Ben Goldacre: Battling Bad Science

Translator: Jone Aliri Lazcano Reviewer: Ainize Sarrionandia

Medikua naiz, baina ikerketa aukeratu nuen

eta orain epidemiologoa naiz.

So I'm a doctor, but I kind of slipped sideways into research,

Eta, inork ez daki epidemiologia zer den.

and now I'm an epidemiologist.

Zerbait mundu errealean ona ala txarra den

And nobody really knows what epidemiology is.

jakiteko balio duen zientzia da.

Epidemiology is the science of how we know in the real world

Adibide batekin hobeto ulertzen da:

if something is good for you or bad for you.

Egunkarietako ez buru eta ez hankarik ez duten izenburuen zientzia da.

And it's best understood through example

as the science of those crazy, wacky newspaper headlines.

Ikus ditzagun adibide batzuk:

Hau Daily Mail-ekoa da. Herrialde guztiek dute horrelako bat.

And these are just some of the examples.

Proiektu filosofiko arraro bat du, non

These are from the Daily Mail.

Every country in the world has a newspaper like this.

munduko objektu inanimatu guztiak

It has this bizarre, ongoing philosophical project

minbiziaren sortzaile edo babesle bezala banatzen dituen.

of dividing all the inanimate objects in the world

Hemen minbiziaren sortzailetako batzuk:

into the ones that either cause or prevent cancer.

dibortzioa, wifia, higiene produktuak eta kafea.

Here are some of the things they said cause cancer:

Eta hemen minbizitik babesten dutenak:

azala, piper gorria, erregaliza eta kafea.

divorce, Wi-Fi, toiletries and coffee.

Ikus dezakezuenez kontraesanak daude.

Some things they say prevent cancer:

Kafea minbiziaren sortzailea eta babeslea da.

crusts, red pepper, licorice and coffee.

Irakurtzen zoazten heinean, ikusiko duzue

So you can see there are contradictions.

guzti honen atzean politika egon daitekeela.

Coffee both causes and prevents cancer.

As you start to read on, you can see

Emakumeetan, etxeko lanek bularreko minbizia saihesten dute,

that maybe there's some political valence behind some of this.

baina, gizonetan, erosketak egiteak inpotentzia sor dezake.

For women, housework prevents breast cancer,

Horregatik, hasi behar dugu

but for men, shopping could make you impotent.

honen azpian dagoen zientzia argitzen.

(Laughter)

So we know that we need to start unpicking the science behind this.

Eta, zera erakutsi nahi dut,

baieztapen arriskatu hauek desegitea,

And what I hope to show is that unpicking the evidence behind dodgy claims

eta baieztapen hauen azpian dauden ebidentziak desegitea

ez dela intentzio txarrarekin marmar egitea;

gizartearentzat lagungarria dela,

isn't a kind of nasty, carping activity;

eta oso baliotsua den

it's socially useful.

tresna argigarri bat ere badela.

But it's also an extremely valuable explanatory tool,

Benetako zientzia hori baita,

besteen ebidentziak kritikoki ebaluatzea.

because real science is about critically appraising the evidence

Hau argitalpen akademikoetan gertatzen da.

Konferentzia akademikoetan gertatzen da.

for somebody else's position.

Ebakuntza osteko eztabaidetako datuak

That's what happens in academic journals,

izugarrizko iskanbila izaten dira.

it's what happens at academic conferences --

Eta ez dio inori axola. Gustura hartzen dugu.

the Q&A session after a postdoc presents data is often a bloodbath.

Hitzartutako ekintza intelektual sadomasokista bat bezala da.

And nobody minds that; we actively welcome it.

Erakutsiko dizuedana, nire diziplinaren,

It's like a consenting intellectual S&M activity.

zati nagusiak,

(Laughter)

eta ezaugarri nagusiak dira

So what I'm going to show you is all of the main things,

ebidentzian oinarritutako medikuntzarenak.

