Ben Goldacre: Battling Bad Science

Translator: Klavdija Cernilogar Reviewer: Tilen Pigac - EFZG

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

Torej, sem zdravnik, ampak nekako sem pristal v raziskovanju

and now I'm an epidemiologist.

in sedaj sem epidemiolog.

And nobody really knows what epidemiology is.

Nihče zares ne ve, kaj je epidemiologija.

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

Epidemiologija je veda o tem, kako v resničnem svetu vemo,

if something is good for you or bad for you.

ali je za nas nekaj dobro ali slabo.

And it's best understood through example

In najlažje jo je razumeti skozi primere

as the science of those crazy, wacky newspaper headlines.

znanosti norih prismojenih časopisnih naslovov.

And these are just some of the examples.

In to je samo nekaj primerov.

These are from the Daily Mail.

Tile so iz Daily Maila. Vsaka država na svetu ima takšne časopise.

Every country in the world has a newspaper like this.

Ima ta bizarni, neprenehni filozofski projekt

It has this bizarre, ongoing philosophical project

delitve vseh neživih stvari na svetu

of dividing all the inanimate objects in the world

na tiste, ki povzročajo, in take, ki preprečujejo raka.

into the ones that either cause or prevent cancer.

Here are some of the things they said cause cancer:

Tule je nekaj stvari, ki naj bi po njihovih nedavnih trditvah povzročale raka:

ločitev, brezžični internet, kozmetika in kava.

divorce, Wi-Fi, toiletries and coffee.

Tule pa je nekaj stvari, za katere pravijo, da preprečujejo raka:

Some things they say prevent cancer:

skorja, rdeča paprika, sladki koren in kava.

crusts, red pepper, licorice and coffee.

Tu že lahko vidite, da obstajajo protislovja.

So you can see there are contradictions.

Kava povzroča in preprečuje raka.

Coffee both causes and prevents cancer.

In ko berete naprej, boste videli,

As you start to read on, you can see

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

da čez del tega morda visi nekakšna politična prevleka.

For women, housework prevents breast cancer,

Pri ženskah gospodinjsko delo preprečuje raka na dojki,

but for men, shopping could make you impotent.

moškega pa bi nakupovanje lahko naredilo impotentnega.

(Laughter)

Vemo torej, da moramo začeti

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

odkrivati znanost za vsem tem.

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

In kar bi rad pokazal,

je, da razkrivanje premetenih trditev,

razkrivanje dokazov za takimi trditvami,

isn't a kind of nasty, carping activity;

ni nekakšno umazano dlakocepstvo;

it's socially useful.

socialno koristno je,

But it's also an extremely valuable explanatory tool,

je pa tudi izjemno pomembno

orodje za razlago.

because real science is about critically appraising the evidence

Kajti pri pravi znanosti

gre za kritično ocenjevanje dokazov za stališča nekoga drugega.

for somebody else's position.

To se dogaja v akademskih revijah.

That's what happens in academic journals,

To se dogaja na akademskih konferencah.

it's what happens at academic conferences --

Seja z vprašanji in odgovori po predstavitvi poteka operacije

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

je pogosto pravi pokol.

And nobody minds that; we actively welcome it.

In to nikogar ne moti. To je dobrodošlo.

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

Podobno je privolitvi v intelektualni sadomazohizem.

(Laughter)

Kar vam bom pokazal,

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

so bistvene stvari,

bistveni elementi moje discipline --

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

medicine, utemeljene na dokazih.

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

Povedal vam bom o njih

in pokazal, kako delujejo,

exclusively using examples of people getting stuff wrong.

izključno skozi primere tega, kako ljudje napačno razumejo stvari.

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

Začnimo z najšibkejšo obliko dokaza, kar jih pozna človeštvo,

to je avtoriteta.

and that is authority.

V znanosti nas ne zanima, koliko črk imate za svojim imenom.

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

V znanosti hočemo vedeti, kateri so vaši razlogi za verjetje v določeno stvar.

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

Kako veste, da je nekaj za nas dobro

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

ali slabo?

