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BenGoldacre_2012P-_医生开药的盲点所在_
Hi. So, this chap here, he thinks he can tell you the future. 嗨！报纸上的这个家伙
chap:n.小伙子;家伙;龟裂;v.使皲裂;皲裂;
His name is Nostradamus , although here the Sun have made him look a little bit like Sean Connery. (Laughter) 把他画得有点像肖恩·康纳利。（笑声）
Nostradamus:n.占卜者;诺斯特拉德马斯(法国占星家);
And like most of you, I suspect , I don't really believe that people can see into the future. 像你们一样,我很怀疑,我不太相信 人真能预知未来。
suspect:n.犯罪嫌疑人;v.怀疑;不信任;adj.可疑的;
I don't believe in precognition , and every now and then , you hear that somebody has been able to predict something that happened in the future, and that's probably because it was a fluke, and we only hear about the flukes and about the freaks . 但这可能仅仅是因为瞎猫撞着死耗子,而且我们也仅仅
precognition:n.预知;先知; every now and then:不时地;常常; predict:v.预报;预言;预告; flukes:n.吸虫(fluke的复数形式);锚爪;v.侥幸成功(fluke的第三人称单数); 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)
We don't hear about all the times that people got stuff wrong.
stuff:n.东西:物品:基本特征:v.填满:装满:标本:
Now we expect that to happen with silly stories about precognition, but the problem is, we have exactly the same problem in academia and in medicine, and in this environment, it costs lives. 我们认为这就是关于预知的
academia:n.学术界;学术生涯;
So firstly , thinking just about precognition, as it turns out, just last year a researcher called Daryl Bem conducted a piece of research where he found evidence of precognitive powers in undergraduate students, 所以,首先想想“预知”这个问题,因为去年 一个研究,他发现了关于大学生的
firstly:adv.首先(主要用于列举条目,论点时);第一; conducted:v.组织;安排;实施;执行;指挥;带领;引导;(conduct的过去分词和过去式) evidence:n.证据,证明;迹象;明显;v.证明; precognitive:(对证人等的)预审;预审笔录; undergraduate:n.本科生;
and this was published in a peer-reviewed academic journal and most of the people who read this just said, "Okay, well, fair enough , but I think that's a fluke, that's a freak, because I know that if I did a study where I found no evidence 如果我进行研究,并得出没有任何证据
peer-reviewed:n.同行评议;同行审阅; academic:adj.学术的;理论的;学院的;n.大学生,大学教师;学者; journal:n.杂志;日记;日志;(用于报纸名)…报; fair enough:同意或接受但有所保留;
that undergraduate students had precognitive powers, it probably wouldn't get published in a journal. 表明大学生有预知能力,
And in fact, we know that that's true, because several different groups of research scientists tried to replicate the findings of this precognition study, 其实,我们知道这个问题是存在的, 因为几组科学家尝试 重复关于预知能力的研究,
replicate:vt.复制; vi.重复; adj.复制的; n.复制品; findings:n.调查发现;判决;裁决;(finding的复数)
and when they submitted it to the exact same journal, the journal said, "No, we're not interested in publishing replication . We're not interested in your negative data." 期刊编辑说:“不,我们对重复实验不感兴趣。
submitted:v.提交;顺从;投降;表示;认为;建议;(submit的过去分词和过去式) replication:n.复制;回答;反响; 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;
So this is already evidence of how, in the academic literature , we will see a biased sample of the true picture of all of the scientific studies that have been conducted. 几乎所有科学研究都是存在偏见。
literature:n.文学;文献;文艺;著作; biased:adj.有偏见的;结果偏倚的,有偏的; scientific:adj.科学的,系统的;
But it doesn't just happen in the dry academic field of psychology .
psychology:n.心理学;心理状态;
It also happens in, for example, cancer research. 在癌症研究方面这个问题也存在。
cancer:n.癌症;恶性肿瘤;
So in March, 2012, just one month ago, some researchers reported in the journal Nature how they had tried to replicate 53 different basic science studies looking at potential treatment targets in cancer, and out of those 53 studies, they were only able to successfully replicate six. 重复53个关于癌症潜在疗法的 基本科学研究,
potential:n.潜能;可能性;[电]电势;adj.潜在的;可能的;势的; treatment:n.治疗;疗法;对待;处理;讨论;
Forty-seven out of those 53 were unreplicable.
