TEDGlobal 2011
Ben Goldacre: Battling bad science
本･高达克：与坏科学做斗争
Filmed:
Readability: 4.3
2,713,579 views
每天都有新出炉的健康资讯，你如何分辨真伪呢？身为医生和流行病学家的本･高达克给我们讲述，不论是关于营养的漏洞百出的论述还是医药产业里难以觉察的手段，证据是如何轻易地就被歪曲了。
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,
0
0
3000
我是名医生，又另起炉灶做研究
00:18
and now I'm an epidemiologist.
1
3000
2000
如今我是名流行病学家
00:20
And nobody really knows what epidemiology is.
2
5000
2000
没有人真正知道什么是流行病学
00:22
Epidemiology is the science of how we know in the real world
3
7000
3000
流行病学是了解现实世界里
00:25
if something is good for you or bad for you.
4
10000
2000
某种东西对我们是有益还是有害的科学
00:27
And it's best understood through example
5
12000
2000
了解它最好的方法就是例子了
00:29
as the science of those crazy, wacky newspaper headlines.
6
14000
5000
特别是那些疯狂古怪的报纸头条
00:34
And these are just some of the examples.
7
19000
2000
这里有几个例子
00:36
These are from the Daily Mail. Every country in the world has a newspaper like this.
8
21000
3000
首先来看每日邮报。每个国家都有像这样的报纸
00:39
It has this bizarre, ongoing philosophical project
9
24000
3000
它们的一项长期而古怪的哲学使命就是
00:42
of dividing all the inanimate objects in the world
10
27000
2000
把这世上所有的事物
00:44
into the ones that either cause or prevent cancer.
11
29000
3000
分成致癌和防癌两类
00:47
So here are some of the things they said cause cancer recently:
12
32000
2000
这些是最近发布的致癌的东西：
00:49
divorce, Wi-Fi, toiletries and coffee.
13
34000
2000
离婚，无线网，梳妆用品还有咖啡
00:51
Here are some of the things they say prevents cancer:
14
36000
2000
这些是防癌的：
00:53
crusts, red pepper, licorice and coffee.
15
38000
2000
面包皮，红辣椒，甘草和咖啡
00:55
So already you can see there are contradictions.
16
40000
2000
你已经发现了自相矛盾之处
00:57
Coffee both causes and prevents cancer.
17
42000
2000
咖啡既致癌又防癌
00:59
And as you start to read on, you can see
18
44000
2000
如果继续读下去
01:01
that maybe there's some kind of political valence behind some of this.
19
46000
3000
你会开始怀疑这类报道是否别有用心
01:04
So for women, housework prevents breast cancer,
20
49000
2000
“女人们，做家务能预防乳腺癌”
01:06
but for men, shopping could make you impotent.
21
51000
3000
“购物可能导致男人性无能”
01:09
So we know that we need to start
22
54000
3000
那么我们就要
01:12
unpicking the science behind this.
23
57000
3000
揭开这些说法一看究竟
01:15
And what I hope to show
24
60000
2000
我要说明的观点是
01:17
is that unpicking dodgy claims,
25
62000
2000
揭穿骗人的说法
01:19
unpicking the evidence behind dodgy claims,
26
64000
2000
以及它们背后的证据
01:21
isn't a kind of nasty carping activity;
27
66000
3000
这不是卑鄙的吹毛求疵行为
01:24
it's socially useful,
28
69000
2000
这是对社会有用的
01:26
but it's also an extremely valuable
29
71000
2000
也是极有价值的
01:28
explanatory tool.
30
73000
2000
阐述工具
01:30
Because real science is all about
31
75000
2000
因为真正的科学
01:32
critically appraising the evidence for somebody else's position.
32
77000
2000
是批判性地评估他人提出的论据
01:34
That's what happens in academic journals.
33
79000
2000
这是就学术期刊的评审方法
01:36
That's what happens at academic conferences.
34
81000
2000
也是学术会议上的常事
01:38
The Q&A session after a post-op presents data
35
83000
2000
会场发言完毕后的提问环节
01:40
is often a blood bath.
36
85000
2000
常常是场血战
01:42
And nobody minds that. We actively welcome it.
37
87000
2000
没人会介意，我们反而十分欢迎
01:44
It's like a consenting intellectual S&M activity.
38
89000
3000
就像是自愿的智力上的SM一样
01:47
So what I'm going to show you
39
92000
2000
我将展示给你们的
01:49
is all of the main things,
40
94000
2000
东西是
01:51
all of the main features of my discipline --
41
96000
2000
我研究领域和核心内容和特色-
01:53
evidence-based medicine.
