, but his remembering self in a much better position, because now you have given patient A the best story of his experience.What determines the overall tone of the story? And this applies to the stories that memory provides us, as well as the stories that we make up. The story is determined by changes, significant moments and the ending. The end is very, very important, and in this case, the end was decisive.

So the experiencing self lives a long life. He has moments of experience, one after the other. You may ask: what happens to these moments? The answer is very simple. They disappear forever. What I’m talking about is that most of the moments in our life – and I’ve calculated – you know, the psychological present lasts three seconds.Which means, imagine, in life there are about 600 million of them. A month – about 600,000. Most of them leave no trace. Most of them are completely ignored by the remembering self. And yet somehow it seems that they have to matter, that what happens during these moments is our life. This is a limited resource that we consume while we are on this earth. And how to spend it seems like an appropriate question, but this is not the story that the remembering self keeps for us.

So we have a remembering self and a experiencing self, and they are really quite different from each other. Their biggest difference lies in their approach to timing. From the point of view of the experiencing self, if you are on vacation and the second week of your trip is as good as the first, then a two week trip should be twice as good as a one week trip. But for the remembering me, it works differently. For the one who remembers, a two-week trip is hardly better than a one-week trip, because new experiences are not added.History doesn’t change. And from this perspective, time is the critical variable that distinguishes the remembering self from the experiencing one. Time has little effect on this story.

Besides, the remembering self not only remembers and tells stories. In fact, it is it that makes the decisions, because if you have a patient who has had, say, two colonoscopies with two different surgeons, and he decides which one to choose, then the choice will fall on the one about whom the memory is less negative. , that is the surgeon he will choose.The experiencing self has no voice in this choice. In fact, we are not choosing between the two experiences. We choose between two memories of the experience. And even when we think about the future, we usually don’t think of our future as an experience. We think of our future as an anticipated memory. And, you know, on the whole you can look at it as the tyranny of the remembering self, and you can say that the remembering self is like dragging the experiencing self through the experience that the experiencing does not need me.

I have a feeling that when we go on vacation, it often happens that we go on vacation in large part to please our remembering self.And it’s a little difficult to find an excuse for this, I think. I mean, how often do we then come back to our memories? This is one of the explanations given for the dominance of the remembering self. And when I think about it, I think about the vacation when we went to Antarctica a few years ago, which was definitely my best trip, and I think about it often enough relative to how rarely I think about other trips. I may have reverted to my memories of that three week trip, I would say, for about 25 minutes over the past four years.Also, if I had ever opened a folder with 600 photos, I would have wasted another hour. And now it’s three weeks a week and a maximum of an hour and a half. It would seem that there is a discrepancy here. And I may not be a typical case, because I have a very weak appetite for memories, but even if you do this more than I do, a sincere question arises. Why do we place such a high value on memory over the value of experience?

So, I want you to think about a thought experiment.Imagine your next vacation trip. And imagine that you know that at the end of it all your photos will be destroyed and you will take an amnestic drug so that you will not remember anything. Well, would you still choose the same trip? And if you chose another option, there is a conflict between your two selves, and you need to think about how to resolve it, and in fact it is far from so simple, because if you think through the prism of time, there is only one answer. And if through the prism of memory – the answer is different.Why we choose these or those trips is a problem that confronts us with a choice between two selves.

Further, two selves entail two concepts of happiness. There are indeed two concepts of happiness that we can use, each for a corresponding self. How happy is the experiencing me, you ask? And then: how happy are the moments in the life of the experiencing me? And all this happiness for a moment is a rather complicated process. What are the feelings that can be measured? And by the way, now we are in a position to quite passably understand the idea of ​​the happiness of the experiencing self in time.If you ask about the happiness of the remembering self, this is something completely different. It’s not how happy someone is. It’s about how satisfied or contented a person is when they think about their life. Very different concepts. Anyone who does not differentiate between the two is bound to get confused about happiness, and I myself am one of those welfare students who have been confused about learning about happiness in this way for quite some time.

The distinction between the happiness of the experiencing self and the satisfaction of the remembering self was made not so long ago, and attempts are now being made to measure both states separately.The Gallup organization conducted an international survey of half a million people who answered questions about what they think about their life and their experiences. Besides this, other attempts are being made. So, recently we have begun to study happiness through the prism of two selves. And the main lesson I think we have learned is that they are really very different from each other. You may know how satisfied someone is with their life, but that doesn’t give you an idea of ​​how happily they are living their lives, and vice versa.Just to give you an idea of ​​the ratio, the ratio is about ½. What does it mean if you met someone and were told that his father was six feet tall, how much would you know about his own height? That is, you would have learned a thing or two about its growth, but the uncertainty here is very great. Exactly the same amount of uncertainty will be with you if I tell you that someone set themselves 8 to 10 on a scale when assessing their life, there is a great uncertainty about how happy they are from the point of view of the experiencing self.So the ratio is extremely low.

We know a thing or two about what controls the level of happiness for me. We know that money is important, goals are very important. We know that happiness is often due to the satisfaction of the people we like with the time we spend with them. There are other pleasures, but these are the most important. So if you want to maximize the happiness of the two selves, you end up doing two completely different things. My main thought is that we should not perceive happiness as a substitute for well-being.This is a completely different concept.