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

Ampak avtoriteta nas pusti hladne tudi zato,

ker si jo je tako enostavno izmisliti.

This is somebody called Dr. Gillian McKeith, PhD,

Obstaja nekdo po imenu dr. Gillian McKeith, PhD,

ali, z njenim polnim medicinskim nazivom, Gillian McKeith.

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

(Smeh)

(Laughter)

Ponavljam, v vsaki državi obstajajo taki ljudje.

Again, every country has somebody like this.

Ona je naša gurujka TV diet.

She is our TV diet guru.

She has five series of prime-time television,

Ima pet ogromnih serij v osrednjem televizijskem terminu,

giving out very lavish and exotic health advice.

kjer daje pretirane in eksotične nasvete za zdravje.

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

Izkazalo se je, da ima doktorat na podlagi neakreditiranega tečaja na daljavo

nekje iz Amerike.

from somewhere in America.

She also boasts that she's a certified professional member

Hvali se tudi s tem, da je certificirana profesionalna članica

Ameriške zveze svetovalcev za prehrano,

of the American Association of Nutritional Consultants,

kar se sliši zelo glamurozno in vznemirljivo.

which sounds very glamorous; you get a certificate.

Dajo vam certifikat in vse to.

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

Tale pripada moji mrtvi mački Hetti. Grozna mačka je bila.

Enostavno greste na njihovo spletno stran, izpolnite obrazec,

You go to the website, fill out the form,

plačate 60 dolarjev in dobite ga po pošti.

give them $60, it arrives in the post.

To seveda ni edini razlog, zakaj mislimo, da je ta oseba neumna.

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

Tudi govori stvari, kot so:

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

jesti morate veliko temnozelenih listov,

they contain chlorophyll and really oxygenate your blood.

saj vsebujejo veliko klorofila in to bo dodalo kisik v vašo kri.

Toda vsak, kdor je v šoli imel biologijo, se bo spomnil,

And anybody who's done school biology remembers

da klorofil in kloroplasti

that chlorophyll and chloroplasts only make oxygen in sunlight,

proizvajajo kisik samo na sončni svetlobi,

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

v vašem prebavnem traktu pa je, potem ko ste pojedli špinačo, dokaj temno.

Potrebujemo pravo znanost, prave dokaze.

Next, we need proper science, proper evidence.

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

Torej, "rdeče vino pomaga preprečevati raka dojke."

To je naslov iz Daily Telegrapha v Veliki Britaniji.

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

"Kozarec rdečega vina na dan bi lahko preprečil raka dojke."

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

Torej, greste prebrat tale članek in dobite

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

pravi primerek znanosti.

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

Gre za opis sprememb v encimu,

when you drip a chemical extracted from some red grape skin

ko kemikalijo, odvzeto iz lupine rdeče grozdne lagode, kanete

na nekaj rakavih celic

onto some cancer cells

in a dish on a bench in a laboratory somewhere.

v posodici na klopci nekje v laboratoriju.

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

To je res uporabno za opis

v znanstvenem članku,

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

a na vprašanje o vašem osebnem tveganju,

da bi dobili raka na dojki, če pijete rdeče vino,

if you drink red wine,

vam ne pove popolnoma nič.

it tells you absolutely bugger all.

Pravzaprav se izkaže, da se vaše tveganje za raka dojke

Actually, it turns out that your risk of breast cancer

rahlo poveča

increases slightly with every amount of alcohol you drink.

z vsako enoto alkohola, ki jo popijete.

So what we want are studies in real human people.

Torej, kar želimo, so študije s pravimi ljudmi.

And here's another example.

In tu je še en primer.

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

Tale je last vodilne diete in britanskega strokovnjaka za prehrano iz Daily Mirrorja,

ki je časopis z drugo najvišjo naklado pri nas.

our second-biggest selling newspaper.

"Avstralska študija iz leta 2001

"An Australian study in 2001 found that olive oil,

je ugotovila, da olivno olje v kombinaciji s sadjem, zelenjavo in stročnicami

in combination with fruits, vegetables and pulses,

zagotavlja merljivo zaščito pred gubanjem kože."

offers measurable protection against skin wrinklings,"

In potem svetujejo:

and give the advice:

"Če jeste olivno olje in zelenjavo, boste imeli manj gubic."

