TEDGlobal 2011
Ben Goldacre: Battling bad science
Ben Goldacre: Zientzia txarrarekin borrokan
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Egunero osasunaren inguruko gomendio berriak ditugu, baina nola jakin zuzenak diren? Ben Goldacre mediku eta epidemiologoak, abiadura bizian, ebidentziak nola desitxuratu daitezkeen erakusten digu. Begi bistakoak diren nutrizio aipamenetatik sutilagoak diren farmazeutiken iruzurretara.
Ben Goldacre - Debunker
Ben Goldacre unpicks dodgy scientific claims made by scaremongering journalists, dubious government reports, pharmaceutical corporations, PR companies and quacks. Full bio
Ben Goldacre unpicks dodgy scientific claims made by scaremongering journalists, dubious government reports, pharmaceutical corporations, PR companies and quacks. Full bio
Double-click the English transcript below to play the video.
00:15
So I'm a doctor, but I kind of slipped sideways into research,
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Medikua naiz,
baina ikerketa aukeratu nuen
baina ikerketa aukeratu nuen
00:18
and now I'm an epidemiologist.
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eta orain epidemiologoa naiz.
00:20
And nobody really knows what epidemiology is.
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Eta, inork ez daki
epidemiologia zer den.
epidemiologia zer den.
00:22
Epidemiology is the science of how we know in the real world
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Zerbait mundu errealean ona ala txarra den
00:25
if something is good for you or bad for you.
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jakiteko balio duen zientzia da.
00:27
And it's best understood through example
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Adibide batekin hobeto ulertzen da:
00:29
as the science of those crazy, wacky newspaper headlines.
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Egunkarietako ez buru eta ez hankarik
ez duten izenburuen zientzia da.
ez duten izenburuen zientzia da.
00:34
And these are just some of the examples.
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Ikus ditzagun adibide batzuk:
00:36
These are from the Daily Mail. Every country in the world has a newspaper like this.
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Hau Daily Mail-ekoa da.
Herrialde guztiek dute horrelako bat.
Herrialde guztiek dute horrelako bat.
00:39
It has this bizarre, ongoing philosophical project
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Proiektu filosofiko arraro bat du, non
00:42
of dividing all the inanimate objects in the world
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munduko objektu inanimatu guztiak
00:44
into the ones that either cause or prevent cancer.
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minbiziaren sortzaile edo babesle
bezala banatzen dituen.
bezala banatzen dituen.
00:47
So here are some of the things they said cause cancer recently:
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Hemen minbiziaren sortzailetako batzuk:
00:49
divorce, Wi-Fi, toiletries and coffee.
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dibortzioa, wifia,
higiene produktuak eta kafea.
higiene produktuak eta kafea.
00:51
Here are some of the things they say prevents cancer:
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Eta hemen minbizitik babesten dutenak:
00:53
crusts, red pepper, licorice and coffee.
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azala, piper gorria, erregaliza eta kafea.
00:55
So already you can see there are contradictions.
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Ikus dezakezuenez kontraesanak daude.
00:57
Coffee both causes and prevents cancer.
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Kafea minbiziaren sortzailea
eta babeslea da.
eta babeslea da.
00:59
And as you start to read on, you can see
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Irakurtzen zoazten heinean, ikusiko duzue
01:01
that maybe there's some kind of political valence behind some of this.
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guzti honen atzean politika
egon daitekeela.
egon daitekeela.
01:04
So for women, housework prevents breast cancer,
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Emakumeetan, etxeko lanek
bularreko minbizia saihesten dute,
bularreko minbizia saihesten dute,
01:06
but for men, shopping could make you impotent.
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baina, gizonetan, erosketak egiteak
inpotentzia sor dezake.
inpotentzia sor dezake.
01:09
So we know that we need to start
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Horregatik, hasi behar dugu
01:12
unpicking the science behind this.
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honen azpian dagoen zientzia argitzen.
01:15
And what I hope to show
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Eta, zera erakutsi nahi dut,
01:17
is that unpicking dodgy claims,
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baieztapen arriskatu hauek desegitea,
01:19
unpicking the evidence behind dodgy claims,
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eta baieztapen hauen azpian dauden ebidentziak desegitea
01:21
isn't a kind of nasty carping activity;
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ez dela intentzio txarrarekin
marmar egitea;
marmar egitea;
01:24
it's socially useful,
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gizartearentzat lagungarria dela,
01:26
but it's also an extremely valuable
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eta oso baliotsua den
01:28
explanatory tool.
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tresna argigarri bat ere badela.
01:30
Because real science is all about
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Benetako zientzia hori baita,
01:32
critically appraising the evidence for somebody else's position.
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besteen ebidentziak
kritikoki ebaluatzea.
kritikoki ebaluatzea.
01:34
That's what happens in academic journals.
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Hau argitalpen akademikoetan gertatzen da.
01:36
That's what happens at academic conferences.
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Konferentzia akademikoetan gertatzen da.
01:38
The Q&A session after a post-op presents data
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Ebakuntza osteko eztabaidetako datuak
01:40
is often a blood bath.
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izugarrizko iskanbila izaten dira.
01:42
And nobody minds that. We actively welcome it.
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Eta ez dio inori axola.
Gustura hartzen dugu.
Gustura hartzen dugu.
01:44
It's like a consenting intellectual S&M activity.
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Hitzartutako ekintza intelektual
sadomasokista bat bezala da.
sadomasokista bat bezala da.
01:47
So what I'm going to show you
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Erakutsiko dizuedana, nire diziplinaren,
01:49
is all of the main things,
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zati nagusiak,
01:51
all of the main features of my discipline --
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eta ezaugarri nagusiak dira
01:53
evidence-based medicine.