And now very quickly, another reason why we cannot clearly understand happiness is that we pay attention to different things when we think about life and when we really live it. So if you ask how happy people are in California, you won’t be given the right answer. When you ask this question, you think that people there should be happier if, say, you live in Ohio. And what happens: When you think about life in California, you think about the contrast between it and other places, and the difference, for example, in the climate.But it turns out that the climate is not particularly important for the experiencing self, and not even particularly important for the reflective self, which decides how happy a person is. But now, as the reflective self takes over, the result may be – for some people – a move to California. And it’s rather curious to trace what happens to people who go there in the hope of becoming happier. Well, the experiencing self won’t be happier. We know this for sure. But here’s what will happen. They will consider themselves happier because when they think about it, they will remember the terrible weather in Ohio.And they will think they made the right decision.

It is very difficult to think unequivocally about well-being, and I hope I have conveyed to you how difficult it is.

Thank you.

Chris Anderson: Thank you. I have a question for you. Thank you very much. When you and I spoke on the phone a few weeks ago, you mentioned a rather interesting result from Gallup. Can you tell us a little about this, since you still have a little time left?

Daniel Kahneman: Of course.I think the most interesting result of this survey was the number that we never expected to get. We received it in connection with the happiness of the experiencing self. When we traced how feelings vary depending on income, it turned out that if the income is below $ 60,000 per year for Americans, and the segment there is quite large – about 600,000, but this is a large segment of representatives, with incomes less than $ 600,000 per year …

CA: 60,000.

DC: 60,000. $ 60,000 per year, people are unhappy, and the poorer they are, the more unhappy they are.But everything that is higher than this figure – we get an absolutely flat straight line. Seriously, I’ve rarely seen graphs this straight. That is, it is obvious that money does not buy you experiential happiness, but lack of it leads one hundred percent to unhappiness, and we can measure it very, very clearly. As for the second me, remembering, the situation is different. The higher the income, the more satisfaction. It is not about feelings.

CA: But Danny, all the American aspirations are for life, freedom, the pursuit of happiness.If this discovery is taken seriously, it will turn everything we believe in, such as the tax system and so on, upside down. Is it likely that government officials, the country as a whole, will take such a study seriously and adhere to social policies based on it?

DK: You know, there is official recognition of the study of the role of happiness in social policy. It is slowly coming up in the US, no doubt about it, but it is happening in the UK and elsewhere.People are realizing that they have to take happiness into account when they think about social policy. It will take a long time, and people will argue about whether they want to research experiential happiness or an assessment of the quality of life, so we will need to discuss this soon enough. Ways to increase happiness vary depending on your mindset and whether you are thinking of a remembering self or a experiencing self. This will have an impact on policy. In the coming years, I think. In the United States, attempts are being made to measure the level of empirical happiness of the population.I think over the next decade or two this will become part of national statistics.

CA: Well, I think this is going to be, or at least should be, the most interesting political debate in the next few years. Thank you so much for discovering Behavioral Economics.

Translation: Valeria Burova
Editor: Elena McDonnell

Source

Daniel Kahneman. Riddle of the experience-memory dichotomy

Double-click the English transcript below to play the video.

Everybody all talks negotiations about happiness happiness these days days .

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Now everyone is talking about happiness.

I had somebody someone count count the number number of books books

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9000 books

with “ happiness happiness ” in the title title published published in the last five 5 years years

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with the word “happiness” in the title, published over the last 5 years,

and they gave gave up after about 40, and there were many many more.

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and he gave up after the 40th, but of course there were even more of them.

There is a huge huge wave wave of interest interest in happiness happiness ,

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among among researchers researchers .

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among researchers.

There is a lot of happiness happiness coaching workout .

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There are many trainings on this topic.

Everybody all would like to make people happier happier .

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Everyone wants to make people happier.

But in spite anger of all this flood flood of work,

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But despite such an abundance of literature,

9000 903 there are several

several cognitive cognitive traps traps

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there are some cognitive traps,

that sort

9037 almost impossible to sort impossible of make it3 to think straight Straight

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which practically do not allow thinking correctly

about happiness happiness .

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And my talk today Today will be mostly mostly about these cognitive cognitive traps traps

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And my talk today will mainly focus on these cognitive traps.

This applies applies to laypeople laypeople thinking thinking about their their own own happiness happiness 37000 9000 3000

This also applies to ordinary people who think about their happiness,

and it applies applies to scholars scientists thinking thinking about happiness happiness ,

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and equally scientists thinking about happiness

because it turns turns out we’re just as messed messed up up as anybody someone else another is.

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because it turns out that we are all equally confused.

The first of these traps traps

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The first of these traps –

is a reluctance reluctance complexity to admit38 complexity 3 .

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is a reluctance to admit how complex the concept is.

It turns turns out that the word word happiness happiness

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It turns out that not the word “happiness” is

9000 useful useful word word anymore no longer ,

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is no longer such a useful word,

because we apply 80 it to too many many different other things.

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because we apply it to too different things.

I think there is one particular specific meaning meaning to which which we might might restrict limit it, 61

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I think there is one specific value that we should limit ourselves to,

but by and large large ,

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but, in general,

this is something that we’ll well have to give up

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this is what we’ll have to forget about

and we’ll Well have to adopt take the more complicated difficult view View

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and develop a more comprehensive view of what well-being well-being is.

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what is well-being.

The second second trap trap is a confusion confusion between between experience experience and memory Memory; memory

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The second pitfall is the confusion of experience and memory:

basically basically , it’s between between being being happy happy in your life,

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that is, between the state of happiness in life

and being being happy happy about your life

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and feeling happy about your life

or happy happy with your life.

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or the feeling that life suits you.

And those are two very different other concepts concepts ,

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These are two completely different concepts,

and they’re both both lumped lumped in the notion concept of happiness happiness .