42
98000
2000
循证医学
01:55
And I will talk you through all of these
43
100000
2000
我将给各位讲解
01:57
and demonstrate how they work,
44
102000
2000
并展示那些出了纰漏的例子
01:59
exclusively using examples of people getting stuff wrong.
45
104000
3000
是如何欺骗大众的
02:02
So we'll start with the absolute weakest form of evidence known to man,
46
107000
3000
首先是最不堪一击的证据来源
02:05
and that is authority.
47
110000
2000
权威人士
02:07
In science, we don't care how many letters you have after your name.
48
112000
3000
在科学面前，你名字后面有多少头衔并不重要
02:10
In science, we want to know what your reasons are for believing something.
49
115000
3000
我们在乎的是你确信某事的原因是什么
02:13
How do you know that something is good for us
50
118000
2000
你是怎么知道什么对我们有益
02:15
or bad for us?
51
120000
2000
什么又有害？
02:17
But we're also unimpressed by authority,
52
122000
2000
不过我们早就对权威不感冒了
02:19
because it's so easy to contrive.
53
124000
2000
因为如今权威的身份太容易伪造
02:21
This is somebody called Dr. Gillian McKeith Ph.D,
54
126000
2000
这是个叫Gillian McKeith的博士（医生？）
02:23
or, to give her full medical title, Gillian McKeith.
55
128000
3000
加上她的医学头衔嘛，也就是Gillian McKeith
02:26
(Laughter)
56
131000
3000
（笑声）
02:29
Again, every country has somebody like this.
57
134000
2000
每个国家都有这样一个人
02:31
She is our TV diet guru.
58
136000
2000
她是电视饮食节目大师
02:33
She has massive five series of prime-time television,
59
138000
3000
上五个黄金档的系列节目
02:36
giving out very lavish and exotic health advice.
60
141000
3000
放出丰富又充满异域风情的保健意见
02:39
She, it turns out, has a non-accredited correspondence course Ph.D.
61
144000
3000
结果发现她的学历是不知美国哪儿的
02:42
from somewhere in America.
62
147000
2000
一个不可信的函授博士
02:44
She also boasts that she's a certified professional member
63
149000
2000
她还吹牛说她是美国营养咨询师协会的
02:46
of the American Association of Nutritional Consultants,
64
151000
2000
持证专业人员
02:48
which sounds very glamorous and exciting.
65
153000
2000
这听起来大有来头
02:50
You get a certificate and everything.
66
155000
2000
一张证书就能解决一切
02:52
This one belongs to my dead cat Hetti. She was a horrible cat.
67
157000
2000
这是我死掉的猫Hetti的证。她可一点都不乖
02:54
You just go to the website, fill out the form,
68
159000
2000
你只要到网站主页填张表
02:56
give them $60, and it arrives in the post.
69
161000
2000
交60美元，证书就寄到你家去
02:58
Now that's not the only reason that we think this person is an idiot.
70
163000
2000
这不是我们认为她是个蠢货的唯一原因
03:00
She also goes and says things like,
71
165000
2000
她还说
03:02
you should eat lots of dark green leaves,
72
167000
2000
你应该吃大量的暗绿色叶子
03:04
because they contain lots of chlorophyll, and that will really oxygenate your blood.
73
169000
2000
因为它们含有大量叶绿素，能给你的血液提供氧气
03:06
And anybody who's done school biology remembers
74
171000
2000
只要学过生物学的人都知道
03:08
that chlorophyll and chloroplasts
75
173000
2000
叶绿素和叶绿体
03:10
only make oxygen in sunlight,
76
175000
2000
只通过光合作用产生氧气
03:12
and it's quite dark in your bowels after you've eaten spinach.
77
177000
3000
如果你把菠菜吃下去，胃里肯定一片漆黑
03:15
Next, we need proper science, proper evidence.
78
180000
3000
接下来，我们需要正确的科学，正当的证据
03:18
So, "Red wine can help prevent breast cancer."
79
183000
2000
“红酒能防止乳腺癌”
03:20
This is a headline from the Daily Telegraph in the U.K.
80
185000
2000
这是英国每日电讯报的头条
03:22
"A glass of red wine a day could help prevent breast cancer."
81
187000
3000
“每天一杯红酒能防止乳腺癌”
03:25
So you go and find this paper, and what you find
82
190000
2000
你读了报纸
03:27
is it is a real piece of science.
83
192000
2000
会觉得真是科学的
03:29
It is a description of the changes in one enzyme
84
194000
3000
其解释说，在一个什么实验室里
03:32
when you drip a chemical extracted from some red grape skin
85
197000
3000
一个凳子上有个装着癌细胞的碟子
03:35
onto some cancer cells
86
200000
2000
你把红葡萄皮的提取物滴在细胞上
03:37
in a dish on a bench in a laboratory somewhere.
