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.
Torej, sem zdravnik, ampak nekako sem pristal v raziskovanju in sedaj sem epidemiolog. Nihče zares ne ve, kaj je epidemiologija. Epidemiologija je veda o tem, kako v resničnem svetu vemo, ali je za nas nekaj dobro ali slabo. In najlažje jo je razumeti skozi primere znanosti norih prismojenih časopisnih naslovov. In to je samo nekaj primerov.
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.
Tile so iz Daily Maila. Vsaka država na svetu ima takšne časopise. Ima ta bizarni, neprenehni filozofski projekt delitve vseh neživih stvari na svetu na tiste, ki povzročajo, in take, ki preprečujejo raka. Tule je nekaj stvari, ki naj bi po njihovih nedavnih trditvah povzročale raka: ločitev, brezžični internet, kozmetika in kava. Tule pa je nekaj stvari, za katere pravijo, da preprečujejo raka: skorja, rdeča paprika, sladki koren in kava. Tu že lahko vidite, da obstajajo protislovja. Kava povzroča in preprečuje raka. In ko berete naprej, boste videli, da čez del tega morda visi nekakšna politična prevleka. Pri ženskah gospodinjsko delo preprečuje raka na dojki, moškega pa bi nakupovanje lahko naredilo impotentnega. Vemo torej, da moramo začeti
(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.
odkrivati znanost za vsem tem. In kar bi rad pokazal, je, da razkrivanje premetenih trditev, razkrivanje dokazov za takimi trditvami, ni nekakšno umazano dlakocepstvo; socialno koristno je, je pa tudi izjemno pomembno orodje za razlago. Kajti pri pravi znanosti gre za kritično ocenjevanje dokazov za stališča nekoga drugega. To se dogaja v akademskih revijah. To se dogaja na akademskih konferencah. Seja z vprašanji in odgovori po predstavitvi poteka operacije je pogosto pravi pokol. In to nikogar ne moti. To je dobrodošlo. Podobno je privolitvi v intelektualni sadomazohizem.
(Laughter)
Kar vam bom pokazal,
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.
so bistvene stvari, bistveni elementi moje discipline -- medicine, utemeljene na dokazih. Povedal vam bom o njih in pokazal, kako delujejo, izključno skozi primere tega, kako ljudje napačno razumejo stvari.
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.
Začnimo z najšibkejšo obliko dokaza, kar jih pozna človeštvo, to je avtoriteta. V znanosti nas ne zanima, koliko črk imate za svojim imenom. V znanosti hočemo vedeti, kateri so vaši razlogi za verjetje v določeno stvar. Kako veste, da je nekaj za nas dobro ali slabo? Ampak avtoriteta nas pusti hladne tudi zato, ker si jo je tako enostavno izmisliti. Obstaja nekdo po imenu dr. Gillian McKeith, PhD, ali, z njenim polnim medicinskim nazivom, Gillian McKeith.
(Laughter)
(Smeh)
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.
Ponavljam, v vsaki državi obstajajo taki ljudje. Ona je naša gurujka TV diet. Ima pet ogromnih serij v osrednjem televizijskem terminu, kjer daje pretirane in eksotične nasvete za zdravje. Izkazalo se je, da ima doktorat na podlagi neakreditiranega tečaja na daljavo nekje iz Amerike. Hvali se tudi s tem, da je certificirana profesionalna članica Ameriške zveze svetovalcev za prehrano, kar se sliši zelo glamurozno in vznemirljivo. Dajo vam certifikat in vse to. Tale pripada moji mrtvi mački Hetti. Grozna mačka je bila. Enostavno greste na njihovo spletno stran, izpolnite obrazec, plačate 60 dolarjev in dobite ga po pošti. To seveda ni edini razlog, zakaj mislimo, da je ta oseba neumna. Tudi govori stvari, kot so: jesti morate veliko temnozelenih listov, saj vsebujejo veliko klorofila in to bo dodalo kisik v vašo kri. Toda vsak, kdor je v šoli imel biologijo, se bo spomnil, da klorofil in kloroplasti proizvajajo kisik samo na sončni svetlobi, v vašem prebavnem traktu pa je, potem ko ste pojedli špinačo, dokaj temno.
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.
