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