And they say in their discussion that this is very likely because freaks get published. 他们在分析中指出这很有可能是 因为怪异的结果容易被发表。
People will do lots and lots and lots of different studies, and the occasions when it works they will publish , and the ones where it doesn't work they won't. 人们会做许多许多不同的实验, 实验成功就会被发表, 不成功则难见天日。
publish:v.出版;发表;公布;
And their first recommendation of how to fix this problem, because it is a problem, because it sends us all down blind alleys , their first recommendation of how to fix this problem 他们对解决这个问题的第一个建议, 他们纠正这个问题的第一个建议就是
recommendation:n.推荐;介绍;提议;正式建议; alleys:n.小巷,大巷(alley的复数);大街小巷;
is to make it easier to publish negative results in science, and to change the incentives so that scientists are encouraged to post more of their negative results in public. 让在科学界发表负面结果变得更加容易, 并改变科学家们的奖励机制,鼓励他们
incentives:n.激励;奖励;诱因(incentive的复数形式);奖励措施;
But it doesn't just happen in the very dry world of preclinical basic science cancer research. 这不仅仅发生在枯燥的
preclinical:adj.临床前的;现出症状之前的潜伏期的;
It also happens in the very real, flesh and blood of academic medicine. So in 1980, some researchers did a study on a drug called lorcainide, and this was an anti-arrhythmic drug, a drug that suppresses abnormal heart rhythms , 学术医学领域。在1980年, 可以抑制不正常的心率。
flesh and blood:adj.血肉般的; suppresses:抑制;封锁;压制; abnormal:adj.反常的,不规则的;变态的; rhythms:韵律;
and the idea was, after people have had a heart attack , they're quite likely to have abnormal heart rhythms, so if we give them a drug that suppresses abnormal heart rhythms, this will increase the chances of them surviving. 研究者想法是,当病人心脏病发作, 他们很可能心率失常, 所以如果我们给他们抑制心率失常的药,
heart attack:n.[医]心肌梗塞
Early on its development, they did a very small trial, just under a hundred patients . 在研究早期,他们进行了一个非常小规模的实验, 只有100个病人参加。
patients:n.接受治疗者,病人;(patient的复数)
Fifty patients got lorcainide, and of those patients, 10 died. 50人服用劳卡胺,他们中有10人死了。
Another 50 patients got a dummy placebo sugar pill with no active ingredient , and only one of them died. 另外50人服用了假的（安慰剂糖片）药片, 没有摄入任何有效成分,他们中只有1人死了。
dummy:adj.虚拟的;假的;n.傀儡;哑巴;仿制品; placebo:n.安慰剂;为死者所诵的晚祷词; pill:n.[医]药丸;药品; ingredient:n.原料;要素;组成部分;adj.构成组成部分的;
So they rightly regarded this drug as a failure, and its commercial development was stopped, and because its commercial development was stopped, this trial was never published. 所以研究人员很诚实地将这种药列为失败产品, 有关的商业开发马上停止,而导致了 这次研究的结果一直没有发表。
rightly:adv.正确地;恰当地;公正地;合适地; commercial:adj.贸易的;商业的;赢利的;以获利为目的的;n.(电台或电视播放的)广告;
Unfortunately , over the course of the next five, 10 years, other companies had the same idea about drugs that would prevent arrhythmias in people who have had heart attacks. 对心脏病人使用抗心律不齐药物。
Unfortunately:adv.不幸地; arrhythmias:n.[内科]心律失常(arrhythmia的复数);心律不整;
These drugs were brought to market. They were prescribed very widely because heart attacks are a very common thing, and it took so long for us to find out that these drugs also caused an increased rate of death that before we detected that safety signal, over 100,000 people died unnecessarily in America from the prescription of anti-arrhythmic drugs. 我们花了很长时间才意识到这些药物 致使患者死亡率上升。 在我们发现到这一点之前,
prescribed:v.给…开(药); (prescribe的过去式和过去分词) detected:v.发现;查明;侦察出;(detect的过去分词和过去式) unnecessarily:adv.不必要地;多余地; prescription:n.处方;药方;医生开的药;开处方;
Now actually, in 1993, the researchers who did that 1980 study, that early study, published a mea culpa , an apology to the scientific community , in which they said, "When we carried out our study in 1980, 实际上,在1993年, 那些在1980年进行早期实验的研究人员 他们写道:“当我们在1980年进行研究时,
