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BenGoldacre_2011G-_与坏科学做斗争_
So I'm a doctor, but I kind of slipped sideways into research, and now I'm an epidemiologist . 我是名医生,又另起炉灶做研究 如今我是名流行病学家
slipped:adj.打滑的;v.滑倒;滑落;脱落;(slip的过去分词和过去式) sideways:adv.往一侧;侧着;侧面朝前; epidemiologist:n.流行病学家;
And nobody really knows what epidemiology is. 没有人真正知道什么是流行病学
epidemiology:n.流行病学;传染病学;
Epidemiology is the science of how we know in the real world if something is good for you or bad for you. 流行病学是了解现实世界里 某种东西对我们是有益还是有害的科学
And it's best understood through example as the science of those crazy, wacky newspaper headlines. 了解它最好的方法就是例子了 特别是那些疯狂古怪的报纸头条
wacky:adj.乖僻的,古怪的;
And these are just some of the examples. 这里有几个例子
These are from the Daily Mail. Every country in the world has a newspaper like this. 首先来看每日邮报。每个国家都有像这样的报纸
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 . 它们的一项长期而古怪的哲学使命就是 把这世上所有的事物 分成致癌和防癌两类
bizarre:adj.奇异的(指态度,容貌,款式等); ongoing:n.发展; adj.持续存在的; philosophical:adj.哲学的(等于philosophic);冷静的; inanimate:adj.无生命的;无生气的; cancer:n.癌症;恶性肿瘤;
So here are some of the things they said cause cancer recently : divorce , Wi-Fi , toiletries and coffee. 这些是最近发布的致癌的东西: 离婚,无线网,梳妆用品还有咖啡
recently:adv.最近;新近; divorce:n.离婚;分离;v.与某人离婚;使分离; Wi-Fi:abbr.无线保真技术(wirelessfidelity);无线上网技术; toiletries:n.化妆品;化妆用具;旅行洗漱包;
Here are some of the things they say prevents cancer: crusts , red pepper , licorice and coffee. 这些是防癌的: 面包皮,红辣椒,甘草和咖啡
crusts:n.面包皮;糕饼(尤指馅饼)酥皮;硬表面;(crust的第三人称单数和复数) red pepper:红辣椒,辣椒; licorice:n.欧亚甘草;甘草汁;甘草糖(等于liquorice);
So already you can see there are contradictions . 你已经发现了自相矛盾之处
contradictions:n.不一致,矛盾,对立;反驳;驳斥;(contradiction的复数)
Coffee both causes and prevents cancer. 咖啡既致癌又防癌
And as you start to read on, you can see that maybe there's some kind of political valence behind some of this. 如果继续读下去 你会开始怀疑这类报道是否别有用心
valence:n.[化学]价;[化学]原子价;[化学]化合价;效价;
So for women, housework prevents breast cancer, but for men, shopping could make you impotent . “女人们,做家务能预防乳腺癌” “购物可能导致男人性无能”
impotent:adj.无力的;无效的;虚弱的;阳萎的;
So we know that we need to start unpicking the science behind this. 那么我们就要 揭开这些说法一看究竟
And what I hope to show is that unpicking dodgy claims , 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. 我要说明的观点是 揭穿骗人的说法 以及它们背后的证据 这不是卑鄙的吹毛求疵行为 这是对社会有用的 也是极有价值的 阐述工具
dodgy:adj.狡猾的,逃避的;善于骗人的;躲闪的; claims:v.宣称; n.声明; (claim的第三人称单数和复数) evidence:n.证据,证明;迹象;明显;v.证明; nasty:adj.极差的:令人厌恶的:不友好的:n.令人不愉快的事物: carping:adj.挑毛病的;吹毛求疵的(副词carpingly); extremely:adv.非常,极其;极端地; valuable:adj.有价值的;贵重的;可估价的;n.贵重物品; explanatory:adj.解释的;说明的;
Because real science is all about critically appraising the evidence for somebody else's position. 因为真正的科学 是批判性地评估他人提出的论据
critically:adv.精密地;危急地;批评性地;用钻研眼光地; appraising:v.估量;估价;(appraise的现在分词)
That's what happens in academic journals . 这是就学术期刊的评审方法
academic:adj.学术的;理论的;学院的;n.大学生,大学教师;学者; journals:n.学术期刊(journal的复数);日记;日记账;
That's what happens at academic conferences . 也是学术会议上的常事
conferences:n.会议(conference的复数形式);
The QA session after a post-op presents data is often a blood bath. 会场发言完毕后的提问环节 常常是场血战
session:n.会议;(法庭的)开庭;(议会等的)开会;学期;讲习会; post-op:n.变性人;手术后;
And nobody minds that. We actively welcome it. 没人会介意,我们反而十分欢迎
It's like a consenting intellectual SM activity. 就像是自愿的智力上的SM一样
consenting:adj.同意的;准许的;v.允许;赞成(consent的现在分词); intellectual:n.知识分子;脑力劳动者;adj.智力的;脑力的;理智的;有才智的;
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. 我将展示给你们的 东西是 我研究领域和核心内容和特色- 循证医学