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ebidentzian oinarritutako medikuntzarenak.
01:55
And I will talk you through all of these
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Guzti horren inguruan hitz egingo dut, eta
01:57
and demonstrate how they work,
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nola funtzionatzen duen azalduko dizuet,
01:59
exclusively using examples of people getting stuff wrong.
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gauzak gaizki ulertzen dituztenen
adibideak soilik erabiliz.
adibideak soilik erabiliz.
02:02
So we'll start with the absolute weakest form of evidence known to man,
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Ezagutzen den ebidentzia mota
ahulenarekin hasiko gara...
ahulenarekin hasiko gara...
02:05
and that is authority.
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autoritatea.
02:07
In science, we don't care how many letters you have after your name.
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Zientzian zure abizenak ez digu axola.
02:10
In science, we want to know what your reasons are for believing something.
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Zientzian gauza bat sinisteko
arrazoiak ezagutu nahi ditugu.
arrazoiak ezagutu nahi ditugu.
02:13
How do you know that something is good for us
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Nola dakigu zerbait guretzat ona
02:15
or bad for us?
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edo txarra den?
02:17
But we're also unimpressed by authority,
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Autoritateak ez gaitu konbentzitzen
02:19
because it's so easy to contrive.
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asmatzea erraza delako.
02:21
This is somebody called Dr. Gillian McKeith Ph.D,
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Hau Gillian McKeith doktorea da,
02:23
or, to give her full medical title, Gillian McKeith.
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edo, bere titulu mediku osoa emateko,
Gillian McKeith.
Gillian McKeith.
02:26
(Laughter)
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(Barreak)
02:29
Again, every country has somebody like this.
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Herrialde guztietan
dago horrelako norbait.
dago horrelako norbait.
02:31
She is our TV diet guru.
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Hau gure telebistako
nutrizionista gurua da
nutrizionista gurua da
02:33
She has massive five series of prime-time television,
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Audientzia handieneko ordutegian
5 saio ditu,
5 saio ditu,
02:36
giving out very lavish and exotic health advice.
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bertan, sekulako osasun gomendio
exotikoak ematen ditu.
exotikoak ematen ditu.
02:39
She, it turns out, has a non-accredited correspondence course Ph.D.
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Ofiziala ez den eta, korrespondentziaz
lortutako doktoregoa du,
lortutako doktoregoa du,
02:42
from somewhere in America.
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Ameriketako nonbaitekoa.
02:44
She also boasts that she's a certified professional member
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Harro dago ere, AANC-ko
kide izateaz
kide izateaz
02:46
of the American Association of Nutritional Consultants,
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Nutrizio Aholkularitzako
Ameriketako Elkartea,
Ameriketako Elkartea,
02:48
which sounds very glamorous and exciting.
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glamurosoa eta txundigarria dirudiena.
02:50
You get a certificate and everything.
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Zertifikatu bat eta guzti ematen dizute.
02:52
This one belongs to my dead cat Hetti. She was a horrible cat.
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Hau Hetti nire katuarena da.
Katu beldurgarria.
Katu beldurgarria.
02:54
You just go to the website, fill out the form,
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Web orrialdean sartu, imprimakia bete,
02:56
give them $60, and it arrives in the post.
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60 dolar ordaindu eta postaz etortzen da.
02:58
Now that's not the only reason that we think this person is an idiot.
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Hau ez da pertsona hau tentela dela
pentsatzeko arrazoi bakarra.
pentsatzeko arrazoi bakarra.
03:00
She also goes and says things like,
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Horrelakoak esaten ditu:
03:02
you should eat lots of dark green leaves,
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Hosto berde ilun asko jan behar dira,
03:04
because they contain lots of chlorophyll, and that will really oxygenate your blood.
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klorofila asko dutelako, eta
odola oxigenatzen dutelako.
odola oxigenatzen dutelako.
03:06
And anybody who's done school biology remembers
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Eskolan biologia ikasi duen
edozeinek daki
edozeinek daki
03:08
that chlorophyll and chloroplasts
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klorofilak eta kloroplastoek
03:10
only make oxygen in sunlight,
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oxigenoa, eguzki argiarekin
sortzen dutela,
sortzen dutela,
03:12
and it's quite dark in your bowels after you've eaten spinach.
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eta gure hesteak nahiko ilunak direla
espinakak jan ostean.
espinakak jan ostean.
03:15
Next, we need proper science, proper evidence.
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Gainera, zientzia behar da,
eta froga egokiak.
eta froga egokiak.
03:18
So, "Red wine can help prevent breast cancer."
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"Ardoak bularreko minbizitik
babesten du".
babesten du".
03:20
This is a headline from the Daily Telegraph in the U.K.
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Erresuma Batuko
Daily Telegraph-eko izenburua.
Daily Telegraph-eko izenburua.
03:22
"A glass of red wine a day could help prevent breast cancer."
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"Egunean ardo baso batek
bularreko minbizia prebenituko luke"
bularreko minbizia prebenituko luke"
03:25
So you go and find this paper, and what you find
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Artikulua aurkitzen duzu,
eta zer dago han?
eta zer dago han?
03:27
is it is a real piece of science.
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benetako zientzia.
03:29
It is a description of the changes in one enzyme
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Entzima batean ematen diren
aldaketen deskribapena da
aldaketen deskribapena da
03:32
when you drip a chemical extracted from some red grape skin
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mahatsen azaletik ateratako
osagai kimiko bat
osagai kimiko bat
03:35
onto some cancer cells
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minbizia duten zelula batzuetara isurtzean
03:37
in a dish on a bench in a laboratory somewhere.