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

In zelo prijazno vam povejo, kako pridete do članka.

They helpfully tell you how to find the paper,

Najdete ga in ugotovite, da je šlo za študijo z opazovanjem.

and what you find is an observational study.

Očitno nikomur ni uspelo

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

iti nazaj v leto 1930,

dobiti vseh ljudi iz določene porodnišnice,

get all the people born in one maternity unit,

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

polovica katerih bi jedla veliko sadja, zelenjave in olivnega olja,

druga polovica pa hrano iz McDonaldsa

half of them eat McDonald's,

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

in potem bi izmerili, koliko gubic bodo dobili čez leta.

Gre za trenutno sliko, kakšni so ljudje sedaj.

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

In seveda ugotovite tudi,

And what you find is, of course:

da imajo ljudje, ki jedo zelenjavo in olivno olje, manj gubic.

people who eat veg and olive oil have fewer wrinkles.

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

A to je zato, ker so ljudje, ki jedo sadje, zelenjavo in olivno olje,

pošasti, niso normalni, taki so kot ste vi,

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

prihajajo na dogodke, kakršen je tale.

(Laughter)

Elegantni so, bogati, manj verjetno je, da delajo zunaj,

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

manj verjetno je, da opravljajo fizična dela,

less likely to do manual labor,

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

imajo boljšo socialno podporo in manj verjetno je, da kadijo --

torej zaradi kupa očarljivih, povezanih

for a host of fascinating, interlocking

socialnih, političnih in kulturnih razlogov

social, political and cultural reasons,

obstaja manjša verjetnost, da imajo gubice.

they're less likely to have wrinkles.

To pa ne pomeni, da je tako zaradi zelenjave in olivnega olja.

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

(Smeh)

(Laughter)

V idealnem primeru torej hočete napraviti testiranje.

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

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

In vsi mislijo, da so dobro seznanjeni z idejo testiranja.

Testi so zelo stari. Prvi je bil v Svetem pismu -- Danijel 1:12.

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

Zelo neposreden je: vzamete skupino ljudi, jih razdelite na dva dela,

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

eno skupino obravnavate na en način, drugo pa na drugega

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

in malo kasneje jih preverite

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

in ugotovite, kaj se je z njimi zgodilo.

Povedal vam bom o testu,

I'm going to tell you about one trial,

ki je verjetno eden tistih, o katerih so v britanskih novicah

which is probably the most well-reported trial

v zadnjem desetletju največ poročali.

in the UK news media over the past decade.

In to je test o tabletah ribjega olja.

This is the trial of fish oil pills.

Trdili so, da tablete z ribjim oljem izboljšajo uspeh in obnašanje v šoli

The claim: fish oil pills improve school performance and behavior

pri povprečnih otrocih.

in mainstream children.

In rekli so: "Testirali smo jih.

They said, "We did a trial.

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

Vsi prejšnji testi so bili pozitivni in vemo, da bo tudi tale."

Take stvari bi vedno morale sprožiti alarm.

That should ring alarm bells:

Kajti če vnaprej poznate rezultat svojega testa, potem testa ne bi smeli opravljati.

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

Bodisi ste goljufali namenoma

Either you've rigged it by design,

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

bodisi imate dovolj podatkov, zato vam ni treba več delati naključnih vzorcev ljudi.

No, tole so želeli napraviti s svojim testom.

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

They were taking 3,000 children,

Vzeli so 3.000 otrok,

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

vsem so hoteli dati ogromne tablete z ribjim oljem,

po šest na dan,

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

in potem so nameravali leto dni kasneje izmeriti njihov uspeh pri izpitih

and compare their performance

ter ga primerjati

against what they predicted their exam performance would have been

s pričakovanim uspehom, ki bi ga otroci dosegli,

če ne bi jemali tablet.

if they hadn't had the pills.

Now, can anybody spot a flaw in this design?

Lahko kdo zazna zmoto v tem pristopu?

