TEDGlobal 2011
Ben Goldacre: Battling bad science
Ben Goldejkr: Borba protiv loše nauke
Filmed:
Readability: 4.3
2,713,579 views
Svakog dana smo bombradovani savetima o dobrom zdravlju, ali kako možemo znati da li su to dobri saveti? Doktor i epidemiolog Ben Goldejkr objašnjava načine kojima dokazi mogu biti izokrenuti, od očigledno netačnih tvrdnji o ishrani do veoma suptilnih trikova kojima se koriste farmaceutske kompanije.
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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Ja sam doktor, ali sam nekako zalutao u istraživačku oblast
00:18
and now I'm an epidemiologist.
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i sada sam epidemiolog.
00:20
And nobody really knows what epidemiology is.
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I niko u principu ne zna šta je epidemiologija.
00:22
Epidemiology is the science of how we know in the real world
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To je nauka koja nas uči šta je u stvarnom svetu
00:25
if something is good for you or bad for you.
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zaista dobro ili loše za vas.
00:27
And it's best understood through example
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I najbolje se razume kroz primere,
00:29
as the science of those crazy, wacky newspaper headlines.
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kao nauka o ovim ludim, zabavnim naslovima u novinama.
00:34
And these are just some of the examples.
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A ovo su samo neki od primera.
00:36
These are from the Daily Mail. Every country in the world has a newspaper like this.
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Ovo je uzeto iz "Daily Mail"-a. Svaka zamlja na svetu ima novine kao što su ove.
00:39
It has this bizarre, ongoing philosophical project
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Poseduje ovaj čudan, filozofski projekat koji
00:42
of dividing all the inanimate objects in the world
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se bavi podelom svih neživih stvari u svetu
00:44
into the ones that either cause or prevent cancer.
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na one koji ili uzrokuju ili štite od raka.
00:47
So here are some of the things they said cause cancer recently:
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Ovo su neke za koje je rečeno u skorije vreme da uzrokuju rak:
00:49
divorce, Wi-Fi, toiletries and coffee.
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razvod, "Wi-Fi", sredstva za higijenu i kafa.
00:51
Here are some of the things they say prevents cancer:
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A ovo su neke od stvari koje deluju preventivno:
00:53
crusts, red pepper, licorice and coffee.
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kore, crvena paprika, sladić i kafa.
00:55
So already you can see there are contradictions.
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Već i sami možete uočiti kontradiktornosti.
00:57
Coffee both causes and prevents cancer.
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Kafa i uzrokuje i sprečava rak.
00:59
And as you start to read on, you can see
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Kada nastavite da čitate, uočićete
01:01
that maybe there's some kind of political valence behind some of this.
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da tu možda postoji neka vrsta političke pozadine.
01:04
So for women, housework prevents breast cancer,
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Rad u kući štiti žene od raka,
01:06
but for men, shopping could make you impotent.
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a kupovina može muškarce učiniti impotentnim.
01:09
So we know that we need to start
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Tako da znamo da moramo da počnemo
01:12
unpicking the science behind this.
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da analiziramo nauku koja stoji iza toga.
01:15
And what I hope to show
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Ono što se ja nadam da ću vam pokazati
01:17
is that unpicking dodgy claims,
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je da analiziranje sumnjivih tvrdnji,
01:19
unpicking the evidence behind dodgy claims,
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analiziranje dokaza koji podržavaju sumnjive tvrdnje,
01:21
isn't a kind of nasty carping activity;
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nije neka vrsta zanovetajuće aktivnosti;
01:24
it's socially useful,
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već je socijalno korisno,
01:26
but it's also an extremely valuable
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i veoma značajno
01:28
explanatory tool.
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pomagalo za objašnjavanje.
01:30
Because real science is all about
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Jer prava nauka se bavi
01:32
critically appraising the evidence for somebody else's position.
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kritičnom procenom dokaza iza tvrdnji drugih ljudi.
01:34
That's what happens in academic journals.
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To je ono što se dešava u akademskim časopisima.
01:36
That's what happens at academic conferences.
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To se dešava na akademskim konferencijama.
01:38
The Q&A session after a post-op presents data
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Sesije pitanja i odgovora nakon prezentacija rezultata
01:40
is often a blood bath.
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su često vrlo oštre.
01:42
And nobody minds that. We actively welcome it.
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To nikome ne smeta. Svi se raduju tome.
01:44
It's like a consenting intellectual S&M activity.
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To je kao intelektualna sado-mazo aktivnost.
01:47
So what I'm going to show you
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Tako da ću vam ja objasniti
01:49
is all of the main things,
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glavne stvari,
01:51
all of the main features of my discipline --
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glavne karakteristike discipline kojom se bavim--
01:53
evidence-based medicine.
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a to je medicina zasnovana na dokazima.
