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: 關於處方,醫生所不知道的事

Filmed:
2,501,600 views

新研發藥物的測試結果應讓整體醫療界知道,但醫生和研究員對於實驗結果顯示負面以及未下定論的試驗卻無從得知。Ben Goldacre 透過這段慷慨激昂的演講,解釋被埋藏的負面實驗結果是如何地將人倒入危險歧途。
- 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,
0
671
2785
嗨各位! 這位仁兄呢
00:19
he thinks he can tell you the future未來.
1
3456
2262
自認可以預知未來
00:21
His name名稱 is Nostradamus諾查丹瑪斯, although雖然 here the Sun太陽 have
2
5718
1979
他的名字是諾斯特拉達姆士,但這張圖看起來
00:23
made製作 him look a little bit like Sean肖恩 Connery康納利. (Laughter笑聲)
3
7697
3670
反倒有點像西恩康納瑞
00:27
And like most of you, I suspect疑似, I don't really believe
4
11367
2903
我呢,跟大部分的人一樣
00:30
that people can see into the future未來.
5
14270
1108
不太相信人類能預見未來
00:31
I don't believe in precognition預知, and every一切 now and then,
6
15378
2704
我不信這套,但你時常會聽到
00:33
you hear that somebody has been able能夠 to predict預測 something that happened發生 in the future未來,
7
18082
3182
有些人能夠預測未來
00:37
and that's probably大概 because it was a fluke吸蟲, and we only
8
21264
3059
大概都是僥倖猜中的吧
00:40
hear about the flukes吸蟲 and about the freaks怪胎.
9
24323
2615
我們也只能聽到這些不尋常的故事
00:42
We don't hear about all the times that people got stuff東東 wrong錯誤.
10
26938
4079
看到人凸槌的機會卻很少
00:46
Now we expect期望 that to happen發生 with silly愚蠢 stories故事
11
31017
2160
我們以為只有預知未來這種事才會出錯
00:49
about precognition預知, but the problem問題 is,
12
33177
3139
但實際上,
00:52
we have exactly究竟 the same相同 problem問題 in academia學術界
13
36316
3344
學術界和醫藥界也有同樣的問題
00:55
and in medicine醫學, and in this environment環境, it costs成本 lives生活.
14
39660
4501
出錯會賠上人命的
01:00
So firstly首先, thinking思維 just about precognition預知, as it turns out,
15
44161
3365
現在我們先把焦點放在預知未來上
01:03
just last year a researcher研究員 called Daryl達里爾 Bem貝姆 conducted進行
16
47526
2529
去年有位名叫Daryl Bem的研究員
01:05
a piece of research研究 where he found發現 evidence證據
17
50055
1836
做了一項研究,證明大學生
01:07
of precognitive預知 powers權力 in undergraduate大學本科 students學生們,
18
51891
3658
有預測未來的能力
01:11
and this was published發表 in a peer-reviewed同行評審 academic學術的 journal日誌
19
55549
2574
研究結果收錄在一個同儕審查的學術期刊中
01:14
and most of the people who read this just said, "Okay, well,
20
58123
2281
看過的人大部分表示
01:16
fair公平 enough足夠, but I think that's a fluke吸蟲, that's a freak怪物, because I know
21
60404
2181
"好吧算他厲害,但這純粹是僥倖猜中,
01:18
that if I did a study研究 where I found發現 no evidence證據
22
62585
2834
因為我如果做了一個無法證明
01:21
that undergraduate大學本科 students學生們 had precognitive預知 powers權力,
23
65419
2512
大學生有預知能力的研究,
01:23
it probably大概 wouldn't不會 get published發表 in a journal日誌.
24
67931
3552
應該就沒有期刊會出版了"
01:27
And in fact事實, we know that that's true真正, because
25
71483
2855
事實也真的是如此
01:30
several一些 different不同 groups of research研究 scientists科學家們 tried試著
26
74338
2529
有數個研究團隊試圖
01:32
to replicate複製 the findings發現 of this precognition預知 study研究,
27
76867
3520
重復這項研究的成果
01:36
and when they submitted提交 it to the exact精確 same相同 journal日誌,
28
80387
2635
當他們把結果呈給同樣的出版社時
01:38
the journal日誌 said, "No, we're not interested有興趣 in publishing出版
29
83022
3152
出版社表示,"我們對同樣的研究沒興趣,
01:42
replication複製. We're not interested有興趣 in your negative data數據."
