Ben Goldacre: Battling Bad Science

Translator: Carme Paz Reviewer: Xusto Rodriguez

Eu son médico, pero inclineime pola investigación

e agora son epidemiólogo.

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

E ninguén sabe de certo que é a epidemioloxía.

and now I'm an epidemiologist.

A epidemioloxía é a ciencia que estuda como saber no mundo real

And nobody really knows what epidemiology is.

se algo é bo ou malo para nós.

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

Enténdese mellor a través dun exemplo:

if something is good for you or bad for you.

é a ciencia deses titulares tolos, absurdos, dos xornais.

And it's best understood through example

as the science of those crazy, wacky newspaper headlines.

Imos ver algúns exemplos.

Este é do Daily Mail. Todos os países teñen un xornal coma este.

And these are just some of the examples.

These are from the Daily Mail.

Ten o estraño proxecto filosófico

Every country in the world has a newspaper like this.

de dividir os obxectos inanimados do mundo

It has this bizarre, ongoing philosophical project

nos que causan cancro e nos que o preveñen.

of dividing all the inanimate objects in the world

Segundo eles, causan cancro:

into the ones that either cause or prevent cancer.

o divorcio, a rede sen fíos, os artigos de aseo e o café.

Here are some of the things they said cause cancer:

E preveñen o cancro:

a codia, o pemento vermello, a regalicia e o café.

divorce, Wi-Fi, toiletries and coffee.

Some things they say prevent cancer:

Como podedes ver, hai contradicións.

crusts, red pepper, licorice and coffee.

O café causa cancro e á vez preveno.

So you can see there are contradictions.

E cando comezades a ler vedes

que quizais haxa algún tipo de interese político por tras.

Coffee both causes and prevents cancer.

As you start to read on, you can see

Para as mulleres, o traballo doméstico causa cancro de mama

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

pero para os homes, comprar pode facelos impotentes.

For women, housework prevents breast cancer,

but for men, shopping could make you impotent.

Así que hai que comezar

descifrando a ciencia que hai aí detrás.

(Laughter)

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

E espero demostrar

que examinar afirmacións tan arriscadas,

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

examinar a evidencia que subxace a elas

non é rosmar con mala intención;

socialmente é útil,

isn't a kind of nasty, carping activity;

pero ademais é unha ferramenta explicativa

it's socially useful.

extremadamente valiosa.

But it's also an extremely valuable explanatory tool,

Porque a ciencia verdadeira consiste

na avaliación crítica das probas que avalan unha postura.

because real science is about critically appraising the evidence

Así se fai nas publicacións académicas.

for somebody else's position.

E nas reunións académicas.

As preguntas que seguen unha presentación de datos

That's what happens in academic journals,

it's what happens at academic conferences --

adoitan ser un baño de sangue.

E a ninguén lle importa. Gústanos.

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

É como unha actividade intelectual sadomasoquista consensuada.

And nobody minds that; we actively welcome it.

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

Así que vou amosarvos

as partes principais,

(Laughter)

as características principais da miña disciplina:

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

a medicina baseada en evidencias.

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

Explicaréivolas

e demostrareivos como funcionan

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

usando exclusivamente exemplos de xente que o fai mal.

Así que comezaremos coa forma máis débil de evidencia coñecida polo home:

exclusively using examples of people getting stuff wrong.

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

a autoridade.

Na ciencia, non nos importa cantos títulos tes.

and that is authority.

O que queremos é saber as túas razóns para crer en algo.

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

Como sabes que algo é bo

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

ou malo para nós?

Non nos impresiona a autoridade,

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

porque é tan fácil inventala...

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

Esta é a Dra. Gillian McKeith

ou, para darlle o seu título médico completo, Gillian McKeith.

This is somebody called Dr. Gillian McKeith, PhD,

(Risos)

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

En fin, todos os países teñen alguén así.

(Laughter)

É a nosa gurú mediática das dietas.

Again, every country has somebody like this.

Ten cinco programas de televisión en horario de máxima audiencia

She is our TV diet guru.