01:55
And I will talk you through all of these
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Pokazaću vam sve to
01:57
and demonstrate how they work,
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i demonstrirati kako to funkcioniše,
01:59
exclusively using examples of people getting stuff wrong.
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isključivo koristeći primere ljudi koji stvari shvataju pogrešno.
02:02
So we'll start with the absolute weakest form of evidence known to man,
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Počećemo od najslabijeg tipa dokaza poznatog čovečanstvu,
02:05
and that is authority.
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poznatog čovečanstvu, a to je autoritet.
02:07
In science, we don't care how many letters you have after your name.
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U nauci, nas ne interesuje koliko titula imate iza svog imena.
02:10
In science, we want to know what your reasons are for believing something.
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U nauci, mi želimo da znamo iz kojih razloga Vi verujete u nešto.
02:13
How do you know that something is good for us
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Kako to Vi znate da li je nešto dobro
02:15
or bad for us?
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ili loše za nas?
02:17
But we're also unimpressed by authority,
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Ali nismo impresionirani autoritetom,
02:19
because it's so easy to contrive.
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zato što je lako izmišljati.
02:21
This is somebody called Dr. Gillian McKeith Ph.D,
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Ovo osoba se zove Dr. Džilijan MekKit, Ph.D,
02:23
or, to give her full medical title, Gillian McKeith.
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ili, po punoj medicinkoj tituli, Džilijan MekKit.
02:26
(Laughter)
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(Smeh)
02:29
Again, every country has somebody like this.
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Naravno, u svakoj zemlji postoji takva osoba.
02:31
She is our TV diet guru.
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Ona je naš TV-guru za ishranu.
02:33
She has massive five series of prime-time television,
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Ona ima ogromne serijale na najboljim kanalima,
02:36
giving out very lavish and exotic health advice.
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i daje veoma temeljne i egzotične savete o zdravlju.
02:39
She, it turns out, has a non-accredited correspondence course Ph.D.
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Završila je neakreditovan Ph.D. kurs zasnovan na preprisci
02:42
from somewhere in America.
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negde u Americi.
02:44
She also boasts that she's a certified professional member
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A takođe se hvali da je sertifikovani profesionalni član
02:46
of the American Association of Nutritional Consultants,
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Američke asocijacije konsultanata za ishranu,
02:48
which sounds very glamorous and exciting.
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što zvuči veoma glamurozno i uzbudljivo.
02:50
You get a certificate and everything.
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Dobijete sertifikat i sve što ide uz to.
02:52
This one belongs to my dead cat Hetti. She was a horrible cat.
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Ovaj priprada mojoj preminuloj mački Heti. Bila je očajna mačka.
02:54
You just go to the website, fill out the form,
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Samo otvorite internet-stranicu, ispunite formular,
02:56
give them $60, and it arrives in the post.
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platite 60$ i stiže vam poštom.
02:58
Now that's not the only reason that we think this person is an idiot.
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Ali to nije jedini razlog zbog čega nam se čini da je ova osoba idiot.
03:00
She also goes and says things like,
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Ona zastupa i mišljenja tipa:
03:02
you should eat lots of dark green leaves,
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treba da jedete puno tamno-zelenog lišća
03:04
because they contain lots of chlorophyll, and that will really oxygenate your blood.
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jer sadrži puno hlorofila, i on će oksidisati vašu krv.
03:06
And anybody who's done school biology remembers
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Svako ko je imao časove biologije u školi
03:08
that chlorophyll and chloroplasts
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se seća da hlorofil i hloroplasti
03:10
only make oxygen in sunlight,
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proizvode kiseonik samo na svetlosti,
03:12
and it's quite dark in your bowels after you've eaten spinach.
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a kada već pojedete spanać, u vašim crevima je mrak.
03:15
Next, we need proper science, proper evidence.
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Dalje, neophodna je prava nauka, pravi dokazi.
03:18
So, "Red wine can help prevent breast cancer."
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"Crno vino sprečava nastanak raka dojke."
03:20
This is a headline from the Daily Telegraph in the U.K.
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To je naslov u "Daily Telegraph"-u u Velikoj Britaniji.
03:22
"A glass of red wine a day could help prevent breast cancer."
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"Čaša crnog vina dnevno može vas zaštiti od raka dojke."
03:25
So you go and find this paper, and what you find
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A onda nađete naučni rad, i shvatite
03:27
is it is a real piece of science.
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da je to zaista prava nauka.
03:29
It is a description of the changes in one enzyme
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Opisuje promene u jednom enzimu
03:32
when you drip a chemical extracted from some red grape skin
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koje se dešavaju kada ubacite supstancu izolovanu iz kožice neke sorte grožđa
03:35
onto some cancer cells
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na neke ćelije raka
03:37
in a dish on a bench in a laboratory somewhere.