Guzti horren inguruan hitz egingo dut, eta

all of the main features of my discipline, evidence-based medicine.

nola funtzionatzen duen azalduko dizuet,

And I will talk you through all of these and demonstrate how they work,

gauzak gaizki ulertzen dituztenen adibideak soilik erabiliz.

Ezagutzen den ebidentzia mota ahulenarekin hasiko gara...

exclusively using examples of people getting stuff wrong.

autoritatea.

We'll start with the absolute weakest form of evidence known to man,

Zientzian zure abizenak ez digu axola.

and that is authority.

Zientzian gauza bat sinisteko arrazoiak ezagutu nahi ditugu.

In science, we don't care how many letters you have after your name --

Nola dakigu zerbait guretzat ona

we want to know what your reasons are for believing something.

edo txarra den?

Autoritateak ez gaitu konbentzitzen

How do you know that something is good for us or bad for us?

asmatzea erraza delako.

But we're also unimpressed by authority because it's so easy to contrive.

Hau Gillian McKeith doktorea da,

edo, bere titulu mediku osoa emateko, Gillian McKeith.

This is somebody called Dr. Gillian McKeith, PhD,

(Barreak)

or, to give her full medical title, Gillian McKeith.

Herrialde guztietan dago horrelako norbait.

(Laughter)

Hau gure telebistako nutrizionista gurua da

Audientzia handieneko ordutegian 5 saio ditu,

Again, every country has somebody like this.

She is our TV diet guru.

bertan, sekulako osasun gomendio exotikoak ematen ditu.

She has five series of prime-time television,

Ofiziala ez den eta, korrespondentziaz lortutako doktoregoa du,

giving out very lavish and exotic health advice.

Ameriketako nonbaitekoa.

She, it turns out, has a non-accredited correspondence course PhD

Harro dago ere, AANC-ko kide izateaz

Nutrizio Aholkularitzako Ameriketako Elkartea,

from somewhere in America.

She also boasts that she's a certified professional member

glamurosoa eta txundigarria dirudiena.

Zertifikatu bat eta guzti ematen dizute.

of the American Association of Nutritional Consultants,

Hau Hetti nire katuarena da. Katu beldurgarria.

which sounds very glamorous; you get a certificate.

Web orrialdean sartu, imprimakia bete,

This one belongs to my dead cat, Hettie. She was a horrible cat.

60 dolar ordaindu eta postaz etortzen da.

Hau ez da pertsona hau tentela dela pentsatzeko arrazoi bakarra.

You go to the website, fill out the form,

Horrelakoak esaten ditu:

give them $60, it arrives in the post.

Hosto berde ilun asko jan behar dira,

That's not the only reason we think this person is an idiot.

klorofila asko dutelako, eta odola oxigenatzen dutelako.

She also says things like eat lots of dark green leaves,

Eskolan biologia ikasi duen edozeinek daki

they contain chlorophyll and really oxygenate your blood.

klorofilak eta kloroplastoek

oxigenoa, eguzki argiarekin sortzen dutela,

And anybody who's done school biology remembers

eta gure hesteak nahiko ilunak direla espinakak jan ostean.

that chlorophyll and chloroplasts only make oxygen in sunlight,

Gainera, zientzia behar da, eta froga egokiak.

and it's quite dark in your bowels after you've eaten spinach.

"Ardoak bularreko minbizitik babesten du".

Next, we need proper science, proper evidence.

Erresuma Batuko Daily Telegraph-eko izenburua.

So: "Red wine can help prevent breast cancer."

"Egunean ardo baso batek bularreko minbizia prebenituko luke"

This is a headline from The Daily Telegraph in the UK.

Artikulua aurkitzen duzu, eta zer dago han?

"A glass of red wine a day could help prevent breast cancer."

benetako zientzia.

