ABOUT THE SPEAKER
Ben Goldacre - Debunker
Ben 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."

Read an excerpt of Bad Pharma >>

More profile about the speaker
Ben Goldacre | Speaker | TED.com
TEDMED 2012

Ben Goldacre: What doctors don't know about the drugs they prescribe

Ben Goldacre:医生开药的盲点所在

Filmed:
2,501,600 views

当一种新型药物被测试的时候,试验结果应该对其余医药界开放 -- 但很多时候, 负面或者无效的结论未被上报,导致医生和研究人员对此一无所知。在这激情洋溢的演讲中,Ben Goldacre讲述了为什么这些未上报的负面的案例会误导大众,并有潜在的危险。
- Debunker
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.

00:16
Hi你好. So, this chap皴裂 here,
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嗨!报纸上的这个家伙
00:19
he thinks he can tell you the future未来.
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认为他能预知未来。
00:21
His name名称 is Nostradamus诺查丹玛斯, although虽然 here the Sun太阳 have
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他叫诺查丹玛斯,尽管太阳报
00:23
made制作 him look a little bit like Sean肖恩 Connery康纳利. (Laughter笑声)
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把他画得有点像肖恩·康纳利。(笑声)
00:27
And like most of you, I suspect疑似, I don't really believe
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像你们一样,我很怀疑,我不太相信
00:30
that people can see into the future未来.
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人真能预知未来。
00:31
I don't believe in precognition预知, and every一切 now and then,
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我不相信先知,你常常会
00:33
you hear that somebody has been able能够 to predict预测 something that happened发生 in the future未来,
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听说有人能够预知某事的发生,
00:37
and that's probably大概 because it was a fluke吸虫, and we only
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但这可能仅仅是因为瞎猫撞着死耗子,而且我们也仅仅
00:40
hear about the flukes吸虫 and about the freaks怪胎.
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听说了那些侥幸和怪异之事。
00:42
We don't hear about all the times that people got stuff东东 wrong错误.
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我们可不会听说那些被预测搞砸的事情。
00:46
Now we expect期望 that to happen发生 with silly愚蠢 stories故事
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我们认为这就是关于预知的
00:49
about precognition预知, but the problem问题 is,
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荒诞故事的原因,但问题在于,
00:52
we have exactly究竟 the same相同 problem问题 in academia学术界
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同样问题也存在于学术领域,
00:55
and in medicine医学, and in this environment环境, it costs成本 lives生活.
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和医学方面,这关乎人命。
01:00
So firstly首先, thinking思维 just about precognition预知, as it turns out,
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所以,首先想想“预知”这个问题,因为去年
01:03
just last year a researcher研究员 called Daryl达里尔 Bem贝姆 conducted进行
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有一个叫达里尔·贝姆的研究者进行了
01:05
a piece of research研究 where he found发现 evidence证据
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一个研究,他发现了关于大学生的
01:07
of precognitive预知 powers权力 in undergraduate大学本科 students学生们,
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预知能力的证据,
01:11
and this was published发表 in a peer-reviewed同行评审 academic学术的 journal日志
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并且这篇论文被发表在了一本同行评议的学术期刊中。
01:14
and most of the people who read this just said, "Okay, well,
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很多读过这篇论文的人都说:“好吧,嗯,
01:16
fair公平 enough足够, but I think that's a fluke吸虫, that's a freak怪物, because I know
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有道理,但我认为这是巧合,因为我知道
01:18
that if I did a study研究 where I found发现 no evidence证据
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如果我进行研究,并得出没有任何证据
01:21
that undergraduate大学本科 students学生们 had precognitive预知 powers权力,
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表明大学生有预知能力,
01:23
it probably大概 wouldn't不会 get published发表 in a journal日志.