discipline:n.纪律;训练;自制力;风纪;v.训练;管教;惩罚;处罚; evidence-based:adj.基于证据的;
And I will talk you through all of these and demonstrate how they work, exclusively using examples of people getting stuff wrong. 我将给各位讲解 并展示那些出了纰漏的例子 是如何欺骗大众的
demonstrate:vt.证明;展示;论证;vi.示威; exclusively:adv.唯一地;专有地;排外地; stuff:n.东西:物品:基本特征:v.填满:装满:标本:
So we'll start with the absolute weakest form of evidence known to man, and that is authority . 首先是最不堪一击的证据来源 权威人士
authority:n.权威;权力;当局;
In science, we don't care how many letters you have after your name. 在科学面前,你名字后面有多少头衔并不重要
In science, we want to know what your reasons are for believing something. 我们在乎的是你确信某事的原因是什么
How do you know that something is good for us or bad for us? 你是怎么知道什么对我们有益 什么又有害？
But we're also unimpressed by authority, because it's so easy to contrive . 不过我们早就对权威不感冒了 因为如今权威的身份太容易伪造
unimpressed:adj.无印记的(没有印象的);未受感动的; contrive:vt.设计;发明;图谋;vi.谋划;设法做到;
This is somebody called Dr. Gillian McKeith Ph.D, or, to give her full medical title, Gillian McKeith. 这是个叫Gillian McKeith的博士（医生？） 加上她的医学头衔嘛,也就是Gillian McKeith
(Laughter) （笑声）
Again, every country has somebody like this. 每个国家都有这样一个人
She is our TV diet guru . 她是电视饮食节目大师
guru:n.古鲁(指印度教等宗教的宗师或领袖);领袖;专家;
She has massive five series of prime-time television, giving out very lavish and exotic health advice. 上五个黄金档的系列节目 放出丰富又充满异域风情的保健意见
massive:adj.大量的;巨大的,厚重的;魁伟的; series:n.系列,连续;[电]串联;级数;丛书; prime-time:n.黄金时段; lavish:adj.浪费的;丰富的;大方的;vt.浪费;慷慨给予;滥用; exotic:adj.异国的;外来的;异国情调的;
She, it turns out, has a non-accredited correspondence course Ph.D. 结果发现她的学历是不知美国哪儿的
correspondence course:n.函授课程;
from somewhere in America. 一个不可信的函授博士
She also boasts that she's a certified professional member of the American Association of Nutritional Consultants , which sounds very glamorous and exciting. 她还吹牛说她是美国营养咨询师协会的 持证专业人员 这听起来大有来头
boasts:v.自夸;自吹自擂;(boast的第三人称单数) certified:adj.被证明了的; v.(尤指书面)证明,证实; (certify的过去式和过去分词) professional:adj.专业的;职业的;职业性的;n.专业人员;职业运动员; Association:n.协会;关联;联想;交往; Nutritional:adj.营养的;滋养的; Consultants:n.[经]顾问;咨询顾问;咨询公司;咨询人员(consultant的复数); glamorous:adj.迷人的,富有魅力的;
You get a certificate and everything. 一张证书就能解决一切
certificate:n.证明;证明书;合格证书;文凭;v.发给结业证书;(尤指)发给职业培训证书;
This one belongs to my dead cat Hetti. She was a horrible cat. 这是我死掉的猫Hetti的证。她可一点都不乖
horrible:可怕的,极讨厌的,
You just go to the website, fill out the form, give them $60, and it arrives in the post. 你只要到网站主页填张表 交60美元,证书就寄到你家去
Now that's not the only reason that we think this person is an idiot . 这不是我们认为她是个蠢货的唯一原因
idiot:n.笨蛋,傻瓜;白痴;
She also goes and says things like, you should eat lots of dark green leaves, because they contain lots of chlorophyll , and that will really oxygenate your blood. 她还说 你应该吃大量的暗绿色叶子 因为它们含有大量叶绿素,能给你的血液提供氧气
chlorophyll:n.[植][生化]叶绿素; oxygenate:vt.氧化,充氧;以氧处理;使…与氧化合;
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 . 只要学过生物学的人都知道 叶绿素和叶绿体 只通过光合作用产生氧气 如果你把菠菜吃下去,胃里肯定一片漆黑
biology:n.(一个地区全部的)生物;生物学; chloroplasts:n.[植]叶绿体(chloroplast的复数); sunlight:n.日光; bowels:n.内脏(尤指人的肠); v.取出…的肠子(bowel的第三人称单数); spinach:n.菠菜;
Next, we need proper science, proper evidence. 接下来,我们需要正确的科学,正当的证据
So, "Red wine can help prevent breast cancer." “红酒能防止乳腺癌”
This is a headline from the Daily Telegraph in the U.K. 这是英国每日电讯报的头条
Telegraph:n.[通信]电报机,电报;vt.电汇;流露出;打电报给…;vi.打电报;
'"A glass of red wine a day could help prevent breast cancer." “每天一杯红酒能防止乳腺癌”