Entzima batean ematen diren aldaketen deskribapena da

So you find this paper, and find that it is a real piece of science.

mahatsen azaletik ateratako osagai kimiko bat

It's a description of the changes in the behavior of one enzyme

minbizia duten zelula batzuetara isurtzean

when you drip a chemical extracted from some red grape skin

laborategi batetako plaka batean.

onto some cancer cells

Eta deskribapen hau oso baliagarria da

in a dish on a bench in a laboratory somewhere.

artikulu zientifiko batean,

And that's a really useful thing to describe in a scientific paper.

baina ardoa edateak bularreko minbizia

pairatzeko arriskuan eragiten duenari buruz

But on the question of your own personal risk of getting breast cancer

ezer gutxi esaten digu.

Izatez bularreko minbizia izateko arriskua

if you drink red wine,

apur bat handiagotu egiten da

it tells you absolutely bugger all.

edaten dugun alkohol kantitate bakoitzarekin.

Actually, it turns out that your risk of breast cancer

Beraz nahi duguna benetako pertsonekin egindako ikerketak dira.

increases slightly with every amount of alcohol you drink.

So what we want are studies in real human people.

Eta hemen doa beste adibide bat.

Britainiako dietista eta nutrizionista handienetik Daily Mirror-etik,

And here's another example.

gehien saltzen den bigarren egunkaritik.

This is from Britain's "leading" diet nutritionist in the Daily Mirror,

"2001-eko ikerketa australiar batek

oliba olioak, fruta, berdura eta lekaleekin konbinatuz

our second-biggest selling newspaper.

azaleko zimurrak saihesten dituela aurkitu du".

"An Australian study in 2001 found that olive oil,

Gero gomendio hau egiten du:

in combination with fruits, vegetables and pulses,

"Oliba olioa eta berdurak janez, zimur gutxiago izango dituzu".

offers measurable protection against skin wrinklings,"

Eta argitalpena non topatu esaten digute.

and give the advice:

Eta irakurtzean behaketa ikerketa aurkitzen dugu.

"If you eat olive oil and vegetables, you'll have fewer wrinkles."

Noski, inork ezin izan du

They helpfully tell you how to find the paper,

1930. urtera itzuli,

and what you find is an observational study.

jaiotako jende guztia maternitate unitate batean ipini,

Obviously, nobody has been able to go back to 1930,

eta erdiei fruta, berdura eta oliba olioa eman,

get all the people born in one maternity unit,

eta beste erdiak McDonald's-era eraman,

and half of them eat lots of fruit and veg and olive oil,

eta gero zanbat zimur dituzten neurtu.

Egun jendea nolakoa den aztertu behar duzu.

half of them eat McDonald's,

and then we see how many wrinkles you've got later.

Eta noski, zera ikusten duzu,

berdura eta oliba olioa jaten dutenek azaleko zimur gutxiago dituztela.

You have to take a snapshot of how people are now.

And what you find is, of course:

Baina hori, berdura eta oliba olioa hartzen dutenak

people who eat veg and olive oil have fewer wrinkles.

frikiak direlako da, ez dira normalak zuek bezalakoak dira;

But that's because people who eat fruit and veg and olive oil are freaks --

honelakoetara etortzen dira.

they're not normal, they're like you; they come to events like this.

Dotoreak dira, osasuntsuak, kanpoan lan egiteko probabilitate txikiagoa dute,

eskulanak egiteko probabilitate gutxiago,

(Laughter)

They're posh, they're wealthy, less likely to have outdoor jobs,

laguntza sozial gehiago dute, erretzaileak izateko aukera gutxiago...

beraz, hainbat arrazoi liluragarri,

less likely to do manual labor,

they have better social support, are less likely to smoke;

sozial, politiko eta kulturalen ondorioz,

azaleko zimurrak edukitzeko aukera gutxiago dituzte.

for a host of fascinating, interlocking

Honek ez du esan nahi berdurak eta oliba olioa direnik.

social, political and cultural reasons,

(Barreak)

they're less likely to have wrinkles.

Idealki esperimentu bat egin beharko litzateke.

That doesn't mean it's the vegetables or olive oil.

(Laughter)

Denok uste dugu esperimentuen ideia ezaguna dugula.

So ideally, what you want to do is a trial.

Esperimentuak oso zaharrak dira. Lehena Biblian -- Daniel 1:12

People think they're familiar with the idea of a trial.