87
202000
3000
就有个酶发生变化
03:40
And that's a really useful thing to describe
88
205000
2000
在一个有科学性的报纸上
03:42
in a scientific paper,
89
207000
2000
如此描述是很有用
03:44
but on the question of your own personal risk
90
209000
2000
但是至于你喝红酒患乳腺癌风险的事
03:46
of getting breast cancer if you drink red wine,
91
211000
2000
它只字没提
03:48
it tells you absolutely bugger all.
92
213000
2000
它什么都没说
03:50
Actually, it turns out that your risk of breast cancer
93
215000
2000
事实上，如果你每喝一次酒
03:52
actually increases slightly
94
217000
2000
患乳腺癌的机率
03:54
with every amount of alcohol that you drink.
95
219000
2000
都会相应轻微地上升
03:56
So what we want is studies in real human people.
96
221000
4000
我们需要的是针对人进行的研究
04:00
And here's another example.
97
225000
2000
这是另一个例子
04:02
This is from Britain's leading diet and nutritionist in the Daily Mirror,
98
227000
3000
来自英国每日镜报的人气营养师
04:05
which is our second biggest selling newspaper.
99
230000
2000
镜报是我们全国销售量第二的报纸
04:07
"An Australian study in 2001
100
232000
2000
“2001年澳大利亚一项研究
04:09
found that olive oil in combination with fruits, vegetables and pulses
101
234000
2000
表明橄榄油与水果，蔬菜和豆子一起食用
04:11
offers measurable protection against skin wrinklings."
102
236000
2000
对皮肤防皱有可观的效果”
04:13
And then they give you advice:
103
238000
2000
然后他们开出建议：
04:15
"If you eat olive oil and vegetables, you'll have fewer skin wrinkles."
104
240000
2000
“如果你使用橄榄油和蔬菜，你的皱纹就会减少”
04:17
And they very helpfully tell you how to go and find the paper.
105
242000
2000
他们还给出文献出处
04:19
So you go and find the paper, and what you find is an observational study.
106
244000
3000
如果你去找该论文，会发现它是个观察性研究
04:22
Obviously nobody has been able
107
247000
2000
显然没有人
04:24
to go back to 1930,
108
249000
2000
能回到1930年
04:26
get all the people born in one maternity unit,
109
251000
3000
找到在同一个产科出生的所有人群样本
04:29
and half of them eat lots of fruit and veg and olive oil,
110
254000
2000
让一半人大量食用水果蔬菜和橄榄油
04:31
and then half of them eat McDonald's,
111
256000
2000
另一半吃麦当劳
04:33
and then we see how many wrinkles you've got later.
112
258000
2000
然后看看他们长了多少皱纹
04:35
You have to take a snapshot of how people are now.
113
260000
2000
你得存照纪录人们的样子
04:37
And what you find is, of course,
114
262000
2000
当然你发现
04:39
people who eat veg and olive oil have fewer skin wrinkles.
115
264000
3000
吃水果蔬菜和橄榄油的人皱纹少
04:42
But that's because people who eat fruit and veg and olive oil,
116
267000
3000
但那是因为吃水果蔬菜和橄榄油的人
04:45
they're freaks, they're not normal, they're like you;
117
270000
3000
他们是怪胎，不正常，和你一样；
04:48
they come to events like this.
118
273000
2000
他们来参加这样的活动
04:50
They are posh, they're wealthy, they're less likely to have outdoor jobs,
119
275000
3000
他们优雅，富有，不大可能从事户外工作
04:53
they're less likely to do manual labor,
120
278000
2000
很少从事体力劳动
04:55
they have better social support, they're less likely to smoke --
121
280000
2000
他们有更好的社会基础，不大抽烟－
04:57
so for a whole host of fascinating, interlocking
122
282000
2000
所以是因为整体关联的
04:59
social, political and cultural reasons,
123
284000
2000
社会政治文化的缘故
05:01
they are less likely to have skin wrinkles.
124
286000
2000
他们较不易产生皱纹
05:03
That doesn't mean that it's the vegetables or the olive oil.
125
288000
2000
这不意味着是蔬菜或橄榄油的功劳
05:05
(Laughter)
126
290000
2000
（笑声）
05:07
So ideally what you want to do is a trial.
127
292000
3000
做试验往往是最好的选择
05:10
And everybody thinks they're very familiar with the idea of a trial.
128
295000
2000
每个人都觉得这是他们熟悉的话题
05:12
Trials are very old. The first trial was in the Bible -- Daniel 1:12.