mea culpa:int.是我的错;是我的责任; community:n.社区;[生态]群落;共同体;团体;
we thought that the increased death rate that occurred in the lorcainide group was an effect of chance." 我们以为劳卡胺实验组的
death rate:n.死亡率; occurred:v.发生;出现;存在于;出现在;(occur的过去分词和过去式)
The development of lorcainide was abandoned for commercial reasons, and this study was never published; it's now a good example of publication bias. 劳卡胺的研发因商业原因被停止,
abandoned:adj.被抛弃的放纵的;v.抛弃;丢弃,离开;放弃;(abandon的过去分词和过去式) publication:n.出版物;发表;公布;发行;
That's the technical term for the phenomenon where unflattering data gets lost, gets unpublished , is left missing in action, and they say the results described here "might have provided an early warning of trouble ahead." ‘发表偏倚’(Publication bias)是一个用来形容负面数据被忽视, 之后,他们得出的结论是 “本可以在灾难之前提前敲响警钟。”
technical:adj.工艺的,科技的;技术上的;专门的; phenomenon:n.现象;杰出的人;非凡的人(或事物); unflattering:adj.不吸引人的,不好看的; unpublished:adj.未公开出版的;未发表过的; described:v.描述;形容;把…称为;做…运动;(describe的过去分词和过去式) provided:conj.假如; v.提供; (provide的过去分词和过去式) early warning:adj.预先警报的,预警的;远程警戒的;
Now these are stories from basic science. 这是些基础科学界的故事。
These are stories from 20, 30 years ago. 这些都是20,30年前的老故事了。
The academic publishing environment is very different now. 如今,学术出版业大环境已经今非昔比。
There are academic journals like "Trials," the open access journal, which will publish any trial conducted in humans regardless of whether it has a positive or a negative result. 现在有类似《试验》的开源期刊(the open access journal),
journals:n.学术期刊(journal的复数);日记;日记账; regardless:adj.不管的; v.不顾后果地; positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片;
But this problem of negative results that go missing in action is still very prevalent . In fact it's so prevalent that it cuts to the core of evidence-based medicine. 但负面结果被忽视的问题 威胁“循证医药学”的根本。
prevalent:adj.流行的;普遍的,广传的; to the core:到心;彻底;彻底地;透顶的; evidence-based:adj.基于证据的;
So this is a drug called reboxetine, and this is a drug that I myself have prescribed. It's an antidepressant . 这是一种叫做瑞波西汀的药物,之前
antidepressant:n.抗抑郁剂;adj.抗抑郁的(等于antidepressive);
And I'm a very nerdy doctor, so I read all of the studies that I could on this drug. I read the one study that was published that showed that reboxetine was better than placebo, 而我又比较死板书呆子,所以我浏览了
nerdy:adj.书呆子式的;n.令人厌烦的人;
and I read the other three studies that were published that showed that reboxetine was just as good as any other antidepressant, and because this patient hadn't done well on those other antidepressants , 我又读到另外三篇声称 瑞波西汀和其他抗抑药物的效果没什么差别,
antidepressants:n.[药]抗抑郁药(antidepressant的复数形式);抗忧郁剂;
I thought, well, reboxetine is just as good. It's one to try.
But it turned out that I was misled . In fact, seven trials were conducted comparing reboxetine against a dummy placebo sugar pill. One of them was positive and that was published, but six of them were negative and they were left unpublished. 但最终证明我是被误导了。实际上, 有七项关于瑞波西汀和 效果出众也得以发表,其他六项 无效果,导致无法发表结论。
misled:v.把…带错方向(mislead的过去式); comparing:v.比较;对比;(compare的现在分词)
Three trials were published comparing reboxetine against other antidepressants in which reboxetine was just as good, and they were published, but three times as many patients' worth of data was collected which showed that reboxetine was worse than those other treatments , and those trials were not published. 三项发表的试验记载 在瑞波西汀和其他抗抑郁药物的对比中,瑞波西汀 效果同样显著,并得以发表, 而另外收集的多达三倍的病例数据
treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数)
I felt misled.
