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.
雖然我是醫生,但無心插柳做了點研究 所以現在我也是個流行病學家 沒有人真正知道流行病學是什麼 流行病學是一種科學,讓我們知道在生活中 什麼東西對你好,或對你不好 而有例可循最是簡單明瞭 好比誇張、奇怪的新聞標題就是一例 這裡有些例子
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.
它們來自《每日郵報》,全世界各國都有類似的報紙 這類報紙一直都有個古怪、看似有理的企畫 就是將世界上所有不會動的物件 都分別歸類成致癌物或防癌物。 這些是一部分最近據說會致癌的玩意兒 離婚、無線網路、衛生用品和咖啡 而這些則是據說能防癌的東西 麵包皮、紅椒、甘草和咖啡 我想你看到了矛盾的地方 咖啡同時致癌也防癌 當你開始讀下去,你會發現 這些報導說不定別有用心。 拿女性來說,做家事能預防乳癌 但對男性而言,購物會使他們性無能 所以,我們要開始
(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.
揭露這一切背後的科學真相 我想要做的 是揭穿那些騙人的說法 以及那些假象背後的證據, 這並非卑鄙、催毛求疵的事 這對社會有用, 同時,也是個極具價值的 解說工具。 因為真正的科學 是批判地評斷他人提出的證據 這就是在學術期刊, 以及學術研討論上,上演的戲碼。 有時在發言完後的問答時間 就像場血戰。 但沒人在乎,我們還熱烈歡迎。 就像是雙方同意,來場學術上的激烈性愛一樣。
(Laughter)
所以,接下來要讓各位看的
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.
是我的研究領域 也就是流行病學的主要特色- 循證醫學。 我會一步步的講解, 說明他們是如何運作的, 但不會拿出錯的事情做為例子。
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.
一開始,我們先談最不堪一擊的證據來源 就是權威。 在科學界,我們不在乎你名字後面有多少頭銜, 我們想知道,你發表某樣事物的背後有什麼理由。 你怎麼知道那對我們是好, 還是不好? 但,因為權威容易偽造, 所以我們對權威並不有什麼感覺。 這是麥基絲醫生博士 或者,給她一個完整的醫學頭銜,吉輪 ●麥基絲。
(Laughter)
(笑聲)
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.
每個國家都有像這個的一個人。 她是電視上的健康飲食大師, 她有多達五個黃金時段的系列節目 分享又豐富,又充滿異國風情的保健建議 結果,她的學歷只是在美國某一大學的 非公認的函授課程博士。 她也自豪地說她是美國營養顧問協會 的認證專業會員 聽起來是多麼吸引人又讓人興奮 你有張結業證書,就什麼都有了 這是我的貓,海地,她已經過世了,一隻很不乖的貓 你只要上網,填表格, 交六十塊給他們,然後證書就郵寄給你 但,這不是我們覺得這傢伙是笨蛋的唯一理由 她也會說些話像是 你該吃很多的深綠色蔬菜, 因為深綠色蔬菜有大量葉綠素,可讓血液充滿氧氣 但,任何在學校做過生物實驗的人都記得 葉綠素及葉綠粒 只透過光合作用來製造氧氣 而當你把菠菜吃掉時,身體裡其實是黑暗的
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.
接著,我們需要正確的科學、有理的證據來證實 「紅酒可預防乳癌。」 這是英國的《每日電訊》的頭條新聞 「一天一杯紅酒能幫助預防乳癌。」 接著你去找這則新聞,你會發現 這確實有科學佐證 這是描述某實驗室的工作臺上的培養皿, 把紅葡萄皮上所萃取的化學物質, 滴到一些癌細胞上, 酵素會產生變化 就科學報告而言, 這樣的實驗描述很有用, 但,一問到喝紅酒 和得到乳癌的風險為何, 這樣的實驗描述什麼屁都沒告訴你。 事實上,你得到乳癌的風險 會隨著你喝的含酒精飲料 一點一點的增加 因此,我們要看的,是拿真人做的研究
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.
這是另一個例子 來自英國的《每日鏡報》,一位頗具影響力的飲食營養學家 《每日鏡報》是英國銷售量第二的報紙 「2001年,澳洲當地的實驗發現 若把橄欖油與水果、蔬菜,或豆類植物搭配食用, 將對皮膚防皺有相當顯著效果。」 然後,他們就給妳這樣的建議: 「如果把橄欖油及蔬菜搭配著吃,你的皺紋會比較少。」 他們也很熱心地告訴你文獻出處 而在你看完報告後,你就會知道這是份觀測研究 很顯然地,沒人有辦法 回到1930年 把同個產科所有出生的小孩找來 其中一半給他們吃水果、蔬菜和橄欖油 另一半給他們吃麥當勞 之後,看他們的皺紋誰多誰少
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.
你得拍照記錄人們的樣子 當然,你會發現到 吃蔬菜和橄欖油的人,確實皺紋較少 但,這是因為那些吃水果、蔬菜,橄欖油的人是怪胎 他們不正常,就像你們一樣 他們會出席TED這樣的活動
(Laughter)
他們受歡迎、有錢、也不太可能做室外工作
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.