So you go and find this paper, and what you find is it is a real piece of science. 你读了报纸 会觉得真是科学的
It is a description of the changes in 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. 其解释说,在一个什么实验室里 一个凳子上有个装着癌细胞的碟子 你把红葡萄皮的提取物滴在细胞上 就有个酶发生变化
description:n.说明;形容;描写(文字);类型; enzyme:n.[生化]酶; drip:n.滴落;滴落(的液体);水滴;v.(液体)滴下; chemical:n.化学制品,化学药品;adj.化学的; extracted:adj.萃取的;引出的;v.提取(extract的过去式及过去分词); laboratory:n.实验室,研究室;
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 . 在一个有科学性的报纸上 如此描述是很有用 但是至于你喝红酒患乳腺癌风险的事 它只字没提 它什么都没说
describe:v.描述;形容;把…称为;画出…图形; scientific:adj.科学的,系统的; personal:adj.个人的;身体的;亲自的;n.人事消息栏;人称代名词; absolutely:adv.绝对地;完全地; bugger all:n.什么也没有;屁都没有;
Actually, it turns out that your risk of breast cancer actually increases slightly with every amount of alcohol that you drink. 事实上,如果你每喝一次酒 患乳腺癌的机率 都会相应轻微地上升
slightly:adv.些微地,轻微地;纤细地; alcohol:n.酒精;乙醇;含酒精饮料;
So what we want is studies in real human people. 我们需要的是针对人进行的研究
And here's another example. 这是另一个例子
This is from Britain's leading diet and nutritionist in the Daily Mirror, which is our second biggest selling newspaper. 来自英国每日镜报的人气营养师 镜报是我们全国销售量第二的报纸
nutritionist:n.营养工作者;
'"An Australian study in 2001 found that olive oil in combination with fruits, vegetables and pulses offers measurable protection against skin wrinklings." “2001年澳大利亚一项研究 表明橄榄油与水果,蔬菜和豆子一起食用 对皮肤防皱有可观的效果”
olive oil:n.橄榄油(用于烹饪和凉拌色拉); combination:n.结合;组合;联合;[化学]化合; pulses:n.[电子]脉冲(pulse的复数); v.使跳动; measurable:adj.可测量的;重要的;重大的;
And then they give you advice: "If you eat olive oil and vegetables, you'll have fewer skin wrinkles ." 然后他们开出建议: “如果你使用橄榄油和蔬菜,你的皱纹就会减少”
wrinkles:n.皱纹;皱痕;v.起皱纹;皱起;(使)起皱褶;(wrinkle的第三人称单数和复数)
And they very helpfully tell you how to go and find the paper. 他们还给出文献出处
helpfully:adv.有益地;有用地;
So you go and find the paper, and what you find is an observational study. 如果你去找该论文,会发现它是个观察性研究
observational:adj.观测的;根据观察的;
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, and then half of them eat McDonald's, and then we see how many wrinkles you've got later. 显然没有人 能回到1930年 找到在同一个产科出生的所有人群样本 让一半人大量食用水果蔬菜和橄榄油 另一半吃麦当劳 然后看看他们长了多少皱纹
maternity:n.母性,母道;[妇产]妇产科医院;adj.产科的;产妇的,孕妇的;
You have to take a snapshot of how people are now. 你得存照纪录人们的样子
snapshot:n.快照,快相;急射,速射;简单印象;vt.给…拍快照;vi.拍快照;
And what you find is, of course, people who eat veg and olive oil have fewer skin wrinkles. 当然你发现 吃水果蔬菜和橄榄油的人皱纹少
But that's because people who eat fruit and veg and olive oil, they're freaks , they're not normal, they're like you; they come to events like this. 但那是因为吃水果蔬菜和橄榄油的人 他们是怪胎,不正常,和你一样; 他们来参加这样的活动
freaks:n.狂热爱好者; v.(使)强烈反应,震惊,畏惧; (freak的第三人称单数和复数)
They are posh , they're wealthy, they're less likely to have outdoor jobs, they're less likely to do manual labor, they have better social support, they're less likely to smoke -- so for a whole host of fascinating , interlocking social, political and cultural reasons, they are less likely to have skin wrinkles. 他们优雅,富有,不大可能从事户外工作 很少从事体力劳动 他们有更好的社会基础,不大抽烟－ 所以是因为整体关联的 社会政治文化的缘故 他们较不易产生皱纹
posh:adj.时髦的;漂亮的;奢侈的; outdoor:adj.户外的;露天的; manual:n.说明书;指南;使用手册;adj.用手的;手工的;体力的;手动的; fascinating:adj.极有吸引力的;迷人的;v.深深吸引;迷住;(fascinate的现在分词) interlocking:adj.连锁的;n.连锁;咬合作用; cultural:adj.与文化有关的;文化的;与艺术、文学、音乐等有关的;
That doesn't mean that it's the vegetables or the olive oil. 这不意味着是蔬菜或橄榄油的功劳
(Laughter) （笑声）
So ideally what you want to do is a trial. 做试验往往是最好的选择
ideally:adv.理想地;观念上地;
And everybody thinks they're very familiar with the idea of a trial. 每个人都觉得这是他们熟悉的话题