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negde u laboratoriji, u plastičnoj posudi.
03:40
And that's a really useful thing to describe
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To je dobar fenomen za opisivanje
03:42
in a scientific paper,
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u naučnom radu,
03:44
but on the question of your own personal risk
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ali o pitanju o povezanosti vašeg ličnog rizika
03:46
of getting breast cancer if you drink red wine,
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za oboljenje od raka dojke i korišćenja crnog vina
03:48
it tells you absolutely bugger all.
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vam ne govori apsolutno ništa.
03:50
Actually, it turns out that your risk of breast cancer
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U stvari, ispostavilo se da se rizik razvijanja raka dojki
03:52
actually increases slightly
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u stvari pomalo povećava
03:54
with every amount of alcohol that you drink.
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sa svakom čašom alkohola koju popijete.
03:56
So what we want is studies in real human people.
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Tako da ono što mi želimo su studije na ljudima.
04:00
And here's another example.
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Ovo je još jedan primer.
04:02
This is from Britain's leading diet and nutritionist in the Daily Mirror,
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Ovo je iz članka glavnog britanskog dijatetičara i nutricioniste u "Daily Mirror"-u,
04:05
which is our second biggest selling newspaper.
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a to su druge po stopi prodaje novine u našoj zemlji.
04:07
"An Australian study in 2001
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"Australijska studija iz 2001.
04:09
found that olive oil in combination with fruits, vegetables and pulses
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je pronašla da maslinovo ulje u kombinaciji sa voćem, povrćem i vežbanjem
04:11
offers measurable protection against skin wrinklings."
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dovodi do značajne zaštite od pojave bora na koži."
04:13
And then they give you advice:
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A onda vam daju savet:
04:15
"If you eat olive oil and vegetables, you'll have fewer skin wrinkles."
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"Ukoliko jedete maslinovo ulje i povrće, imaćete manje bora."
04:17
And they very helpfully tell you how to go and find the paper.
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Oni vam pruže informacije kako da pronađete originalan rad.
04:19
So you go and find the paper, and what you find is an observational study.
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Vi potom pronađete taj rad, i tu se radi o opisnoj studiji.
04:22
Obviously nobody has been able
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Očigledno niko nije u stanju
04:24
to go back to 1930,
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da se vrati u 1930.,
04:26
get all the people born in one maternity unit,
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okupi sve ljude koji su rođeni u istoj bolnici,
04:29
and half of them eat lots of fruit and veg and olive oil,
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i podeli ih u dve grupe od kojih jedna jede puno voća, povrća i maslinovog ulja,
04:31
and then half of them eat McDonald's,
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a druga grupa se hrani u MekDonaldsu,
04:33
and then we see how many wrinkles you've got later.
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a mi potom pratimo koliko bora imaju kasnije.
04:35
You have to take a snapshot of how people are now.
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Morate da uhvatite sliku kako ljudi izgledaju danas.
04:37
And what you find is, of course,
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Potom, naravno, zaključite
04:39
people who eat veg and olive oil have fewer skin wrinkles.
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da ljudi koji jedu povrće i maslinove ulje imaju manje bora.
04:42
But that's because people who eat fruit and veg and olive oil,
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Ali to je zbog toga što su ljudi koji jedu voće i povrće i maslinovo ulje,
04:45
they're freaks, they're not normal, they're like you;
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čudaci, oni nisu normalni, oni su kao vi,
04:48
they come to events like this.
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oni dolaze na događaje kao što je ovaj.
04:50
They are posh, they're wealthy, they're less likely to have outdoor jobs,
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Oni su elegantni, bogati i manje je verovatno da se bave poslovima na otvorenom prostoru,
04:53
they're less likely to do manual labor,
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manja je verovatnoća da se bave fizičkim radom,
04:55
they have better social support, they're less likely to smoke --
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imaju bolju socijalnu podršku, manje je verovatno da puše--
04:57
so for a whole host of fascinating, interlocking
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tako da iz mnogo fascinirajućih, povezanih
04:59
social, political and cultural reasons,
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socijalnih, političkih i kulturoloških razloga,
05:01
they are less likely to have skin wrinkles.
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je manja verovatnoća da će imati bore.
05:03
That doesn't mean that it's the vegetables or the olive oil.
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To ne znači da su razlog tome povrće ili maslinovo ulje.
05:05
(Laughter)
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(Smeh)
05:07
So ideally what you want to do is a trial.
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Idealno, želite da obavite studiju.
05:10
And everybody thinks they're very familiar with the idea of a trial.
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Svi misle da su dobro upoznati sa konceptom studija.
05:12
Trials are very old. The first trial was in the Bible -- Daniel 1:12.
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Studije su veoma stare. Prvo istraživanje datira iz perioda Biblije--Danijel 1:12.