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but both are usually combined into one concept of happiness.

And the third in the third is the focusing focusing illusion illusion ,

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And the third is the focusing illusion

, it’s 9000 unfortunate unfortunate fact fact that we can’t think about any circumstance circumstance

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and it’s a sad fact that we can’t think of any circumstance,

that affects well-being well-being

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which affects our well-being,

without distorting 9038 without 9038 distorting 9038 9038 9038 its importance importance .

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without distorting its significance.

I mean, this is a real real cognitive cognitive trap trap .

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This is a real cognitive trap.

There’s just no way of getting getting it right.

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And there is simply no way to get it right.

Now, I’d like to start Start with an example example

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I would like to start with example

of somebody who had a question-and-answer question and answer session session

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people who took part in the question and answer session

after one of my lectures lectures reported a story story ,

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after one of my lectures and told the story

and that was a

story –

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(illegible)

He said he’d he 9 0382 been listening listening to a symphony symphony ,

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He told how he once listened to a symphony,

and it was absolutely absolutely nice music Music

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and it was just amazing music,

and at the very end end of the recording, recording

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but at the very end of the recording

there was a dreadful terrible screeching screeching sound sound .

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a terrible grinding sound was heard.

And then he added , really quite pretty emotionally emotionally ,

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And then he added, quite emotionally, it

destroyed the whole all experience experience .

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that it ruined the whole experience.

But it hadn’t didn’t have .

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What it had ruined destroyed were the memories memories of the experience experience .

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This spoiled the memory of the experience.

He had the experience experience .

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He had this experience.

He had had 20 minutes minutes of glorious glorious music Music .

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He experienced 20 minutes of great music.

They counted counted for nothing

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But they didn’t matter,

because he was left with a memory Memory ;

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because all that remains is his memory;

the memory Memory was ruined ruined ,

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the memory was ruined,

and the memory and the memory and the memory that got all

memory that had all was received to keep.

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and the memory was the only thing he had left.

What this is telling saying us, really,

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And the conclusion from this, in fact, is that

is that we might could be thinking thinking of ourselves ourselves and of other people

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that we may perceive ourselves and others

in terms terms of two selves selves .

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through the prism of two I.

There is an experiencing self ,

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One is our experiencing self,

who lives lives in the lives present

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the one who is currently living

and knows knows the present present ,

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and knows only the present,

is capable capable of re-living re-lives the past past ,

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experience,

but basically basically it has only the present present time .

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but, in fact, has only the present.

It’s the experiencing self that the doctor doctor approaches

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see a doctor,

you know, when the doctor doctor asks asks ,

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well, you know when he asks,

“Does it hurt hurt now when I touch touch you here? ”

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“Does it hurt when I touch here?”

And then there is a remembering remembering self itself ,

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And there is a remembering me,

and the self remembering is the one that keeps score Goal ,

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and the remembering me is the one that keeps score,

and 9037 maintains 1 the story history of our life,

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and keeps the history of our life,

and it’s the one that the doctor doctor approaches approaches

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and this is what the doctor calls

in asking 9038 0 ask the question question ,

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“How have you been feeling feeling lately recently ?”

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“How are you feeling lately?”

or “How was your trip trip to Albania Albania ?” or something like that.

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or “How was your trip to Albania?”, Or something like that.

Those are two very different other entities legal entities ,

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These are two completely different entities,

the experiencing self experiencing 1 self and the remembering remembering self self ,

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experiencing me and remembering me,

and getting

getting getting getting between between them is part part of the mess mess

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and confusion between them creates confusion

concept 9037 happiness happiness .

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with the concept of happiness.

Now, the remembering remembering self self

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is a storyteller storyteller .

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is a storyteller.

And that really starts starts with a basic main response response of our memories memories

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And it starts with

the base response of our memories is

it starts starts immediately immediately .

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starts immediately.

We don’t only tell stories stories when we set set out to tell stories stories .

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We tell stories not only when we intend to tell them.

Our memory Memory tells says us stories stories ,

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Our memory tells us stories,

we keep that is, from our experiences experience

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everything we take from our experience

is a story story .

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is history.

And let me begin start with one example example .

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And let me give you one example.

This is an old old study study .

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This is one long study.

Those are actual actual patients patients undergoing undergoing a painful painful procedure procedure .

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Real patients undergo a painful procedure.

I won’t go into detail detail . It’s no longer longer than painful painful these days days ,

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It’s painless these days,

but it was painful painful when this study study was run running in the 1990s.

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but then, in the 1990s, it was different.

They were asked asked to report report on their them pain pain every every 60 seconds seconds .

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They were asked to share their feelings every minute.

Here are two patients patients ,

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Here are two patients.

those are their them recordings records .

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And you are asked asked , “Who of them suffered suffered more?”

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And they ask you: “Which of them suffered the most?”

And it’s a very easy easy question question .

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And this is a very simple question.

Clearly obviously , Patient Patient B suffered suffered more –

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It is clear that Patient B suffered more.

his colonoscopy colonoscopy was longer longer than ,

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His colonoscopy was longer,

and every every minutes of pain pain that Patient Patient A had,

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And every minute of pain that Patient A suffered,

Patient Patient and more B had

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Patient B also suffered, plus additional time.

But now there is another other question question :

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But another question appears:

“How much did these patients patients 9038 suffered suffered ? ”

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“How much did the patients themselves think they suffered?”

And here is a surprise surprise .

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And here a surprise awaits us.