familiar:adj.熟悉的;常见的;亲近的;n.常客;密友;
Trials are very old. The first trial was in the Bible -- Daniel 1:12. 试验是老话题。第一个试验是圣经里－《但以理书》第一章第十二节
Bible:n.有权威的书;
It's very straightforward -- you take a bunch of people, you split them in half, you treat one group one way, you treat the other group the other way, and a little while later, you follow them up and see what happened to each of them. 非常简单－找一群人,分两组 用不同的方式分别对待两组人 之后你跟着他们 看他们都怎么样了
straightforward:adj.简单的;坦率的;明确的;径直的;adv.直截了当地;坦率地; a bunch of:一群;一束;一堆; split:v.分离;使分离;劈开;离开;分解;n.劈开;裂缝;adj.劈开的; treat:v.治疗;处理;招待;款待;n.款待;乐事;乐趣;
So I'm going to tell you about one trial, which is probably the most well-reported trial in the U.K. news media over the past decade. 我要给你讲的试验 也许是过去十年间英国媒体上 曝光率最高的试验
media:n.媒体;媒质(medium的复数);血管中层;浊塞音;中脉;
And this is the trial of fish oil pills . 这就是关于鱼肝油胶囊的试验
pills:n.药丸; v.起球; (pill的第三人称单数和复数)
And the claim was fish oil pills improve school performance and behavior in mainstream children. 这个说法是鱼肝油胶囊能提高大部分学生的在校表现 和行为习惯
improve:v.改进;改善; performance:n.性能;表现;业绩;表演; mainstream:n.主流;
And they said, "We've done a trial. 他们说“我们做过试验
All the previous trials were positive , and we know this one's gonna be too." 之前都显示正面结果,我们可以肯定这次也是”
previous:adj.以前的;早先的;过早的;adv.在先;在…以前; positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片;
That should always ring alarm bells. 这是个警示
Because if you already know the answer to your trial, you shouldn't be doing one. 如果你已经知道一个试验的结果,那还进行干什么
Either you've rigged it by design, or you've got enough data so there's no need to randomize people anymore. 或者说如果实验设计就存在人为操纵性 或者你已经有足够的数据那就没有必要再随机挑选更多的人了
rigged:v.操纵,控制;(给船只)装帆;(秘密地)安装,装配;(rig的过去分词和过去式) randomize:vt.使随机化;(使)作任意排列或不规则分布;
So this is what they were going to do in their trial. 试验是这样进行的:
They were taking 3,000 children, they were going to give them all these huge fish oil pills, six of them a day, and then a year later, they were going to measure their school exam performance and compare their school exam performance 他们找了三千名儿童 给他们大个儿的鱼肝油药片 每天6个 一年以后,他们去测量他们的在校测试表现 并把在校测试表现和
compare:v.比较;对比;n.比较;
against what they predicted their exam performance would have been if they hadn't had the pills. 在没有摄入鱼肝油的情况下他们预期的测试表现 进行对比
predicted:v.预言;预告;预报;(predict的过去分词和过去式)
Now can anybody spot a flaw in this design? 你看出了设计缺陷吗？
flaw:n.瑕疵,缺点; v.使生裂缝,使有裂纹; vi.生裂缝;
And no professors of clinical trial methodology are allowed to answer this question. 临床医学试验方法论的教授 不允许回答这个问题
clinical:adj.临床的;诊所的; methodology:n.方法学,方法论;
So there's no control; there's no control group. 是的,没有对照组！
But that sounds really techie . 这听上去挺技术范儿
techie:n.高科技专家;热衷电子学的电子迷;技师;
That's a technical term. 这是个术语
technical:adj.工艺的,科技的;技术上的;专门的;
The kids got the pills, and then their performance improved . 食用了药片的孩子表现提高了
improved:adj.改良的:v.改进:改善(improve的过去分词和过去式)
What else could it possibly be if it wasn't the pills? 不然还能怎样呢？
They got older. We all develop over time. 他们长大了,我们都会随着时间不断发展
And of course, also there's the placebo effect. 当然,这里还有安慰效应在起作用
placebo:n.安慰剂;为死者所诵的晚祷词;
The placebo effect is one of the most fascinating things in the whole of medicine. 安慰效应是医学上最不可思议的玩意之一
It's not just about taking a pill, and your performance and your pain getting better. 不仅仅是吃一个药片,你的表现提升,痛苦缓解这么简单
It's about our beliefs and expectations . 而是关乎我们的信念和期待
expectations:n.预料;预期;期待;希望;指望;(expectation的复数)
It's about the cultural meaning of a treatment . 这就是治疗的文化意义