129
297000
3000
试验是老话题。第一个试验是圣经里－《但以理书》第一章第十二节
05:15
It's very straightforward -- you take a bunch of people, you split them in half,
130
300000
2000
非常简单－找一群人，分两组
05:17
you treat one group one way, you treat the other group the other way,
131
302000
2000
用不同的方式分别对待两组人
05:19
and a little while later, you follow them up
132
304000
2000
之后你跟着他们
05:21
and see what happened to each of them.
133
306000
2000
看他们都怎么样了
05:23
So I'm going to tell you about one trial,
134
308000
2000
我要给你讲的试验
05:25
which is probably the most well-reported trial
135
310000
2000
也许是过去十年间英国媒体上
05:27
in the U.K. news media over the past decade.
136
312000
2000
曝光率最高的试验
05:29
And this is the trial of fish oil pills.
137
314000
2000
这就是关于鱼肝油胶囊的试验
05:31
And the claim was fish oil pills improve school performance and behavior
138
316000
2000
这个说法是鱼肝油胶囊能提高大部分学生的在校表现
05:33
in mainstream children.
139
318000
2000
和行为习惯
05:35
And they said, "We've done a trial.
140
320000
2000
他们说“我们做过试验
05:37
All the previous trials were positive, and we know this one's gonna be too."
141
322000
2000
之前都显示正面结果，我们可以肯定这次也是”
05:39
That should always ring alarm bells.
142
324000
2000
这是个警示
05:41
Because if you already know the answer to your trial, you shouldn't be doing one.
143
326000
3000
如果你已经知道一个试验的结果，那还进行干什么
05:44
Either you've rigged it by design,
144
329000
2000
或者说如果实验设计就存在人为操纵性
05:46
or you've got enough data so there's no need to randomize people anymore.
145
331000
3000
或者你已经有足够的数据那就没有必要再随机挑选更多的人了
05:49
So this is what they were going to do in their trial.
146
334000
3000
试验是这样进行的：
05:52
They were taking 3,000 children,
147
337000
2000
他们找了三千名儿童
05:54
they were going to give them all these huge fish oil pills,
148
339000
2000
给他们大个儿的鱼肝油药片
05:56
six of them a day,
149
341000
2000
每天6个
05:58
and then a year later, they were going to measure their school exam performance
150
343000
3000
一年以后，他们去测量他们的在校测试表现
06:01
and compare their school exam performance
151
346000
2000
并把在校测试表现和
06:03
against what they predicted their exam performance would have been
152
348000
2000
在没有摄入鱼肝油的情况下他们预期的测试表现
06:05
if they hadn't had the pills.
153
350000
3000
进行对比
06:08
Now can anybody spot a flaw in this design?
154
353000
3000
你看出了设计缺陷吗？
06:11
And no professors of clinical trial methodology
155
356000
3000
临床医学试验方法论的教授
06:14
are allowed to answer this question.
156
359000
2000
不允许回答这个问题
06:16
So there's no control; there's no control group.
157
361000
2000
是的，没有对照组！
06:18
But that sounds really techie.
158
363000
2000
这听上去挺技术范儿
06:20
That's a technical term.
159
365000
2000
这是个术语
06:22
The kids got the pills, and then their performance improved.
160
367000
2000
食用了药片的孩子表现提高了
06:24
What else could it possibly be if it wasn't the pills?
161
369000
3000
不然还能怎样呢？
06:27
They got older. We all develop over time.
162
372000
3000
他们长大了，我们都会随着时间不断发展
06:30
And of course, also there's the placebo effect.
163
375000
2000
当然，这里还有安慰效应在起作用
06:32
The placebo effect is one of the most fascinating things in the whole of medicine.
164
377000
2000
安慰效应是医学上最不可思议的玩意之一
06:34
It's not just about taking a pill, and your performance and your pain getting better.
165
379000
3000
不仅仅是吃一个药片，你的表现提升，痛苦缓解这么简单
06:37
It's about our beliefs and expectations.
166
382000
2000
而是关乎我们的信念和期待
06:39
It's about the cultural meaning of a treatment.
167
384000
2000
这就是治疗的文化意义
06:41
And this has been demonstrated in a whole raft of fascinating studies
168
386000
3000
大量研究已经通过不同的安慰剂对照试验
06:44
comparing one kind of placebo against another.
169
389000
3000
展示了这种效应
06:47
So we know, for example, that two sugar pills a day
170
392000
2000
我们知道，比如说，每天2个糖丸
06:49
are a more effective treatment for getting rid of gastric ulcers
171
394000
2000
比一个糖丸在治疗胃溃疡上
06:51
than one sugar pill.