The surprise surprise is that Patient Patient A

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It consists in the fact that the memories of Patient A

had worse 9037 memory Memory of the colonoscopy colonoscopy

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about colonoscopy is much worse,

than Patient Patient B.

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than Patient B.

The stories stories of the colonoscopies colonoscopy were different 106 9000

9000 9000 other

2,

The histories of these procedures were different,

and because a very critical critical part part of the story history is how it ends ends .

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and since a very important part of them is how they end

And neither nor of these stories stories is very inspiring inspiring or great –

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and none of them particularly inspiring –

but one of them is this distinct distinct … ( Laughter Laughter )

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but one of them is defined … (Laughter)

but one of them is distinctly distinctly worse than the other.

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but one of them is definitely worse than the other.

And the one that is worse

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And the one that is worse

is the one where pain pain was at its peak mountain top at the very end end ;

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is the one with the most pain at the end of the procedure.

it’s a bad Bad story story .

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This is a bad story.

How do we know that?

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How do we know this?

Because we asked asked these people after their them colonoscopy colonoscopy ,

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Because we asked much

later later , too,

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and also much later.

“How bad Bad was the whole all thing, in total Total ?”

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“How bad was it, overall?”

And it was much worse worse for A than for B, in memory Memory .

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And for A, according to recollections, it was much worse than for B.

Now this is a direct direct conflict conflict

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And there is a direct conflict

between the self and the remembering remembering self self .

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between the experiencing and the remembering self.

From the point point of view View of the experiencing experiencing self self ,

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clearly clearly , B had a worse worse than time.

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it is obvious that Patient B had a more difficult experience.

Now, what you could do with Patient Patient A,

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And now what can you try with patient A,

and we actually actually ran ran clinical clinical experiments experiments ,

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and we actually did clinical research,

and 903 done done 903 done 903 , and it does work –

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and it worked,

you could actually actually extend extend the colonoscopy colonoscopy colonoscopy colonoscopy Patient A

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you can extend patient A’s colonoscopy,

by just keeping storage the tube tube in without without jiggling jiggle it too much.

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leaving the tube inside but not moving it too much.

That will cause cause the patient patient

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This will cause the patient

to suffer to suffer a little

, but just 9000 358000

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discomfort, but not severe pain,

and much less Less than than before.

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is much less than before.

And if you do that for a couple pair of minutes minutes ,

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And, if you do this for a couple of minutes,

you have made made the experiencing experiencing self self

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you put the experiencing me

of 90 Patient Patient worse off

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Patient A in the worst position,

and you have the remembering remembering self of Patient 9000 9000 9000 36000 36000 36000 A 9000

3000

but the remembering me –

a lot better off,

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to much better,

because now you have endowed endowed Patient Patient A

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A because now you have given

to the patient a better story

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best story

about his experience experience .

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about his experience.

What defines defines a story story ?

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What determines the overall tone of the story?

And that is true true of the stories stories

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for us,

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which memory provides us,

and it’s also also true true of the stories stories that we make up.

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as well as the stories we make up.

What defines defines a story history are changes changes ,

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Change

significant

moments and endings .

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Highlights and ending.

Endings are very, very important important

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The end is very, very important,

and, in this case , the case ending ending dominated dominated .

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and, in this case, the end was decisive.

Now, the experiencing self self

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lives a long life.

It has moments moments of experience experience , one after the other.

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He has moments of experience, one by one.

And you can ask ask : What happens happens to these moments moments ?

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And if you ask: what happens to these moments?

And the answer answer is really straightforward simple :

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The answer is very simple.

They are lost lost forever forever .

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They disappear forever.

I mean, most most of the moments moments of our life –

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I’m talking about most of the moments of our life –

and I calculated calculated , you know, the psychological psychological present

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and I calculated – you know, psychological present is

9000 be about three three seconds seconds long;

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lasts three seconds.

that means means that, you know,

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What does it mean, imagine,

in a life there are about 600 million million of them;

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in their life – about 600 million.

in a month month , there are about 600,000 –

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Per month – about 600,000.

most most of them don’t leave leave a trace trace .

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Most of them leave no trace.

Most Most of them are completely completely ignored are ignored

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Most of them 9080 is completely ignored 9037 by the remembering 9037 by the remembering 9038 self itself .

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And yet still , somehow somehow you get the sense sense

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that they should count count ,

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that they should matter,

that what happens happens during during these moments moments of experience experience

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something that happens during these moments –

is our life.

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this is our life.

It’s the finite finite resource resource that we’re spending

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This is a limited resource that we spend2, we ‘

re on this earth Earth .

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while we are on this land.

And how to spend spend it

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And how to spend it –

would seem seem to be relevant 9000 9000 Relevant 9038

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seems like an appropriate question,

but that is not the story story

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but this is not the same story,

that the

remembering self self keeps keeps for us.

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which the remembering self keeps for us.

So we have the remembering remembering self self

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,

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and testing me,

and they’re really quite pretty distinct distinct .

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and they are really quite seriously different from each other.

The biggest biggest difference difference between between them

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The biggest difference

is in the circulation time.

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lies in their approach to time.

From the point point of view View of the experiencing experiencing self self ,

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if you have a vacation vacation ,

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if you are on vacation,

and the second second week week is just as good as first,

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and the second week of your trip is as good as the first one,

then the two-week two weeks vacation vacation

180

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then two week trip should be

is twice twice a s good as the one-week one week vacation .

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is twice as good as one week.

That’s not the way it works works at all for the remembering remembering self itself .

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But for those who remember me, it works differently.