She has five series of prime-time television,

nos que dá consellos moi exóticos sobre saúde.

giving out very lavish and exotic health advice.

Resulta que ten un doutoramento non oficial por correspondencia,

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

de algures nos Estados Unidos.

Tamén se gaba de ser membro certificado

da Asociación Americana de Consultores Nutricionais,

from somewhere in America.

She also boasts that she's a certified professional member

que soa moi glamuroso e fascinante.

Danche un certificado e todo.

of the American Association of Nutritional Consultants,

Este é de Hetti, a miña defunta gata. Unha gata horrible.

which sounds very glamorous; you get a certificate.

Vas á web, enches o impreso,

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

dáslles 60 dólares e chégache por correo.

Pero esta non é a única razón para pensar que é idiota.

You go to the website, fill out the form,

give them $60, it arrives in the post.

Tamén vai e di cousas como

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

que deberiamos comer moita verdura verde escura

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

porque ten moita clorofila e iso osixena o sangue.

Calquera que estudara bioloxía na escola lembra

they contain chlorophyll and really oxygenate your blood.

que a clorofila e os cloroplastos

And anybody who's done school biology remembers

só producen osíxeno á luz do día

that chlorophyll and chloroplasts only make oxygen in sunlight,

e os intestinos están bastante escuros para as espinacas.

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

Seguimos. Precisamos ciencia e evidencia axeitadas.

"O viño tinto axuda a previr o cancro de mama."

Next, we need proper science, proper evidence.

Este é un titulardo Daily Telegraph do Reino Unido.

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

"Un vaso de viño tinto ao día axuda a previr o cancro de mama."

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

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

Pero collemos o xornal e descubrimos

que é un verdadeiro artigo científico.

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

É a descrición dos cambios nun enzima

ao colocar unha gota dun produto químico extraído da tona da uva tinta

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

when you drip a chemical extracted from some red grape skin

en células cancerosas

nunha mesa de laboratorio en algures.

onto some cancer cells

in a dish on a bench in a laboratory somewhere.

E esa é unha cousa moi útil para describir

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

nunha publicación científica,

pero en canto ao risco persoal

de ter cancro de mama se bebemos viño tinto,

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

non di nada.

En realidade, resulta que o risco de cancro de mama

if you drink red wine,

it tells you absolutely bugger all.

aumenta un pouco

Actually, it turns out that your risk of breast cancer

canto máis alcol bebemos.

increases slightly with every amount of alcohol you drink.

Queremos estudos feitos en xente real.

So what we want are studies in real human people.

Aquí hai outro exemplo

do destacado nutricionista británico do Daily Mirror,

And here's another example.

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

o noso segundo xornal máis vendido:

"Un estudo australiano do 2001 atopou

our second-biggest selling newspaper.

que o aceite de oliva combinado con froitas, vexetais e legumes

"An Australian study in 2001 found that olive oil,

protexe contra as engurras da pel."

in combination with fruits, vegetables and pulses,

E despois dános un consello:

offers measurable protection against skin wrinklings,"

"Se tomamos aceite de oliva e vexetais teremos menos engurras."

and give the advice:

E dinos como atopar a publicación.

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

Así que buscas o artigo e o que atopas é un estudo observacional.

They helpfully tell you how to find the paper,

Obviamente, ninguén puido ir a 1930,

and what you find is an observational study.

coller os bebés dunha maternidade,

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

facer que a metade comese moita froita, verduras e aceite de oliva

get all the people born in one maternity unit,

e a que outra metade comese McDonald's

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

e despois analizar as súas engurras.

half of them eat McDonald's,

Hai que facer unha mostraxe de como son as persoas agora.

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

E o que atopas, claro,

é que a xente que come verduras e aceite de oliva ten menos engurras.

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

And what you find is, of course:

Pero iso é porque a xente que come froita e aceite de oliva

people who eat veg and olive oil have fewer wrinkles.

é rara, non é normal, é coma vós;

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

veñen a eventos coma este.