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这篇论文很可能不会被在期刊中发表。
01:27
And in fact事实, we know that that's true真正, because
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其实,我们知道这个问题是存在的,
01:30
several一些 different不同 groups of research研究 scientists科学家们 tried试着
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因为几组科学家尝试
01:32
to replicate复制 the findings发现 of this precognition预知 study研究,
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重复关于预知能力的研究,
01:36
and when they submitted提交 it to the exact精确 same相同 journal日志,
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但当他们试图发表在这同一本期刊上时,
01:38
the journal日志 said, "No, we're not interested有兴趣 in publishing出版
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期刊编辑说:“不,我们对重复实验不感兴趣。
01:42
replication复制. We're not interested有兴趣 in your negative data数据."
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我们对你的负面数据不感兴趣。”
01:46
So this is already已经 evidence证据 of how, in the academic学术的
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所以这就是证据,在学术文献中,
01:49
literature文学, we will see a biased sample样品 of the true真正 picture图片
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我们会看到真实情况的例证,
01:54
of all of the scientific科学 studies学习 that have been conducted进行.
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几乎所有科学研究都是存在偏见。
01:57
But it doesn't just happen发生 in the dry academic学术的 field领域 of psychology心理学.
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但这并不只发生在枯燥的心理学领域。
02:02
It also happens发生 in, for example, cancer癌症 research研究.
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在癌症研究方面这个问题也存在。
02:06
So in March游行, 2012, just one month ago, some researchers研究人员
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所以,在2012年3月,也就是一个月前,一些研究人员
02:10
reported报道 in the journal日志 Nature性质 how they had tried试着
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在自然杂志上发表文章,表示他们如何尝试
02:13
to replicate复制 53 different不同 basic基本 science科学 studies学习 looking at
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重复53个关于癌症潜在疗法的
02:17
potential潜在 treatment治疗 targets目标 in cancer癌症,
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基本科学研究,
02:20
and out of those 53 studies学习, they were only able能够
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结果在这53个研究中,他们只能成功
02:23
to successfully顺利 replicate复制 six.
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重复其中六个。
02:26
Forty-seven四十七 out of those 53 were unreplicable不可复制.
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剩余47个实验则无法成功重复。
02:30
And they say in their discussion讨论 that this is very likely容易
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他们在分析中指出这很有可能是
02:34
because freaks怪胎 get published发表.
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因为怪异的结果容易被发表。
02:37
People will do lots and lots and lots of different不同 studies学习,
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人们会做许多许多不同的实验,
02:39
and the occasions场合 when it works作品 they will publish发布,
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实验成功就会被发表,
02:41
and the ones那些 where it doesn't work they won't惯于.
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不成功则难见天日。
02:43
And their first recommendation建议 of how to fix固定 this problem问题,
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他们对解决这个问题的第一个建议,
02:47
because it is a problem问题, because it sends发送 us all down blind alleys小巷,
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因为这确实是个问题,它把我们都送进死胡同,
02:50
their first recommendation建议 of how to fix固定 this problem问题
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他们纠正这个问题的第一个建议就是
02:52
is to make it easier更轻松 to publish发布 negative results结果 in science科学,
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让在科学界发表负面结果变得更加容易,
02:55
and to change更改 the incentives奖励 so that scientists科学家们 are
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并改变科学家们的奖励机制,鼓励他们
02:58
encouraged鼓励 to post岗位 more of their negative results结果 in public上市.
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更多地公开发表负面的结果。
03:02
But it doesn't just happen发生 in the very dry world世界
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这不仅仅发生在枯燥的
03:06
of preclinical临床前 basic基本 science科学 cancer癌症 research研究.
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临床基础癌症研究。
03:10
It also happens发生 in the very real真实, flesh and blood血液
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它还发生在活生生的
03:14
of academic学术的 medicine医学. So in 1980,
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学术医学领域。在1980年,
03:17
some researchers研究人员 did a study研究 on a drug药物 called lorcainidelorcainide,
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一些研究人员研究了一种叫劳卡胺的药物,
03:20
and this was an anti-arrhythmic抗心律不整 drug药物,
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这是一种抗心律失常药,
03:23
a drug药物 that suppresses禁止显示 abnormal不正常 heart rhythms节奏,
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可以抑制不正常的心率。
03:25
and the idea理念 was, after people have had a heart attack攻击,
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研究者想法是,当病人心脏病发作,
03:27
they're quite相当 likely容易 to have abnormal不正常 heart rhythms节奏,
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他们很可能心率失常,
03:29
so if we give them a drug药物 that suppresses禁止显示 abnormal不正常 heart
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所以如果我们给他们抑制心率失常的药,
03:31
rhythms节奏, this will increase增加 the chances机会 of them surviving幸存.