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laborategi batetako plaka batean.
03:40
And that's a really useful thing to describe
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Eta deskribapen hau oso baliagarria da
03:42
in a scientific paper,
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artikulu zientifiko batean,
03:44
but on the question of your own personal risk
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baina ardoa edateak bularreko minbizia
03:46
of getting breast cancer if you drink red wine,
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pairatzeko arriskuan
eragiten duenari buruz
eragiten duenari buruz
03:48
it tells you absolutely bugger all.
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ezer gutxi esaten digu.
03:50
Actually, it turns out that your risk of breast cancer
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Izatez bularreko minbizia izateko arriskua
03:52
actually increases slightly
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apur bat handiagotu egiten da
03:54
with every amount of alcohol that you drink.
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edaten dugun alkohol
kantitate bakoitzarekin.
kantitate bakoitzarekin.
03:56
So what we want is studies in real human people.
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Beraz nahi duguna benetako pertsonekin
egindako ikerketak dira.
egindako ikerketak dira.
04:00
And here's another example.
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Eta hemen doa beste adibide bat.
04:02
This is from Britain's leading diet and nutritionist in the Daily Mirror,
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Britainiako dietista eta nutrizionista
handienetik Daily Mirror-etik,
handienetik Daily Mirror-etik,
04:05
which is our second biggest selling newspaper.
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gehien saltzen den bigarren egunkaritik.
04:07
"An Australian study in 2001
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"2001-eko ikerketa australiar batek
04:09
found that olive oil in combination with fruits, vegetables and pulses
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oliba olioak, fruta, berdura
eta lekaleekin konbinatuz
eta lekaleekin konbinatuz
04:11
offers measurable protection against skin wrinklings."
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azaleko zimurrak saihesten dituela
aurkitu du".
aurkitu du".
04:13
And then they give you advice:
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Gero gomendio hau egiten du:
04:15
"If you eat olive oil and vegetables, you'll have fewer skin wrinkles."
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"Oliba olioa eta berdurak janez,
zimur gutxiago izango dituzu".
zimur gutxiago izango dituzu".
04:17
And they very helpfully tell you how to go and find the paper.
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Eta argitalpena non topatu esaten digute.
04:19
So you go and find the paper, and what you find is an observational study.
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Eta irakurtzean behaketa ikerketa
aurkitzen dugu.
aurkitzen dugu.
04:22
Obviously nobody has been able
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Noski, inork ezin izan du
04:24
to go back to 1930,
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1930. urtera itzuli,
04:26
get all the people born in one maternity unit,
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jaiotako jende guztia maternitate
unitate batean ipini,
unitate batean ipini,
04:29
and half of them eat lots of fruit and veg and olive oil,
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eta erdiei fruta, berdura eta
oliba olioa eman,
oliba olioa eman,
04:31
and then half of them eat McDonald's,
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eta beste erdiak McDonald's-era
eraman,
eraman,
04:33
and then we see how many wrinkles you've got later.
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eta gero zanbat zimur dituzten neurtu.
04:35
You have to take a snapshot of how people are now.
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Egun jendea nolakoa den
aztertu behar duzu.
aztertu behar duzu.
04:37
And what you find is, of course,
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Eta noski, zera ikusten duzu,
04:39
people who eat veg and olive oil have fewer skin wrinkles.
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berdura eta oliba olioa jaten dutenek
azaleko zimur gutxiago dituztela.
azaleko zimur gutxiago dituztela.
04:42
But that's because people who eat fruit and veg and olive oil,
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Baina hori, berdura eta oliba olioa
hartzen dutenak
hartzen dutenak
04:45
they're freaks, they're not normal, they're like you;
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frikiak direlako da, ez dira normalak
zuek bezalakoak dira;
zuek bezalakoak dira;
04:48
they come to events like this.
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honelakoetara etortzen dira.
04:50
They are posh, they're wealthy, they're less likely to have outdoor jobs,
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Dotoreak dira, osasuntsuak, kanpoan
lan egiteko probabilitate txikiagoa dute,
lan egiteko probabilitate txikiagoa dute,
04:53
they're less likely to do manual labor,
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eskulanak egiteko
probabilitate gutxiago,
probabilitate gutxiago,
04:55
they have better social support, they're less likely to smoke --
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laguntza sozial gehiago dute,
erretzaileak izateko aukera gutxiago...
erretzaileak izateko aukera gutxiago...
04:57
so for a whole host of fascinating, interlocking
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beraz, hainbat arrazoi liluragarri,
04:59
social, political and cultural reasons,
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sozial, politiko eta kulturalen ondorioz,
05:01
they are less likely to have skin wrinkles.
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azaleko zimurrak edukitzeko
aukera gutxiago dituzte.
aukera gutxiago dituzte.
05:03
That doesn't mean that it's the vegetables or the olive oil.
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Honek ez du esan nahi berdurak eta
oliba olioa direnik.
oliba olioa direnik.
05:05
(Laughter)
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(Barreak)
05:07
So ideally what you want to do is a trial.
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Idealki esperimentu bat
egin beharko litzateke.
egin beharko litzateke.
05:10
And everybody thinks they're very familiar with the idea of a trial.
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Denok uste dugu esperimentuen ideia
ezaguna dugula.
ezaguna dugula.
05:12
Trials are very old. The first trial was in the Bible -- Daniel 1:12.
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Esperimentuak oso zaharrak dira.