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

Son elegantes, son ricos, traballan menos ao aire libre,

(Laughter)

fan menos traballos manuais,

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

teñen máis apoio social, fuman menos...

less likely to do manual labor,

así que por unha chea de fascinantes razóns,

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

sociais, políticas e culturais entrelazadas,

for a host of fascinating, interlocking

é menos probable que teñan engurras na pel.

social, political and cultural reasons,

Iso non significa que sexa polos vexetais e o aceite de oliva.

they're less likely to have wrinkles.

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

(Risos)

Entón, o ideal sería facer un ensaio.

(Laughter)

Todo o mundo cre que sabe que é un ensaio.

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

Os ensaios son moi antigos. O primeiro está na Biblia, Daniel 1:12.

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

É moi fácil, cóllese un grupo de xente, divídese en dous,

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

trátase un grupo dun xeito, e o outro, doutro,

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

e despois, fáiselles un seguimento

para ver que ocorre con cada un.

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

Así que vou falarvos dun ensaio

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

que foi probablemente o máis popular

nos medios británicos na pasada década.

I'm going to tell you about one trial,

which is probably the most well-reported trial

É o ensaio das pílulas de aceite de peixe.

in the UK news media over the past decade.

Dicíase que melloraban o rendemento escolar

This is the trial of fish oil pills.

e o comportamento na maioría dos nenos.

The claim: fish oil pills improve school performance and behavior

Dixeron: "Fixemos un ensaio.

Os anteriores foron positivos e sabemos que este tamén."

in mainstream children.

They said, "We did a trial.

Iso sempre debería facer soar unha alarma.

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

Porque se xa se sabe a resposta do ensaio non se debería facer.

That should ring alarm bells:

Ou está manipulado o deseño

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

ou xa hai datos dabondo, así que non é preciso probalo en máis persoas.

Either you've rigged it by design,

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

Isto é o que ían facer no seu ensaio.

Ían coller 3 000 nenos,

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

ían darlles unhas enormes pílulas de aceite de peixe,

They were taking 3,000 children,

seis ao día,

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

e un ano máis tarde, ían medir o rendemento escolar en exames

e comparar ese rendemento

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

co que eles calculaban que terían

and compare their performance

se non tomaran as pílulas.

against what they predicted their exam performance would have been

Pode ver alguén o punto fraco no deseño?

if they hadn't had the pills.

Se sodes profesores de metodoloxía de ensaios clínicos

Now, can anybody spot a flaw in this design?

non respondades esta cuestión.

(Laughter)

And no professors of clinical trial methodology

Non hai control; non hai ningún grupo de control.

are allowed to answer this question.

Pero isto soa moi técnico.

So there's no control group.

É un termo técnico.

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

Os rapaces tomaron as pílulas e o seu rendemento mellorou.

The kids got the pills, and their performance improved.

Que outra cousa podería ser senón as pílulas?

Medraron. Todos evolucionamos co tempo.

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

Por suposto, tamén está o efecto placebo,

They got older; we all develop over time.

que é unha das cousas máis fascinantes en medicina.

And of course, there's the placebo effect,

E non se trata só de tomar unha pílula e que mellore o rendemento e a dor.

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

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

Trátase das nosas crenzas e expectativas.

Do significado cultural dun tratamento.

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

E isto demostrouse nunha chea de estudos fascinantes

que comparaban un tipo de placebo con outro.

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

Sabemos, por exemplo, que 2 pílulas de azucre ao día

comparing one kind of placebo against another.

son máis efectivas para as úlceras gástricas

So we know, for example,

that two sugar pills a day are a more effective treatment

que unha soa pílula de azucre.

2 pílulas ao día son mellores que unha.

for gastric ulcers

than one sugar pill.

Ese é un achado estraño e ridículo, pero verdadeiro.

Two sugar pills a day beats one a day.

Sabemos por 3 estudos diferentes sobre 3 tipos de dor

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

que unha inxección de auga salgada é máis efectivo para a dor

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

que tomar unha pílula de azucre, unha pílula que non contén nada,

that a saltwater injection is a more effective treatment

non porque unha nin outra fagan algo fisicamente no corpo,

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

senón porque a inxección parece unha intervención máis drástica.