05:15
It's very straightforward -- you take a bunch of people, you split them in half,
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Veoma je jasan princip-- analizirate grupu ljudi, podeljenu u dve pod-grupe,
05:17
you treat one group one way, you treat the other group the other way,
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jedna grupa dobije jedan tretman, a druga grupa drugi tretman,
05:19
and a little while later, you follow them up
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i nakon nekog vremena, analizirate te ljude
05:21
and see what happened to each of them.
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i vidite šta se desilo svakom od njih.
05:23
So I'm going to tell you about one trial,
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Objasniću vam sada jednu studju,
05:25
which is probably the most well-reported trial
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koja je verovatno medijski najpropraćenija
05:27
in the U.K. news media over the past decade.
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u Velikoj Britaniji tokom protekle dekade.
05:29
And this is the trial of fish oil pills.
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Radi se o izučavanju efekata pilula ribljeg ulja.
05:31
And the claim was fish oil pills improve school performance and behavior
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Tvrdilo se da pilule ribljeg ulja poboljšavaju uspeh u školi i ponašanje
05:33
in mainstream children.
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kod prosečne dece.
05:35
And they said, "We've done a trial.
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Rekoše, "Uradili smo studiju.
05:37
All the previous trials were positive, and we know this one's gonna be too."
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Sve prethodne studije su dale pozitivne rezultate i mi znamo da će i ova takođe biti pozitivna."
05:39
That should always ring alarm bells.
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To je izjava koja zove na opreznost.
05:41
Because if you already know the answer to your trial, you shouldn't be doing one.
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Jer ukoliko već znate odgovor, ne bi trebalo ni da radite studiju.
05:44
Either you've rigged it by design,
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Ili namestite rezultate studije dizajnom,
05:46
or you've got enough data so there's no need to randomize people anymore.
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ili već imate dovoljno podataka, tako da nema potrebe da se bavite time.
05:49
So this is what they were going to do in their trial.
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Evo šta su oni uradili u svojoj studiji.
05:52
They were taking 3,000 children,
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Okupili su 3,000 dece,
05:54
they were going to give them all these huge fish oil pills,
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i planirali su da im daju pilule ribljeg ulja,
05:56
six of them a day,
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šest pilula dnevno,
05:58
and then a year later, they were going to measure their school exam performance
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i godinu dana kasnije, bi analizirali njihove rezultate na ispitima u školi
06:01
and compare their school exam performance
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i potom bi uporedili te rezultate
06:03
against what they predicted their exam performance would have been
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sa onima koje su očekivali da će dobiti
06:05
if they hadn't had the pills.
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ukoliko nisu uzimali pilule.
06:08
Now can anybody spot a flaw in this design?
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Da li iko uočava grešku u ovom dizajnu?
06:11
And no professors of clinical trial methodology
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Ni jednom profesoru metodologije kliničkih studija
06:14
are allowed to answer this question.
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nije dozvoljeno da odgovori na ovo pitanje.
06:16
So there's no control; there's no control group.
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Pa, tu nema kontrole, ne postoji kontrolna grupa.
06:18
But that sounds really techie.
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Zvuči poprilično tehnički.
06:20
That's a technical term.
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To je tehnički izraz.
06:22
The kids got the pills, and then their performance improved.
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Klinci su uzimali pilule i njihovi rezultati u školi su se poboljšali.
06:24
What else could it possibly be if it wasn't the pills?
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Šta bi drugo mogao da bude uzrok tome osim pilula?
06:27
They got older. We all develop over time.
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Oni su stariji. Mi se svi razvijamo tokom vremena.
06:30
And of course, also there's the placebo effect.
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Takođe, postoji tu i placebo efekat.
06:32
The placebo effect is one of the most fascinating things in the whole of medicine.
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Placebo efekat je jedan od najfascinantnijih fenomena u celokupnoj medicini.
06:34
It's not just about taking a pill, and your performance and your pain getting better.
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Ne radi se samo o pozitivnom uticaju pilula na vaše rezultate i bol koji osećate.
06:37
It's about our beliefs and expectations.
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Tiče se i naših verovanja i očekivanja.
06:39
It's about the cultural meaning of a treatment.
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Tiče se kulturološkog smisla tretmana.
06:41
And this has been demonstrated in a whole raft of fascinating studies
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A to je pokazano u čitavoji seriji fascinantnih studija
06:44
comparing one kind of placebo against another.
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u kojima je jedan placebo upoređivan sa drugim.
06:47
So we know, for example, that two sugar pills a day
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Tako da znamo, na primer, da dve pilule šećera dnevno
06:49
are a more effective treatment for getting rid of gastric ulcers
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imaju veći efekat na uklanjanje čireva na želucu
06:51
than one sugar pill.