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他们的存活率就会增加。
03:35
Early on its development发展, they did a very small trial审讯,
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在研究早期,他们进行了一个非常小规模的实验,
03:38
just under a hundred patients耐心.
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只有100个病人参加。
03:40
Fifty五十 patients耐心 got lorcainidelorcainide, and of those patients耐心, 10 died死亡.
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50人服用劳卡胺,他们中有10人死了。
03:43
Another另一个 50 patients耐心 got a dummy placebo安慰剂 sugar pill
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另外50人服用了假的(安慰剂糖片)药片,
03:46
with no active活性 ingredient成分, and only one of them died死亡.
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没有摄入任何有效成分,他们中只有1人死了。
03:49
So they rightly正当地 regarded认为 this drug药物 as a failure失败,
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所以研究人员很诚实地将这种药列为失败产品,
03:52
and its commercial广告 development发展 was stopped停止, and because
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有关的商业开发马上停止,而导致了
03:55
its commercial广告 development发展 was stopped停止, this trial审讯 was never published发表.
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这次研究的结果一直没有发表。
03:59
Unfortunately不幸, over the course课程 of the next下一个 five, 10 years年份,
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不幸的是,在接下来的五到十年里,
04:04
other companies公司 had the same相同 idea理念 about drugs毒品 that would
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其它公司也有制造同样药物的想法——
04:08
prevent避免 arrhythmias心律失常 in people who have had heart attacks攻击.
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对心脏病人使用抗心律不齐药物。
04:11
These drugs毒品 were brought to market市场. They were prescribed规定
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这些药物被投入市场,并被
04:13
very widely广泛 because heart attacks攻击 are a very common共同 thing,
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广为使用,因为心脏病是种很常见的病。
04:16
and it took so long for us to find out that these drugs毒品
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我们花了很长时间才意识到这些药物
04:20
also caused造成 an increased增加 rate of death死亡
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致使患者死亡率上升。
04:23
that before we detected检测 that safety安全 signal信号,
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在我们发现到这一点之前,
04:25
over 100,000 people died死亡 unnecessarily不必要的 in America美国
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美国十万多条本可挽留的生命就因
04:32
from the prescription处方 of anti-arrhythmic抗心律不整 drugs毒品.
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使用这种抗心律不齐药物而失去。
04:35
Now actually其实, in 1993,
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实际上,在1993年,
04:39
the researchers研究人员 who did that 1980 study研究, that early study研究,
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那些在1980年进行早期实验的研究人员
04:42
published发表 a meaMEA culpa过失, an apology歉意 to the scientific科学 community社区,
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发表了公开道歉,以对科学界表达歉意。
04:46
in which哪一个 they said, "When we carried携带的 out our study研究 in 1980,
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他们写道:“当我们在1980年进行研究时,
04:49
we thought that the increased增加 death死亡 rate that occurred发生
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我们以为劳卡胺实验组的
04:51
in the lorcainidelorcainide group was an effect影响 of chance机会."
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死亡率上升只是巧合罢了。”
04:54
The development发展 of lorcainidelorcainide was abandoned for commercial广告 reasons原因,
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劳卡胺的研发因商业原因被停止,
04:56
and this study研究 was never published发表;
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而这项研究也从未被发表。
04:58
it's now a good example of publication出版物 bias偏压.
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这就是‘发表偏倚’(Publication bias)的极佳例子。
05:00
That's the technical技术 term术语 for the phenomenon现象 where
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‘发表偏倚’(Publication bias)是一个用来形容负面数据被忽视,
05:02
unflattering直言不讳 data数据 gets得到 lost丢失, gets得到 unpublished未公布, is left
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不被发表,的特有名词
05:07
missing失踪 in action行动, and they say the results结果 described描述 here
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之后,他们得出的结论是
05:10
"might威力 have provided提供 an early warning警告 of trouble麻烦 ahead."