172
396000
2000
更有效
06:53
Two sugar pills a day beats one sugar pill a day.
173
398000
2000
每天2个糖丸胜过每天1个糖丸
06:55
And that's an outrageous and ridiculous finding, but it's true.
174
400000
3000
这是个令人吃惊的荒唐发现，但这是真的
06:58
We know from three different studies on three different types of pain
175
403000
2000
针对3种不同的痛症的3个研究显示
07:00
that a saltwater injection is a more effective treatment for pain
176
405000
3000
盐水注射比食用糖丸对痛症更有效
07:03
than taking a sugar pill, taking a dummy pill that has no medicine in it --
177
408000
4000
糖丸里头根本没有药－
07:07
not because the injection or the pills do anything physically to the body,
178
412000
3000
并不是说注射或者药丸对身体有任何物理影响
07:10
but because an injection feels like a much more dramatic intervention.
179
415000
3000
而是因为感觉上注射是一种更强力的手段
07:13
So we know that our beliefs and expectations
180
418000
2000
我们知道我们的信念和期待
07:15
can be manipulated,
181
420000
2000
是可被操纵的
07:17
which is why we do trials
182
422000
2000
这就是为什么试验上
07:19
where we control against a placebo --
183
424000
2000
需要安慰剂对照组－
07:21
where one half of the people get the real treatment
184
426000
2000
这样一半人接受真正的治疗
07:23
and the other half get placebo.
185
428000
2000
一半人得到安慰剂
07:25
But that's not enough.
186
430000
3000
但这并不够
07:28
What I've just shown you are examples of the very simple and straightforward ways
187
433000
3000
我刚刚展示的是非常简单直观的例子
07:31
that journalists and food supplement pill peddlers
188
436000
2000
记者、保健食品商贩
07:33
and naturopaths
189
438000
2000
和理疗家
07:35
can distort evidence for their own purposes.
190
440000
3000
都能为各自的目的歪曲证据
07:38
What I find really fascinating
191
443000
2000
真正令人惊讶的是
07:40
is that the pharmaceutical industry
192
445000
2000
制药产业
07:42
uses exactly the same kinds of tricks and devices,
193
447000
2000
用一样的手段和方式
07:44
but slightly more sophisticated versions of them,
194
449000
3000
只不过更加隐秘精巧
07:47
in order to distort the evidence that they give to doctors and patients,
195
452000
3000
来歪曲他们给医生和患者的证据
07:50
and which we use to make vitally important decisions.
196
455000
3000
而那些是我们用来做重要决定的证据
07:53
So firstly, trials against placebo:
197
458000
2000
首先，安慰剂对照组：
07:55
everybody thinks they know that a trial should be
198
460000
2000
谁都知道要用新药
07:57
a comparison of your new drug against placebo.
199
462000
2000
和安慰剂对照组做试验
07:59
But actually in a lot of situations that's wrong.
200
464000
2000
但是很多情况下这是错的
08:01
Because often we already have a very good treatment that is currently available,
201
466000
3000
因为通常我们目前已经有一个有效的治疗方法
08:04
so we don't want to know that your alternative new treatment
202
469000
2000
所以我们想要知道的不是你的新疗法
08:06
is better than nothing.
203
471000
2000
比坐以待毙强
08:08
We want to know that it's better than the best currently available treatment that we have.
204
473000
3000
我们想知道的是它是不是比目前的疗法更有效
08:11
And yet, repeatedly, you consistently see people doing trials
205
476000
3000
但是你总是看到他们做
08:14
still against placebo.
206
479000
2000
安慰剂对照试验
08:16
And you can get license to bring your drug to market
207
481000
2000
这样你就能拿到许可证进入市场了
08:18
with only data showing that it's better than nothing,
208
483000
2000
而试验数据只显示此药只不过比什么都没有好点
08:20
which is useless for a doctor like me trying to make a decision.
209
485000
3000
这对像我一样的医生要做决定一点帮助都没有
08:23
But that's not the only way you can rig your data.
210
488000
2000
这还不是操纵数据的唯一手段
08:25
You can also rig your data
211
490000
2000
你还可以通过
08:27
by making the thing you compare your new drug against
212
492000
2000
将你的新药和真的废物做对照试验
08:29
really rubbish.
213
494000
2000
来操纵数据
08:31
You can give the competing drug in too low a dose,
214
496000
2000
你可以将对照药物剂量控制在非常低的水平
08:33
so that people aren't properly treated.
215
498000
2000
这样人们没有得到适当的治疗
08:35
You can give the competing drug in too high a dose,
216
500000
2000
也可以将对照药物剂量控制在非常高的水平
08:37
so that people get side effects.