Oso sinplea da -- jendea hartu, bitan zatitu,

Trials are old; the first one was in the Bible, Daniel 1:12.

talde bakoitza era batera tratatu

eta beranduxeago jarraipena egin

It's straightforward: take a bunch of people, split them in half,

eta bakoitzari zer gertatu zaion ikusi.

treat one group one way, the other group, the other way.

Esperimentu batez hitz egingo dizuet,

A while later, you see what happened to each of them.

ziuraski esperimentu ezagunena dena

behintzat EB-ko medioetan azken hamarkadan.

I'm going to tell you about one trial,

Arrain pilulen esperimentua.

which is probably the most well-reported trial

Ondorioa arrain pilulek eskola errendimendua eta jokabidea hobetezen dituztela izan zen

in the UK news media over the past decade.

haurren gehiengoan.

This is the trial of fish oil pills.

Eta zioten: "Esperimentu bat egin dugu.

The claim: fish oil pills improve school performance and behavior

Aurreko esperimentuak positiboak izan ziren, badakigu hau ere hala izango dela."

in mainstream children.

Honek alarmak piztu beharko lituzke.

They said, "We did a trial.

All the previous ones were positive, this one will be too."

Esperimentuaren erantzuna badakizu, ez zenuke berau egin behar.

That should ring alarm bells:

Edo disenua trukatuta dago,

if you know the answer to your trial, you shouldn't be doing one.

edo informazio nahikoa dago eta ez dago aleatorizazio beharrik.

Either you've rigged it by design,

Esperimentuan zera egitera zihoazen:

or you've got enough data so there's no need to randomize people anymore.

3.000 haur hartu,

So this is what they were going to do in their trial:

pilula handi batzuk eman,

They were taking 3,000 children,

6 eguneko,

they were going to give them these huge fish oil pills, six of them a day,

eta, urte bete beranduago, eskola errendimendua ebaluatu,

eta errendimendu hori konparatu

and then, a year later, measure their school exam performance

pilulak hartu ez balituzte, haur horiek izango zuten errendimenduarekin

and compare their performance

against what they predicted their exam performance would have been

Norbaitek diseinu honetan akatsik ikus dezake?

if they hadn't had the pills.

Saiakera klinikoko metodologia irakasleak, mesedez ez erantzun.

Now, can anybody spot a flaw in this design?

(Laughter)

And no professors of clinical trial methodology

Ez dago kontrolik; ez kontrol talderik.

are allowed to answer this question.

Baina horrek teknikoa dirudi.

So there's no control group.

Kontzeptu tekniko bat da.

But that sounds really techie, right? That's a technical term.

Haurrek pilulak hartu eta errendimendua hobetu zen.

Zer izango zen pilulak ez baziren?

The kids got the pills, and their performance improved.

Hazi egin ziren. Guztiok uneoro garatzen goaz.

What else could it possibly be if it wasn't the pills?

Noski, plazebo efektua ere hor dago.

They got older; we all develop over time.

Plazebo efektua medikuntzako gauza txundigarrienetakoa da.

And of course, there's the placebo effect,

Ez da pilulak hartu eta errendimendua eta mina hobetzeari buruz soilik.

one of the most fascinating things in the whole of medicine.

Gure uste eta itxaropenei buruz da.

It's not just taking a pill and performance or pain improving;

Tratamenduaren esanahi kulturalari buruz.

Eta hau, ikerketa multzo handi batean frogatu da,

it's about our beliefs and expectations, the cultural meaning of a treatment.

plazebo bat eta bestea konparatuz.

And this has been demonstrated in a whole raft of fascinating studies

Esaterako, eguneko bi azukre pilula,

comparing one kind of placebo against another.

tratamendu eraginkorragoa da urdaileko ultzera tratatzeko

So we know, for example,

azukre pilula bat baino.

that two sugar pills a day are a more effective treatment

Bi pilulak pilula bati irabazten diote.

for gastric ulcers

Aurkikuntza hau barregarria da, baina egia da.

than one sugar pill.