treatment:n.治疗;疗法;对待;处理;讨论;
And this has been demonstrated in a whole raft of fascinating studies comparing one kind of placebo against another. 大量研究已经通过不同的安慰剂对照试验 展示了这种效应
demonstrated:v.证明;证实;论证;说明;表达;(demonstrate的过去分词和过去式) raft:n.筏;救生艇;(美)大量;vt.筏运;制成筏;vi.乘筏; comparing:v.比较;对比;(compare的现在分词)
So we know, for example, that two sugar pills a day are a more effective treatment for getting rid of gastric ulcers than one sugar pill. 我们知道,比如说,每天2个糖丸 比一个糖丸在治疗胃溃疡上 更有效
effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象; gastric:adj.胃的;胃部的; ulcers:n.[病理]溃疡,疡(ulcer的复数);
Two sugar pills a day beats one sugar pill a day. 每天2个糖丸胜过每天1个糖丸
And that's an outrageous and ridiculous finding, but it's true. 这是个令人吃惊的荒唐发现,但这是真的
outrageous:adj.粗暴的;可恶的;令人吃惊的; ridiculous:adj.可笑的;荒谬的;
We know from three different studies on three different types of pain that a saltwater injection is a more effective treatment for pain than taking a sugar pill, taking a dummy pill that has no medicine in it -- 针对3种不同的痛症的3个研究显示 盐水注射比食用糖丸对痛症更有效 糖丸里头根本没有药－
saltwater:adj.盐水的;海产的; injection:n.注射;大量资金的投入;(液体的)注入; dummy:adj.虚拟的;假的;n.傀儡;哑巴;仿制品;
not because the injection or the pills do anything physically to the body, but because an injection feels like a much more dramatic intervention . 并不是说注射或者药丸对身体有任何物理影响 而是因为感觉上注射是一种更强力的手段
dramatic:adj.突然的;巨大的;令人吃惊的;激动人心的; intervention:n.介入;调停;妨碍;
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. 我们知道我们的信念和期待 是可被操纵的 这就是为什么试验上 需要安慰剂对照组－ 这样一半人接受真正的治疗 一半人得到安慰剂
manipulated:v.(暗中)控制,操纵,影响;使用;治疗脱臼;(manipulate的过去式和过去分词) other half:n.另一半(指配偶或男友,女友);
But that's not enough. 但这并不够
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. 我刚刚展示的是非常简单直观的例子 记者、保健食品商贩 和理疗家 都能为各自的目的歪曲证据
journalists:n.新闻记者(journalist的复数); supplement:v.补充;增补;n.补遗;增补(物);补充(物);添加物; peddlers:n.小贩(peddler的复数); naturopaths:n.理疗家;自然疗者; distort:v.使变形;扭曲;使失真;歪曲;
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, 真正令人惊讶的是 制药产业 用一样的手段和方式 只不过更加隐秘精巧
pharmaceutical:adj.制药(学)的;n.药物; devices:n.[机][计]设备;[机]装置;[电子]器件(device的复数); sophisticated:adj.复杂的;老练的;见多识广的;水平高的;
in order to distort the evidence that they give to doctors and patients , and which we use to make vitally important decisions. 来歪曲他们给医生和患者的证据 而那些是我们用来做重要决定的证据
patients:n.接受治疗者,病人;(patient的复数) vitally:adv.极其;紧要地;生死攸关地;
So firstly , trials against placebo: everybody thinks they know that a trial should be a comparison of your new drug against placebo. 首先,安慰剂对照组: 谁都知道要用新药 和安慰剂对照组做试验
firstly:adv.首先(主要用于列举条目,论点时);第一; comparison:n.比较;对比;相比;
But actually in a lot of situations that's wrong. 但是很多情况下这是错的
Because often we already have a very good treatment that is currently available, so we don't want to know that your alternative new treatment is better than nothing. 因为通常我们目前已经有一个有效的治疗方法 所以我们想要知道的不是你的新疗法 比坐以待毙强
currently:adv.当前;一般地; alternative:adj.供选择的;选择性的;交替的;n.二中择一;供替代的选择;
We want to know that it's better than the best currently available treatment that we have. 我们想知道的是它是不是比目前的疗法更有效
And yet, repeatedly , you consistently see people doing trials still against placebo. 但是你总是看到他们做 安慰剂对照试验
repeatedly:adv.反复地;再三地;屡次地; consistently:adv.一贯地;一致地;坚实地;
And you can get license 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. 这样你就能拿到许可证进入市场了 而试验数据只显示此药只不过比什么都没有好点 这对像我一样的医生要做决定一点帮助都没有
license:v.许可;批准;
But that's not the only way you can rig your data. 这还不是操纵数据的唯一手段