(Laughter)

In prosim, naj profesorji klinične metodologije testov

And no professors of clinical trial methodology

are allowed to answer this question.

ne odgovarjajo na to vprašanje.

So there's no control group.

Torej, ni kontrole, ni kotrolne skupine.

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

A to zveni precej tehnično.

Gre za tehnični izraz.

The kids got the pills, and their performance improved.

Otroci so dobili tablete in njihov uspeh se je izboljšal.

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

Kaj drugega kot tablete bi lahko bilo razlog za to?

Postali so starejši. Vsi se s časom razvijamo.

They got older; we all develop over time.

And of course, there's the placebo effect,

In seveda obstaja placebo učinek.

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

Placebo učinek je ena najbolj zanimivih stvari v vsej medicini.

Ne gre samo za jemanje tablete, kar povzroči, da se vaše delovanje izboljša in bolečina zmanjša.

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

Gre za verjetje in pričakovanja.

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

Gre za kulturni pomen zdravljenja.

In to so dokazale številne izjemne študije,

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

ki so primerjale različne vrste placeba med seboj.

comparing one kind of placebo against another.

So we know, for example,

Vemo, na primer, da sta dve tableti sladkorja na dan

that two sugar pills a day are a more effective treatment

bolj učinkovito zdravilo za čir na želodcu

for gastric ulcers

kot ena tableta sladkorja.

than one sugar pill.

Dve tableti sladkorja premagata eno.

Two sugar pills a day beats one a day.

To je nezaslišana in smešna stvar, a tako je.

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

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

Iz treh različnih študij na treh vrstah bolečine vemo,

da je injekcija slane vode bolj učinkovito zdravilo

that a saltwater injection is a more effective treatment

kot tableta sladkorja, tableta, v kateri ni zdravila --

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

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

ne zato, ker bi injekcija ali tableta imeli kak fizikalni vpliv na telo,

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

ampak zato, ker je injekcija bolj dramatična intervencija.

Vemo torej, da je z našimi verjetji in pričakovanji

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

mogoče manipulirati,

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

zato delamo teste,

kjer kontroliramo s placebom --

where one half of the people get the real treatment,

kjer polovica ljudi dobi pravo zdravilo,

and the other half get placebo.

druga polovica pa placebo.

But that's not enough.

A to še ni dovolj.

What I've just shown you are examples

Pravkar smo vam pokazali primere enostavnih in jasnih načinov,

of the very simple and straightforward ways

kako novinarji in krošnjarji s tabletami kot prehranskimi dopolnili

that journalists and food supplement pill peddlers and naturopaths

in mazači

can distort evidence for their own purposes.

lahko izkrivijo dokaze v svoje namene.

What I find really fascinating

Zdi se mi res fascinantno,

is that the pharmaceutical industry uses exactly the same kinds

kako farmacevtska industrija

uporablja popolnoma iste trike in pristope,

of tricks and devices,

le v malo bolj prefinjeni obliki,

but slightly more sophisticated versions of them,

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

da bi izkrivila dokaze, ki jih dobijo zdravniki in pacienti,

in katere uporabljamo za sprejemanje življenjsko pomembnih odločitev.

and which we use to make vitally important decisions.

So firstly, trials against placebo:

Torej, prvič, testi s placebom:

vsak misli, da bi test moral biti

everybody thinks a trial should be a comparison

primerjava novega zdravila s placebom.

of your new drug against placebo.

A v resnici je to v veliko primerih narobe.

But in a lot of situations that's wrong;

Kajti pogosto že obstaja dosegljivo dobro zdravljenje,

often, we already have a good treatment currently available.

zato nočemo, da bi bilo alternativno novo zdravljenje

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

boljše kot nič.

is better than nothing,

Hočemo vedeti, da je boljše od najboljšega trenutno dostopnega zdravljenja.

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

A vseeno, in vedno znova, stalno videvamo teste,

And yet, repeatedly, you consistently see people doing trials

ki se primerjajo s placebom.

still against placebo.

And you can get licensed to bring your drug to market

In licenco za trženje zdravila lahko dobite

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

že s podatki, ki kažejo, da je boljše kot nič,

kar je zame kot zdravnika, ki mora sprejeti odločitev, neuporabno.