Two sugar pills a day beats one a day.

Hiru ikerketek, hiru min mota aztertu eta ondorioztatu dute

That's an outrageous and ridiculous finding, but it's true.

ur gazidun injekzioa minaren tratamenduan eraginkorragoa dela

We know from three different studies on three different types of pain

azukre pilula baino, sendagairik ez duen pilula baino --

that a saltwater injection is a more effective treatment

ez injekzioak edo pilulek gorputzari fisikoki eragiten diotelako,

than a sugar pill, a dummy pill with no medicine in it,

injekzioak eskuhartze indartsuagoa dirudielako baizik.

not because the injection or pills do anything physically to the body,

Badakigu gure uste eta itxaropenak

but because an injection feels like a much more dramatic intervention.

manipulatuak izan daitezkeela,

horregatik egiten ditugu esperimentu hauek

So we know that our beliefs and expectations can be manipulated,

plazeboa kontrolatuz --

which is why we do trials where we control against a placebo,

pertsonen erdiek benetako tratamendua jasotzen dutelarik

eta beste erdiak plazeboa.

where one half of the people get the real treatment,

Baina ez da nahikoa.

and the other half get placebo.

Hauek adibide soilak dira, eta zera erakusten dute

But that's not enough.

kazetariek eta elikagai-osagarrien saltzaileek

What I've just shown you are examples

eta naturopatek

of the very simple and straightforward ways

ebidentziak euren nahierara desitxuratu ditzaketela.

that journalists and food supplement pill peddlers and naturopaths

Benetan txundigarria dena zera da

can distort evidence for their own purposes.

industria farmazeutikoak

What I find really fascinating

truko eta gailu berdinak darabiltzala,

is that the pharmaceutical industry uses exactly the same kinds

edo hauen bertsio sofistikatuagoak,

of tricks and devices,

mediku eta pazienteei emandako ebidentziak desitxuratzeko.

but slightly more sophisticated versions of them,

Ebidentzia hauetan oinarrituz erabaki garrantzitsuak hartzen ditugu.

in order to distort the evidence they give to doctors and patients,

Lehendabizi, plazebodun esperimentuak:

and which we use to make vitally important decisions.

uste dugu badakigula esperimentuak nolakoa izan behar duen:

So firstly, trials against placebo:

medikamentu berriaren eta plazeboaren arteko konparaketa.

Baina hau ez da zuzena hainbat kasutan.

everybody thinks a trial should be a comparison

Askotan jada badaukagu eskuragarria den tratamendu eraginkor bat,

of your new drug against placebo.

But in a lot of situations that's wrong;

beraz ez dugu jakin nahi tratamendu berria

often, we already have a good treatment currently available.

ezer ez baino hobea den.

Daukagun tratamendu hoberena baino hobea den jakin nahi dugu.

So we don't want to know that your alternative new treatment

Eta, hala ere, etengabe ikusten ditugu esperimentuak

is better than nothing,

but that it's better than the best available treatment we have.

plazeboarekin konparatzen direnak.

And yet, repeatedly, you consistently see people doing trials

Eta zure medikamentua merkaturatu dezakezu

ezer ez baino hobea dela dioten datuak lortuz gero.

still against placebo.

And you can get licensed to bring your drug to market

Datu hauek ez dute balio ni bezalako medikuak erabakiak hartzerakoan.

with only data showing that it's better than nothing,

Hau ez da datuekin iruzur egiteko modu bakarra.

which is useless for a doctor like me trying to make a decision.

Iruzur egin dezakezu,

zure medikamentu berria konparatzen duzun gauza hori

But that's not the only way you can rig your data.

ezereza bihurtuz.

You can also rig your data

Beste medikamentua oso dosi txikian emanez

by making the thing you compare your new drug against

eta beraz tratamendu ezeraginkorra emanez.

really rubbish.

You can give the competing drug in too low a dose,

Beste medikamentua oso dosi altuan emanez,

eta bigarren mailako efektuak sortuz.

so people aren't properly treated.