You can also rig your data by making the thing you compare your new drug against really rubbish. 你还可以通过 将你的新药和真的废物做对照试验 来操纵数据
You can give the competing drug in too low a dose , so that people aren't properly treated . 你可以将对照药物剂量控制在非常低的水平 这样人们没有得到适当的治疗
competing:adj.相互冲突的;相互矛盾的;v.竞争;对抗;参加比赛;(compete的现在分词) dose:n.剂量;一剂,一服;v.服药;给药;给…服药; treated:v.以…态度对待;把…看作;(treat的过去分词和过去式)
You can give the competing drug in too high a dose, so that people get side effects. 也可以将对照药物剂量控制在非常高的水平 这样就产生副作用
And this is exactly what happened which antipsychotic medication for schizophrenia . 治疗精神分裂症的安定药 就是这么干的
antipsychotic:adj.治疗精神病的,抗精神病的;n.安定药; medication:n.药;药物; schizophrenia:n.[内科]精神分裂症;
20 years ago, a new generation of antipsychotic drugs were brought in and the promise was that they would have fewer side effects. 20年前,一批新的安定药面世 有承诺说它们的副作用更低
So people set about doing trials of these new drugs against the old drugs, but they gave the old drugs in ridiculously high doses -- 20 milligrams a day of haloperidol . 人们就对这些新药做了试验 跟旧的药对比 但他们使用的旧药剂量无比之高－ 每天20毫克的氟哌丁苯
ridiculously:adv.可笑地;荒谬地; doses:v.服药(dose的三单形式);n.[药][核]剂量(dose的复数); milligrams:[计量]毫克; haloperidol:n.氟哌啶醇,氟哌丁苯(一种强安定药);
And it's a foregone conclusion , if you give a drug at that high a dose, that it will have more side effects and that your new drug will look better. 毫无疑问 如果这么大的剂量 肯定会导致更多的副作用从而让新药看上去更好
foregone conclusion:注定的结果,不可避免的结果;
10 years ago, history repeated itself, interestingly , when risperidone , which was the first of the new-generation antipscyhotic drugs, came off copyright , so anybody could make copies. 10年前,历史重演,有趣的是 当利培酮,这一第二代抗精神病药的先锋 产权到期的时候,谁都可以进行生产
interestingly:adv.有趣地; risperidone:n.利培酮; copyright:n.版权;著作权;adj.受版权保护的;未经准许不得复制的;v.获得…的版权;
Everybody wanted to show that their drug was better than risperidone, so you see a bunch of trials comparing new antipsychotic drugs against risperidone at eight milligrams a day. 每个人都想展示他们的药比利培酮好 接着你就看到一堆新的抗精神病药的对照试验 和每天8毫克的利培酮对照
Again, not an insane dose, not an illegal dose, but very much at the high end of normal. 这个剂量不算疯狂,不是违法 但绝对超出正常
insane:adj.疯狂的;精神病的;极愚蠢的; illegal:adj.不合法的;非法的;n.非法移民;非法劳工;
And so you're bound to make your new drug look better. 所以你肯定能让新药表现更好
bound:n.跳跃:v.跳跃着跑:形成…的边界(或界限)adj.一定会:很可能会:
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. 果不其然 制药业赞助的试验 比私人赞助试验得到正面结果（阳性结果）的机率 要高出4倍
overall:v.全部; n.外套; adj.全面的; independently:adv.独立地;自立地; sponsored:adj.(活动或比赛)为慈善筹款而举办的; v.赞助(活动、节目等); (sponsor的过去式和过去分词)
But -- and it's a big but -- 但是－这是一个很大的但是－
(Laughter) （笑声）
it turns out, when you look at the methods used by industry-funded trials, that they're actually better than independently sponsored trials. 结果是 如果你查看制药业赞助的试验使用的方法 反而比私人赞助试验的方法 更好
And yet, they always manage to to get the result that they want. 不过他们总能得到他们想要的结果
So how does this work? 那这是怎么回事？
How can we explain this strange phenomenon ? 怎么解释这一奇怪现象？
phenomenon:n.现象;杰出的人;非凡的人(或事物);
Well it turns out that what happens is the negative data goes missing in action; it's withheld from doctors and patients. 实际情况是 负面结果的数据完全丢失; 医生和患者扣留着这些信息
negative:adj.[数]负的;消极的;否定的;阴性的;n.否定;负数;[摄]底片;v.否定;拒绝; withheld:v.拒绝给:抑制;忍住(withhold的过去分词和过去式)
And this is the most important aspect of the whole story. 这是整个过程里最重要的一个方面
aspect:n.方面;层面;外观;方位;
It's at the top of the pyramid of evidence. 这是证据金字塔的塔尖
We need to have all of the data on a particular treatment to know whether or not it really is effective. 我们需要一个疗法的所有数据 才能知道它是否有效
whether or not:是否…;