For the remembering remembering self itself , a two-week two weeks vacation vacation

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is barely barely better than the one-week one week vacation

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hardly better than

because there

new new memories memories added added .

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because no new experiences are added.

You have not changed changed the story story .

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History does not change.

And in this way,

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And in this view

time is actually actually the critical critical variable 0 variable 9000

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time is a critical variable,

that distinguishes distinguishes a remembering 50380 self

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9000 i

from an experiencing experiencing self self ;

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from the test subject.

time has very little impact impact on the story story .

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Time has little effect on this story.

Now, the remembering remembering self itself does more

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Besides, remembering me not only

than remember tell stories and remember stories .

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remembers and tells stories.

It is actually actually the one that makes marks decisions decisions

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It actually makes decisions, if

you have a patient patient who has had, say,

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because if you have a patient who had, say,

two colonoscopies colonoscopy with two different other surgeons surgeons

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two colonoscopies at two different surgeons,

and is deciding 9038 which deciding 9038 which of them 9038 to choose choose ,

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and he decides which of them to choose,

then the one that chooses chooses

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in this case the choice will fall on that

is the one that has the memory Memory that is less Less than bad Bad ,

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of whom the memory is less negative,

9038 surgeon 90 surgeon and that’s the39038 that will be chosen chosen .

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exactly the surgeon he will choose.

The experiencing experiencing self self

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experiencing me

has no voice voice in this choice

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has no voice in this choice.

We actually actually don’t choose select between between experiences experiences ,

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We don’t actually choose 3000

between the two experiments.

we choose select between between memories memories of experiences experiences .

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We choose between two memories of the experience.

And even when we think about the future future ,

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And even when we think about the future,

we don’t think of our future future normally as usual as experiences experiences .

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We usually don’t think of our future as an experience.

We think of our future future

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We think of our future,

as anticipated expected memories memories memories.

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as an anticipated memory.

And basically basically you can look at this,

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And, you know, in general you can look at it,

you know, as a tyranny tyranny of the remembering remembering self itself ,

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as on the tyranny of the remembering self,

and you can think of the self remembering self

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and you can say that remembering me

sort sort of dragging dragging the self experiencing

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As if dragging the experiencing self

t hrough through experiences experience that

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through the experience that

the experiencing self need itself.

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The testier does not need me.

I have that sense meaning that

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I have a feeling that

when we go on vacations vacations

576

when we go on vacation,

this is very frequently often the case case ;

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it often happens that

that is, we go on vacations holidays ,

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we go a very large large extent degree ,

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largely

in the service providing services of our

82 remembering remembering 9037 self itself .

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to please our remembering self.

And this is a bit slightly hard hard to justify justify I think.

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And it’s a little hard to find an excuse for that, I think.

I mean, how much do we consume consume our memories memories ?

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I mean, how often do we then return to our memories?

That is one of the explanations explanations

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This is one of the explanations,

that is given given for the 90 dominance 9000

5

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which is given to dominance

of the remembering remembering self itself .

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And when I think about that, I think about a vacation vacation

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And when I think about it, I think about vacation ,

we had in Antarctica Antarctica a few little years years ago ago ,

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years ago,

which which was clearly clearly the best Best vacation vacation I’ve ever had,

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and I think of it relatively relatively often satisfied but often ,

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and I remember it quite often,

relative relative to how much I think of other vacations vacations .

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About how rarely I think about other trips.

And I probably probably have consumed consumed

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I may have returned

my memories memories of 9037-three weeks trip trip , I would say,

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to my memory of that three week trip, I would say

for about 25 minutes in the last four 4 years years .

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for about 25 minutes over the past four years.

Now, if I had ever opened open the folder folder

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Also, if I ever opened the folder

pictures with the 600 pictures pictures in it,

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with 600 photos,

I would have spent spent another other hour hours 9038

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I would have spent another hour.

Now, that is three three weeks weeks ,

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And now it’s three weeks

and that hour is at most most 9038 hours and a half half .

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weeks and maximum one and a half hours.

There seems seems to be a discrepancy mismatch .

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It would seem that there is a discrepancy here.

Now, I may May be a bit slightly extreme extreme , you know,

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because

in how little appetite appetite I have for consuming consuming memories memories ,

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I have very little appetite 9000 but even if you do more of this,

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but even if you do more than me,

there is a genuine genuine question question :

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a sincere question arises.

Why do we put so much weight weight on memory Memory

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Why are we attaching such a high value to memory

relative weight weight that we put on experiences experience ?

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in comparison with experience value?

So I want you to think

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So I want you to think

about a thought experiment experiment .

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about a thought experiment.

Imagine Submit that for your next next vacation vacation ,

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Imagine your next vacation trip.

you know that at the end end of the vacation vacation

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And imagine that you know that at the end of it

all your pictures pictures will be destroyed destroyed ,

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all your photos will be destroyed

and you’ll you will be get an amnesic amnesic drug drug

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and you will take an amnestic drug,

so that you won’t remember remember anything.

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so you won’t remember anything.

Now, would you choose select the same same vacation ? ( Laughter Laughter )

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Well, would you still choose the same ride? (Laughter)

And if you would choose choose a different other vacation ,

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And if you would choose another option

there is a conflict conflict between between your two selves selves ,

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here a conflict arises between your two selves and you need

think about how to adjudicate to adjudicate that conflict conflict ,

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and you need to think about how to resolve it yourself,

and it’s actually case not at all obvious obvious , because

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and in fact it is far from so simple,

if you think in terms terms of time,

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because if you think through the prism of time,

then you get one answer answer ,

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and if you think in terms terms of memories memories ,

2603

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And if through the prism of memory –

you might could get another another answer answer .