217
502000
2000
这样就产生副作用
08:39
And this is exactly what happened
218
504000
2000
治疗精神分裂症的安定药
08:41
which antipsychotic medication for schizophrenia.
219
506000
2000
就是这么干的
08:43
20 years ago, a new generation of antipsychotic drugs were brought in
220
508000
3000
20年前，一批新的安定药面世
08:46
and the promise was that they would have fewer side effects.
221
511000
3000
有承诺说它们的副作用更低
08:49
So people set about doing trials of these new drugs
222
514000
2000
人们就对这些新药做了试验
08:51
against the old drugs,
223
516000
2000
跟旧的药对比
08:53
but they gave the old drugs in ridiculously high doses --
224
518000
2000
但他们使用的旧药剂量无比之高－
08:55
20 milligrams a day of haloperidol.
225
520000
2000
每天20毫克的氟哌丁苯
08:57
And it's a foregone conclusion,
226
522000
2000
毫无疑问
08:59
if you give a drug at that high a dose,
227
524000
2000
如果这么大的剂量
09:01
that it will have more side effects and that your new drug will look better.
228
526000
3000
肯定会导致更多的副作用从而让新药看上去更好
09:04
10 years ago, history repeated itself, interestingly,
229
529000
2000
10年前，历史重演，有趣的是
09:06
when risperidone, which was the first of the new-generation antipscyhotic drugs,
230
531000
3000
当利培酮，这一第二代抗精神病药的先锋
09:09
came off copyright, so anybody could make copies.
231
534000
3000
产权到期的时候，谁都可以进行生产
09:12
Everybody wanted to show that their drug was better than risperidone,
232
537000
2000
每个人都想展示他们的药比利培酮好
09:14
so you see a bunch of trials comparing new antipsychotic drugs
233
539000
3000
接着你就看到一堆新的抗精神病药的对照试验
09:17
against risperidone at eight milligrams a day.
234
542000
2000
和每天8毫克的利培酮对照
09:19
Again, not an insane dose, not an illegal dose,
235
544000
2000
这个剂量不算疯狂，不是违法
09:21
but very much at the high end of normal.
236
546000
2000
但绝对超出正常
09:23
And so you're bound to make your new drug look better.
237
548000
3000
所以你肯定能让新药表现更好
09:26
And so it's no surprise that overall,
238
551000
3000
果不其然
09:29
industry-funded trials
239
554000
2000
制药业赞助的试验
09:31
are four times more likely to give a positive result
240
556000
2000
比私人赞助试验得到正面结果（阳性结果）的机率
09:33
than independently sponsored trials.
241
558000
3000
要高出4倍
09:36
But -- and it's a big but --
242
561000
3000
但是－这是一个很大的但是－
09:39
(Laughter)
243
564000
2000
（笑声）
09:41
it turns out,
244
566000
2000
结果是
09:43
when you look at the methods used by industry-funded trials,
245
568000
3000
如果你查看制药业赞助的试验使用的方法
09:46
that they're actually better
246
571000
2000
反而比私人赞助试验的方法
09:48
than independently sponsored trials.
247
573000
2000
更好
09:50
And yet, they always manage to to get the result that they want.
248
575000
3000
不过他们总能得到他们想要的结果
09:53
So how does this work?
249
578000
2000
那这是怎么回事？
09:55
How can we explain this strange phenomenon?
250
580000
3000
怎么解释这一奇怪现象？
09:58
Well it turns out that what happens
251
583000
2000
实际情况是
10:00
is the negative data goes missing in action;
252
585000
2000
负面结果的数据完全丢失；
10:02
it's withheld from doctors and patients.
253
587000
2000
医生和患者扣留着这些信息
10:04
And this is the most important aspect of the whole story.
254
589000
2000
这是整个过程里最重要的一个方面
10:06
It's at the top of the pyramid of evidence.
255
591000
2000
这是证据金字塔的塔尖
10:08
We need to have all of the data on a particular treatment
256
593000
3000
我们需要一个疗法的所有数据
10:11
to know whether or not it really is effective.
257
596000
2000
才能知道它是否有效
10:13
And there are two different ways that you can spot
258
598000
2000
有两种方法你可以发现
10:15
whether some data has gone missing in action.
259
600000
2000
是否有数据丢失
10:17
You can use statistics, or you can use stories.
260
602000
3000
可以用统计学，或者事例
10:20
I personally prefer statistics, so that's what I'm going to do first.
261
605000
2000
我个人倾向统计学，所以我首先做的就是
10:22
This is something called funnel plot.