也不太從事勞力的工作 他們在社會上獲得較多的支持,他們不太抽菸- 因此,這麼多關於社會、政治,文化等等原因, 這些原因這麼棒,又如此環環相扣 而這些人,也就不太可能有皺紋 這並不意味著蔬菜還是橄欖油的功勞 (笑聲)
(Laughter)
所以,做實驗往往是最理想的選擇
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.
大家都認為,他們對於實驗都得很熟 實驗是個老話題。第一個是出現在聖經-但以理書,第一章十二節 這試驗很簡單,你找一群人,把他們分兩組 這兩組人,你都用不同的方法去對待他們 過了一下子之後 你就看會他們會發生什麼事 現在我要和你說的這個試驗 在過去十年的英國新聞媒體報導中 可以算是名聲相當不錯的試驗 這是個魚肝油的試驗 魚肝油宣稱,可以改善大部分小孩的學業表現 及學校行為 他們說:「我們做了個試驗 而之前的試驗結果都是好的,我想我們的也會是好的。」 會這樣說,就是個警訊 當你已經知道實驗的結果,那還做它幹什麼 無論這試驗只是隨意起草 或是你已有充分的數據,而你已不需要隨機挑選更多的試驗者 實驗就是這樣進行的
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?
他們找了三千位孩童 並給孩童吃很多的魚肝油 一天吃六顆 一年後,他們來測量孩童的學業表現 並把得來的結果和 這些孩童沒有吃魚肝油的預期結果 來兩相比較 有人現在看出這實驗設計的缺失了嗎?
(Laughter)
所有臨床試驗方法的教授
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.
都不準回答這問題 這實驗沒有對照組 聽起來像電子迷才會做的事 那是一個專業術語 孩童吃了魚肝油,他們的學業表現進步了
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.
除了魚肝油,還有什麼其它的原因嗎? 他們隨著時間長大了 當然,還有安慰劑的影響 安慰劑的效果是所有藥品中,最令人神往的一個 不是吃藥而已,然後你的表現變好,疼痛舒緩如此而已 是我們的信念,以及期望 這就是治療的文化定譯 許多很好的研究也和安慰劑的效果 做了對照實驗 舉例來說,一天吃兩顆糖的人 較不容易得到胃潰瘍 和吃一顆糖的人相比 一天吃兩顆糖比吃一顆糖更有用 儘管這個發現讓人覺得奇怪又好笑,但這是事實 從三種不同疼痛的研究當中,我們瞭解 注射生理食鹽水來治療疼痛,是個較有效的方法, 相較於吃糖果,安慰劑...等等沒有任何藥品成分的東西 而這並非是注射或吃藥對生體產生了什麼影響 而是人們覺得注射是種更強力的手段 我們曉得自己的信念,期待 是可被操控的 這也為什麼我們做實驗時 需要拿安慰劑來對照 一半的人接受真正的治療 另一半的人則使用安慰劑
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.
但,這樣是不夠的 目前為止,我給你們看的實驗例子的方法,都很簡單易懂 簡單到記者、食物供應商、糖果小販 以及自然療法醫生 都可以根據他們自己的目的,來曲解證據 令我相當驚訝的 是那些醫藥工業 他們使用相同的方法、設備 只不過把證據扭曲成較複雜的版本 而醫生及病人,都根據那些扭曲的證據 做出攸關性命的重要決定
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.
首先,大家都認為 一個和安慰劑對照的實驗,應該是 拿新藥品和安慰劑來相比較 但,在很多情況下,這樣的方法是錯的 因為,我們通常已經有了一個可行的良好療法 我們就不需要知道那可有可無的 替代療法 我們想知道的是,替代療法是否比現行的最佳療法更好 然而,你卻看到人們一再地 拿安慰劑來對照做實驗 只要你得到許可證,你的藥品就可以上市 藥品背後的數據,證明這種藥物可有可無 對一個像我這樣需要做決定的醫生來說是沒有任何用處的
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.
而這不是唯一可以扭曲數據的方法 你還可以把和新藥品要比較的物品 弄得像垃圾一樣 毫無價值 在使用競爭者的藥品時,你也可以只給予很少的劑量, 而人們自然沒有辦法治療好 或是你把劑量提高 這樣就會產生副作用 而這正是發生在治療人格分裂症的 抗精神病療程的事情 二十年前,從國外引進了一批新的抗精神病藥物 這些藥物都保證副作用比現有的藥物還少 所以人們就開始拿這些新的藥物和舊的藥物 做實驗比較 但,他們卻把舊的藥物劑量提高很多- 一天要吃20毫克的施寧錠(抗精神病藥物) 結論可想而知 要是你把一種藥物的劑量開這麼高 它的副作用當然比新的藥物還要多
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.