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Why do we pick choose the vacations vacations we do

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Why do we choose other trips

is a problem problem that confronts in confrontation us

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this is the problem that puts us

with a choice choice between 1 between 1 between the two selves selves .

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before choosing between two I.

Now, the two selves selfies

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bring bring up two notions concepts of happiness happiness.

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entail two concepts of happiness.

There are really two concepts concepts of happiness happiness

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There are really two concepts of happiness,

that we can apply one apply per at self self .

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which we can use, each for the corresponding I.

So you can ask ask : How happy happy is the experiencing experiencing self itself ?

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You ask, how happy am I?

And then you would ask ask : How happy happy are the moments moments

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And then: how happy are the moments

experiencing experiencing self’s self’s life?

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in the life of the testing self?

And they’re all – happiness happiness for moments moments

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And all this is happiness for moments

is a fairly pretty complicated complicated process process .

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is a rather complicated process.

What are the emotions emotions that can be measured measured ?

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What are the feelings that can be measured?

And, by the way, now we are capable capable

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And by the way, now we are able to

of getting getting a pretty pretty good idea idea

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pretty passable to understand

of the happiness happiness of the self experiencing

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the idea of ​​the happiness of the experiencing self in time.

If you ask ask for the happiness happiness of the remembering remembering self itself ,

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if you ask 3000 i,

it’s a completely completely different another thing.

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is something completely different.

This is not about how happily happily a person people lives lives .

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It’s not how happy someone is.

It is about how satisfied satisfied or pleased happy the person people is

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when that person people thinks thinks about her life.

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when he thinks about his life.

Very different other notion Concept .

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Very different concepts.

Anyone Anyone who doesn’t distinguish highlight those notions concepts

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Anyone who does not distinguish between them2 is going

9000 to mess mess up the study study of happiness happiness ,

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will surely get confused about happiness,

belong

and I to a crowd crowd of students students of well-being well-being ,

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and I myself am one of those students who’ve been

which are already been messing messing up the study study of happiness happiness for a long time

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who have been confused for a long time in the study of happiness

in precisely exactly this way.

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in this way.

The distinction the difference between between the

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The difference between

happiness happiness of the experience

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happiness of the experiencing self

and the satisfaction satisfaction of the remembering remembering self 9000 9000 9000 9000 9000 itself 77381 9000 and the satisfaction of the remembering self

has been recognized recognized in recent recent years years ,

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now efforts 90 380 forces to measure measurement the two separately separately .

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and now attempts are being made to measure both states separately,

The Gallup Gallup Organization organization has a world world poll 9038

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The Gallup organization conducted an international survey,

where more than half half a million million people

295

789000 in which half a million people participated

have been asked asked questions questions

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and answered the questions

about

about

about

about what they think of their life

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what do they think about their life

and about their experiences experience ,

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and their experience.

and there have been other efforts efforts along along those lines lines .

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In addition, other attempts are being made.

So in recent recent years years , we have begun started to learn learn

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study

about the happiness happiness of the two selves selves .

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happiness through the prism of two I.

And the main main lesson lesson I think that we have learned learned

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And the main lesson, I think we have

is they are really different other .

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is that they are really very different from each other.

You can know how satisfied somebody someone is with their life,

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You can know how satisfied someone is your life,

and that really doesn’t teach teach you much

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2000

but it doesn’t give you an understanding of

about how happily happily they ‘ re living live their their life,

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how happily he lives his life,

and vice vice versa

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2000

Just to give you a sense meaning of the correlation correlation ,

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the correlation correlation is about .5.

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Ratio approx. ½.

What that means means is if you met met somebody someone ,

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What does it mean if you met

9000 and you were told, “Oh his father father is six six feet feet tall high ,”

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and 4000

and 4000

that his father is six feet tall,

how much would you know about his height ?

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How much would you know about his own growth?

Well, you would know something about his height ,

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That is, you would know something about his height,

but there’s a lot of uncertainty uncertainty .

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but the uncertainty here is very great.

You have that much uncertainty uncertainty .

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Exactly the same amount of uncertainty you will have,

If I tell you that somebody someone ranked ranks their 9038 life 8 on a scale scale of ten 10 ,

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,

you have a lot of uncertainty uncertainty

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there is a lot of uncertainty,

about how happy happy they are

318 9000

how happy they are

with their them experiencing experiencing 9 0379 self itself .

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from the point of view of the testing self.

So the correlation correlation is low low .

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So the ratio is extremely low.

We know something about what controls controls

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We know something about what controls

satisfaction satisfaction of the happiness happiness self itself .

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level of satisfaction with happiness for me.

We know that money Money is very important important ,

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We know that money is important,

goals goals are very important important .

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goals are very important

We know that happiness happiness is mainly mostly

325

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40002 due to

being being satisfied satisfied with people that we like,

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satisfaction with people we like,

spending spending that we like.

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by spending time with them.

There are other pleasures pleasures , but this is dominant dominant .

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There are other pleasures, but these are the most important.

So if you want to maximize maximize the happiness happiness of the two selves selves ,

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3000

So if you want two i max,

you are going to end end up

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you end up with

doing very different other things.

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do two completely different things.

The bottom bottom line line of what I’ve said here

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My main thought is

is that we really should not think of happiness happiness

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we should not perceive happiness

as a substitute replacement for well-being well-being .

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as a substitute for well-being.

It is a completely completely different other notion concept .

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This is a completely different concept.