Eta hauxe gertatu zen

You can give the competing drug in too high a dose,

eskizofrenia tratatzeko antipsikotikoekin.

so people get side effects.

And this is exactly what happened

Duela 20 urte, antipsikotiko belaunaldi berri bat azaldu zen

with antipsychotic medication for schizophrenia.

bigarren mailako efektu gutxiago eragingo zituztela ziurtatzen.

Twenty years ago, a new generation of antipsychotic drugs were brought in;

Medikamentu horiekin esperimentuak egiten hasi ziren

the promise was they would have fewer side effects.

medikamentu zaharrekin alderatuz,

baina medikamentu zaharrak dosi izugarri altuetan emanaz --

So people set about doing trials of the new drugs against the old drugs.

20 mg haloperidol eguneko.

But they gave the old drugs in ridiculously high doses:

Eta ondorioa logikoa da,

medikamentua hain dosi altuan ematen baduzu,

20 milligrams a day of haloperidol.

medikamentu berriak baino 2.mailako efektu gehiago eragingo ditu.

And it's a foregone conclusion if you give a drug at that high a dose,

Duela 10 urte, gauza bera gertatu zen, kasualitatez,

it will have more side effects, and your new drug will look better.

risperidona, belaunaldi berriko lehen antipsikotikoa zena,

Ten years ago, history repeated itself,

copyright-etik atera zenean, edonork kopiatu zezakeenean.

when risperidone, the first of the new-generation antipsychotic drugs,

Denek euren medikamentua risperidona baino hobea zela erakutsi nahi zuten,

came off copyright, so anybody could make copies.

eta esperimentu mordoa hasi zen antipsikotiko berriak

Everybody wanted to show their drug was better than risperidone,

8mg risperidona eguneko dosiarekin konparatzen.

so you see trials comparing new antipsychotic drugs

Berriz, ez zen dosi kaltegarria edo ilegala

baina normala baino altuagoa zen.

against risperidone at eight milligrams a day.

Eta horrela zure medikamentu berriak hobea dirudi.

Again, not an insane dose, not an illegal dose,

but very much at the high end of normal.

Beraz ez da harritzekoa,

So you're bound to make your new drug look better.

industriak diruz lagundutako esperimentuek

And so it's no surprise that overall,

emaitza positiboak izateko lau aldiz aukera gehiago izatea

industry-funded trials are four times more likely

esperimentu independenteek baino.

to give a positive result

Baina -eta hau baina handi bat da-

than independently sponsored trials.

(Barreak)

But -- and it's a big but --

zera gertatzen da,

(Laughter)

industriak diruz lagundutako esperimentuen metodoa aztertzean,

it turns out,

benetan hobeak direla

when you look at the methods used by industry-funded trials,

esperimentu independenteak baino.

Eta hala ere, nahi dituzten emaitzak lortzen dituzte.

that they're actually better than independently sponsored trials.

Nola liteke?

And yet, they always manage to get the result that they want.

Nola azaldu gertaera bitxi hau?

So how does this work?

(Laughter)

Gertatzen dena zera da,

How can we explain this strange phenomenon?

datu negatiboak bidean galtzen direla;

Well, it turns out that what happens

medikuek eta pazienteek ezkutazen dituzte.

is the negative data goes missing in action;

Eta hau da gauzarik garrantzitsuena.

it's withheld from doctors and patients.

Ebidentziaren piramidearen goian dago.

And this is the most important aspect of the whole story.

Tratamendu baten inguruko datu guztiak behar ditugu

It's at the top of the pyramid of evidence.

benetan eraginkorra den edo ez jakiteko.

We need to have all of the data on a particular treatment

Bi modu daude jakin ahal izateko

datuak bidean galdu ote diren.

to know whether or not it really is effective.

Estatistika erabili dezakezu, edo istorioak erabili ditzakezu.

There are two different ways you can spot whether some data has gone missing.

Estatistikak nahiago ditut, beraz horiekin hasiko nahiz.

You can use statistics or you can use stories.

Inbutu grafikoa deritzona dago.