30
86174
4525
你們的結果與先前的相反,所以我們沒興趣"
01:46
So this is already已經 evidence證據 of how, in the academic學術的
31
90699
2754
由此可見,在學術界裡
01:49
literature文學, we will see a biased sample樣品 of the true真正 picture圖片
32
93453
4870
許多科學研究
01:54
of all of the scientific科學 studies學習 that have been conducted進行.
33
98323
3467
都存在一種特定偏見
01:57
But it doesn't just happen發生 in the dry academic學術的 field領域 of psychology心理學.
34
101790
4429
這種導向不只出現在心理學研究
02:02
It also happens發生 in, for example, cancer癌症 research研究.
35
106219
4367
在癌症的研究中也會出現
02:06
So in March遊行, 2012, just one month ago, some researchers研究人員
36
110586
4077
2012年三月,也就是一個月前
02:10
reported報導 in the journal日誌 Nature性質 how they had tried試著
37
114663
2896
幾位研究員在自然期刊中表示
02:13
to replicate複製 53 different不同 basic基本 science科學 studies學習 looking at
38
117559
3846
他們重新做了先前53種治療癌症的基本研究
02:17
potential潛在 treatment治療 targets目標 in cancer癌症,
39
121405
3555
尋找治療癌症的可行方法
02:20
and out of those 53 studies學習, they were only able能夠
40
124960
2638
53項研究中,
02:23
to successfully順利 replicate複製 six.
41
127598
3076
只有6項成功
02:26
Forty-seven四十七 out of those 53 were unreplicable不可複製.
42
130674
4333
有47項是失敗的
02:30
And they say in their discussion討論 that this is very likely容易
43
135007
3913
討論過程中他們表示,這個結果很可能是因為
02:34
because freaks怪胎 get published發表.
44
138920
2639
不尋常的事物容易備受矚目
02:37
People will do lots and lots and lots of different不同 studies學習,
45
141559
2096
人們做了一大堆研究
02:39
and the occasions場合 when it works作品 they will publish發布,
46
143655
2120
成功的實驗結果會被公諸於世
02:41
and the ones那些 where it doesn't work they won't慣於.
47
145775
1679
失敗的結果不會受到注意
02:43
And their first recommendation建議 of how to fix固定 this problem問題,
48
147454
3941
這些研究員對這個問題提出解決辦法
02:47
because it is a problem問題, because it sends發送 us all down blind alleys小巷,
49
151395
3289
這個問題將大眾導入迷途
02:50
their first recommendation建議 of how to fix固定 this problem問題
50
154684
1706
他們認為處理這個問題的辦法
02:52
is to make it easier更輕鬆 to publish發布 negative results結果 in science科學,
51
156390
3393
即是使失敗的研究結果受到更多重視
02:55
and to change更改 the incentives獎勵 so that scientists科學家們 are
52
159783
2907
改變研究動機,鼓勵科學家勇於
02:58
encouraged鼓勵 to post崗位 more of their negative results結果 in public上市.
53
162690
4352
公布失敗的結果
03:02
But it doesn't just happen發生 in the very dry world世界
54
167042
3852
這不只發生在臨床基本癌症研究
03:06
of preclinical臨床前 basic基本 science科學 cancer癌症 research研究.
55
170894
3851
這不只發生在臨床基本癌症研究
03:10
It also happens發生 in the very real真實, flesh and blood血液
56
174745
3657
這也發生在活生生的學術醫藥中
03:14
of academic學術的 medicine醫學. So in 1980,
57
178402
3591
1980年幾位研究員
03:17
some researchers研究人員 did a study研究 on a drug藥物 called lorcainidelorcainide,
58
181993
3008
對一種叫lorcainide的藥物做研究
03:20
and this was an anti-arrhythmic抗心律不整 drug藥物,
59
185001
2331
這是一種抗心律失常藥
03:23
a drug藥物 that suppresses禁止顯示 abnormal不正常 heart rhythms節奏,
60
187332
2251
用來抑制異常的心搏
03:25
and the idea理念 was, after people have had a heart attack攻擊,
61
189598
2228
病人心臟病發後
03:27
they're quite相當 likely容易 to have abnormal不正常 heart rhythms節奏,
62
191826
1537
很有可能心律不整
03:29
so if we give them a drug藥物 that suppresses禁止顯示 abnormal不正常 heart
63
193363
2377
若給病人能夠抑制異常心搏的藥
03:31
rhythms節奏, this will increase增加 the chances機會 of them surviving倖存.