Lehena Biblian -- Daniel 1:12
Lehena Biblian -- Daniel 1:12
05:15
It's very straightforward -- you take a bunch of people, you split them in half,
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Oso sinplea da -- jendea hartu,
bitan zatitu,
bitan zatitu,
05:17
you treat one group one way, you treat the other group the other way,
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talde bakoitza
era batera tratatu
era batera tratatu
05:19
and a little while later, you follow them up
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eta beranduxeago jarraipena egin
05:21
and see what happened to each of them.
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eta bakoitzari zer gertatu zaion ikusi.
05:23
So I'm going to tell you about one trial,
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Esperimentu batez hitz egingo dizuet,
05:25
which is probably the most well-reported trial
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ziuraski esperimentu ezagunena dena
05:27
in the U.K. news media over the past decade.
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behintzat EB-ko medioetan
azken hamarkadan.
azken hamarkadan.
05:29
And this is the trial of fish oil pills.
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Arrain pilulen esperimentua.
05:31
And the claim was fish oil pills improve school performance and behavior
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Ondorioa arrain pilulek eskola errendimendua
eta jokabidea hobetezen dituztela izan zen
eta jokabidea hobetezen dituztela izan zen
05:33
in mainstream children.
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haurren gehiengoan.
05:35
And they said, "We've done a trial.
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Eta zioten: "Esperimentu bat egin dugu.
05:37
All the previous trials were positive, and we know this one's gonna be too."
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Aurreko esperimentuak positiboak izan ziren,
badakigu hau ere hala izango dela."
badakigu hau ere hala izango dela."
05:39
That should always ring alarm bells.
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Honek alarmak piztu beharko lituzke.
05:41
Because if you already know the answer to your trial, you shouldn't be doing one.
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Esperimentuaren erantzuna badakizu,
ez zenuke berau egin behar.
ez zenuke berau egin behar.
05:44
Either you've rigged it by design,
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Edo disenua trukatuta dago,
05:46
or you've got enough data so there's no need to randomize people anymore.
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edo informazio nahikoa dago
eta ez dago aleatorizazio beharrik.
eta ez dago aleatorizazio beharrik.
05:49
So this is what they were going to do in their trial.
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Esperimentuan zera egitera zihoazen:
05:52
They were taking 3,000 children,
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3.000 haur hartu,
05:54
they were going to give them all these huge fish oil pills,
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pilula handi batzuk eman,
05:56
six of them a day,
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6 eguneko,
05:58
and then a year later, they were going to measure their school exam performance
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eta, urte bete beranduago, eskola
errendimendua ebaluatu,
errendimendua ebaluatu,
06:01
and compare their school exam performance
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eta errendimendu hori konparatu
06:03
against what they predicted their exam performance would have been
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pilulak hartu ez balituzte,
haur horiek izango zuten errendimenduarekin
haur horiek izango zuten errendimenduarekin
06:05
if they hadn't had the pills.
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06:08
Now can anybody spot a flaw in this design?
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Norbaitek diseinu honetan
akatsik ikus dezake?
akatsik ikus dezake?
06:11
And no professors of clinical trial methodology
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Saiakera klinikoko metodologia
irakasleak, mesedez ez erantzun.
irakasleak, mesedez ez erantzun.
06:14
are allowed to answer this question.
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06:16
So there's no control; there's no control group.
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Ez dago kontrolik;
ez kontrol talderik.
ez kontrol talderik.
06:18
But that sounds really techie.
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Baina horrek teknikoa dirudi.
06:20
That's a technical term.
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Kontzeptu tekniko bat da.
06:22
The kids got the pills, and then their performance improved.
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Haurrek pilulak hartu
eta errendimendua hobetu zen.
eta errendimendua hobetu zen.
06:24
What else could it possibly be if it wasn't the pills?
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Zer izango zen pilulak ez baziren?
06:27
They got older. We all develop over time.
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Hazi egin ziren.
Guztiok uneoro garatzen goaz.
Guztiok uneoro garatzen goaz.
06:30
And of course, also there's the placebo effect.
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Noski, plazebo efektua ere hor dago.
06:32
The placebo effect is one of the most fascinating things in the whole of medicine.
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Plazebo efektua medikuntzako gauza
txundigarrienetakoa da.
txundigarrienetakoa da.
06:34
It's not just about taking a pill, and your performance and your pain getting better.
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Ez da pilulak hartu eta errendimendua
eta mina hobetzeari buruz soilik.
eta mina hobetzeari buruz soilik.
06:37
It's about our beliefs and expectations.
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Gure uste eta itxaropenei buruz da.
06:39
It's about the cultural meaning of a treatment.
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Tratamenduaren esanahi kulturalari buruz.
06:41
And this has been demonstrated in a whole raft of fascinating studies
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Eta hau, ikerketa multzo handi batean
frogatu da,
frogatu da,
06:44
comparing one kind of placebo against another.
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plazebo bat eta bestea konparatuz.
06:47
So we know, for example, that two sugar pills a day
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Esaterako, eguneko
bi azukre pilula,
bi azukre pilula,
06:49
are a more effective treatment for getting rid of gastric ulcers
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tratamendu eraginkorragoa da
urdaileko ultzera tratatzeko
urdaileko ultzera tratatzeko
06:51
than one sugar pill.
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azukre pilula bat baino.
06:53
Two sugar pills a day beats one sugar pill a day.
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Bi pilulak pilula bati irabazten diote.
06:55
And that's an outrageous and ridiculous finding, but it's true.
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Aurkikuntza hau barregarria da,
baina egia da.
baina egia da.