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“本可以在灾难之前提前敲响警钟。”
05:15
Now these are stories故事 from basic基本 science科学.
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这是些基础科学界的故事。
05:18
These are stories故事 from 20, 30 years年份 ago.
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这些都是20,30年前的老故事了。
05:23
The academic学术的 publishing出版 environment环境 is very different不同 now.
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如今,学术出版业大环境已经今非昔比。
05:26
There are academic学术的 journals期刊 like "Trials试验," the open打开 access访问 journal日志,
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现在有类似《试验》的开源期刊(the open access journal),
05:30
which哪一个 will publish发布 any trial审讯 conducted进行 in humans人类
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这些期刊是不论结果好坏,只要关于人体试验的
05:33
regardless而不管 of whether是否 it has a positive or a negative result结果.
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悉数发表的学术期刊。
05:36
But this problem问题 of negative results结果 that go missing失踪 in action行动
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但负面结果被忽视的问题
05:40
is still very prevalent流行. In fact事实 it's so prevalent流行
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还是很严重。实际上,这严重到了
05:43
that it cuts削减 to the core核心 of evidence-based循证 medicine医学.
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威胁“循证医药学”的根本。
05:49
So this is a drug药物 called reboxetine瑞波西汀, and this is a drug药物
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这是一种叫做瑞波西汀的药物,之前
05:52
that I myself have prescribed规定. It's an antidepressant抗抑郁剂.
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我也开过这药的处方。这是一种抗抑郁的药物。
05:55
And I'm a very nerdy书呆子 doctor医生, so I read all of the studies学习
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而我又比较死板书呆子,所以我浏览了
05:57
that I could on this drug药物. I read the one study研究 that was published发表
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所有我能找到关于此药的文章。我读到的其中一篇声称
06:00
that showed显示 that reboxetine瑞波西汀 was better than placebo安慰剂,
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瑞波西汀比安慰剂要有效果,
06:03
and I read the other three studies学习 that were published发表
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我又读到另外三篇声称
06:05
that showed显示 that reboxetine瑞波西汀 was just as good as any other antidepressant抗抑郁剂,
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瑞波西汀和其他抗抑药物的效果没什么差别,
06:09
and because this patient患者 hadn't有没有 doneDONE well on those other antidepressants抗抑郁药,
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就因为那个病人对其他抗抑郁的药物没什么反应,
06:11
I thought, well, reboxetine瑞波西汀 is just as good. It's one to try.
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所以我觉得,瑞波西汀效果也不错。试试也没什么坏处。
06:13
But it turned转身 out that I was misled误导. In fact事实,
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但最终证明我是被误导了。实际上,
06:17
seven trials试验 were conducted进行 comparing比较 reboxetine瑞波西汀
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有七项关于瑞波西汀和
06:19
against反对 a dummy placebo安慰剂 sugar pill. One of them
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安慰糖片的比较试验。其中一项
06:22
was positive and that was published发表, but six of them
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效果出众也得以发表,其他六项
06:24
were negative and they were left unpublished未公布.
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无效果,导致无法发表结论。
06:28
Three trials试验 were published发表 comparing比较 reboxetine瑞波西汀
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三项发表的试验记载
06:30
against反对 other antidepressants抗抑郁药 in which哪一个 reboxetine瑞波西汀
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在瑞波西汀和其他抗抑郁药物的对比中,瑞波西汀
06:32
was just as good, and they were published发表,
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效果同样显著,并得以发表,
06:34
but three times as many许多 patients'耐心' worth价值 of data数据 was collected
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而另外收集的多达三倍的病例数据
06:38
which哪一个 showed显示 that reboxetine瑞波西汀 was worse更差 than
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显示瑞波西汀的表现
06:40
those other treatments治疗, and those trials试验 were not published发表.
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远不如其它药物的疗效,而这些试验结果没有被发表。
06:45
I felt misled误导.