Potrebujemo pravo znanost, prave dokaze. Torej, "rdeče vino pomaga preprečevati raka dojke." To je naslov iz Daily Telegrapha v Veliki Britaniji. "Kozarec rdečega vina na dan bi lahko preprečil raka dojke." Torej, greste prebrat tale članek in dobite pravi primerek znanosti. Gre za opis sprememb v encimu, ko kemikalijo, odvzeto iz lupine rdeče grozdne lagode, kanete na nekaj rakavih celic v posodici na klopci nekje v laboratoriju. To je res uporabno za opis v znanstvenem članku, a na vprašanje o vašem osebnem tveganju, da bi dobili raka na dojki, če pijete rdeče vino, vam ne pove popolnoma nič. Pravzaprav se izkaže, da se vaše tveganje za raka dojke rahlo poveča z vsako enoto alkohola, ki jo popijete. Torej, kar želimo, so študije s pravimi ljudmi.
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.
In tu je še en primer. Tale je last vodilne diete in britanskega strokovnjaka za prehrano iz Daily Mirrorja, ki je časopis z drugo najvišjo naklado pri nas. "Avstralska študija iz leta 2001 je ugotovila, da olivno olje v kombinaciji s sadjem, zelenjavo in stročnicami zagotavlja merljivo zaščito pred gubanjem kože." In potem svetujejo: "Če jeste olivno olje in zelenjavo, boste imeli manj gubic." In zelo prijazno vam povejo, kako pridete do članka. Najdete ga in ugotovite, da je šlo za študijo z opazovanjem. Očitno nikomur ni uspelo iti nazaj v leto 1930, dobiti vseh ljudi iz določene porodnišnice, polovica katerih bi jedla veliko sadja, zelenjave in olivnega olja, druga polovica pa hrano iz McDonaldsa in potem bi izmerili, koliko gubic bodo dobili čez leta.
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.
Gre za trenutno sliko, kakšni so ljudje sedaj. In seveda ugotovite tudi, da imajo ljudje, ki jedo zelenjavo in olivno olje, manj gubic. A to je zato, ker so ljudje, ki jedo sadje, zelenjavo in olivno olje, pošasti, niso normalni, taki so kot ste vi, prihajajo na dogodke, kakršen je tale.
(Laughter)
Elegantni so, bogati, manj verjetno je, da delajo zunaj,
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.
manj verjetno je, da opravljajo fizična dela, imajo boljšo socialno podporo in manj verjetno je, da kadijo -- torej zaradi kupa očarljivih, povezanih socialnih, političnih in kulturnih razlogov obstaja manjša verjetnost, da imajo gubice. To pa ne pomeni, da je tako zaradi zelenjave in olivnega olja. (Smeh)
(Laughter)
V idealnem primeru torej hočete napraviti testiranje.
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.
In vsi mislijo, da so dobro seznanjeni z idejo testiranja. Testi so zelo stari. Prvi je bil v Svetem pismu -- Danijel 1:12. Zelo neposreden je: vzamete skupino ljudi, jih razdelite na dva dela, eno skupino obravnavate na en način, drugo pa na drugega in malo kasneje jih preverite in ugotovite, kaj se je z njimi zgodilo. Povedal vam bom o testu, ki je verjetno eden tistih, o katerih so v britanskih novicah v zadnjem desetletju največ poročali. In to je test o tabletah ribjega olja. Trdili so, da tablete z ribjim oljem izboljšajo uspeh in obnašanje v šoli pri povprečnih otrocih. In rekli so: "Testirali smo jih. Vsi prejšnji testi so bili pozitivni in vemo, da bo tudi tale." Take stvari bi vedno morale sprožiti alarm. Kajti če vnaprej poznate rezultat svojega testa, potem testa ne bi smeli opravljati. Bodisi ste goljufali namenoma bodisi imate dovolj podatkov, zato vam ni treba več delati naključnih vzorcev ljudi. No, tole so želeli napraviti s svojim testom.
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?
Vzeli so 3.000 otrok, vsem so hoteli dati ogromne tablete z ribjim oljem, po šest na dan, in potem so nameravali leto dni kasneje izmeriti njihov uspeh pri izpitih ter ga primerjati s pričakovanim uspehom, ki bi ga otroci dosegli, če ne bi jemali tablet. Lahko kdo zazna zmoto v tem pristopu?
(Laughter)
In prosim, naj profesorji klinične metodologije testov
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.
ne odgovarjajo na to vprašanje. Torej, ni kontrole, ni kotrolne skupine. A to zveni precej tehnično. Gre za tehnični izraz. Otroci so dobili tablete in njihov uspeh se je izboljšal.
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.