06:58
We know from three different studies on three different types of pain
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Hiru ikerketek, hiru min mota
aztertu eta ondorioztatu dute
aztertu eta ondorioztatu dute
07:00
that a saltwater injection is a more effective treatment for pain
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ur gazidun injekzioa minaren
tratamenduan eraginkorragoa dela
tratamenduan eraginkorragoa dela
07:03
than taking a sugar pill, taking a dummy pill that has no medicine in it --
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azukre pilula baino, sendagairik
ez duen pilula baino --
ez duen pilula baino --
07:07
not because the injection or the pills do anything physically to the body,
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ez injekzioak edo pilulek gorputzari
fisikoki eragiten diotelako,
fisikoki eragiten diotelako,
07:10
but because an injection feels like a much more dramatic intervention.
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injekzioak eskuhartze indartsuagoa
dirudielako baizik.
dirudielako baizik.
07:13
So we know that our beliefs and expectations
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Badakigu gure uste eta itxaropenak
07:15
can be manipulated,
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manipulatuak izan daitezkeela,
07:17
which is why we do trials
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horregatik egiten ditugu
esperimentu hauek
esperimentu hauek
07:19
where we control against a placebo --
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plazeboa kontrolatuz --
07:21
where one half of the people get the real treatment
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pertsonen erdiek benetako tratamendua
jasotzen dutelarik
jasotzen dutelarik
07:23
and the other half get placebo.
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eta beste erdiak plazeboa.
07:25
But that's not enough.
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Baina ez da nahikoa.
07:28
What I've just shown you are examples of the very simple and straightforward ways
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Hauek adibide soilak dira,
eta zera erakusten dute
eta zera erakusten dute
07:31
that journalists and food supplement pill peddlers
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kazetariek eta elikagai-osagarrien
saltzaileek
saltzaileek
07:33
and naturopaths
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eta naturopatek
07:35
can distort evidence for their own purposes.
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ebidentziak euren nahierara
desitxuratu ditzaketela.
desitxuratu ditzaketela.
07:38
What I find really fascinating
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Benetan txundigarria dena zera da
07:40
is that the pharmaceutical industry
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industria farmazeutikoak
07:42
uses exactly the same kinds of tricks and devices,
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truko eta gailu berdinak darabiltzala,
07:44
but slightly more sophisticated versions of them,
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edo hauen bertsio sofistikatuagoak,
07:47
in order to distort the evidence that they give to doctors and patients,
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mediku eta pazienteei emandako
ebidentziak desitxuratzeko.
ebidentziak desitxuratzeko.
07:50
and which we use to make vitally important decisions.
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Ebidentzia hauetan oinarrituz
erabaki garrantzitsuak hartzen ditugu.
erabaki garrantzitsuak hartzen ditugu.
07:53
So firstly, trials against placebo:
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Lehendabizi, plazebodun esperimentuak:
07:55
everybody thinks they know that a trial should be
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uste dugu badakigula
esperimentuak nolakoa izan behar duen:
esperimentuak nolakoa izan behar duen:
07:57
a comparison of your new drug against placebo.
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medikamentu berriaren eta plazeboaren
arteko konparaketa.
arteko konparaketa.
07:59
But actually in a lot of situations that's wrong.
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Baina hau ez da zuzena hainbat kasutan.
08:01
Because often we already have a very good treatment that is currently available,
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Askotan jada badaukagu eskuragarria
den tratamendu eraginkor bat,
den tratamendu eraginkor bat,
08:04
so we don't want to know that your alternative new treatment
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beraz ez dugu jakin nahi tratamendu berria
08:06
is better than nothing.
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ezer ez baino hobea den.
08:08
We want to know that it's better than the best currently available treatment that we have.
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Daukagun tratamendu hoberena
baino hobea den jakin nahi dugu.
baino hobea den jakin nahi dugu.
08:11
And yet, repeatedly, you consistently see people doing trials
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Eta, hala ere, etengabe ikusten ditugu
esperimentuak
esperimentuak
08:14
still against placebo.
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plazeboarekin konparatzen direnak.
08:16
And you can get license to bring your drug to market
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Eta zure medikamentua merkaturatu dezakezu
08:18
with only data showing that it's better than nothing,
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ezer ez baino hobea dela dioten
datuak lortuz gero.
datuak lortuz gero.
08:20
which is useless for a doctor like me trying to make a decision.
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Datu hauek ez dute balio ni bezalako
medikuak erabakiak hartzerakoan.
medikuak erabakiak hartzerakoan.
08:23
But that's not the only way you can rig your data.
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Hau ez da datuekin iruzur
egiteko modu bakarra.
egiteko modu bakarra.
08:25
You can also rig your data
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Iruzur egin dezakezu,
08:27
by making the thing you compare your new drug against
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zure medikamentu berria konparatzen
duzun gauza hori
duzun gauza hori
08:29
really rubbish.
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ezereza bihurtuz.
08:31
You can give the competing drug in too low a dose,
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Beste medikamentua oso dosi txikian emanez
08:33
so that people aren't properly treated.
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eta beraz tratamendu ezeraginkorra emanez.
08:35
You can give the competing drug in too high a dose,
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Beste medikamentua oso dosi altuan emanez,
08:37
so that people get side effects.
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eta bigarren mailako efektuak sortuz.
08:39
And this is exactly what happened
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Eta hauxe gertatu zen
08:41
which antipsychotic medication for schizophrenia.
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eskizofrenia tratatzeko
antipsikotikoekin.
antipsikotikoekin.
08:43
20 years ago, a new generation of antipsychotic drugs were brought in
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Duela 20 urte, antipsikotiko belaunaldi
berri bat azaldu zen
berri bat azaldu zen
08:46
and the promise was that they would have fewer side effects.
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bigarren mailako efektu gutxiago
eragingo zituztela ziurtatzen.
eragingo zituztela ziurtatzen.