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我感觉被误导了。
06:49
Now you might威力 say, well, that's an extremely非常 unusual异常 example,
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也许你会说,那可能是个案中的个案吧,
06:51
and I wouldn't不会 want to be guilty有罪 of the same相同 kind of
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我也不必自己和自己较真,
06:53
cherry-picking采摘樱桃 and selective可选择的 referencing引用
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不必为其他人这种只挑有利的选择性
06:56
that I'm accusing指责 other people of.
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发表而指责别人。
06:58
But it turns out that this phenomenon现象 of publication出版物 bias偏压
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但结果证实这种“发表偏倚”
07:00
has actually其实 been very, very well studied研究.
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已经被很深入的研究过了。
07:02
So here is one example of how you approach途径 it.
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举个例子,你如何看待它。
07:04
The classic经典 model模型 is, you get a bunch of studies学习 where
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经典的例子就是,你有了一堆
07:06
you know that they've他们已经 been conducted进行 and completed完成,
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已经临床使用过并有结论的试验
07:09
and then you go and see if they've他们已经 been published发表 anywhere随地
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而你要找学术文献机构
07:11
in the academic学术的 literature文学. So this took all of the trials试验
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询问是否曾经有发表。他们寻找了所有抗抑郁药物有关的
07:14
that had ever been conducted进行 on antidepressants抗抑郁药
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被食品药物管理局15年前审批的
07:16
that were approved批准 over a 15-year-年 period by the FDAFDA.
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相关临床案例。
07:20
They took all of the trials试验 which哪一个 were submitted提交 to the FDAFDA as part部分 of the approval赞同 package.
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他们根据所有曾经上交给食品医药管理局的试验案例作为基础。
07:23
So that's not all of the trials试验 that were ever conducted进行 on these drugs毒品,
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所以那并不是所有此类药物的所有临床试验结果,
07:26
because we can never know if we have those,
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因为我们不知道那些没有被公布的,
07:29
but it is the ones那些 that were conducted进行 in order订购 to get the marketing营销 authorization授权.
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只知道那些为了获得上市批准而进行试验研究的结果。
07:32
And then they went to see if these trials试验 had been published发表
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之后,他们去了解那些试验有没有被发表
07:34
in the peer-reviewed同行评审 academic学术的 literature文学. And this is what they found发现.
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在那些需同行审核的学术期刊中。这是他们的发现结果。
07:37
It was pretty漂亮 much a 50-50 split分裂. Half of these trials试验
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是大致上平分秋色。现实情况,一半试验显示
07:40
were positive, half of them were negative, in reality现实.
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效果显著,另外一半显示效果不显著。
07:44
But when they went to look for these trials试验 in the peer-reviewed同行评审 academic学术的 literature文学,
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但他们从那些需审核的学术机构里搜索那些试验的时候,
07:49
what they found发现 was a very different不同 picture图片.
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他们发现结果是截然不同的。
07:51
Only three of the negative trials试验 were published发表,
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只有三项效果负面的试验被发表了出来,
07:55
but all but one of the positive trials试验 were published发表.
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而除了一例几乎所有效果显著的试验案例都被发表了出去。
08:00
Now if we just flick拂去 back and forth向前 between之间 those two,
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当我们前后跳转进行两者对比的话,
08:04
you can see what a staggering踉跄 difference区别 there was
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你能发现横在现实和
08:06
between之间 reality现实 and what doctors医生, patients耐心,
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医生、病人、卫生服务专员、专业学者
08:10
commissioners委员 of health健康 services服务, and academics学者
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所能读到的审核的学术期刊文献,之间消息的鸿沟了。
08:12
were able能够 to see in the peer-reviewed同行评审 academic学术的 literature文学.
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所能读到的审核的学术期刊文献,之间消息的鸿沟了。
08:15
We were misled误导, and this is a systematic系统的 flaw缺陷
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我们被误导了,这是医药学核心中的体制漏洞。
08:20
in the core核心 of medicine医学.