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od jedne pilule dnevno.
06:53
Two sugar pills a day beats one sugar pill a day.
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Dve pilule sećera dnevno su efektnije od jedne pilule dnevno.
06:55
And that's an outrageous and ridiculous finding, but it's true.
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To je nečuveno i smešno otkriće, ali je tačno.
06:58
We know from three different studies on three different types of pain
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Mi znamo na osnovu tri različite studije urađene na tri različite vrste bola
07:00
that a saltwater injection is a more effective treatment for pain
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da je injektiranje slane vode efektivniji tretman za tretiranje bola
07:03
than taking a sugar pill, taking a dummy pill that has no medicine in it --
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u odnosu na pilulu šećera, uzimanje lažne pilule bez ikakvih medicinskih svojstava--
07:07
not because the injection or the pills do anything physically to the body,
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ne usled toga što injekcija ili pilule dovode do nekih fizičkih promena u telu,
07:10
but because an injection feels like a much more dramatic intervention.
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već usled toga što injekciju doživljavamo kao mnogo drastičniju intervenciju.
07:13
So we know that our beliefs and expectations
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Tako da mi znamo da naša verovanja i iščekivanja
07:15
can be manipulated,
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mogu biti manipulisana
07:17
which is why we do trials
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i zbog toga mi radimo studije
07:19
where we control against a placebo --
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gde kontrolišemo efekat placeba--
07:21
where one half of the people get the real treatment
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u kojima jedna polovina ljudi dobija pravi tretman,
07:23
and the other half get placebo.
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a druga polovina je na placebu.
07:25
But that's not enough.
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Ali to nije dovoljno.
07:28
What I've just shown you are examples of the very simple and straightforward ways
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Ono što sam vam upravo pokazao su primeri veoma jednostavnih načina
07:31
that journalists and food supplement pill peddlers
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pomoću kojih novinari i prodavci suplemenata hrani
07:33
and naturopaths
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i naturopate
07:35
can distort evidence for their own purposes.
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mogu da izmene dokaze u svoje svrhe.
07:38
What I find really fascinating
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Ono što mene zaista fascinira
07:40
is that the pharmaceutical industry
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jeste da farmaceutska industrija
07:42
uses exactly the same kinds of tricks and devices,
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koristi upravo iste vrste trikova i izuma,
07:44
but slightly more sophisticated versions of them,
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ali malo sofisticiranije verzije,
07:47
in order to distort the evidence that they give to doctors and patients,
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ne bi li izobličila dokaze koje daju doktorima i pacijentima,
07:50
and which we use to make vitally important decisions.
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i koje mi koristimo kako bismo doneli važne odluke.
07:53
So firstly, trials against placebo:
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Prvo o studijama koje kontrolišu efekat placeba
07:55
everybody thinks they know that a trial should be
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svi misle da znaju kako studije treba da izgledaju,
07:57
a comparison of your new drug against placebo.
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upoređivanje vašeg novog leka i efekta placeba.
07:59
But actually in a lot of situations that's wrong.
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Ali u stvari je to u mnogim situacijama pogrešno.
08:01
Because often we already have a very good treatment that is currently available,
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Usled toga što mi već imamo veoma dobre dostupne lekove,
08:04
so we don't want to know that your alternative new treatment
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mi ne želimo da znamo da li je taj alternativni tretman
08:06
is better than nothing.
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bolji ni od čega.
08:08
We want to know that it's better than the best currently available treatment that we have.
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Mi želimo da znamo da li je bolji od najboljeg tretmana koji trenutno postoji.
08:11
And yet, repeatedly, you consistently see people doing trials
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A opet, iznova i iznova, vi stalno slušate o studijama
08:14
still against placebo.
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koje koriste placebo kao komparator.
08:16
And you can get license to bring your drug to market
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Čak možete dobiti i licencu da vaš lek pustite na tržište
08:18
with only data showing that it's better than nothing,
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samo sa podacima koji pokazuju da je tretman bolji ni od čega,
08:20
which is useless for a doctor like me trying to make a decision.
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a to je beskorisno za doktora poput mene koji pokušava da donese odluku.
08:23
But that's not the only way you can rig your data.
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Ali to nije jedini način kako možete da namestite svoje rezultate.
08:25
You can also rig your data
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Možete ih promeniti tako
08:27
by making the thing you compare your new drug against
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što komparator sa kojim upoređujete vaš novi lek
08:29
really rubbish.
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potpuno obezvredite.
08:31
You can give the competing drug in too low a dose,
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Možete dati niže doze konkurentnog leka,
08:33
so that people aren't properly treated.
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tako da ti ljudi nisu lečeni na pravi način.
08:35
You can give the competing drug in too high a dose,
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A možete i primeniti preveliku dozu konkurentnog leka,
08:37
so that people get side effects.