Now you might say, well, that's an extremely unusual example, and I wouldn't want to be guilty of the same kind of cherry-picking and selective referencing that I'm accusing other people of. 也许你会说,那可能是个案中的个案吧, 发表而指责别人。
extremely:adv.非常,极其;极端地; guilty:adj.有罪的;内疚的; cherry-picking:n.作最良好或最适宜选择的行为或习惯;v.挑选(cherry-pick的ing形式); selective:adj.选择性的;有选择的;认真挑选的;严格筛选的; referencing:v.参考;查阅;给(书等)附参考资料;(reference的现在分词) accusing:adj.谴责的;指责的;v.控告;控诉;谴责;(accuse的现在分词)
But it turns out that this phenomenon of publication bias has actually been very, very well studied. 但结果证实这种“发表偏倚” 已经被很深入的研究过了。
So here is one example of how you approach it. 举个例子,你如何看待它。
approach:n.方法;路径;v.接近;建议;着手处理;
The classic model is, you get a bunch of studies where you know that they've been conducted and completed, and then you go and see if they've been published anywhere 已经临床使用过并有结论的试验
classic:n.名著;优秀的典范;adj.最优秀的;第一流的;有代表性的;典型的; a bunch of:一群;一束;一堆;
in the academic literature. So this took all of the trials that had ever been conducted on antidepressants that were approved over a 15-year period by the FDA.
approved:adj.被正式接受的,被正式认可的; v.赞成; (approve的过去分词和过去式)
They took all of the trials which were submitted to the FDA as part of the approval package. 他们根据所有曾经上交给食品医药管理局的试验案例作为基础。
approval:n.批准;认可;赞成;
So that's not all of the trials that were ever conducted on these drugs, because we can never know if we have those, but it is the ones that were conducted in order to get the marketing authorization .
authorization:n.授权,认可;批准,委任;
And then they went to see if these trials had been published in the peer-reviewed academic literature. And this is what they found. 之后,他们去了解那些试验有没有被发表
It was pretty much a 50-50 split . Half of these trials were positive, half of them were negative, in reality. 效果显著,另外一半显示效果不显著。
split:v.分离;使分离;劈开;离开;分解;n.劈开;裂缝;adj.劈开的;
But when they went to look for these trials in the peer-reviewed academic literature, what they found was a very different picture. 但他们从那些需审核的学术机构里搜索那些试验的时候, 他们发现结果是截然不同的。
Only three of the negative trials were published, but all but one of the positive trials were published. 而除了一例几乎所有效果显著的试验案例都被发表了出去。
Now if we just flick back and forth between those two, you can see what a staggering difference there was between reality and what doctors, patients, commissioners of health services, and academics were able to see in the peer-reviewed academic literature. 所能读到的审核的学术期刊文献,之间消息的鸿沟了。
flick:v.轻弹;忽然摇动;轻轻拂去;n.弹开;快速的轻打;轻打声; back and forth:前后移动的,来回的,反复的; staggering:adj.惊人的; v.蹒跚; (stagger的现在分词) commissioners:委员;政府的特派员;地方长官(commissioner的名词复数); academics:n.学术水平;学术知识;专业学者;
We were misled, and this is a systematic flaw in the core of medicine.
systematic:adj.系统的;体系的;有系统的;[图情]分类的;一贯的,惯常的; flaw:n.瑕疵,缺点; v.使生裂缝,使有裂纹; vi.生裂缝;
In fact, there have been so many studies conducted on publication bias now, over a hundred, that they've been collected in a systematic review, published in 2010, that took every single study on publication bias that they could find. 他们能找到的所有的“发表偏倚”的研究 “发表偏倚”的试验案例有一百多项。
Publication bias affects every field of medicine. “发表偏倚”影响了医学的所有领域。
About half of all trials, on average, go missing in action, and we know that positive findings are around twice as likely to be published as negative findings. 大约一半的试验,被遗忘忽视, 几乎是没效果发表几率的两倍。
This is a cancer at the core of evidence-based medicine.