08:49
So people set about doing trials of these new drugs
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Medikamentu horiekin esperimentuak
egiten hasi ziren
egiten hasi ziren
08:51
against the old drugs,
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medikamentu zaharrekin alderatuz,
08:53
but they gave the old drugs in ridiculously high doses --
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baina medikamentu zaharrak
dosi izugarri altuetan emanaz --
dosi izugarri altuetan emanaz --
08:55
20 milligrams a day of haloperidol.
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20 mg haloperidol eguneko.
08:57
And it's a foregone conclusion,
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Eta ondorioa logikoa da,
08:59
if you give a drug at that high a dose,
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medikamentua hain dosi altuan
ematen baduzu,
ematen baduzu,
09:01
that it will have more side effects and that your new drug will look better.
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medikamentu berriak baino
2.mailako efektu gehiago eragingo ditu.
2.mailako efektu gehiago eragingo ditu.
09:04
10 years ago, history repeated itself, interestingly,
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Duela 10 urte, gauza bera gertatu zen,
kasualitatez,
kasualitatez,
09:06
when risperidone, which was the first of the new-generation antipscyhotic drugs,
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risperidona, belaunaldi berriko lehen
antipsikotikoa zena,
antipsikotikoa zena,
09:09
came off copyright, so anybody could make copies.
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copyright-etik atera zenean,
edonork kopiatu zezakeenean.
edonork kopiatu zezakeenean.
09:12
Everybody wanted to show that their drug was better than risperidone,
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Denek euren medikamentua risperidona
baino hobea zela erakutsi nahi zuten,
baino hobea zela erakutsi nahi zuten,
09:14
so you see a bunch of trials comparing new antipsychotic drugs
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eta esperimentu mordoa hasi zen
antipsikotiko berriak
antipsikotiko berriak
09:17
against risperidone at eight milligrams a day.
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8mg risperidona eguneko dosiarekin
konparatzen.
konparatzen.
09:19
Again, not an insane dose, not an illegal dose,
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Berriz, ez zen dosi kaltegarria
edo ilegala
edo ilegala
09:21
but very much at the high end of normal.
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baina normala baino altuagoa zen.
09:23
And so you're bound to make your new drug look better.
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Eta horrela zure medikamentu berriak
hobea dirudi.
hobea dirudi.
09:26
And so it's no surprise that overall,
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Beraz ez da harritzekoa,
09:29
industry-funded trials
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industriak diruz lagundutako
esperimentuek
esperimentuek
09:31
are four times more likely to give a positive result
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emaitza positiboak izateko
lau aldiz aukera gehiago izatea
lau aldiz aukera gehiago izatea
09:33
than independently sponsored trials.
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esperimentu independenteek baino.
09:36
But -- and it's a big but --
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Baina -eta hau baina handi bat da-
09:39
(Laughter)
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(Barreak)
09:41
it turns out,
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zera gertatzen da,
09:43
when you look at the methods used by industry-funded trials,
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industriak diruz lagundutako esperimentuen
metodoa aztertzean,
metodoa aztertzean,
09:46
that they're actually better
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benetan hobeak direla
09:48
than independently sponsored trials.
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esperimentu independenteak baino.
09:50
And yet, they always manage to to get the result that they want.
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Eta hala ere, nahi dituzten emaitzak
lortzen dituzte.
lortzen dituzte.
09:53
So how does this work?
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Nola liteke?
09:55
How can we explain this strange phenomenon?
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Nola azaldu gertaera bitxi hau?
09:58
Well it turns out that what happens
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Gertatzen dena zera da,
10:00
is the negative data goes missing in action;
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datu negatiboak bidean galtzen direla;
10:02
it's withheld from doctors and patients.
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medikuek eta pazienteek ezkutazen dituzte.
10:04
And this is the most important aspect of the whole story.
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Eta hau da gauzarik garrantzitsuena.
10:06
It's at the top of the pyramid of evidence.
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Ebidentziaren piramidearen goian dago.
10:08
We need to have all of the data on a particular treatment
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Tratamendu baten inguruko datu
guztiak behar ditugu
guztiak behar ditugu
10:11
to know whether or not it really is effective.
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benetan eraginkorra den edo ez jakiteko.
10:13
And there are two different ways that you can spot
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Bi modu daude jakin ahal izateko
10:15
whether some data has gone missing in action.
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datuak bidean galdu ote diren.
10:17
You can use statistics, or you can use stories.
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Estatistika erabili dezakezu,
edo istorioak erabili ditzakezu.
edo istorioak erabili ditzakezu.
10:20
I personally prefer statistics, so that's what I'm going to do first.
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Estatistikak nahiago ditut,
beraz horiekin hasiko nahiz.
beraz horiekin hasiko nahiz.
10:22
This is something called funnel plot.
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Inbutu grafikoa deritzona dago.
10:24
And a funnel plot is a very clever way of spotting
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Eta inbutu grafikoarekin
jakin dezakezu
jakin dezakezu
10:26
if small negative trials have disappeared, have gone missing in action.
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esperimentu txiki negatiboak desagertu,
bidean galdu diren.
bidean galdu diren.
10:29
So this is a graph of all of the trials
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Hau tratamendu baten inguruko
esperimentuen grafikoa da.
esperimentuen grafikoa da.
10:31
that have been done on a particular treatment.
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10:33
And as you go up towards the top of the graph,
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Grafikoaren goiko muturrerantz joanez,
10:35
what you see is each dot is a trial.
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puntu bakoitza
esperimentu bat da.
esperimentu bat da.
10:37
And as you go up, those are the bigger trials, so they've got less error in them.