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

Sabemos que as nosas crenzas e expectativas

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

poden ser manipuladas,

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

por iso facemos ensaios

onde comparamos un control cun un placebo:

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

a metade da xente recibe o tratamento real

e a outra metade, o placebo.

where one half of the people get the real treatment,

Pero non abonda.

and the other half get placebo.

O que vos amosei son exemplos das formas sinxelas e directas

But that's not enough.

en que xornalistas e vendedores de suplementos dietéticos

What I've just shown you are examples

of the very simple and straightforward ways

e naturópatas

terxiversan as probas a favor dos seus propios intereses.

that journalists and food supplement pill peddlers and naturopaths

O que é realmente fascinante

can distort evidence for their own purposes.

é que a industria farmacéutica

What I find really fascinating

usa exactamente os mesmos trucos e instrumentos

is that the pharmaceutical industry uses exactly the same kinds

pero con versións lixeiramente máis sofisticadas

of tricks and devices,

para terxiversar as probas que lles dan a médicos e pacientes

but slightly more sophisticated versions of them,

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

e que usamos para tomar decisións vitais.

En primeiro lugar, o ensaio con placebos:

and which we use to make vitally important decisions.

todo o mundo pensa que un ensaio debería ser

So firstly, trials against placebo:

unha comparación entre un novo fármaco e un placebo.

everybody thinks a trial should be a comparison

Pero, realmente, moitas veces non é así

of your new drug against placebo.

porque a miúdo xa existe un bo tratamento

But in a lot of situations that's wrong;

así que non queremos saber se o novo tratamento alternativo

often, we already have a good treatment currently available.

é mellor que nada.

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

Queremos saber se supera o mellor dos tratamentos que xa temos.

is better than nothing,

E aínda así, de xeito repetido vemos xente

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

que fai ensaios contra o placebo.

And yet, repeatedly, you consistently see people doing trials

E pódese obter licenza para sacar un fármaco ao mercado

still against placebo.

só cuns datos que digan que é mellor que nada,

And you can get licensed to bring your drug to market

algo inútil para un médico coma min que intenta tomar unha decisión.

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

Pero non é a única forma de manipular os datos.

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

Tamén pode facerse comparando o novo fármaco

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

You can also rig your data

con algo inútil.

by making the thing you compare your new drug against

Pódese dar o fármaco competidor en dose moi baixa

really rubbish.

para que a xente non teña o tratamento adecuado.

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

Ou nunha dose moi alta

so people aren't properly treated.

para que produza efectos secundarios.

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

Isto foi talmente o que ocorreu

cos antipsicóticos para a esquizofrenia.

so people get side effects.

And this is exactly what happened

Hai 20 anos, apareceu unha nova xeración de antipsicóticos

with antipsychotic medication for schizophrenia.

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

coa promesa de que terían menos efectos secundarios.

Así que se comezaron a facer ensaios con eles

the promise was they would have fewer side effects.

comparándoos cos vellos

pero dábanse doses ridiculamente altas dos vellos fármacos

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

-20 mg ao día de haloperidol.

But they gave the old drugs in ridiculously high doses:

E é unha conclusión evidente

20 milligrams a day of haloperidol.

que se se dá un fármaco nunha dose tan alta

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

terá máis efectos secundarios e o novo parecerá mellor.

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

Hai 10 anos, repetiuse a historia

cando a risperidona, o primeiro antipsicótico da nova xeración,

Ten years ago, history repeated itself,

xa non tiña dereitos de autor, e podía reproducirse libremente.

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

Todos querían probar que o seu fármaco era mellor ca ela

came off copyright, so anybody could make copies.

así que houbo moitos ensaios que comparaban os novos antipsicóticos

Everybody wanted to show their drug was better than risperidone,

con 8 mg por día de risperidona.

so you see trials comparing new antipsychotic drugs

Outra vez, non é unha dose absurda, non é ilegal,

against risperidone at eight milligrams a day.

pero está moi cerca de superar o normal.