64
195740
3713
便能提高存活率
03:35
Early on its development發展, they did a very small trial審訊,
65
199453
3008
初期試用階段,他們對一百多名病患
03:38
just under a hundred patients耐心.
66
202461
1644
做了一個試驗
03:40
Fifty五十 patients耐心 got lorcainidelorcainide, and of those patients耐心, 10 died死亡.
67
204105
3652
五十名服用lorcainide的患者中,有十人死亡
03:43
Another另一個 50 patients耐心 got a dummy placebo安慰劑 sugar pill
68
207757
3043
另外五十名服用單純糖做的藥丸
03:46
with no active活性 ingredient成分, and only one of them died死亡.
69
210800
2958
只有一個人死亡
03:49
So they rightly正當地 regarded認為 this drug藥物 as a failure失敗,
70
213758
2649
他們馬上認定這是個失敗的藥物
03:52
and its commercial廣告 development發展 was stopped停止, and because
71
216407
2869
廣告活動也停止宣傳
03:55
its commercial廣告 development發展 was stopped停止, this trial審訊 was never published發表.
72
219276
4348
因為如此,試驗結果也從未公布
03:59
Unfortunately不幸, over the course課程 of the next下一個 five, 10 years年份,
73
223624
5397
不幸的是,五年、十年過後
04:04
other companies公司 had the same相同 idea理念 about drugs毒品 that would
74
229021
3825
其他藥廠開發了同樣能
04:08
prevent避免 arrhythmias心律失常 in people who have had heart attacks攻擊.
75
232846
2592
抑制心臟病患異常心搏的藥
04:11
These drugs毒品 were brought to market市場. They were prescribed規定
76
235438
1720
這些藥在市面販售,又因為心臟疾病普遍
04:13
very widely廣泛 because heart attacks攻擊 are a very common共同 thing,
77
237158
3412
這些藥經常變成處方藥物
04:16
and it took so long for us to find out that these drugs毒品
78
240570
3843
我們花了很久的時間才發現
04:20
also caused造成 an increased增加 rate of death死亡
79
244413
2911
這些藥物會提高死亡率
04:23
that before we detected檢測 that safety安全 signal信號,
80
247324
2747
在我們發覺這些危險前
04:25
over 100,000 people died死亡 unnecessarily不必要的 in America美國
81
250071
6051
美國有十萬人因服用抗心律失常藥而白白送命
04:32
from the prescription處方 of anti-arrhythmic抗心律不整 drugs毒品.
82
256122
3451
美國有十萬人因服用抗心律失常藥而白白送命
04:35
Now actually其實, in 1993,
83
259573
3598
而在1993年
04:39
the researchers研究人員 who did that 1980 study研究, that early study研究,
84
263171
3560
1980年做過早期試驗的那批研究員
04:42
published發表 a meaMEA culpa過失, an apology歉意 to the scientific科學 community社區,
85
266731
3841
發表了一篇悔過書,向科學界致歉
04:46
in which哪一個 they said, "When we carried攜帶的 out our study研究 in 1980,
86
270572
3125
他們表示 "1980年進行lorcainide試驗時,
04:49
we thought that the increased增加 death死亡 rate that occurred發生
87
273697
1936
我們以為死亡率的提升只是巧合"
04:51
in the lorcainidelorcainide group was an effect影響 of chance機會."
88
275633
3358
我們以為死亡率的提升只是機率問題"
04:54
The development發展 of lorcainidelorcainide was abandoned for commercial廣告 reasons原因,
89
278991
2032
基於商業因素,lorcainide停止研發
04:56
and this study研究 was never published發表;
90
281023
1638
這項試驗結果也從未公布
04:58
it's now a good example of publication出版物 bias偏壓.
91
282661
2386
由此可見出版業的偏見
05:00
That's the technical技術 term術語 for the phenomenon現象 where
92
285047
1891
也就是不起眼的資訊常遭到封殺
05:02
unflattering直言不諱 data數據 gets得到 lost丟失, gets得到 unpublished未公佈, is left
93
286938
4238
不是被埋沒就是沒下文
05:07
missing失踪 in action行動, and they say the results結果 described描述 here
94
291176
3371
他們表示,這個結果"原本有可能做為警惕"
05:10
"might威力 have provided提供 an early warning警告 of trouble麻煩 ahead."