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Goraka goazela, esperimentuak handiagoak
dira, errore txikiagoa dute.
dira, errore txikiagoa dute.
10:40
So they're less likely to be randomly false positives, randomly false negatives.
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Zoriz faltsu positibo edo negatiboak
izateko aukera txikiagoa dute.
izateko aukera txikiagoa dute.
10:43
So they all cluster together.
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Guztiak batera biltzen dira.
10:45
The big trials are closer to the true answer.
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Esperimentu handiak benetako
erantzunetik gertuago daude.
erantzunetik gertuago daude.
10:47
Then as you go further down at the bottom,
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Beheraka bagoaz, beheko muturrera
10:49
what you can see is, over on this side, the spurious false negatives,
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alde honetan gezurrezko faltsu negatiboak
ikus daitezke,
ikus daitezke,
10:52
and over on this side, the spurious false positives.
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eta alde honetan,
gezurrezko faltsu positiboak.
gezurrezko faltsu positiboak.
10:54
If there is publication bias,
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Argitaratze alborapena baldin badago,
10:56
if small negative trials have gone missing in action,
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esperimentu txiki negatiboak bidean
galdu badira,
galdu badira,
10:59
you can see it on one of these graphs.
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horrelako grafikoetan ikus daiteke.
11:01
So you can see here that the small negative trials
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Hemen ikus dezakezu, esperimentu
negatibo txikiak
negatibo txikiak
11:03
that should be on the bottom left have disappeared.
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beheko ezkerreko aldean
egon beharko luketenak desagertu direla.
egon beharko luketenak desagertu direla.
11:05
This is a graph demonstrating the presence of publication bias
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Grafiko honek argitaratze alborapena
frogatzen du
frogatzen du
11:08
in studies of publication bias.
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argitaratze alborapenen ikerketa batean.
11:10
And I think that's the funniest epidemiology joke
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Eta uste dut, inoizko epidemiologiari
buruzko txisterik onena dela.
buruzko txisterik onena dela.
11:12
that you will ever hear.
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11:14
That's how you can prove it statistically,
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Horrela frogatzen da estatistikoki.
11:16
but what about stories?
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Baina, eta istorioen bidez?
11:18
Well they're heinous, they really are.
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Beno, ankerrak dira, benetan.
11:20
This is a drug called reboxetine.
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Hau reboxetina izeneko medikamentua da.
11:22
This is a drug that I myself have prescribed to patients.
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Nik neuk pazienteei eman
diedan medikamentu bat.
diedan medikamentu bat.
11:24
And I'm a very nerdy doctor.
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Eta oso mediku ikastuna nahiz.
11:26
I hope I try to go out of my way to try and read and understand all the literature.
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Ahal beste bibliografia irakurri
eta ulertzen saiatzen naiz.
eta ulertzen saiatzen naiz.
11:29
I read the trials on this. They were all positive. They were all well-conducted.
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Honen inguruko esperimentuak irakurri
nituen. Positiboak ziren, ongi eginak.
nituen. Positiboak ziren, ongi eginak.
11:32
I found no flaw.
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Ez nuen akatsik aurkitu.
11:34
Unfortunately, it turned out,
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Zoritxarrez,
11:36
that many of these trials were withheld.
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esperimentuetako asko ezkutatuta zeuden.
11:38
In fact, 76 percent
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Izatez medikamentu horrekin
egindakoen %76
egindakoen %76
11:40
of all of the trials that were done on this drug
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mediku eta pazienteek ezkutatu egin zuten.
11:42
were withheld from doctors and patients.
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11:44
Now if you think about it,
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Pentsatzen jartzen bagara,
11:46
if I tossed a coin a hundred times,
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txanpon bat ehun aldiz botako banu,
11:48
and I'm allowed to withhold from you
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eta datuak ezkutatu baditzaket
11:50
the answers half the times,
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demagun kasuen erdietan,
11:52
then I can convince you
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konbentzitu ahalko zintuzket
11:54
that I have a coin with two heads.
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daukadan txanpona
bi burukoa dela.
bi burukoa dela.
11:56
If we remove half of the data,
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Datuen erdia kentzen badugu,
11:58
we can never know what the true effect size of these medicines is.
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ezingo dugu medikamentuen
benetako efektua zein den jakin.
benetako efektua zein den jakin.
12:01
And this is not an isolated story.
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Eta hau ez da istorio isolatu bat.
12:03
Around half of all of the trial data on antidepressants has been withheld,
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Depresioaren aurkakoen esperimentuen
erdiak ezkutatu egin dira,
erdiak ezkutatu egin dira,
12:07
but it goes way beyond that.
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eta haratago doa.
12:09
The Nordic Cochrane Group were trying to get a hold of the data on that
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Nordic Cochrane taldea datu horiek
lortzen saiatu da
lortzen saiatu da
12:11
to bring it all together.
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guztiak biltzeko.
12:13
The Cochrane Groups are an international nonprofit collaboration
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Cochrane taldeak irabazi asmorik gabeko
nazioarteko kolaborazioak dira
nazioarteko kolaborazioak dira
12:16
that produce systematic reviews of all of the data that has ever been shown.
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argitaratutako datuen errebisio
sistematikoak egiten dituztenak.
sistematikoak egiten dituztenak.
12:19
And they need to have access to all of the trial data.
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Esperimentuetako datu guztiak
behar dituzte.
behar dituzte.
12:22
But the companies withheld that data from them,
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Baina elkarteek datu hauek
ezkutatu egiten dizkiete,
ezkutatu egiten dizkiete,
12:25
and so did the European Medicines Agency
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baita Europako Medikamentuen Elkarteak ere
12:27
for three years.