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我们被误导了,这是医药学核心中的体制漏洞。
08:23
In fact事实, there have been so many许多 studies学习 conducted进行 on
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实际上,如今已经有很多关于
08:26
publication出版物 bias偏压 now, over a hundred, that they've他们已经 been
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“发表偏倚”的研究了,
08:29
collected in a systematic系统的 review评论, published发表 in 2010,
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在2010年发表的被收集并系统性的调查中,
08:32
that took every一切 single study研究 on publication出版物 bias偏压
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他们能找到的所有的“发表偏倚”的研究
08:35
that they could find.
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“发表偏倚”的试验案例有一百多项。
08:37
Publication出版物 bias偏压 affects影响 every一切 field领域 of medicine医学.
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“发表偏倚”影响了医学的所有领域。
08:39
About half of all trials试验, on average平均, go missing失踪 in action行动,
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大约一半的试验,被遗忘忽视,
08:44
and we know that positive findings发现 are around twice两次 as likely容易
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我们还发现,有效果的结果发表的几率
08:47
to be published发表 as negative findings发现.
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几乎是没效果发表几率的两倍。
08:50
This is a cancer癌症 at the core核心 of evidence-based循证 medicine医学.
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这是循证医药学中的毒瘤。
08:54
If I flipped翻转 a coin硬币 100 times but then
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如果我抛100次硬币,但是
08:58
withheld扣留 the results结果 from you from half of those tosses,
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隐瞒一半的投掷结果,
09:01
I could make it look as if I had a coin硬币 that always came来了 up heads.
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我就能让它看以来是一个永远头像朝上的硬币。
09:04
But that wouldn't不会 mean that I had a two-headed双头 coin硬币.
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但这不代表我这硬币有两面都是头像。
09:06
That would mean that I was a chancerchancer
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这只能说我是个投机者
09:08
and you were an idiot白痴 for letting出租 me get away with it. (Laughter笑声)
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而你是相信我说法的白痴。(笑声)
09:11
But this is exactly究竟 what we blindly盲目地 tolerate容忍
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但这就是我们在循证医药学中盲目纵容的现状。
09:15
in the whole整个 of evidence-based循证 medicine医学.
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但这就是我们在循证医药学中盲目纵容的现状。
09:19
And to me, this is research研究 misconduct处理不当.
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对我来说,这是学术不端行为。
09:23
If I conducted进行 one study研究 and I withheld扣留
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如果我做某项研究,而我隐瞒了
09:26
half of the data数据 points from that one study研究,
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此研究中一半的数据,
09:29
you would rightly正当地 accuse me, essentially实质上, of research研究 fraud舞弊.
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你就有权利指控我,学术诈骗。
09:33
And yet然而, for some reason原因, if somebody conducts行为
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但出于某种原因,如果某人做了
09:36
10 studies学习 but only publishes发布 the five that give the result结果 that they want,
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10项研究但只发表其中他希望的5项的话,
09:41
we don't consider考虑 that to be research研究 misconduct处理不当.
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我们却不会考虑这是学术不端。
09:44
And when that responsibility责任 is diffused扩散的 between之间
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但当学术不端的责任分散于学术网络,学术期刊,商业赞助商,期刊编辑的时候,
09:46
a whole整个 network网络 of researchers研究人员, academics学者,
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但当学术不端的责任分散于学术网络,学术期刊,商业赞助商,期刊编辑的时候,
09:49
industry行业 sponsors赞助商, journal日志 editors编者, for some reason原因
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但当学术不端的责任分散于学术网络,学术期刊,商业赞助商,期刊编辑的时候,
09:53
we find it more acceptable接受,
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不知怎么的,我们觉得这样是可以接受的,
09:54
but the effect影响 on patients耐心 is damning确凿.
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但这对病人的后果是惨痛的。
09:58
And this is happening事件 right now, today今天.
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如今这样的情况还在发生。
10:03
This is a drug药物 called Tamiflu达菲. Tamiflu达菲 is a drug药物
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这是种叫达菲的药物。达菲是
10:06
which哪一个 governments政府 around the world世界 have spent花费 billions数十亿
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全球政府花费了数十亿美元的
10:08
and billions数十亿 of dollars美元 on stockpiling堆存,
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资金作为应急储备的,
10:11
and we've我们已经 stockpiled储备 Tamiflu达菲 in panic恐慌,
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我们储备达菲,以备不时之需,
10:14
in the belief信仰 that it will reduce减少 the rate of complications并发症 of influenza流感.