95
294547
4808
他們表示,這個結果"原本有可能做為警惕"
05:15
Now these are stories故事 from basic基本 science科學.
96
299355
3213
以上只是基層科學方面的故事
05:18
These are stories故事 from 20, 30 years年份 ago.
97
302568
4787
而且距今也二、三十年了
05:23
The academic學術的 publishing出版 environment環境 is very different不同 now.
98
307355
3147
現今的學術出版業已截然不同
05:26
There are academic學術的 journals期刊 like "Trials試驗," the open打開 access訪問 journal日誌,
99
310502
3995
有一個叫Trials(實驗)的公開期刊
05:30
which哪一個 will publish發布 any trial審訊 conducted進行 in humans人類
100
314497
2655
收錄各種與人體有關的實驗結果
05:33
regardless而不管 of whether是否 it has a positive or a negative result結果.
101
317152
3303
結果是好是壞都會被收錄
05:36
But this problem問題 of negative results結果 that go missing失踪 in action行動
102
320455
3969
但失敗的實驗結果仍普遍遭到隱埋
05:40
is still very prevalent流行. In fact事實 it's so prevalent流行
103
324424
3559
事實上這種情況甚至影響到
05:43
that it cuts削減 to the core核心 of evidence-based循證 medicine醫學.
104
327983
5851
講究科學根據為重的藥物研發
05:49
So this is a drug藥物 called reboxetine瑞波西汀, and this is a drug藥物
105
333834
3015
這是一種叫rebozetine的藥
05:52
that I myself have prescribed規定. It's an antidepressant抗抑鬱劑.
106
336849
2535
我曾把這種藥物開做處方,對抗憂鬱症
05:55
And I'm a very nerdy書呆子 doctor醫生, so I read all of the studies學習
107
339384
2536
身為一個菜鳥醫生,我竭盡所能的查詢
05:57
that I could on this drug藥物. I read the one study研究 that was published發表
108
341920
3052
與此藥有關的研究,其中一篇表示
06:00
that showed顯示 that reboxetine瑞波西汀 was better than placebo安慰劑,
109
344972
2947
reboxetine比安慰劑(寬心丸)有效
06:03
and I read the other three studies學習 that were published發表
110
347919
1864
又有三篇表示
06:05
that showed顯示 that reboxetine瑞波西汀 was just as good as any other antidepressant抗抑鬱劑,
111
349783
3571
reboxetine和其他的抗憂鬱藥效果相當
06:09
and because this patient患者 hadn't有沒有 doneDONE well on those other antidepressants抗抑鬱藥,
112
353354
2187
由於其他藥對我的病人幫助不大
06:11
I thought, well, reboxetine瑞波西汀 is just as good. It's one to try.
113
355541
2466
我就嘗試使用藥效類似的reboxetine
06:13
But it turned轉身 out that I was misled誤導. In fact事實,
114
358007
3392
結果我被誤導了,事實上
06:17
seven trials試驗 were conducted進行 comparing比較 reboxetine瑞波西汀
115
361399
2449
在七項比較reboxetine與安慰劑的實驗中
06:19
against反對 a dummy placebo安慰劑 sugar pill. One of them
116
363848
2712
在七項比較reboxetine與安慰劑的實驗中
06:22
was positive and that was published發表, but six of them
117
366560
2312
只有一個的結果是正面的
06:24
were negative and they were left unpublished未公佈.
118
368872
4048
其他六項負面的結果都沒被公布
06:28
Three trials試驗 were published發表 comparing比較 reboxetine瑞波西汀
119
372920
1739
有三項顯示reboxetine
06:30
against反對 other antidepressants抗抑鬱藥 in which哪一個 reboxetine瑞波西汀
120
374659
2226
與其他抗憂鬱劑效果相當的實驗結果被公布
06:32
was just as good, and they were published發表,
121
376885
1793
與其他抗憂鬱劑效果相當的實驗結果被公布
06:34
but three times as many許多 patients'耐心' worth價值 of data數據 was collected
122
378678
4389
但有三倍的病例顯示reboxetine的效果
06:38
which哪一個 showed顯示 that reboxetine瑞波西汀 was worse更差 than
123
383067
1871
不如其他治療方式
06:40
those other treatments治療, and those trials試驗 were not published發表.