Now, very quickly quickly ,

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And now, very quickly,

another other other reason reason we 9037 cannot think straight Straight about happiness happiness

337

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4000

Another reason why we cannot clearly understand happiness is

is that we do not attend visit to the same the same things

338

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7000

is that we pay attention to different things,

when we think about life, and we actually actually live live .

339

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3000

when we think of life and when we really live it.

So, if you ask ask the simple just question question of how happy happy people are in California California ,

3402 9000

5000

So if you ask how happy people are in California,

you are not going to get to the correct correct answer answer .

341

0

3000

will not give you the right answer.

When you ask ask that question question ,

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When you ask this question

you think happ people must should be happier in California California

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2000

you think people should be happier there,

if, say, you live live in

79 Ohio .

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if, for example, you live in Ohio.

( Laughter Laughter )

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And what happens happens is

346

0

30003

0

30003 9000 about living live in California California ,

347

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4000

when you think about life in California

you are thinking 3 of the contrast 9080

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2000

you think of contrast

between between California California and other places places 9000 ,

3000

between her and other places,

and that cont rast contrast , say, is in climate climate .

350

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and the difference, for example, in the climate.

Well, it turns turns out that climate climate

351

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But it turns out that the climate

is not verycing important important test self self

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not particularly important to the test person

and it’s not even very important reflective important to the to the itself

353

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3000

and not even particularly important for the reflective self,

that decides solves how happy happy people are.

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0

3000

which decides how happy a person is.

But now, because the reflective reflective self itself is in charge charge ,

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hands,

you may may end end up – some people may may end end up

356

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2000

– for some people –

moving moving to California California .

357

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2000

moving to California.

And it’s sort Sort of interesting interesting to trace trace what is going to happen happen

358

0

30002 30002 what happens

to people who move move to California California in the hope hope of getting getting happier happier .

359

0

3000

with people who go there in the hope of becoming happier.

Well, their experiencing experiencing self myself

360

0

2000

Well, experiencing

361

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2000

will not be happier.

We know that.

362

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2000

We know this for sure.

But one thing will happen happen : They will think they are happier happier ,

363

0

3000

But here’s what happens. They will consider themselves happier,

because, when they think about it,

364

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4000

because when they think about it

they’ll they’ll be be reminded reminded of how horrible what horrible the weather Weather was in Ohio Ohio ,

365

0

4000

and they will feel they made made the right decision decision .

366

0

3000

And they will think they made the right decision.

It is very difficult difficult

367

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2000

Very difficult

to think straight Straight about well-being about well-being about well-being about well-being about well-being 2 9000 9000

2000

think unambiguously about well-being,

and I hope hope I have given given you a sense meaning

369

9

and

9000 I hope I told you

of how difficult difficult it is.

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2000

how difficult it is.

( Applause Applause )

372

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3000

(Applause)

Chris Chris Anderson 90 you 9038 Anderson: Thank you I’ve got a question question for you.

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Chris Anderson: Thank you. I have a question for you.

Thank you so much.

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Thank you very much.

Now, when we were on the phone Phone a few little weeks weeks ago ago ,

375

1006000

When 40002 When we are

You spoke on the phone a few weeks ago,

you mentioned mentioned to me that there was quite pretty an interesting interesting result result

376

1010000 9000

You mentioned a rather interesting result,

came came out of that Gallup Gallup survey survey .

377

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2000

obtained by Gallup.

Is that something you can share

378

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2000

Can you tell us a little about this,

since since you do have a few moments moments left now?

379

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2000

times you still have a little time left?

Daniel Daniel Kahneman Kahneman : Sure.

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2000

Daniel Kahneman: Of course.

I think the most most interesting interesting result result that we found in the Gallup Gallup 9382 38000 survey 1021000

3000

I think the most interesting result of this survey was

is a number number , which which we absolutely absolutely did not expect expect to find.

382

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3000

a number that we never expected to receive.

We found found that with respect respect to the happiness happiness

383

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2000

We got it in connection with the happiness of

test self self .

384

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3000

testing I.

When we looked looked at how feelings feelings ,

385

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5000

When we traced how feelings with

income vary vary vary .

386

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2000

vary according to income,

And it turns turns out that, below below an income income 387393

9000

3000

turned out if income is below

of 60,000 dollars dollars a year , for Americans

388

1042000

3000 9000 per year, for Americans,

and that’s a very large large sample sample of Americans Americans , like 600,000,

389

1045000

3000

large – about 600,000,

so it’s a large large representa tive representative sample sample

390

1048000

2000

but this is a large segment of representatives,

below below an dollars 9080,000 income dollars a year year

391

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2000

with income less than $ 600,000 per year …

CA California : 60,000.

392

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2000

DK DK : 60,000.

393

1054000

2000

( Laughter Laughter )

394

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2000

60,000 dollars a year unhappy ,

395

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4000

60,000 dollars per year, people are unhappy,

and they get progressively gradually unhappier unhappy the poorer the poorer …

396

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3000

and the poorer they are, the more unhappy they are.

Above Above that, we get an absolutely absolutely flat apartment line line .

397

1065000

3000

But everything above this figure – we get an absolutely flat straight line.

I mean I’ve rarely rarely seen seen lines lines so flat apartment .

398

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3000

Seriously, I’ve rarely seen graphs this straight.

Clearly obviously , what is happening happens is

399

1071000

2000

That is, it is obvious that

money Money buy

you experiential empirical happiness happiness ,

400

1073000

3000

money doesn’t buy you empirical happiness,

but 9080 lack certainly of day money undoubtedly buys buys you misery poverty ,

401

1076000

3000

but their shortage is 100% unfortunate 9037

and we measure misery poverty

402

1079000

2000

and we can measure it

very, very clearly clearly .