I prefer statistics, so that's what I'll do first.

Eta inbutu grafikoarekin jakin dezakezu

This is a funnel plot.

esperimentu txiki negatiboak desagertu, bidean galdu diren.

A funnel plot is a very clever way of spotting

Hau tratamendu baten inguruko esperimentuen grafikoa da.

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.

Grafikoaren goiko muturrerantz joanez,

puntu bakoitza esperimentu bat da.

As you go up towards the top of the graph,

Goraka goazela, esperimentuak handiagoak dira, errore txikiagoa dute.

what you see is each dot is a trial.

Zoriz faltsu positibo edo negatiboak izateko aukera txikiagoa dute.

As you go up, those are bigger trials, so they've got less error;

Guztiak batera biltzen dira.

they're less likely to be randomly false positives or negatives.

Esperimentu handiak benetako erantzunetik gertuago daude.

So they all cluster together.

Beheraka bagoaz, beheko muturrera

The big trials are closer to the true answer.

alde honetan gezurrezko faltsu negatiboak ikus daitezke,

Then as you go further down at the bottom,

eta alde honetan, gezurrezko faltsu positiboak.

what you can see is, on this side, spurious false negatives,

Argitaratze alborapena baldin badago,

and over on this side, spurious false positives.

esperimentu txiki negatiboak bidean galdu badira,

If there is publication bias,

horrelako grafikoetan ikus daiteke.

if small negative trials have gone missing in action,

Hemen ikus dezakezu, esperimentu negatibo txikiak

you can see it on one of these graphs.

beheko ezkerreko aldean egon beharko luketenak desagertu direla.

So you see here that the small negative trials

Grafiko honek argitaratze alborapena frogatzen du

that should be on the bottom left have disappeared.

argitaratze alborapenen ikerketa batean.

This is a graph demonstrating the presence of publication bias

Eta uste dut, inoizko epidemiologiari buruzko txisterik onena dela.

in studies of publication bias.

Horrela frogatzen da estatistikoki.

And I think that's the funniest epidemiology joke you will ever hear.

Baina, eta istorioen bidez?

(Laughter)

Beno, ankerrak dira, benetan.

That's how you can prove it statistically.

Hau reboxetina izeneko medikamentua da.

But what about stories?

Well, they're heinous, they really are.

Nik neuk pazienteei eman diedan medikamentu bat.

This is a drug called reboxetine.

Eta oso mediku ikastuna nahiz.

This is a drug which I, myself, have prescribed to patients.

Ahal beste bibliografia irakurri eta ulertzen saiatzen naiz.

And I'm a very nerdy doctor.

Honen inguruko esperimentuak irakurri nituen. Positiboak ziren, ongi eginak.

I hope I go out of my way

to try and read and understand all the literature.

Ez nuen akatsik aurkitu.

I read the trials on this.

Zoritxarrez,

They were all positive, all well-conducted.

esperimentuetako asko ezkutatuta zeuden.

I found no flaw.

Izatez medikamentu horrekin egindakoen %76

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

mediku eta pazienteek ezkutatu egin zuten.

Pentsatzen jartzen bagara,

txanpon bat ehun aldiz botako banu,

were withheld from doctors and patients.

eta datuak ezkutatu baditzaket

Now if you think about it,

if I tossed a coin a hundred times,

demagun kasuen erdietan,

and I'm allowed to withhold from you the answers half the times,

konbentzitu ahalko zintuzket

daukadan txanpona bi burukoa dela.

then I can convince you that I have a coin with two heads.

Datuen erdia kentzen badugu,

ezingo dugu medikamentuen benetako efektua zein den jakin.

If we remove half of the data,

Eta hau ez da istorio isolatu bat.

we can never know what the true effect size of these medicines is.

Depresioaren aurkakoen esperimentuen erdiak ezkutatu egin dira,

And this is not an isolated story.

eta haratago doa.

Around half of all of the trial data on antidepressants has been withheld,

Nordic Cochrane taldea datu horiek lortzen saiatu da

guztiak biltzeko.

but it goes way beyond that.