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tako da ljudi pokažu mnogo kontraindikacija.
08:39
And this is exactly what happened
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To je upravo ono što se desilo
08:41
which antipsychotic medication for schizophrenia.
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u slučaju anti-psihotičkih lekova za šizofreniju.
08:43
20 years ago, a new generation of antipsychotic drugs were brought in
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Pre 20 godina, nova generacija anti-psihotičkih lekova se pojavila
08:46
and the promise was that they would have fewer side effects.
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i obećanje je bilo to da pokazuju manje kontra-efekata.
08:49
So people set about doing trials of these new drugs
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Tako da su ljudi počeli sa izučavanjem tih novih lekova
08:51
against the old drugs,
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i upoređivanjem istih sa starim,
08:53
but they gave the old drugs in ridiculously high doses --
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ali su stare lekove primenjivali u smešno velikim dozama--
08:55
20 milligrams a day of haloperidol.
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20mg haloperidola dnevno.
08:57
And it's a foregone conclusion,
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A odavno je poznato da ukoliko
08:59
if you give a drug at that high a dose,
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primenite lek u visokim dozama,
09:01
that it will have more side effects and that your new drug will look better.
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doći će do više kontraindikacija i vaš novi lek će imati bolji efekat.
09:04
10 years ago, history repeated itself, interestingly,
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Interesantno je da se pre 10 godina istorija ponovila,
09:06
when risperidone, which was the first of the new-generation antipscyhotic drugs,
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kada je risperidonu, a to je jedan od prvih lekova nove generacije anti-psihotika,
09:09
came off copyright, so anybody could make copies.
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istekla licenca, tako da je svako mogao da ga sintetiše.
09:12
Everybody wanted to show that their drug was better than risperidone,
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Svi su želeli da dokažu da je njihov novi lek bolji od risperidona,
09:14
so you see a bunch of trials comparing new antipsychotic drugs
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tako da je došlo do gomile studija o novim anti-psihoticima
09:17
against risperidone at eight milligrams a day.
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koji su upoređivani sa risperidonom u dozi od 8mg dnevno.
09:19
Again, not an insane dose, not an illegal dose,
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Ponovo, to nije luda doza leka, nije nezakonita,
09:21
but very much at the high end of normal.
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ali jeste na gornjoj granici normale.
09:23
And so you're bound to make your new drug look better.
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Tako da će zasigurno vaš novi lek pokazivati bolje rezultate.
09:26
And so it's no surprise that overall,
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Tako da uopšteno gledajući nije iznenađujuće što
09:29
industry-funded trials
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studije koje finansira industrija
09:31
are four times more likely to give a positive result
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imaju 4 puta više izgleda da dođu do pozitivnih rezultata
09:33
than independently sponsored trials.
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u odnosu na nezavisno sponzorisane studije.
09:36
But -- and it's a big but --
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Ali- i to je jedno veliko ali--
09:39
(Laughter)
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(Smeh)
09:41
it turns out,
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ispostavilo se,
09:43
when you look at the methods used by industry-funded trials,
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da kada pogledate metode koje se koriste u studijama koje finansira industrija,
09:46
that they're actually better
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one su u stvari bolje
09:48
than independently sponsored trials.
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u odnosu na nezavisno finansirane studije.
09:50
And yet, they always manage to to get the result that they want.
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A opet, oni uvek uspeju da dođu do rezultata koji žele.
09:53
So how does this work?
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Pa kako to funkcioniše?
09:55
How can we explain this strange phenomenon?
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Kako bismo mogli da objasnimo ovaj čudan fenomen?
09:58
Well it turns out that what happens
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Ispostavilo se da nekako
10:00
is the negative data goes missing in action;
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negativni rezultati nestanu u celoj toj akciji,
10:02
it's withheld from doctors and patients.
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ne pokazuju se doktorima i pacijentima.
10:04
And this is the most important aspect of the whole story.
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A to je najznačajniji momenat cele priče.
10:06
It's at the top of the pyramid of evidence.
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To je na vrhu piramide dokaza.
10:08
We need to have all of the data on a particular treatment
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Neophodno je da imamo sve podatke o određenom tretmanu
10:11
to know whether or not it really is effective.
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kako bismo znali da li je zaista efektivan.
10:13
And there are two different ways that you can spot
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Postoje dva načina pomoću kojih možete uočiti
10:15
whether some data has gone missing in action.
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da li su neki podaci nestali u akciji.
10:17
You can use statistics, or you can use stories.
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Možete koristiti statistiku, ili se oslanjati na priče.
10:20
I personally prefer statistics, so that's what I'm going to do first.
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Ja lično više volim statistiku, tako da ću to obrazložiti prvo.
10:22
This is something called funnel plot.