Kaj drugega kot tablete bi lahko bilo razlog za to? Postali so starejši. Vsi se s časom razvijamo. In seveda obstaja placebo učinek. Placebo učinek je ena najbolj zanimivih stvari v vsej medicini. Ne gre samo za jemanje tablete, kar povzroči, da se vaše delovanje izboljša in bolečina zmanjša. Gre za verjetje in pričakovanja. Gre za kulturni pomen zdravljenja. In to so dokazale številne izjemne študije, ki so primerjale različne vrste placeba med seboj. Vemo, na primer, da sta dve tableti sladkorja na dan bolj učinkovito zdravilo za čir na želodcu kot ena tableta sladkorja. Dve tableti sladkorja premagata eno. To je nezaslišana in smešna stvar, a tako je. Iz treh različnih študij na treh vrstah bolečine vemo, da je injekcija slane vode bolj učinkovito zdravilo kot tableta sladkorja, tableta, v kateri ni zdravila -- ne zato, ker bi injekcija ali tableta imeli kak fizikalni vpliv na telo, ampak zato, ker je injekcija bolj dramatična intervencija. Vemo torej, da je z našimi verjetji in pričakovanji mogoče manipulirati, zato delamo teste, kjer kontroliramo s placebom -- kjer polovica ljudi dobi pravo zdravilo, druga polovica pa placebo.
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.
A to še ni dovolj. Pravkar smo vam pokazali primere enostavnih in jasnih načinov, kako novinarji in krošnjarji s tabletami kot prehranskimi dopolnili in mazači lahko izkrivijo dokaze v svoje namene. Zdi se mi res fascinantno, kako farmacevtska industrija uporablja popolnoma iste trike in pristope, le v malo bolj prefinjeni obliki, da bi izkrivila dokaze, ki jih dobijo zdravniki in pacienti, in katere uporabljamo za sprejemanje življenjsko pomembnih odločitev.
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.
Torej, prvič, testi s placebom: vsak misli, da bi test moral biti primerjava novega zdravila s placebom. A v resnici je to v veliko primerih narobe. Kajti pogosto že obstaja dosegljivo dobro zdravljenje, zato nočemo, da bi bilo alternativno novo zdravljenje boljše kot nič. Hočemo vedeti, da je boljše od najboljšega trenutno dostopnega zdravljenja. A vseeno, in vedno znova, stalno videvamo teste, ki se primerjajo s placebom. In licenco za trženje zdravila lahko dobite že s podatki, ki kažejo, da je boljše kot nič, kar je zame kot zdravnika, ki mora sprejeti odločitev, neuporabno.
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.
A to ni edini način, kako lahko potvorite podatke. To lahko storite tudi tako, da za stvar, s katero primerjate svoje novo zdravilo, vzamete nekaj res slabega. Konkurenčno zdravilo lahko date v prenizki dozi, tako da ljudje ne dobijo pravilne terapije. Konkurenčno zdravilo lahko date v previsoki dozi, tako da pride do stranskih učinkov. In prav to se je zgodilo z antipsihotikom za shizofrenijo. Pred dvajsetimi leti je na trg prišla nova generacija antipsihotikov in obljubljali so, da bodo imeli manj stranskih učinkov. Tako so se začeli testi tega novega zdravila v primerjavi s starim, a starega so dajali v absurdno visokih dozah -- 20 miligramov haloperidola na dan. In vnaprej je jasno, da če date zdravilo v visoki dozi, bo to imelo več stranskih učinkov in vaše novo zdravilo bo videti boljše.
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.
Pred desetimi leti se je zgodovina ponovila, kako zanimivo, ko je risperidonu, prvemu antipsihotiku nove generacije, potekla patentna zaščita in so ga vsi lahko kopirali. Vsi so hoteli pokazati, da je njihovo zdravilo boljše od risperidona, in priča smo bili kupu testov, ki so nove antipsihotike primerjali z osmimi miligrami risperidona na dan. Spet, ne gre za noro dozo, niti za ilegalno, a zelo na meji normalnega. Na ta način je bilo enostavno doseči, da vaše novo zdravilo izgleda boljše. In nič presenetljivega ni, da v celoti testi, ki jih plača industrija, štirikrat bolj verjetno dajo pozitivne rezultate kot neodvisno opravljeni testi.
But -- and it's a big but --
Ampak -- in gre za velik ampak --
(Laughter)
(Smeh)
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?
izkaže se, da ko pogledate metode, ki jih za teste uporablja industrija, so te pravzaprav boljše od neodvisnih testov. In vseeno uspejo priti do željenih rezultatov. Kako to deluje?
(Laughter)
Kako lahko pojasnimo ta nenavaden pojav?
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.
Izkaže se, da gre za to, da se negativni rezultati izgubijo, da niso na voljo zdravnikom in pacientom. In to je najpomembnejši vidik zgodbe. Je na vrhu piramide dokazov. Potrebujemo vse podatke o določenem zdravilu, da bi vedeli, ali je dejansko učinkovito. Obstajata dva načina za ugotavljanje, ali se je določen del podatkov "izgubil". Lahko uporabite statistiko ali pa zgodbe. Osebno imam raje statistiko, zato bom začel z njo.