124
384938
4701
這些結果也並未被公布
06:45
I felt misled誤導.
125
389639
3759
我覺得被誤導了
06:49
Now you might威力 say, well, that's an extremely非常 unusual異常 example,
126
393398
2130
你或許認為這只是少數極端的例子
06:51
and I wouldn't不會 want to be guilty有罪 of the same相同 kind of
127
395528
2008
我也不想斷章取義,只挑有利的資料
06:53
cherry-picking採摘櫻桃 and selective可選擇的 referencing引用
128
397536
2981
我也不想斷章取義,只挑有利的資料
06:56
that I'm accusing指責 other people of.
129
400517
1791
藉此指控他人
06:58
But it turns out that this phenomenon現象 of publication出版物 bias偏壓
130
402308
1884
但後來發現其實有很多人
07:00
has actually其實 been very, very well studied研究.
131
404192
2127
研究這種偏頗的出版取向
07:02
So here is one example of how you approach途徑 it.
132
406319
2218
我舉個例子解釋
07:04
The classic經典 model模型 is, you get a bunch of studies學習 where
133
408537
2440
最常見的方式即是蒐集大量
07:06
you know that they've他們已經 been conducted進行 and completed完成,
134
410977
2185
完整的實驗結果
07:09
and then you go and see if they've他們已經 been published發表 anywhere隨地
135
413162
2321
然後查明他們是否出現在學術文章中
07:11
in the academic學術的 literature文學. So this took all of the trials試驗
136
415483
2863
現在這裡是十五年來所有
07:14
that had ever been conducted進行 on antidepressants抗抑鬱藥
137
418346
2154
與抗憂鬱劑有關的實驗
07:16
that were approved批准 over a 15-year-年 period by the FDAFDA.
138
420500
3642
全都經過FDA認可
07:20
They took all of the trials試驗 which哪一個 were submitted提交 to the FDAFDA as part部分 of the approval贊同 package.
139
424142
3756
他們把所有FDA有列入的試驗劃為一組
07:23
So that's not all of the trials試驗 that were ever conducted進行 on these drugs毒品,
140
427898
3200
所以並不是每個試驗都有列入
07:26
because we can never know if we have those,
141
431098
2098
因為我們無從得知他人的實驗計畫
07:29
but it is the ones那些 that were conducted進行 in order訂購 to get the marketing營銷 authorization授權.
142
433196
3494
但所選的實驗結果是為了上市而檢驗
07:32
And then they went to see if these trials試驗 had been published發表
143
436690
2349
接著我們得看看這些結果是否有公布
07:34
in the peer-reviewed同行評審 academic學術的 literature文學. And this is what they found發現.
144
439039
2572
在同儕審查的學術文章中,這是我們發現的
07:37
It was pretty漂亮 much a 50-50 split分裂. Half of these trials試驗
145
441611
3169
一半的結果顯示有效,一半顯示無效
07:40
were positive, half of them were negative, in reality現實.
146
444780
3597
兩者其實差距不大
07:44
But when they went to look for these trials試驗 in the peer-reviewed同行評審 academic學術的 literature文學,
147
448377
4741
但我們在同儕審查的期刊中找到的試驗結果
07:49
what they found發現 was a very different不同 picture圖片.
148
453118
2234
卻是相當不同
07:51
Only three of the negative trials試驗 were published發表,
149
455352
4372
只有三個負面結果被公布
07:55
but all but one of the positive trials試驗 were published發表.
150
459724
4642
正面結果中只有一個沒被公布
08:00
Now if we just flick拂去 back and forth向前 between之間 those two,
151
464366
3761
如果我們快速切換兩者
08:04
you can see what a staggering踉蹌 difference區別 there was
152
468127
2594
你會發現事實與醫生、病患、
08:06
between之間 reality現實 and what doctors醫生, patients耐心,
153
470721
3450
醫療行政人員透過同儕審查的期刊
08:10
commissioners委員 of health健康 services服務, and academics學者
154
474171
2622
所得知的資訊有著天壤之別
08:12
were able能夠 to see in the peer-reviewed同行評審 academic學術的 literature文學.
155
476793
3281
所得知的資訊有著天壤之別
08:15
We were misled誤導, and this is a systematic系統的 flaw缺陷
156
480074
4454
我們都被誤導了,在醫藥界中
08:20
in the core核心 of medicine醫學.