And there are two different ways that you can spot whether some data has gone missing in action. 有两种方法你可以发现 是否有数据丢失
You can use statistics , or you can use stories. 可以用统计学,或者事例
statistics:n.统计数字;统计资料;统计学;(statistic的复数)
I personally prefer statistics, so that's what I'm going to do first. 我个人倾向统计学,所以我首先做的就是
personally:adv.个人;亲自;本人;就本人而言; prefer:v.更喜欢;宁愿;提出;提升;
This is something called funnel plot . 漏斗图分析
funnel:n.漏斗;烟囱;v.通过漏斗或烟囱等;使成漏斗形; plot:n.情节;阴谋;布局;小块土地;v.密谋;暗中策划;(在地图上)标出;绘制(图表);
And a funnel plot is a very clever way of spotting if small negative trials have disappeared , have gone missing in action. 漏斗图是个非常好的方法 来查看是否有少量负面结果丢失
disappeared:adj.消失的;消失了的;v.消失,失踪;(disappear的过去式和过去分词)
So this is a graph of all of the trials that have been done on a particular treatment. 这是针对某项疗法的 所有试验图表
And as you go up towards the top of the graph, what you see is each dot is a trial. 图片上部 每一个点是一个试验
And as you go up, those are the bigger trials, so they've got less error in them. 越往上,试验规模越大,误差也就越小
So they're less likely to be randomly false positives , randomly false negatives . 也就是越少随机的假阳性和假阴性结果 (阳性即表示试验结果是肯定治疗药物的疗效的,译者注）
randomly:adv.随便地,任意地;无目的,胡乱地;未加计划地; positives:n.实在的事物;阳极板(positive的复数); negatives:n.[摄]底片; v.否定;
So they all cluster together. 它们会聚集在一起
cluster:n.群;簇;丛;串;vi.群聚;丛生;vt.使聚集;聚集在某人的周围;
The big trials are closer to the true answer. 越大的试验越接近事实
Then as you go further down at the bottom, what you can see is, over on this side, the spurious false negatives, and over on this side, the spurious false positives. 越往下 可以发现,这一边是伪造的假阴性结果 那边是伪造的假阳性结果
spurious:adj.假的;伪造的;欺骗的;
If there is publication bias , if small negative trials have gone missing in action, you can see it on one of these graphs. 如果有发表偏倚（有统计学意义的结果更易被发表） 如果得出负面结果的小规模试验数据丢失 你可以在这些图表中找到
publication:n.出版物;发表;公布;发行; bias:adv.使有偏见;n.偏见;偏心;偏爱;v.使有偏见;使偏向;adj.斜的;[电]偏动的;
So you can see here that the small negative trials that should be on the bottom left have disappeared. 这里可以看见,应该在图表左下的 得出负面结果的小规模试验不见了
This is a graph demonstrating the presence of publication bias in studies of publication bias. 这个图表展示的是关于发表偏倚的研究里 出现的发表偏倚
demonstrating:n.演示;v.证明;示威;显示;(demonstrate的现在分词) presence:n.存在;出席;参加;风度;仪态;
And I think that's the funniest epidemiology joke that you will ever hear. 我觉得这是你听过的最有意思的 关于“流行病”的笑话
That's how you can prove it statistically , but what about stories? 这就是统计证明方法 那事例法呢？
statistically:adv.统计地;统计学上;
Well they're heinous , they really are. 那个就比较可恶了
heinous:adj.可憎的;极凶恶的;
This is a drug called reboxetine. 有种药叫瑞波西汀(抗抑郁药)
This is a drug that I myself have prescribed to patients. 我曾给一位病人开过这个药
prescribed:v.给…开(药); (prescribe的过去式和过去分词)
And I'm a very nerdy doctor. 而我是个超级书呆子的医生
nerdy:adj.书呆子式的;n.令人厌烦的人;
I hope I try to go out of my way to try and read and understand all the literature . 我寄希望于阅读和理解所有文献
literature:n.文学;文献;文艺;著作;
I read the trials on this. They were all positive. They were all well-conducted . 我读了试验资料,都是正面结果,都是正规操作
well-conducted:adj.品行端正的;组织妥善的;
I found no flaw. 没发现漏洞
Unfortunately , it turned out, that many of these trials were withheld. 但不幸的是 很多试验结果被扣留
Unfortunately:adv.不幸地;
In fact, 76 percent of all of the trials that were done on this drug were withheld from doctors and patients. 此药有76％的 试验结果都 被医生和病人保留
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. 你想想 如果我把硬币扔一百次 我可以保留一半结果 不告诉你 然后我就能说服你 我的硬币两面都是人头像
tossed:v.扔,抛,掷;甩;(使)摇摆,挥动,颠簸;(toss的过去分词和过去式) withhold:v.保留;隐瞒;抑制;忍住;克制; convince:v.使确信;使相信;说服,劝说;