403

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2000

very, very clear.

In terms terms of the other self itself , the remembering remembering self itself ,

404

1083000

3000

,

you get a different other story story .

405

1086000

2000

Here the situation is different.

The more money Money you earn earn , the more satisfied satisfied you are.

406

1088000

3000

The higher the income, the more satisfaction.

That does not hold hold for emotions emotions .

407

10

2000

It does not concern the senses.

CA California : But Danny Danny , the whole all American American endeavor make efforts is about

000 CA: But Danny, all American aspirations are directed towards

life, liberty freedom , the pursuit pursuit of happiness happiness .

409

10

3000

life, freedom, pursuit of happiness.

If people took took seriously jokes aside that finding ,

410

10

4000

If this discovery is taken seriously

mean2 seems seems to turn turn upside up down

411

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3000

this turns it upside down

everything we believe about example, for like example3 ,

412

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2000

whatever we believe, for example

taxation taxation policy policy and so forth forward .

413

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2000

taxation system and so on.

Is there any chance chance that politicians politicians , that the country country generally generally ,

414

1110000

Is there 3000 that statesmen, the country as a whole,

would take a finding finding like that seriously jokes aside

415

1113000

3000

would take such research seriously

and running public public policy policy based based on on it?

416

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2000

and will we adhere to a social policy based on it?

DK DK : You know I think that there is recognition recognition

417

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2000

DK: You know, official recognition

of the role of happiness happiness research research in public public policy policy .

418

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3000

There is research on the role of happiness in social policy.

The recognition recognition is going to be slow slow in the United united States states ,

419

1123000

2000 9000 ,

no question question about that,

420

1125000

2000

but in the U.K., it is happening happens ,

421

1127000

2000

but it happens in the UK

and in other countries countries it is happening happens .

422

1129000

2000

and in other countries.

People are recognizing recognizing that they ought must

423

1131000

3000

People realize that they must

to be thinking happiness thinking 9038

424

1134000

2000

take happiness into account,

when they think of public public policy policy .

425

1136000

2000

when they think about social policy.

It’s going to take a while,

426

1138000

2000

It will take a long time,

and people are going to debate discussion

427

1140000 and

people will argue about whether

whether they want to study study experience experience happiness happiness ,

428

1143000 2000

they investigate empirical happiness

or whether whether they want to study study life evaluation evaluation ,

429

1145000

2000

or

quality of life evaluation we need to have that debate discussion fairly pretty soon soon .

430

1147000

3000

so we’ll need to discuss this soon enough.

How to enhance enhance happiness happiness

431

1150000

2000

How to increase happiness,

goes very different1 9038 depending depending on on how you think,

432

1152000

3000

it can happen differently depending on your way of thinking,

and whether is you think of the remembering remembering self self

433

1155000

2000

and from whether you think of the self experiencing experiencing itself .

434

1157000

2000

or test I.

This is going to influence influence policy policy , I think, in years years to come.

435

1159000

3000

This will have a policy impact. In the coming years, I think.

In the United States states , efforts are being being made made

436

11000 attempts

to measure measurement the experience experience happiness happiness of the population Population .

437

1165000

3000

to measure the level of empirical happiness of the population.

This is going to be, I think, within in the next next decade decade or two,

438

1168000

3000

or two

part part of national national statistics statistics .

439

1171000

2000

this will become part of national statistics.

CA California : Well, it seems seems to me that this issue question will – or at least least should be –

440

1173000 9000

4000

CA: Well, I think this problem will be, or at least should

the most most interesting interesting policy policy discussion discussion to track track

441

1177000

2000

become the topic of the most interesting political discussion

over the next next few little years

442

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2000

in the next few years.

Thank you so much for inventing inventing behavioral behavioral economics economics .

443

1181000

2000

Thank you so much for discovering behaviorist economics.

Thank you, Danny Danny Kahneman Kahneman .

444

1183000

2000

Thank you Danny Kahneman.

A non-invasive test for bowel disease has been developed

Georgy Golovanov

A team of Polish researchers has proposed a new test for the painless detection of Crohn’s disease or ulcerative colitis. Colonoscopy is not necessary; blood and stool samples are sufficient.

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Leaky gut syndrome, also known as leaky gut syndrome, is another indicator of digestive health and is often associated with inflammatory bowel diseases (IBD), which include Crohn’s disease, ulcerative colitis, and celiac disease , writes New Atlas.

According to the medical journal Lancet, these diseases plague 0.3% of the population of Western countries, and spread as the world gradually becomes Westernized.

A study by scientists from the Medical University of Warsaw gives hope for early diagnosis, which is essential in order to bring an incurable disease under control. IBD is difficult to diagnose now, and the main methods – clinical symptoms and colonoscopy – are invasive, expensive, and often require general anesthesia.

The method of Polish scientists is much simpler. Taking about 1 mm of blood and stool for analysis, doctors measure the ratio of short-chain fatty acids that bacteria secrete. It shows how well the gut-blood barrier is functioning. When it is disturbed, unwanted elements – intestinal bacteria and their waste products – enter the bloodstream and cause disease.

Scientists also hope that their method will be able to determine the presence of other diseases – liver problems or heart failure.

A home test for infections and bacteria and germs in food was developed in Britain. … The result will appear within 90 minutes.

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MEDSI Clinical Hospital in Otradnoye – MEDSI network of clinics

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