157
484528
3330
這是一個深入核心的體制問題
08:23
In fact事實, there have been so many許多 studies學習 conducted進行 on
158
487858
2663
事實上現在有很多研究
08:26
publication出版物 bias偏壓 now, over a hundred, that they've他們已經 been
159
490521
3384
旨在研究這種出版偏向
08:29
collected in a systematic系統的 review評論, published發表 in 2010,
160
493905
3194
在2010年公布的一項系統性調查中
08:32
that took every一切 single study研究 on publication出版物 bias偏壓
161
497099
2766
每一個研究出版取向的研究
08:35
that they could find.
162
499865
1299
加起來總共超過一百多項
08:37
Publication出版物 bias偏壓 affects影響 every一切 field領域 of medicine醫學.
163
501164
2852
整個醫療界會徹底的受影響
08:39
About half of all trials試驗, on average平均, go missing失踪 in action行動,
164
504016
4313
平均多達一半的試驗都從而消失了
08:44
and we know that positive findings發現 are around twice兩次 as likely容易
165
508329
3058
正面試驗結果被公布的機率
08:47
to be published發表 as negative findings發現.
166
511387
3054
比負面結果高了近兩倍
08:50
This is a cancer癌症 at the core核心 of evidence-based循證 medicine醫學.
167
514441
4061
在講究根據為重的醫藥界裡是一個弊端
08:54
If I flipped翻轉 a coin硬幣 100 times but then
168
518502
3871
如果我把一個硬幣拋擲一百次
08:58
withheld扣留 the results結果 from you from half of those tosses,
169
522373
3259
但只告訴你一半的結果
09:01
I could make it look as if I had a coin硬幣 that always came來了 up heads.
170
525632
3400
我就能讓你以為每次投擲都是正面
09:04
But that wouldn't不會 mean that I had a two-headed雙頭 coin硬幣.
171
529032
1806
但並不表是硬幣的兩面都是正面
09:06
That would mean that I was a chancerchancer
172
530853
1712
這只表示我是個投機者
09:08
and you were an idiot白痴 for letting出租 me get away with it. (Laughter笑聲)
173
532565
3114
而你是個白癡,因為你讓我得過且過(笑聲)
09:11
But this is exactly究竟 what we blindly盲目地 tolerate容忍
174
535679
3637
但在已根據為重的醫藥界裡
09:15
in the whole整個 of evidence-based循證 medicine醫學.
175
539316
3789
我們卻盲目縱容
09:19
And to me, this is research研究 misconduct處理不當.
176
543105
4432
對我來說,這是研究上的誤導缺失
09:23
If I conducted進行 one study研究 and I withheld扣留
177
547537
2743
如果我進行了一個研究
09:26
half of the data數據 points from that one study研究,
178
550280
3000
並保留一半的研究結果不公布
09:29
you would rightly正當地 accuse me, essentially實質上, of research研究 fraud舞弊.
179
553280
4707
你會義正嚴詞地指控我研究詐欺
09:33
And yet然而, for some reason原因, if somebody conducts行為
180
557987
2783
但出於某種原因,如果有人做了十項研究
09:36
10 studies學習 but only publishes發布 the five that give the result結果 that they want,
181
560770
4558
卻只公布五個他們想看的結果
09:41
we don't consider考慮 that to be research研究 misconduct處理不當.
182
565328
2788
我們也不會認為那是誤導研究
09:44
And when that responsibility責任 is diffused擴散的 between之間
183
568116
2567
而當責任遍及整體研究員、學術界、
09:46
a whole整個 network網絡 of researchers研究人員, academics學者,
184
570683
3161
贊助人、已及期刊編輯時,基於某些原因
09:49
industry行業 sponsors贊助商, journal日誌 editors編者, for some reason原因
185
573844
3528
贊助人已及期刊編輯時,基於某些原因
09:53
we find it more acceptable接受,
186
577372
1453
我們會認為一切相當合理
09:54
but the effect影響 on patients耐心 is damning確鑿.
187
578825
3675
但病人卻得承擔這些嚴重的後果
09:58
And this is happening事件 right now, today今天.