The Nordic Cochrane Group were trying to get ahold of the data on that

Cochrane taldeak irabazi asmorik gabeko nazioarteko kolaborazioak dira

to bring it all together.

argitaratutako datuen errebisio sistematikoak egiten dituztenak.

The Cochrane Groups are an international nonprofit collaboration

Esperimentuetako datu guztiak behar dituzte.

that produce systematic reviews

of all of the data that has ever been shown.

Baina elkarteek datu hauek ezkutatu egiten dizkiete,

And they need to have access to all of the trial data.

baita Europako Medikamentuen Elkarteak ere

But the companies withheld that data from them.

hiru urtez.

So did the European Medicines Agency --

Hau oraindik konponbiderik ez duen arazoa da.

for three years.

Garrantzia ikusteko, bada Tamiflu izeneko medikamentu bat,

This is a problem that is currently lacking a solution.

mundu guztiko gobernuek

And to show how big it goes, this is a drug called Tamiflu,

bilioika eta bilioika dolar gastatu dituzte Tamifluan.

which governments around the world

Diru hau gastatu dute, zera ziurtatuz

have spent billions and billions of dollars on.

Tamifluak gripearen konplikazio tasak jaitsiko dituela.

And they spend that money on the promise that this is a drug

Datuak baditugu, eta zera diote

which will reduce the rate of complications with flu.

gripearen iraupena txikiagotzen duela ordu gutxi batzuez.

Baina horrek berdin dit. Gobernuei berdin die.

We already have the data

showing it reduces the duration of your flu by a few hours.

Sentitzen dut gripea baduzu, badakit txarra dela,

But I don't care about that, governments don't care.

baina ez ditugu bilioika dolar gastatuko

I'm sorry if you have the flu, I know it's horrible,

zure gripearen sintomak gutxiagotzeko

egun erdiz.

but we're not going to spend billions of dollars

Medikamentu hauek hartzeko agintzen dugu, larrialdietarako gordetzen ditugu

trying to reduce the duration of your flu symptoms by half a day.

konplikazioak gutxituko dituztelakoan,

We prescribe these drugs.

hau da, neumoniak eta heriotzak.

We stockpile them for emergencies

on the understanding they'll reduce the number of complications,

Infekzio gaixotasunen Cochrane taldeak, Italian kokatzen direnak,

which means pneumonia and death.

zera lortzen saiatu dira

The infectious diseases Cochrane Group, which are based in Italy,

farmazeutiken informazio oso eta erabilgarria

has been trying to get the full data in a usable form

erabaki eztabaidaezinak hartu ahal izateko

medikamentuaren eraginkortasunari buruz,

out of the drug companies,

so they can make a full decision

eta ezin izan dute informazio hori lortu.

about whether this drug is effective or not,

Hau da ezbairik gabe

and they've not been able to get that information.

egun medikuntzak duen arazo etiko handiena.

This is undoubtedly the single biggest ethical problem

Ezin ditugu erabakiak hartu

facing medicine today.

informazio guztia ez badaukagu.

We cannot make decisions in the absence of all of the information.

Zail xamarra egiten da hemendik

ondorio positiboak ateratzea.

So it's a little bit difficult from there

to spin in some kind of positive conclusion.

Baina hau esango nizueke:

uste dut eguzkiaren argia

But I would say this:

desinfektatzaile handiena dela.

I think that sunlight

Gauza hauek guztiak begi bistan gertatzen ari dira,

is the best disinfectant.

eta guztiak babestuta daude,

All of these things are happening in plain sight,

monotoniak babesten ditu.

and they're all protected by a force field of tediousness.

Uste dut zientzietako arazo guztietan

egin daitekeen gauzarik hoberenetako bat

And I think, with all of the problems in science,

tapa altxatzea dela,

ezkutuko mekanismoak aztertu ahal izateko.

one of the best things that we can do

is to lift up the lid, finger around at the mechanics

Mila esker.

(Txaloak)

and peer in.

Thank you very much.

(Applause)