過去十年,歷史不斷重演。有趣的是 當那一批抗精神病藥品,像是理思必妥 產權到期時,人人都可以自己做這些藥物 大家想證明,他們自己做的藥比理思必妥還好 所以你會看到,有一堆的抗精神病藥物 拿來和一天八毫克的理思必妥做比較 八毫克不是多得很瘋狂,也沒有超出合法劑量 但幾乎游走在法律邊緣了 所以,你自己做的藥物當然比那些藥來的好 果不其然 藥商贊助的實驗 比那些獨立出資的實驗,得到陽性結果 機率高出四倍
But -- and it's a big but --
但是,但但但但是
(Laughter)
(笑聲)
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?
最後卻發現 那些藥商贊助實驗所使用的方法 確實是比獨立出資的實驗 要來的好 儘管如此,他們仍設法去得到他們想要的結果 怎麼做?
(Laughter)
這樣如此奇怪的現象該如何解釋?
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.
原來,那些負面的數據 在實驗進行中被隱匿起來。 醫生和病人都不知情 而這正是整件事情的重點所在 證據都在這裡 任一特定的療法,我們需要所有的資訊 來知道該療法是否有效 而有兩種不同的方法可以讓你知道 是否有數據在實驗中不見了 妳可以用統計數字,或是實例 我個人偏好統計數字,所以我先講這個
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.
這個圖表叫做漏斗圖 漏斗圖的設計非常聰明 要是有少量的負面結果不見的話,你會看得出來 這圖表上,就是針對某一種醫療法的 所有實驗 隨著你接近圖表的頂端 你看到的每一個點,都是一個實驗 越往上看,那些實驗規模越大,也就越少出錯 也就是越少隨便的假陽性效果、假的陰性效果 他們全聚在一塊 規模較大的實驗,都較接近事實 而你越往底部看 你就會看到捏造的假陰性結果 而另一邊,你也是看到捏造的假陽性結果 要是有發表篇倚(有統計同的結果更容易被發表) 或是少量的負面結果在過程中消失 你在這些圖表都會看到 所以,那些本該在左下角的負面結果 全都消失了 這圖表展示的,是關於發表篇倚的研究中 所出現的發表篇倚 我認為那是個流行病學的笑話,而且,我想這是你聽過的笑話中 最好笑的一個
(Laughter)
剛剛說的,就是說明該如何透過統記證明
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.
那麼實例呢? 實例就比較可惡了,真的很可惡。 這藥叫做瑞波西汀(抗憂鬱劑) 我過去曾開過這種藥給病人 而我是個蠻書呆子的醫生 我盡力去嘗試閱讀,並瞭解所有的文獻 我看了這些實驗,他們都是陽性的,也都進行得很好 我沒發現什麼缺失 不幸地是 許多實驗並沒有公布出來 事實上,有76%關於這項藥品的實驗 並沒有讓醫生 或是病人知道 現在,請你想一想 要是我擲一枚銅板一百次 而其中有一半的答案 我都不和你說 那麼,我就有辦法說服你 這枚銅板兩面都是人頭 若我們刪除一半的數據 那我們永遠都不曉得,這些藥品實際的效果為何
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.
而這類的實例都是息息相關的 大約有一半抗憂鬱藥物的實驗至今仍未公佈 甚至還超出一半 而科克倫小組,正致力於獲得那些數據 來整合所有的事情 科克倫小組是個國際性,非營利的合作機構 他們有系統地提供過去的數據回顧 而他們需要管道,來獲得所有的數據 但這些公司不讓他們知道那些數據 歐洲藥物管理局也是如此 已經達三年了 這個問題現在仍少個解決方法
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.
要讓你們知道問題的嚴重性。來看看克流感 世界上許多政府 花了數十億的金錢在克流感上 這些政府都承諾 克流感可以降低 流感併發症的比率 我們既有的數據顯示 克流感是降低流感的持續時間幾小時 但我不在乎這個,政府也不在乎 如果你得到流感,我很抱歉,我知道那很難受 但,我們絕不會花了幾十億 只是要去縮短流感症狀的持續時間而已 還只減少個半天左右 我們會開這些藥,也會貯存他們為了緊急狀況 因為我們瞭解,他們可以降低併發症可能性 併發症可能是肺炎,或是死亡 以義大利為根基的科克倫小組,正努力從藥品公司 想辦法獲得感染疾病的完整數據 而這些數據都是正確可用的 如此一來,科克倫小組才能決定 一個藥品有效與否 然而,他們卻無法獲得那樣的資訊 無庸置疑 照是現藥品面臨的 一個嚴重的道德問題 若沒有這些資訊 我們便沒有辦法下決定
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.
儘管,現在要下個有希望的結論 是有些困難 但,我會說 我認為,陽光 是最好的消毒劑 我們眼前看到所發生的事物 他們都被我們習以為常的陽光 給保護著 儘管現今科學界存在著這些問題 我認為,我們最好能做的一件事 就是掀開事物的表層 仔細探查,檢視一番
Thank you very much.
謝謝你們
(Applause)
(掌聲)