262
607000
2000
漏斗图分析
10:24
And a funnel plot is a very clever way of spotting
263
609000
2000
漏斗图是个非常好的方法
10:26
if small negative trials have disappeared, have gone missing in action.
264
611000
3000
来查看是否有少量负面结果丢失
10:29
So this is a graph of all of the trials
265
614000
2000
这是针对某项疗法的
10:31
that have been done on a particular treatment.
266
616000
2000
所有试验图表
10:33
And as you go up towards the top of the graph,
267
618000
2000
图片上部
10:35
what you see is each dot is a trial.
268
620000
2000
每一个点是一个试验
10:37
And as you go up, those are the bigger trials, so they've got less error in them.
269
622000
3000
越往上，试验规模越大，误差也就越小
10:40
So they're less likely to be randomly false positives, randomly false negatives.
270
625000
3000
也就是越少随机的假阳性和假阴性结果 (阳性即表示试验结果是肯定治疗药物的疗效的，译者注）
10:43
So they all cluster together.
271
628000
2000
它们会聚集在一起
10:45
The big trials are closer to the true answer.
272
630000
2000
越大的试验越接近事实
10:47
Then as you go further down at the bottom,
273
632000
2000
越往下
10:49
what you can see is, over on this side, the spurious false negatives,
274
634000
3000
可以发现，这一边是伪造的假阴性结果
10:52
and over on this side, the spurious false positives.
275
637000
2000
那边是伪造的假阳性结果
10:54
If there is publication bias,
276
639000
2000
如果有发表偏倚（有统计学意义的结果更易被发表）
10:56
if small negative trials have gone missing in action,
277
641000
3000
如果得出负面结果的小规模试验数据丢失
10:59
you can see it on one of these graphs.
278
644000
2000
你可以在这些图表中找到
11:01
So you can see here that the small negative trials
279
646000
2000
这里可以看见，应该在图表左下的
11:03
that should be on the bottom left have disappeared.
280
648000
2000
得出负面结果的小规模试验不见了
11:05
This is a graph demonstrating the presence of publication bias
281
650000
3000
这个图表展示的是关于发表偏倚的研究里
11:08
in studies of publication bias.
282
653000
2000
出现的发表偏倚
11:10
And I think that's the funniest epidemiology joke
283
655000
2000
我觉得这是你听过的最有意思的
11:12
that you will ever hear.
284
657000
2000
关于“流行病”的笑话
11:14
That's how you can prove it statistically,
285
659000
2000
这就是统计证明方法
11:16
but what about stories?
286
661000
2000
那事例法呢？
11:18
Well they're heinous, they really are.
287
663000
2000
那个就比较可恶了
11:20
This is a drug called reboxetine.
288
665000
2000
有种药叫瑞波西汀(抗抑郁药)
11:22
This is a drug that I myself have prescribed to patients.
289
667000
2000
我曾给一位病人开过这个药
11:24
And I'm a very nerdy doctor.
290
669000
2000
而我是个超级书呆子的医生
11:26
I hope I try to go out of my way to try and read and understand all the literature.
291
671000
3000
我寄希望于阅读和理解所有文献
11:29
I read the trials on this. They were all positive. They were all well-conducted.
292
674000
3000
我读了试验资料，都是正面结果，都是正规操作
11:32
I found no flaw.
293
677000
2000
没发现漏洞
11:34
Unfortunately, it turned out,
294
679000
2000
但不幸的是
11:36
that many of these trials were withheld.
295
681000
2000
很多试验结果被扣留
11:38
In fact, 76 percent
296
683000
2000
此药有76％的
11:40
of all of the trials that were done on this drug
297
685000
2000
试验结果都
11:42
were withheld from doctors and patients.
298
687000
2000
被医生和病人保留
11:44
Now if you think about it,
299
689000
2000
你想想
11:46
if I tossed a coin a hundred times,
300
691000
2000
如果我把硬币扔一百次
11:48
and I'm allowed to withhold from you
301
693000
2000
我可以保留一半结果
11:50
the answers half the times,
302
695000
2000
不告诉你
11:52
then I can convince you
303
697000
2000
然后我就能说服你
11:54
that I have a coin with two heads.
304
699000
2000
我的硬币两面都是人头像
11:56
If we remove half of the data,
305
701000
2000
如果去掉一半数据
11:58
we can never know what the true effect size of these medicines is.
306
703000
3000
我们绝不可能知道这些药的真正的效果
12:01
And this is not an isolated story.
307
706000
2000
这不是个偶发事件
12:03
Around half of all of the trial data on antidepressants has been withheld,
308
708000
4000
针对抗抑郁症药的试验数据有一半左右都被保留
12:07
but it goes way beyond that.