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

A to ni edini način, kako lahko potvorite podatke.

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

To lahko storite tudi tako,

You can also rig your data

da za stvar, s katero primerjate svoje novo zdravilo,

by making the thing you compare your new drug against

vzamete nekaj res slabega.

really rubbish.

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

Konkurenčno zdravilo lahko date v prenizki dozi,

tako da ljudje ne dobijo pravilne terapije.

so people aren't properly treated.

Konkurenčno zdravilo lahko date v previsoki dozi,

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

tako da pride do stranskih učinkov.

so people get side effects.

And this is exactly what happened

In prav to se je zgodilo

with antipsychotic medication for schizophrenia.

z antipsihotikom za shizofrenijo.

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

Pred dvajsetimi leti je na trg prišla nova generacija antipsihotikov

in obljubljali so, da bodo imeli manj stranskih učinkov.

the promise was they would have fewer side effects.

Tako so se začeli testi tega novega zdravila

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

v primerjavi s starim,

But they gave the old drugs in ridiculously high doses:

a starega so dajali v absurdno visokih dozah --

20 miligramov haloperidola na dan.

20 milligrams a day of haloperidol.

In vnaprej je jasno,

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

da če date zdravilo v visoki dozi,

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

bo to imelo več stranskih učinkov in vaše novo zdravilo bo videti boljše.

Pred desetimi leti se je zgodovina ponovila, kako zanimivo,

Ten years ago, history repeated itself,

ko je risperidonu, prvemu antipsihotiku nove generacije,

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

potekla patentna zaščita in so ga vsi lahko kopirali.

came off copyright, so anybody could make copies.

Everybody wanted to show their drug was better than risperidone,

Vsi so hoteli pokazati, da je njihovo zdravilo boljše od risperidona,

in priča smo bili kupu testov, ki so nove antipsihotike primerjali

so you see trials comparing new antipsychotic drugs

z osmimi miligrami risperidona na dan.

against risperidone at eight milligrams a day.

Spet, ne gre za noro dozo, niti za ilegalno,

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

a zelo na meji normalnega.

but very much at the high end of normal.

Na ta način je bilo enostavno doseči, da vaše novo zdravilo izgleda boljše.

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

In nič presenetljivega ni, da v celoti

And so it's no surprise that overall,

industry-funded trials are four times more likely

testi, ki jih plača industrija,

štirikrat bolj verjetno dajo pozitivne rezultate

to give a positive result

than independently sponsored trials.

kot neodvisno opravljeni testi.

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

Ampak -- in gre za velik ampak --

(Laughter)

(Smeh)

izkaže se,

it turns out,

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

da ko pogledate metode, ki jih za teste uporablja industrija,

so te pravzaprav boljše

that they're actually better than independently sponsored trials.

od neodvisnih testov.

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

In vseeno uspejo priti do željenih rezultatov.

So how does this work?

Kako to deluje?

(Laughter)

Kako lahko pojasnimo ta nenavaden pojav?

How can we explain this strange phenomenon?

Well, it turns out that what happens

Izkaže se, da gre za to,

is the negative data goes missing in action;

da se negativni rezultati izgubijo,

it's withheld from doctors and patients.

da niso na voljo zdravnikom in pacientom.

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

In to je najpomembnejši vidik zgodbe.

Je na vrhu piramide dokazov.

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

Potrebujemo vse podatke o določenem zdravilu,

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

da bi vedeli, ali je dejansko učinkovito.

to know whether or not it really is effective.

Obstajata dva načina za ugotavljanje,

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

ali se je določen del podatkov "izgubil".

Lahko uporabite statistiko ali pa zgodbe.

You can use statistics or you can use stories.

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

Osebno imam raje statistiko, zato bom začel z njo.

This is a funnel plot.

Tole je nekaj, čemur pravim zgodba v lijaku.

A funnel plot is a very clever way of spotting

Gre za pameten način odkrivanja,

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

ali so majhni negativni testi izginili, so pogrešani v akciji.