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Ovo je nešto što nazivamo grafik-levak.
10:24
And a funnel plot is a very clever way of spotting
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Grafik-levak je veoma pametan način pomoću kojeg uočavamo
10:26
if small negative trials have disappeared, have gone missing in action.
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da li su male studije sa negativnim rezultatima nestale tokom procesa.
10:29
So this is a graph of all of the trials
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Ovo je grafik svih studija
10:31
that have been done on a particular treatment.
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koje su sprovedene za određeni tretman.
10:33
And as you go up towards the top of the graph,
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Kako se penjete ka vrhu grafika,
10:35
what you see is each dot is a trial.
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ono što vidite je da svaka tačka predstavlja jednu studiju.
10:37
And as you go up, those are the bigger trials, so they've got less error in them.
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I kako se krećete ka vrhu, ovo su velike studije, sa manje grešaka.
10:40
So they're less likely to be randomly false positives, randomly false negatives.
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Manja je verovatnoća da su te studije slučajno lažno pozitivne ili negativne.
10:43
So they all cluster together.
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Tako da su grupisane zajedno.
10:45
The big trials are closer to the true answer.
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Velike studije su bliže pravom odgovoru.
10:47
Then as you go further down at the bottom,
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A onda kako se spuštate ka dnu grafika,
10:49
what you can see is, over on this side, the spurious false negatives,
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ono što možete da vidite, na ovoj strani grafika, su lažno negativni,
10:52
and over on this side, the spurious false positives.
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a na ovoj strani su lažno pozitivni rezultati.
10:54
If there is publication bias,
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Ukoliko postoje određene sklonosti u objavljivanju studija,
10:56
if small negative trials have gone missing in action,
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ukoliko su male studije sa negativnim rezultatima nestale tokom procesa,
10:59
you can see it on one of these graphs.
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možete to uočiti u jednom od ovih grafika.
11:01
So you can see here that the small negative trials
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Tako da ovde možete videti da su male studije sa negativnim rezultatima
11:03
that should be on the bottom left have disappeared.
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koje bi trebalo da budu u donjem levom uglu nestale.
11:05
This is a graph demonstrating the presence of publication bias
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Ovo je grafikon koji pokazuje pristrasnost u publikacijama
11:08
in studies of publication bias.
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u studijama o pristrasnosti u objavljivanju .
11:10
And I think that's the funniest epidemiology joke
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Ja mislim da je to najsmešnija šala u epidemiologiji
11:12
that you will ever hear.
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koju ćete ikada čuti.
11:14
That's how you can prove it statistically,
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Na ovaj način to možete statistički pokazati,
11:16
but what about stories?
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ali šta se dešava sa pričama?
11:18
Well they're heinous, they really are.
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E pa one su gnusne, zaista jesu.
11:20
This is a drug called reboxetine.
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Ovo je lek reboksetin.
11:22
This is a drug that I myself have prescribed to patients.
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Ovaj lek sam ja prepisivao pacijentima.
11:24
And I'm a very nerdy doctor.
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A ja sam pravi doktor-štreber.
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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Ja mislim da ja dajem sve od sebe da pročitam i razumem literaturu.
11:29
I read the trials on this. They were all positive. They were all well-conducted.
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Pročitao sam studije o tome leku. Sve su bile pozitivne. Bile su veoma dobro izvedene.
11:32
I found no flaw.
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Nisam pronašao ni jednu manu.
11:34
Unfortunately, it turned out,
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Na nesreću, ispostavilo se da
11:36
that many of these trials were withheld.
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su mnoge studije bile povučene.
11:38
In fact, 76 percent
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Činjenica je da 76%
11:40
of all of the trials that were done on this drug
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studija koje su ispitivale ovaj lek
11:42
were withheld from doctors and patients.
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nisu pokazane doktorima i pacijentima.
11:44
Now if you think about it,
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Sada ako porazmislite o tome,
11:46
if I tossed a coin a hundred times,
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ukoliko bih ja bacio novčić 100 puta,
11:48
and I'm allowed to withhold from you
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i ukoliko mi je dozvoljeno da sakrijem od vas
11:50
the answers half the times,
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rezultate 50% bacanja,
11:52
then I can convince you
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onda mogu i da vas ubedim
11:54
that I have a coin with two heads.
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da imam novčić sa dve glave.
11:56
If we remove half of the data,
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Ukoliko sakrijemo polovinu podataka,
11:58
we can never know what the true effect size of these medicines is.
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nikada nećemo znati koji je pravi efekat nekog leka.
12:01
And this is not an isolated story.
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A ova priča nije izuzetak.
12:03
Around half of all of the trial data on antidepressants has been withheld,
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Otprilike polovina studija o anti-depresivima je nedostupna,
12:07
but it goes way beyond that.