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因为我们相信,它能减少流感所带来的并发症。
10:18
Complications并发症 is a medical euphemism婉辞 for pneumonia肺炎
194
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并发症则是医学上对肺炎和死亡的
10:21
and death死亡. (Laughter笑声)
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婉转说法。(笑声)
10:25
Now when the Cochrane科克伦 systematic系统的 reviewers评审
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如今,当科克伦(Cochrane临床对照试验资料库)系统审核员
10:29
were trying to collect搜集 together一起 all of the data数据 from all
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想收集所有关于达菲临床应用的,
10:31
of the trials试验 that had ever been conducted进行 on whether是否 Tamiflu达菲 actually其实 did this or not,
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是否有效的试验案例时,
10:35
they found发现 that several一些 of those trials试验 were unpublished未公布.
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他们发现很多试验是未被发表的。
10:38
The results结果 were unavailable不可用 to them.
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他们无法找到那些实验的结果。
10:40
And when they started开始 obtaining获得 the writeupswriteups of those trials试验 through通过 various各个 different不同 means手段,
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当他们通过不同渠道,通过《信息自由法案》,
10:44
through通过 Freedom自由 of Information信息 Act法案 requests要求, through通过
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当他们通过不同渠道,通过《信息自由法案》,
10:45
harassing骚扰 various各个 different不同 organizations组织, what they found发现 was inconsistent不符.
203
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向各种不同组织打探消息后,他们发现里面有很多矛盾的地方。
10:50
And when they tried试着 to get a hold保持 of the clinical临床 study研究 reports报告,
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当他们想查看那一万多页
10:52
the 10,000-page-页 long documents文件 that have
205
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包括了所有试验结果信息的
10:56
the best最好 possible可能 rendition翻译 of the information信息,
206
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临床学术报告的时候,
10:59
they were told they weren't allowed允许 to have them.
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他们被告知,他们无权使用。
11:02
And if you want to read the full充分 correspondence对应
208
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如果你想知道那些制药公司
11:05
and the excuses借口 and the explanations说明 given特定 by the drug药物 company公司,
209
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对此给出的解释和借口全文的话,
11:08
you can see that written书面 up in this week's本周 edition
210
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2717
你可以关注一下这周出版的
11:11
of PLOSPLOS Medicine医学.
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《公共科学图书馆•医学》的期刊。
11:15
And the most staggering踉跄 thing of all of this, to me,
212
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但对我来说,最惊人的事情是,
11:19
is that not only is this a problem问题, not only do we recognize认识
213
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不仅之前讨论的这个问题,和我们是否意识到了
11:22
that this is a problem问题, but we've我们已经 had to suffer遭受 fake fixes修复.
214
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这个问题,还包括我们要忍受装作问题已被解决。
11:26
We've我们已经 had people pretend假装 that this is a problem问题 that's been fixed固定.
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我们让人们以为这个问题已经解决了。
11:29
First of all, we had trials试验 registers寄存器, and everybody每个人 said,
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首先,我们有试验注册,所有人都说,
11:32
oh, it's okay. We'll get everyone大家 to register寄存器 their trials试验, they'll他们会 post岗位 the protocol协议,
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这样就行了。我们让所有人都注册他们的试验案例,他们会发布行业规则的,
11:35
they'll他们会 say what they're going to do before they do it,
218
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事先宣布他们要做什么了,
11:37
and then afterwards之后 we'll be able能够 to check and see if all the trials试验 which哪一个
219
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2121
之后,我们就能查出是否所有的进行过的试验案例都被发表了。
11:39
have been conducted进行 and completed完成 have been published发表.
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之后,我们就能查出是否所有的进行过的试验案例都被发表了。
11:42
But people didn't bother to use those registers寄存器.
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但人们并没有乖乖来注册。
11:44
And so then the International国际 Committee委员会 of Medical Journal日志 Editors编者 came来了 along沿,
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之后国际医学杂志编辑委员会跳出来,
11:47
and they said, oh, well, we will hold保持 the line线.