If I flipped a coin 100 times but then withheld the results from you from half of those tosses , 隐瞒一半的投掷结果,
flipped:v.(使)快速翻转;按(开关);轻掷;(flip的过去分词和过去式) withheld:v.拒绝给:抑制;忍住(withhold的过去分词和过去式) tosses:v.扔,抛,掷;(使)摇摆,挥动,颠簸;(toss的第三人称单数)
I could make it look as if I had a coin that always came up heads. 我就能让它看以来是一个永远头像朝上的硬币。
But that wouldn't mean that I had a two-headed coin. 但这不代表我这硬币有两面都是头像。
two-headed:adj.有两个头的,有两个领袖的;
That would mean that I was a chancer and you were an idiot for letting me get away with it . (Laughter) 这只能说我是个投机者
chancer:n.笨拙的人;敢冒任何风险的人; idiot:n.笨蛋,傻瓜;白痴; get away with it:na.侥幸成功;逃脱处罚;
But this is exactly what we blindly tolerate in the whole of evidence-based medicine.
blindly:adv.盲目地;轻率地;摸索地; tolerate:v.容忍;忍受;容许;包容;
And to me, this is research misconduct .
misconduct:n.不端行为;处理不当;vt.处理不当;行为不检;
If I conducted one study and I withheld half of the data points from that one study, you would rightly accuse me, essentially , of research fraud . 此研究中一半的数据, 你就有权利指控我,学术诈骗。
accuse:v.控告;谴责;控诉; essentially:adv.本质上;本来; fraud:n.欺骗;骗子;诡计;
And yet, for some reason, if somebody conducts 10 studies but only publishes the five that give the result that they want, we don't consider that to be research misconduct. 但出于某种原因,如果某人做了 10项研究但只发表其中他希望的5项的话, 我们却不会考虑这是学术不端。
conducts:vi.导电;带领;vt.管理;引导;表现;n.进行;行为;实施;
And when that responsibility is diffused between a whole network of researchers, academics, industry sponsors , journal editors, for some reason we find it more acceptable , but the effect on patients is damning . 但当学术不端的责任分散于学术网络,学术期刊,商业赞助商,期刊编辑的时候, 但当学术不端的责任分散于学术网络,学术期刊,商业赞助商,期刊编辑的时候, 但当学术不端的责任分散于学术网络,学术期刊,商业赞助商,期刊编辑的时候, 不知怎么的,我们觉得这样是可以接受的, 但这对病人的后果是惨痛的。
diffused:adj.散布的,扩散的;普及的;v.散布,传播(diffuse的过去分词);使分散; sponsors:n.赞助商;主办单位(sponsor的复数);v.赞助(sponsor的三单形式);主办;倡议; acceptable:adj.认同的;可接受的;令人满意的; damning:adj.谴责的;诅咒的;可以定罪的;n.咒诅;v.该死,混账;谴责;(damn的现在分词)
And this is happening right now, today.
This is a drug called Tamiflu. Tamiflu is a drug which governments around the world have spent billions and billions of dollars on stockpiling , and we've stockpiled Tamiflu in panic , in the belief that it will reduce the rate of complications of influenza . 资金作为应急储备的,
stockpiling:n.积存;v.大量储备;(stockpile的现在分词) stockpiled:n.库存;积蓄;vt.贮存;储蓄;vi.积累;储备物资; panic:adj.恐慌的;n.惊恐;恐慌;惶恐不安;v.惊慌失措; influenza:n.[内科]流行性感冒(简写flu);家畜流行性感冒;
Complications is a medical euphemism for pneumonia and death. (Laughter) 并发症则是医学上对肺炎和死亡的
euphemism:n.委婉语;委婉说法; pneumonia:n.肺炎;
Now when the Cochrane systematic reviewers were trying to collect together all of the data from all of the trials that had ever been conducted on whether Tamiflu actually did this or not, they found that several of those trials were unpublished. 如今,当科克伦(Cochrane临床对照试验资料库)系统审核员 是否有效的试验案例时, 他们发现很多试验是未被发表的。
reviewers:n.评论者(reviewer的复数);评审员;
The results were unavailable to them.