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.
Tole je nekaj, čemur pravim zgodba v lijaku. Gre za pameten način odkrivanja, ali so majhni negativni testi izginili, so pogrešani v akciji. Tole je graf vseh testov, ki so bili narejeni na določenem zdravilu. In ko greste proti vrhu grafa, vidite, da je vsaka točka posamezen test. In ko greste navzgor, pridete do večjih testov in v njih je manj napak. Tako so manj verjetno naključno napačno pozitivni, naključno napačni negativni. Vsi pridejo skupaj v grozd. Večji testi so bližje pravemu odgovoru. Ko potem greste navzdol, lahko na tej strani vidite nepristne napačne negativne, na tej strani pa nepristne napačne pozitivne. Če obstaja pristranost pri objavi, če so se majhni negativni testi "izgubili", lahko to vidite na enem od teh grafov. Tule lahko vidite, da so majhni negativni testi, ki bi morali biti levo spodaj, izginili. Ta graf prikazuje prisotnost pristranske objave pri študijah o pristranski objavi. In mislim, da je to najbolj smešna šala o epidemiologiji, ki jo boste kdajkoli slišali.
(Laughter)
Tako torej lahko to dokažete s statistiko,
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.
kaj pa zgodbe? Gnusne so, prav zares. Tole je zdravilo reboksetin. Sam sem ga predpisoval pacientom. In sem zelo čudaški zdravnik. Upam, da se potrudim prebrati in razumeti vso literaturo. Prebral sem teste o tem. Vsi so bili pozitivni. Vsi so bili dobro opravljeni. Nisem našel napake. Na žalost se je izkazalo, da so veliko teh testov zamolčali. V resnici so 76 odstotkov vseh testov na tem zdravilu zamolčali pred zdravniki in pacienti. Razmislite, če stokrat vržete kovanec in vam za polovico metov lahko prikrijem rezultate, potem vas lahko prepričam, da imam kovanec z dvema glavama. Če odstranimo polovico podatkov, ne moremo vedeti, kakšen je pravi učinek teh zdravil.
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.
In to ni osamljen primer. Okoli polovico testnih podatkov za antidepresive so zamolčali, dogaja pa se še več. Nordic Cochrane Group je skušala dobiti podatke o tem in vse sestaviti v celoto. Cochrane Groups so mednarodna neprofitna zveza, ki izvaja sistematski pregled vseh podatkov, ki so bili kdaj objavljeni. In imeti morajo dostop do vseh testnih podatkov. Vendar so podjetja prikrivala te podatke in Evropska agencija za zdravila prav tako, in to tri leta dolgo. To je problem, za katerega trenutno ni rešitve.
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.
Da vam pokažem, kako velik je, tole je zdravilo tamiflu, za katerega so vlade po svetu zapravile milijarde in milijarde dolarjev. Ta denar so plačale zaradi obljube, da bo to zdravilo zmanjšalo pojavnost zapletov pri gripi. Imamo že podatke, ki kažejo, da zmanjša trajanje gripe za nekaj ur. A to mene ne zanima. Vlade to ne zanima. Zelo mi je žal, če imate gripo, vem da je grozna, ampak ne bomo plačali milijard dolarjev za to, da bi vaše simptome gripe zmanjšali za pol dneva. Ta zdravila predpisujemo, hranimo jih za nujne primere, saj razumemo, da bodo zmanjšala raven zapletov, kar pomeni pljučnico, kar pomeni smrt. Cochrane Group za infekcijske bolezni, ki ima sedež v Italiji, se trudi od farmacevtskih podjetij dobiti popolne podatke v uporabni obliki, da bi lahko sprejeli odločitev, ali je to zdravilo učinkovito ali ne, in doslej teh podatkov niso uspeli dobiti. To je brez dvoma največji etični problem današnje medicine. Ne moremo sprejemati odločitev, če nimamo celostnih informacij.
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.
Od tu je malo težko priti do nekakšnega pozitivnega zaključka. A rekel bi tole: mislim, da je sončna svetloba najboljše razkužilo. Vse te stvari se dogajajo vsem na očeh in vse so zaščitene s poljem počasnosti. Mislim, da je od vseh težav v znanosti ena najboljših stvari, kar jih lahko naredimo, ta, da dvignemo pokrov, povrtamo po mehaniki in pogledamo vanjo.
Thank you very much.
Hvala lepa.
(Applause)
(Aplavz)