If we remove half of the data, we can never know what the true effect size of these medicines is. 如果去掉一半数据 我们绝不可能知道这些药的真正的效果
And this is not an isolated story. 这不是个偶发事件
isolated:adj.偏远的; v.隔离,孤立,脱离;
Around half of all of the trial data on antidepressants has been withheld, but it goes way beyond that. 针对抗抑郁症药的试验数据有一半左右都被保留 事实比着更糟
antidepressants:n.[药]抗抑郁药(antidepressant的复数形式);抗忧郁剂;
The Nordic Cochrane Group were trying to get a hold of the data on that to bring it all together. 收集那些被保留的数据
Nordic:adj.北欧人的;斯堪的纳维亚的;日耳曼民族的;n.北欧人;日耳曼民族; get a hold of:联系;得到;联络;找到;
The Cochrane Groups are an international nonprofit collaboration that produce systematic reviews of all of the data that has ever been shown. Nordic Cochrane是个国际性非盈利团体机构 提供对所有公开数据的系统性的评论
nonprofit:adj.非赢利的;不以赢利为目的的; collaboration:n.合作;勾结;通敌; systematic:adj.系统的;体系的;有系统的;[图情]分类的;一贯的,惯常的; reviews:n.综述; v.回顾;
And they need to have access to all of the trial data. 他们需要所有试验数据的查看权限
But the companies withheld that data from them, and so did the European Medicines Agency for three years. 但是制药商保留了数据结果 欧洲药物管理局也这样 做了3年
Agency:n.代理,中介;代理处,经销处;
This is a problem that is currently lacking a solution . 这个问题目前没有解决方案
solution:n.解决方案;溶液;溶解;解答;
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. 为了告诉你们这个问题的严重性,给你们举一个叫达菲的药的例子 各国政府 花了巨资在此药上
And they spend that money on the promise that this is a drug which will reduce the rate of complications with flu. 他们承诺 这个药能降低 流感的并发症几率
We already have the data showing that it reduces the duration of your flu by a few hours. 我们已有数据显示 它能减少几小时流感症状的持续时间
duration:n.持续时间;期间;
But I don't really care about that. Governments don't care about that. 我不关心这个,政府也不关心
I'm very 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. 很抱歉你得流感了,我知道那很糟糕 但我们不可能花上百万美元 只为了减少半天你的 流感症状
symptoms:n.症状;征候;征兆;(symptom的复数)
We prescribe these drugs, we stockpile them for emergencies on the understanding that they will reduce the number of complications, which means pneumonia and which means death. 我们开药,在急诊室有大量存货 觉得这能降低并发症数 也就是说肺炎或者死亡
stockpile:n.库存;积蓄;vt.贮存;储蓄;vi.积累;储备物资; emergencies:n.突发事件;紧急情况;(emergency的复数) pneumonia:n.肺炎;
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 that they can make a full decision about whether this drug is effective or not, and they've not been able to get that information. 位于意大利的Cochrane尝试着 从制药公司获取 关于该药的所有有用数据 以便他们判断 此药是否有效 他们没能拿到信息
infectious:adj.传染的;传染性的;易传染的; diseases:n.[医]病(disease的复数);[医]疾病;[植保]病害;疾病种类;
This is undoubtedly the single biggest ethical problem facing medicine today. 毫无疑问 这是如今医学界面临的 一个重大道德问题
undoubtedly:adv.确实地,毋庸置疑的; ethical:adj.伦理的;道德的;凭处方出售的;n.处方药;
We cannot make decisions in the absence of all of the information. 没有信息 我们无法做决定
in the absence of:缺乏,不存在;无…时,缺少…时;
So it's a little bit difficult from there to spin in some kind of positive conclusion. 据此想得出些正面结论 是有些困难
But I would say this: 但是我想说:
I think that sunlight is the best disinfectant . 阳光是 最好的杀菌剂
disinfectant:n.消毒剂;adj.消毒的;
All of these things are happening in plain sight, and they're all protected by a force field of tediousness . 日光之下无新事 这些事物都受 一种单调的力场所保护
tediousness:n.沉闷;乏味;
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 in the mechanics and peer in. 我认为,对于所有科学问题 我们能做的最好的就是 掀开事物的表层 摸清来去一窥究竟
lid:n.盖子;(容器的)盖;vt.给…盖盖子; mechanics:n.机械师;机械修理工;技工;力学;机械学;(mechanic的复数) peer:n.同辈;同龄人;身份(或地位)相同的人;(英国)贵族成员;v.仔细看;端详;
Thank you very much. 非常感谢
(Applause) （掌声）