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

Así, seguro que o novo fármaco parecerá mellor.

but very much at the high end of normal.

Polo tanto, non sorprende que, en xeral,

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

os ensaios financiados pola industria

And so it's no surprise that overall,

teñan 4 veces máis probabilidades de dar un resultado positivo

industry-funded trials are four times more likely

que os independentes.

to give a positive result

than independently sponsored trials.

Pero -e este é un pero moi grande-

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

(Risos)

resulta que

(Laughter)

cando observas os métodos usados en ensaios financiados pola industria

it turns out,

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

ves que son realmente mellores

que os independentes.

that they're actually better than independently sponsored trials.

E, aínda así, sempre conseguen os resultados que queren.

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

Entón..., como pode ser?

(Risos)

Como podemos explicar este estraño fenómeno?

So how does this work?

(Laughter)

Ben, pois o que ocorre

How can we explain this strange phenomenon?

é que os datos negativos pérdense en combate;

Well, it turns out that what happens

non se revelan a médicos e pacientes.

is the negative data goes missing in action;

Este é o aspecto máis importante da historia.

it's withheld from doctors and patients.

Está no cume da pirámide de probas.

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

Precisamos ter todos os datos dun tratamento en concreto

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

para saber se é efectivo ou non.

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

E hai dous modos de ver

se algúns datos se perderon en combate.

to know whether or not it really is effective.

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

Pódense usar estatísticas ou historias.

Eu prefiro as estatísticas, así que empezarei por elas.

You can use statistics or you can use stories.

Isto é unha gráfica de funil.

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

É unha moi boa forma de identificar

This is a funnel plot.

se pequenos ensaios negativos desapareceron en combate.

A funnel plot is a very clever way of spotting

if small negative trials have disappeared, have gone missing in action.

Esta é unha gráfica de todas as probas

que se fixeron dun tratamento concreto.

This is a graph of all of the trials done on a particular treatment.

Ao observar a parte superior da gráfica

vese que cada punto é un ensaio.

As you go up towards the top of the graph,

E ao subir, estes son os ensaios máis grandes, con menos erros.

what you see is each dot is a trial.

É menos probable que dean falsos positivos ou falsos negativos.

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.

Así que todos se agrupan.

Os grandes ensaios están máis cerca da resposta real.

So they all cluster together.

Cando imos cara ao fondo,

The big trials are closer to the true answer.

o que vemos é, neste lado, os falsos negativos espurios

Then as you go further down at the bottom,

e, neste lado, os falsos positivos espurios.

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

Se hai un nesgo na publicación

and over on this side, spurious false positives.

se os pequenos ensaios negativos desapareceron,

If there is publication bias,

pódese ver nunha destas gráficas.

if small negative trials have gone missing in action,

Aquí pódese ver que os pequenos ensaios negativos

you can see it on one of these graphs.

que deberían estar abaixo á esquerda desapareceron.

So you see here that the small negative trials

Esta gráfica demostra a presenza de nesgos na publicación

that should be on the bottom left have disappeared.

en estudos sobre nesgos nas publicacións.

This is a graph demonstrating the presence of publication bias

E penso que esta é a broma epidemiolóxica

in studies of publication bias.

máis graciosa que escoitastes.

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

Así é como se proba estatisticamente, pero

que pasa coas historias?

(Laughter)

That's how you can prove it statistically.

Ben, son odiosas, abofé que si.

But what about stories?

Hai un fármaco chamado reboxetina.

Well, they're heinous, they really are.

É un medicamento que eu mesmo lles prescribín a pacientes.

This is a drug called reboxetine.

E son un médico moi aplicado.

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

Fago o posible por intentar ler e entender a bibliografía.

And I'm a very nerdy doctor.

I hope I go out of my way

Lin os ensaios sobre este fármaco. Todos positivos. Todos ben dirixidos.

to try and read and understand all the literature.

I read the trials on this.