309
712000
2000
事实比着更糟
12:09
The Nordic Cochrane Group were trying to get a hold of the data on that
310
714000
2000
Nordic Cochrane集团曾尝试
12:11
to bring it all together.
311
716000
2000
收集那些被保留的数据
12:13
The Cochrane Groups are an international nonprofit collaboration
312
718000
3000
Nordic Cochrane是个国际性非盈利团体机构
12:16
that produce systematic reviews of all of the data that has ever been shown.
313
721000
3000
提供对所有公开数据的系统性的评论
12:19
And they need to have access to all of the trial data.
314
724000
3000
他们需要所有试验数据的查看权限
12:22
But the companies withheld that data from them,
315
727000
3000
但是制药商保留了数据结果
12:25
and so did the European Medicines Agency
316
730000
2000
欧洲药物管理局也这样
12:27
for three years.
317
732000
2000
做了3年
12:29
This is a problem that is currently lacking a solution.
318
734000
3000
这个问题目前没有解决方案
12:32
And to show how big it goes, this is a drug called Tamiflu,
319
737000
3000
为了告诉你们这个问题的严重性，给你们举一个叫达菲的药的例子
12:35
which governments around the world
320
740000
2000
各国政府
12:37
have spent billions and billions of dollars on.
321
742000
2000
花了巨资在此药上
12:39
And they spend that money on the promise
322
744000
2000
他们承诺
12:41
that this is a drug which will reduce the rate
323
746000
2000
这个药能降低
12:43
of complications with flu.
324
748000
2000
流感的并发症几率
12:45
We already have the data
325
750000
2000
我们已有数据显示
12:47
showing that it reduces the duration of your flu by a few hours.
326
752000
2000
它能减少几小时流感症状的持续时间
12:49
But I don't really care about that. Governments don't care about that.
327
754000
2000
我不关心这个，政府也不关心
12:51
I'm very sorry if you have the flu, I know it's horrible,
328
756000
3000
很抱歉你得流感了，我知道那很糟糕
12:54
but we're not going to spend billions of dollars
329
759000
2000
但我们不可能花上百万美元
12:56
trying to reduce the duration of your flu symptoms
330
761000
2000
只为了减少半天你的
12:58
by half a day.
331
763000
2000
流感症状
13:00
We prescribe these drugs, we stockpile them for emergencies
332
765000
2000
我们开药，在急诊室有大量存货
13:02
on the understanding that they will reduce the number of complications,
333
767000
2000
觉得这能降低并发症数
13:04
which means pneumonia and which means death.
334
769000
3000
也就是说肺炎或者死亡
13:07
The infectious diseases Cochrane Group, which are based in Italy,
335
772000
3000
位于意大利的Cochrane尝试着
13:10
has been trying to get
336
775000
2000
从制药公司获取
13:12
the full data in a usable form out of the drug companies
337
777000
3000
关于该药的所有有用数据
13:15
so that they can make a full decision
338
780000
3000
以便他们判断
13:18
about whether this drug is effective or not,
339
783000
2000
此药是否有效
13:20
and they've not been able to get that information.
340
785000
3000
他们没能拿到信息
13:23
This is undoubtedly
341
788000
2000
毫无疑问
13:25
the single biggest ethical problem
342
790000
3000
这是如今医学界面临的
13:28
facing medicine today.
343
793000
2000
一个重大道德问题
13:30
We cannot make decisions
344
795000
3000
没有信息
13:33
in the absence of all of the information.
345
798000
4000
我们无法做决定
13:37
So it's a little bit difficult from there
346
802000
3000
据此想得出些正面结论
13:40
to spin in some kind of positive conclusion.
347
805000
4000
是有些困难
13:44
But I would say this:
348
809000
4000
但是我想说：
13:48
I think that sunlight
349
813000
3000
阳光是
13:51
is the best disinfectant.
350
816000
2000
最好的杀菌剂
13:53
All of these things are happening in plain sight,
351
818000
3000
日光之下无新事
13:56
and they're all protected
352
821000
2000
这些事物都受
13:58
by a force field of tediousness.
353
823000
3000
一种单调的力场所保护
14:01
And I think, with all of the problems in science,
354
826000
2000
我认为，对于所有科学问题
14:03
one of the best things that we can do
355
828000
2000
我们能做的最好的就是
14:05
is to lift up the lid,
356
830000
2000
掀开事物的表层
14:07
finger around in the mechanics and peer in.
357
832000
2000
摸清来去一窥究竟
14:09
Thank you very much.
358
834000
2000
非常感谢
14:11
(Applause)
359
836000
3000
（掌声）
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