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ali problem je mnogo veći od toga.
12:09
The Nordic Cochrane Group were trying to get a hold of the data on that
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"Nordic Cochrane Group" je pokušavala da dođe do podataka
12:11
to bring it all together.
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kako bi sagledali celu sliku.
12:13
The Cochrane Groups are an international nonprofit collaboration
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"Cochrane Groups" je neprofitna internacionalna kolaboracija
12:16
that produce systematic reviews of all of the data that has ever been shown.
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koja se bavi sistematskim pregledom svih podataka koji su ikada pokazani.
12:19
And they need to have access to all of the trial data.
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Neophodno je da oni imaju pristup svim podacima iz studija.
12:22
But the companies withheld that data from them,
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Ali kompanije čine te rezultate nedostupnim,
12:25
and so did the European Medicines Agency
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kao i Evropska medicinska agencija (EMA)
12:27
for three years.
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u periodu od tri godine.
12:29
This is a problem that is currently lacking a solution.
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Ovo je problem za koji trenutno ne postoji rešenje.
12:32
And to show how big it goes, this is a drug called Tamiflu,
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Kako bih vam dočarao njegove razmere, obajsniću vam priču o leku "Tamiflu",
12:35
which governments around the world
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za koji su vlade širom sveta
12:37
have spent billions and billions of dollars on.
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potrošile milijarde i milijarde dolara.
12:39
And they spend that money on the promise
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A potrošili su pare na osnovu obećanja
12:41
that this is a drug which will reduce the rate
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da ovaj lek smanjuje stopu
12:43
of complications with flu.
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komplikacija povezanih sa gripom.
12:45
We already have the data
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Mi već imamo podatke
12:47
showing that it reduces the duration of your flu by a few hours.
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koji pokazuju da smanjuje trajanje simptoma gripa za nekoliko sati.
12:49
But I don't really care about that. Governments don't care about that.
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Ali meni u principu uopšte nije stalo do toga. Vladama nije stalo do toga.
12:51
I'm very sorry if you have the flu, I know it's horrible,
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Žao mi je ako imate grip, znam da je to odvratno,
12:54
but we're not going to spend billions of dollars
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ali mi nećemo potrošiti milijarde dolara
12:56
trying to reduce the duration of your flu symptoms
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kako bismo smanjili trajanje simptoma vašeg gripa
12:58
by half a day.
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za pola dana.
13:00
We prescribe these drugs, we stockpile them for emergencies
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Mi prepisujemo te lekove, mi ih čuvamo za hitne slučajeve
13:02
on the understanding that they will reduce the number of complications,
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na osnovu saznanja da će umanjiti brojne komplikacije,
13:04
which means pneumonia and which means death.
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a to su upala pluća i smrt.
13:07
The infectious diseases Cochrane Group, which are based in Italy,
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Ogranak "Cochraine Group"-e za infektivne bolesti, sa sedištem u Italiji,
13:10
has been trying to get
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je pokušavao da dođe do
13:12
the full data in a usable form out of the drug companies
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svih podataka u formatu dostupnom za analizu od kompanija
13:15
so that they can make a full decision
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kako bi mogla da donesu odluku o tome
13:18
about whether this drug is effective or not,
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da li je ovaj lek efektivan ili ne
13:20
and they've not been able to get that information.
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i nije uspela da dođe do tih informacija.
13:23
This is undoubtedly
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Ovo je bez ikakve sumnje
13:25
the single biggest ethical problem
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najveći etički problem
13:28
facing medicine today.
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sa kojim se medicina danas suočava.
13:30
We cannot make decisions
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Mi ne možemo da donosimo odluke
13:33
in the absence of all of the information.
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ukoliko neke informacije nisu dostupne.
13:37
So it's a little bit difficult from there
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Tako da je malo teško doći
13:40
to spin in some kind of positive conclusion.
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do pozitivnog zaključka.
13:44
But I would say this:
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Ali ja bih rekao sledeće:
13:48
I think that sunlight
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ja mislim da je transparentnost
13:51
is the best disinfectant.
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najbolje dezinfekciono sredstvo.
13:53
All of these things are happening in plain sight,
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Sve ove stvari se dešavaju na očigled svih nas
13:56
and they're all protected
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i zaštićene su
13:58
by a force field of tediousness.
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silom monotonije.
14:01
And I think, with all of the problems in science,
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Mislim da pored svih problema koji postoje u nauci,
14:03
one of the best things that we can do
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jedna od najboljih stvari koje možemo da uradimo je
14:05
is to lift up the lid,
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da podignemo poklopac,
14:07
finger around in the mechanics and peer in.
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sagledamo i razmotrimo problematiku koju smo tu uočili.
14:09
Thank you very much.
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Hvala vam puno.
14:11
(Applause)
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(Aplauz)
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