Non atopei puntos febles.

They were all positive, all well-conducted.

Por desgraza, resultou

I found no flaw.

que moitos deses ensaios,

Unfortunately, it turned out, that many of these trials were withheld.

en realidade, o 76 %

dos que se fixeron con este fármaco

In fact, 76 percent of all of the trials that were done on this drug

ocultáronselles a médicos e pacientes.

Se o pensades,

se eu tiro unha moeda ao ar cen veces,

were withheld from doctors and patients.

e se me permite ocultar

Now if you think about it,

if I tossed a coin a hundred times,

o resultado a metade das veces,

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

podería convencervos

de que teño unha moeda de dúas caras.

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

Se eliminamos a metade dos datos,

nunca poderemos saber os verdadeiros efectos dese fármaco.

If we remove half of the data,

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

E isto non é unha historia illada.

Case a metade da información de ensaios con antidepresivos está oculta

And this is not an isolated story.

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

pero isto vai máis alá.

O Nordic Cochrane Group intentou acceder a esa información

but it goes way beyond that.

para agrupala.

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

Os Cochrane Groups son unha alianza internacional sen fin de lucro

to bring it all together.

que fai revisións sistemáticas de todos os datos que aparecen.

The Cochrane Groups are an international nonprofit collaboration

E precisan ter acceso a todos os datos dos ensaios.

that produce systematic reviews

of all of the data that has ever been shown.

Pero as compañías ocúltanlles esta información,

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

tal como fixo tamén a Axencia Europea de Medicamentos

But the companies withheld that data from them.

durante 3 anos.

So did the European Medicines Agency --

Este é un problema actualmente sen solución.

for three years.

This is a problem that is currently lacking a solution.

E para amosarvos o seu tamaño, velaquí un fármaco chamado Tamiflu,

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

en que os gobernos do mundo

gastaron miles e miles de millóns de dólares.

which governments around the world

E gastáronos coa promesa

have spent billions and billions of dollars on.

de que era un fármaco que reduciría a taxa

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

de complicacións da gripe.

Xa temos os datos

which will reduce the rate of complications with flu.

que din que reduce a duración da gripe nunhas horas.

We already have the data

Pero a min éme igual. E aos gobernos tamén.

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

Sinto que teñades a gripe, sei que é horrible,

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

pero non imos gastar miles de millóns de dólares

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

para intentar reducir a duración dos síntomas da túa gripe

but we're not going to spend billions of dollars

en medio día.

Prescribimos eses fármacos, acumulámolos para emerxencias

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

pensando que reducirían o número de complicacións,

We prescribe these drugs.

We stockpile them for emergencies

é dicir, pneumonía e morte.

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

O Cochrane Group de enfermidades infecciosas, con sede en Italia,

which means pneumonia and death.

intentou obter

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

das compañías farmacéuticas todos os datos nun formato usable

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

para poder decidir de forma concluínte

out of the drug companies,

se o fármaco é efectivo ou non

so they can make a full decision

e non foron capaces de conseguir esa información.

about whether this drug is effective or not,

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

Este é, sen dúbida,

o problema ético máis grande

This is undoubtedly the single biggest ethical problem

con que bate a medicina hoxe en día.

Non podemos tomar decisións

facing medicine today.

ao non termos toda a información.

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

Así que é un pouco difícil

So it's a little bit difficult from there

extraer algún tipo de conclusión positiva.

to spin in some kind of positive conclusion.

Pero eu diría isto:

But I would say this:

creo que a luz do sol

I think that sunlight

é o mellor desinfectante.

Todas estas cousas están ocorrendo diante dos nosos ollos,

is the best disinfectant.

e todas están protexidas

All of these things are happening in plain sight,

por un campo de forza de tedio.

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

E penso que, con todos os problemas da ciencia,

unha das mellores cousas que podemos facer

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

é levantar a tapa,

remexer nos mecanismos e osmar.

one of the best things that we can do

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

Moitas grazas.

(Aplausos)

and peer in.

Thank you very much.

(Applause)