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1543
他们说,那好吧,我们会坚守底线的。
11:48
We won't惯于 publish发布 any journals期刊, we won't惯于 publish发布 any trials试验,
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除非试验案例之前已经注册过了,
11:51
unless除非 they've他们已经 been registered注册 before they began开始.
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否则我们是不会让它发表在学术期刊上的。
11:54
But they didn't hold保持 the line线. In 2008, a study研究 was conducted进行
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但他们还是没守住底线。2008年,一篇对此的研究
11:57
which哪一个 showed显示 that half of all of trials试验 published发表 by journals期刊
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表明,被国际医学杂志编辑委员会成员
12:00
edited编辑 by members会员 of the ICMJEICMJE
228
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审核的上述期刊中半数的试验
12:03
weren't properly正确 registered注册, and a quarter25美分硬币 of them weren't registered注册 at all.
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没有被完整注册在案,四分一的案例甚至就根本没有注册。
12:08
And then finally最后, the FDAFDA Amendment修订 Act法案 was passed通过
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最后,食品药物修正法案在几年后通过施行
12:10
a couple一对 of years年份 ago saying that everybody每个人 who conducts行为
231
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强调任何实施临床试验的人
12:13
a trial审讯 must必须 post岗位 the results结果 of that trial审讯 within one year.
232
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都必须在之后一年内公布临床试验的结果。
12:16
And in the BMJBMJ, in the first edition of January一月, 2012,
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在英国医学杂志,2012年1月第一版,
12:20
you can see a study研究 which哪一个 looks容貌 to see if people kept不停
234
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你能找到一项关于人们是否履行上述法案的研究
12:23
to that ruling裁决, and it turns out that only one in five
235
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结果表明只有五分一的人照此办理。
12:27
have doneDONE so.
236
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结果表明只有五分一的人照此办理。
12:30
This is a disaster灾害.
237
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悲剧阿,悲剧。
12:33
We cannot不能 know the true真正 effects效果 of the medicines药品
238
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如果我们不能了解所有的相关信息,
12:36
that we prescribe规定 if we do not have access访问
239
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我们就无法了解我们所开的药物的
12:40
to all of the information信息.
240
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真实疗效。
12:43
And this is not a difficult problem问题 to fix固定.
241
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但这问题不是那么难去克服的。
12:47
We need to force people to publish发布 all trials试验
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我们需要强制人们发表所有临床
12:52
conducted进行 in humans人类, including包含 the older旧的 trials试验,
243
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试验的结果,包括较早以前的案例,
12:55
because the FDAFDA Amendment修订 Act法案 only asks that you publish发布 the trials试验 conducted进行 after 2008,
244
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因为食品药物修正法只要求公开2008年之后的临床试验,
12:59
and I don't know what world世界 it is in which哪一个 we're only
245
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我不知道循证医药学的世界会变成什么样,
13:01
practicing medicine医学 on the basis基础 of trials试验 that completed完成 in the past过去 two years年份.
246
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如果我们用药只依靠这两年里的实验数据。
13:06
We need to publish发布 all trials试验 in humans人类,
247
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我们需要公布所有现用药物的所有临床试验的结果,包括较早以前的试验,
13:08
including包含 the older旧的 trials试验, for all drugs毒品 in current当前 use,
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我们需要公布所有现用药物的所有临床试验的结果,包括较早以前的试验,
13:11
and you need to tell everyone大家 you know
249
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2916
而且你们需要告诉你认识的所有人
13:14
that this is a problem问题 and that it has not been fixed固定.
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这是个问题,这个问题还有待解决。
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Thank you very much. (Applause掌声)
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谢谢大家。(掌声)
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(Applause掌声)
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(掌声)
Translated by Ralph Jin
Reviewed by dahong zhang

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ABOUT THE SPEAKER
Ben Goldacre - Debunker
Ben 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."

Read an excerpt of Bad Pharma >>

More profile about the speaker
Ben Goldacre | Speaker | TED.com

Data provided by TED.

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