188
582500
5018
這些事情正在發生
10:03
This is a drug藥物 called Tamiflu達菲. Tamiflu達菲 is a drug藥物
189
587518
2711
這是一種叫Tamiflu的藥
10:06
which哪一個 governments政府 around the world世界 have spent花費 billions數十億
190
590229
2596
世界各地的政府花了好幾十億資金
10:08
and billions數十億 of dollars美元 on stockpiling堆存,
191
592825
2572
貯藏這個藥物
10:11
and we've我們已經 stockpiled儲備 Tamiflu達菲 in panic恐慌,
192
595397
3148
我們慌忙貯藏此藥的原因乃因
10:14
in the belief信仰 that it will reduce減少 the rate of complications並發症 of influenza流感.
193
598545
3949
此藥被認為能夠減少流感的併發症
10:18
Complications並發症 is a medical euphemism婉辭 for pneumonia肺炎
194
602494
2684
併發症說穿了就是肺炎
10:21
and death死亡. (Laughter笑聲)
195
605178
4814
和死路一條(笑聲)
10:25
Now when the Cochrane科克倫 systematic系統的 reviewers評審
196
609992
3208
現在Cochrane的系統審查員正試圖
10:29
were trying to collect蒐集 together一起 all of the data數據 from all
197
613200
2525
蒐集所有測試Tamiflu用途的實驗
10:31
of the trials試驗 that had ever been conducted進行 on whether是否 Tamiflu達菲 actually其實 did this or not,
198
615725
3648
蒐集所有測試Tamiflu用途的實驗
10:35
they found發現 that several一些 of those trials試驗 were unpublished未公佈.
199
619373
2951
他們發現有幾個試驗並未公布
10:38
The results結果 were unavailable不可用 to them.
200
622324
1842
試驗結果也無從取得
10:40
And when they started開始 obtaining獲得 the writeupswriteups of those trials試驗 through通過 various各個 different不同 means手段,
201
624166
3964
當他們透過不同管道,透過資訊透明法案
10:44
through通過 Freedom自由 of Information信息 Act法案 requests要求, through通過
202
628130
1682
並騷擾各個不同單位後
10:45
harassing騷擾 various各個 different不同 organizations組織, what they found發現 was inconsistent不符.
203
629812
4809
他們發現結果互相矛盾
10:50
And when they tried試著 to get a hold保持 of the clinical臨床 study研究 reports報告,
204
634621
2466
在他們試圖取得長達一萬多頁
10:52
the 10,000-page-頁 long documents文件 that have
205
637087
3046
並付有清晰完整的臨床研究報告時
10:56
the best最好 possible可能 rendition翻譯 of the information信息,
206
640133
3600
並付有清晰完整的臨床研究報告時
10:59
they were told they weren't allowed允許 to have them.
207
643733
2888
卻無法取得
11:02
And if you want to read the full充分 correspondence對應
208
646621
2683
若你想查看藥廠完整的
11:05
and the excuses藉口 and the explanations說明 given特定 by the drug藥物 company公司,
209
649304
3290
信件內容、藉口、和解釋的話
11:08
you can see that written書面 up in this week's本週 edition
210
652594
2717
可以去翻翻這星期的PLOS Medicine期刊
11:11
of PLOSPLOS Medicine醫學.
211
655311
4367
可以去翻翻這星期的PLOS Medicine期刊
11:15
And the most staggering踉蹌 thing of all of this, to me,
212
659678
3859
整件事中最令我無法置信的是
11:19
is that not only is this a problem問題, not only do we recognize認識
213
663537
3299
這不只是一個單純的問題,我們雖然知道
11:22
that this is a problem問題, but we've我們已經 had to suffer遭受 fake fixes修復.
214
666836
4195
這是個問題,卻還得裝作問題已解決
11:26
We've我們已經 had people pretend假裝 that this is a problem問題 that's been fixed固定.
215
671031
3058
我們逼人們假裝這個問題已解決
11:29
First of all, we had trials試驗 registers寄存器, and everybody每個人 said,
216
674089
2188
首先我們讓各方註冊試驗結果
11:32
oh, it's okay. We'll get everyone大家 to register寄存器 their trials試驗, they'll他們會 post崗位 the protocol協議,
217
676277
3603
各方會先提出實驗草案
11:35
they'll他們會 say what they're going to do before they do it,
218
679880
2024
事先告知實驗內容
11:37
and then afterwards之後 we'll be able能夠 to check and see if all the trials試驗 which哪一個
219
681904
2121
之後我們就能查明
11:39
have been conducted進行 and completed完成 have been published發表.