unavailable:adj.难以获得的;不能利用的;不近便的;
And when they started obtaining the writeups of those trials through various different means, through Freedom of Information Act requests, through harassing various different organizations , what they found was inconsistent . 向各种不同组织打探消息后,他们发现里面有很多矛盾的地方。
obtaining:n.得到,获取;v.得到(obtain的现在分词); Freedom of Information:n.信息自由(查阅政府所掌握有关个人及组织的信息的权利); harassing:v.侵扰;骚扰;不断攻击(敌人);(harass的现在分词) organizations:n.组织,构造,有机体(organization的复数);组织机构; inconsistent:adj.不一致的;前后矛盾的;
And when they tried to get a hold of the clinical study reports, the 10,000-page long documents that have the best possible rendition of the information, they were told they weren't allowed to have them. 临床学术报告的时候, 他们被告知,他们无权使用。
get a hold of:联系;得到;联络;找到; rendition:n.译文;演奏;提供;引渡逃奴;
And if you want to read the full correspondence and the excuses and the explanations given by the drug company, you can see that written up in this week's edition of PLOS Medicine. 如果你想知道那些制药公司 对此给出的解释和借口全文的话, 你可以关注一下这周出版的
correspondence:n.通信;一致;相当;
And the most staggering thing of all of this, to me, is that not only is this a problem, not only do we recognize that this is a problem, but we've had to suffer fake fixes. 不仅之前讨论的这个问题,和我们是否意识到了 这个问题,还包括我们要忍受装作问题已被解决。
recognize:v.认识;认出;辨别出;承认;意识到; fake:n.假货;骗子;假动作;v.捏造;假装…的样子;adj.伪造的;
We've had people pretend that this is a problem that's been fixed.
First of all , we had trials registers , and everybody said, oh, it's okay. We'll get everyone to register their trials, they'll post the protocol , they'll say what they're going to do before they do it, 事先宣布他们要做什么了,
First of all:adv.首先; registers:n.登记; v.登记; protocol:n.协议;草案;礼仪;vt.拟定;vi.拟定;
and then afterwards we'll be able to check and see if all the trials which have been conducted and completed have been published. 之后,我们就能查出是否所有的进行过的试验案例都被发表了。
But people didn't bother to use those registers. 但人们并没有乖乖来注册。
bother:v.烦扰,打扰;使…不安;操心,麻烦;n.麻烦;烦恼;
And so then the International Committee of Medical Journal Editors came along, and they said, oh, well, we will hold the line. 之后国际医学杂志编辑委员会跳出来,
Committee:n.委员会;
We won't publish any journals, we won't publish any trials, unless they've been registered before they began. 除非试验案例之前已经注册过了,
registered:adj.登记过的;记名的;挂号的;v.登记;注册;(register的过去式和过去分词)
But they didn't hold the line. In 2008, a study was conducted which showed that half of all of trials published by journals edited by members of the ICMJE weren't properly registered, and a quarter of them weren't registered at all.
edited:v.编辑,校订;编选;编集;(edit的过去分词和过去式)
And then finally , the FDA Amendment Act was passed a couple of years ago saying that everybody who conducts a trial must post the results of that trial within one year. 都必须在之后一年内公布临床试验的结果。
finally:adv.终于;最终;(用于列举)最后;彻底地; Amendment:n.修正案;改善;改正;
And in the BMJ, in the first edition of January, 2012, you can see a study which looks to see if people kept to that ruling, and it turns out that only one in five have done so. 在英国医学杂志,2012年1月第一版, 结果表明只有五分一的人照此办理。
first edition:n.(书籍的)第一版;
This is a disaster .
disaster:n.灾难,灾祸;不幸;
We cannot know the true effects of the medicines that we prescribe if we do not have access to all of the information. 如果我们不能了解所有的相关信息, 我们就无法了解我们所开的药物的 真实疗效。
And this is not a difficult problem to fix. 但这问题不是那么难去克服的。
We need to force people to publish all trials conducted in humans, including the older trials, because the FDA Amendment Act only asks that you publish the trials conducted after 2008, 因为食品药物修正法只要求公开2008年之后的临床试验,
and I don't know what world it is in which we're only practicing medicine on the basis of trials that completed in the past two years.
on the basis of:根据;基于…;
We need to publish all trials in humans, including the older trials, for all drugs in current use, and you need to tell everyone you know that this is a problem and that it has not been fixed. 我们需要公布所有现用药物的所有临床试验的结果,包括较早以前的试验, 这是个问题,这个问题还有待解决。
Thank you very much. (Applause)
(Applause) （掌声）