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hiru urtez.
12:29
This is a problem that is currently lacking a solution.
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Hau oraindik konponbiderik ez duen
arazoa da.
arazoa da.
12:32
And to show how big it goes, this is a drug called Tamiflu,
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Garrantzia ikusteko, bada Tamiflu
izeneko medikamentu bat,
izeneko medikamentu bat,
12:35
which governments around the world
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mundu guztiko gobernuek
12:37
have spent billions and billions of dollars on.
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bilioika eta bilioika dolar gastatu
dituzte Tamifluan.
dituzte Tamifluan.
12:39
And they spend that money on the promise
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Diru hau gastatu dute, zera ziurtatuz
12:41
that this is a drug which will reduce the rate
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Tamifluak gripearen konplikazio
tasak jaitsiko dituela.
tasak jaitsiko dituela.
12:43
of complications with flu.
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12:45
We already have the data
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Datuak baditugu, eta zera diote
12:47
showing that it reduces the duration of your flu by a few hours.
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gripearen iraupena txikiagotzen duela
ordu gutxi batzuez.
ordu gutxi batzuez.
12:49
But I don't really care about that. Governments don't care about that.
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Baina horrek berdin dit.
Gobernuei berdin die.
Gobernuei berdin die.
12:51
I'm very sorry if you have the flu, I know it's horrible,
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Sentitzen dut gripea baduzu,
badakit txarra dela,
badakit txarra dela,
12:54
but we're not going to spend billions of dollars
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baina ez ditugu bilioika dolar gastatuko
12:56
trying to reduce the duration of your flu symptoms
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zure gripearen sintomak
gutxiagotzeko
gutxiagotzeko
12:58
by half a day.
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egun erdiz.
13:00
We prescribe these drugs, we stockpile them for emergencies
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Medikamentu hauek hartzeko agintzen dugu,
larrialdietarako gordetzen ditugu
larrialdietarako gordetzen ditugu
13:02
on the understanding that they will reduce the number of complications,
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konplikazioak gutxituko dituztelakoan,
13:04
which means pneumonia and which means death.
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hau da, neumoniak eta heriotzak.
13:07
The infectious diseases Cochrane Group, which are based in Italy,
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Infekzio gaixotasunen Cochrane taldeak,
Italian kokatzen direnak,
Italian kokatzen direnak,
13:10
has been trying to get
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zera lortzen saiatu dira
13:12
the full data in a usable form out of the drug companies
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farmazeutiken informazio oso
eta erabilgarria
eta erabilgarria
13:15
so that they can make a full decision
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erabaki eztabaidaezinak hartu ahal izateko
13:18
about whether this drug is effective or not,
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medikamentuaren eraginkortasunari buruz,
13:20
and they've not been able to get that information.
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eta ezin izan dute informazio hori lortu.
13:23
This is undoubtedly
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Hau da ezbairik gabe
13:25
the single biggest ethical problem
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egun medikuntzak duen
arazo etiko handiena.
arazo etiko handiena.
13:28
facing medicine today.
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13:30
We cannot make decisions
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Ezin ditugu erabakiak hartu
13:33
in the absence of all of the information.
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informazio guztia ez badaukagu.
13:37
So it's a little bit difficult from there
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Zail xamarra egiten da hemendik
13:40
to spin in some kind of positive conclusion.
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ondorio positiboak ateratzea.
13:44
But I would say this:
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Baina hau esango nizueke:
13:48
I think that sunlight
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uste dut eguzkiaren argia
13:51
is the best disinfectant.
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2000
desinfektatzaile handiena dela.
13:53
All of these things are happening in plain sight,
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Gauza hauek guztiak begi bistan
gertatzen ari dira,
gertatzen ari dira,
13:56
and they're all protected
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eta guztiak babestuta daude,
13:58
by a force field of tediousness.
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3000
monotoniak babesten ditu.
14:01
And I think, with all of the problems in science,
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Uste dut zientzietako arazo guztietan
14:03
one of the best things that we can do
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egin daitekeen gauzarik hoberenetako bat
14:05
is to lift up the lid,
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tapa altxatzea dela,
14:07
finger around in the mechanics and peer in.
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ezkutuko mekanismoak
aztertu ahal izateko.
aztertu ahal izateko.
14:09
Thank you very much.
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Mila esker.
14:11
(Applause)
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(Txaloak)
ABOUT THE SPEAKER
Ben Goldacre - DebunkerBen Goldacre unpicks dodgy scientific claims made by scaremongering journalists, dubious government reports, pharmaceutical corporations, PR companies and quacks.
Why you should listen
"It was the MMR story that finally made me crack," begins the Bad Science manifesto, referring to the sensationalized -- and now-refuted -- link between vaccines and autism. With that sentence Ben Goldacre fired the starting shot of a crusade waged from the pages of The Guardian from 2003 to 2011, on an addicitve Twitter feed, and in bestselling books, including Bad Science and his latest, Bad Pharma, which puts the $600 billion global pharmaceutical industry under the microscope. What he reveals is a fascinating, terrifying mess.
Goldacre was trained in medicine at Oxford and London, and works as an academic in epidemiology. Helped along by this inexhaustible supply of material, he also travels the speaking circuit, promoting skepticism and nerdish curiosity with fire, wit, fast delivery and a lovable kind of exasperation. (He might even convince you that real science, sober reporting and reason are going to win in the end.)
As he writes, "If you're a journalist who misrepresents science for the sake of a headline, a politician more interested in spin than evidence, or an advertiser who loves pictures of molecules in little white coats, then beware: your days are numbered."
Ben Goldacre | Speaker | TED.com