220
684025
2468
是否所有完整的實驗結果都有透明化
11:42
But people didn't bother to use those registers寄存器.
221
686493
2196
但人們並沒有乖乖來註冊
11:44
And so then the International國際 Committee委員會 of Medical Journal日誌 Editors編者 came來了 along沿,
222
688689
2619
國際醫療期刊委員會就上前
11:47
and they said, oh, well, we will hold保持 the line.
223
691308
1543
表示他們會守住防線
11:48
We won't慣於 publish發布 any journals期刊, we won't慣於 publish發布 any trials試驗,
224
692851
2633
並不會公布任何未經註冊的實驗結果
11:51
unless除非 they've他們已經 been registered註冊 before they began開始.
225
695484
2682
並不會公布任何未經註冊的實驗結果
11:54
But they didn't hold保持 the line. In 2008, a study研究 was conducted進行
226
698166
3531
但他們並未履行責任,2008年一項研究發現
11:57
which哪一個 showed顯示 that half of all of trials試驗 published發表 by journals期刊
227
701697
3015
國際醫療委員會編審的期刊中
12:00
edited編輯 by members會員 of the ICMJEICMJE
228
704712
2667
一半以上的實驗結果
12:03
weren't properly正確 registered註冊, and a quarter25美分硬幣 of them weren't registered註冊 at all.
229
707379
4813
並未正式註冊,有四分之一甚至未經註冊
12:08
And then finally最後, the FDAFDA Amendment修訂 Act法案 was passed通過
230
712192
2801
直到最後,幾年前FDA修正案終於通過
12:10
a couple一對 of years年份 ago saying that everybody每個人 who conducts行為
231
714993
2349
並規定所有實驗的結果
12:13
a trial審訊 must必須 post崗位 the results結果 of that trial審訊 within one year.
232
717342
3443
必須在實驗結束一年內公布
12:16
And in the BMJBMJ, in the first edition of January一月, 2012,
233
720785
4096
而2012年BMJ中,一月的第一期版本中
12:20
you can see a study研究 which哪一個 looks容貌 to see if people kept不停
234
724881
2704
有項研究,研究人們是否依然遵循規定
12:23
to that ruling裁決, and it turns out that only one in five
235
727585
3719
結果顯示五人中只有人有做到
12:27
have doneDONE so.
236
731304
2864
結果顯示五人中只有一人有做到
12:30
This is a disaster災害.
237
734168
3283
這是個災難
12:33
We cannot不能 know the true真正 effects效果 of the medicines藥品
238
737451
3564
若我們無法取得所有資訊
12:36
that we prescribe規定 if we do not have access訪問
239
741015
3216
就無從得知處方藥物的實效
12:40
to all of the information信息.
240
744231
3180
就無從得知處方藥物的實效
12:43
And this is not a difficult problem問題 to fix固定.
241
747411
3959
而這並不難解決
12:47
We need to force people to publish發布 all trials試驗
242
751370
5128
我們必須強迫人們公布
12:52
conducted進行 in humans人類, including包含 the older舊的 trials試驗,
243
756498
2971
所有人體實驗,包括舊有的試驗
12:55
because the FDAFDA Amendment修訂 Act法案 only asks that you publish發布 the trials試驗 conducted進行 after 2008,
244
759469
3945
因為FDA修正案指要求公布2008之後的試驗
12:59
and I don't know what world世界 it is in which哪一個 we're only
245
763414
2613
我搞不懂為何我們只能
13:01
practicing medicine醫學 on the basis基礎 of trials試驗 that completed完成 in the past過去 two years年份.
246
766027
4456
根據兩年內的研究資料進行醫療
13:06
We need to publish發布 all trials試驗 in humans人類,
247
770483
2105
所有與人體有關的實驗都得公布
13:08
including包含 the older舊的 trials試驗, for all drugs毒品 in current當前 use,
248
772588
3074
先前的實驗和現用的藥物也是
13:11
and you need to tell everyone大家 you know
249
775662
2916
你必須告訴所有認識的人
13:14
that this is a problem問題 and that it has not been fixed固定.
250
778578
3442
這是一個尚未解決的問題
13:17
Thank you very much. (Applause掌聲)
251
782020
2951
謝謝! (掌聲)
13:20
(Applause掌聲)
252
784971
3273
(掌聲)
Translated by Vivian Mig
Reviewed by Geoff Chen

▲Back to top

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