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

Tole je graf vseh testov,

ki so bili narejeni na določenem zdravilu.

As you go up towards the top of the graph,

In ko greste proti vrhu grafa,

what you see is each dot is a trial.

vidite, da je vsaka točka posamezen test.

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

In ko greste navzgor, pridete do večjih testov in v njih je manj napak.

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

Tako so manj verjetno naključno napačno pozitivni, naključno napačni negativni.

So they all cluster together.

Vsi pridejo skupaj v grozd.

The big trials are closer to the true answer.

Večji testi so bližje pravemu odgovoru.

Then as you go further down at the bottom,

Ko potem greste navzdol,

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

lahko na tej strani vidite nepristne napačne negativne,

and over on this side, spurious false positives.

na tej strani pa nepristne napačne pozitivne.

Če obstaja pristranost pri objavi,

If there is publication bias,

če so se majhni negativni testi "izgubili",

if small negative trials have gone missing in action,

you can see it on one of these graphs.

lahko to vidite na enem od teh grafov.

So you see here that the small negative trials

Tule lahko vidite, da so majhni negativni testi,

that should be on the bottom left have disappeared.

ki bi morali biti levo spodaj, izginili.

Ta graf prikazuje prisotnost pristranske objave

This is a graph demonstrating the presence of publication bias

pri študijah o pristranski objavi.

in studies of publication bias.

In mislim, da je to najbolj smešna šala o epidemiologiji,

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

ki jo boste kdajkoli slišali.

(Laughter)

Tako torej lahko to dokažete s statistiko,

That's how you can prove it statistically.

kaj pa zgodbe?

But what about stories?

Well, they're heinous, they really are.

Gnusne so, prav zares.

This is a drug called reboxetine.

Tole je zdravilo reboksetin.

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

Sam sem ga predpisoval pacientom.

In sem zelo čudaški zdravnik.

And I'm a very nerdy doctor.

I hope I go out of my way

Upam, da se potrudim prebrati in razumeti vso literaturo.

to try and read and understand all the literature.

Prebral sem teste o tem. Vsi so bili pozitivni. Vsi so bili dobro opravljeni.

I read the trials on this.

They were all positive, all well-conducted.

Nisem našel napake.

I found no flaw.

Na žalost se je izkazalo,

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

da so veliko teh testov zamolčali.

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

V resnici so 76 odstotkov

vseh testov na tem zdravilu

zamolčali pred zdravniki in pacienti.

were withheld from doctors and patients.

Razmislite,

Now if you think about it,

if I tossed a coin a hundred times,

če stokrat vržete kovanec

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

in vam za polovico metov

lahko prikrijem rezultate,

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

potem vas lahko prepričam,

da imam kovanec z dvema glavama.

If we remove half of the data,

Če odstranimo polovico podatkov,

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

ne moremo vedeti, kakšen je pravi učinek teh zdravil.

In to ni osamljen primer.

And this is not an isolated story.

Okoli polovico testnih podatkov za antidepresive so zamolčali,

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

dogaja pa se še več.

but it goes way beyond that.

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

Nordic Cochrane Group je skušala dobiti podatke o tem

in vse sestaviti v celoto.

to bring it all together.

Cochrane Groups so mednarodna neprofitna zveza,

The Cochrane Groups are an international nonprofit collaboration

ki izvaja sistematski pregled vseh podatkov, ki so bili kdaj objavljeni.

that produce systematic reviews

of all of the data that has ever been shown.

In imeti morajo dostop do vseh testnih podatkov.

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

Vendar so podjetja prikrivala te podatke

But the companies withheld that data from them.

So did the European Medicines Agency --

in Evropska agencija za zdravila prav tako,

in to tri leta dolgo.

for three years.

This is a problem that is currently lacking a solution.

To je problem, za katerega trenutno ni rešitve.

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

Da vam pokažem, kako velik je, tole je zdravilo tamiflu,

which governments around the world

za katerega so vlade po svetu

have spent billions and billions of dollars on.

zapravile milijarde in milijarde dolarjev.

Ta denar so plačale zaradi obljube,

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

da bo to zdravilo zmanjšalo pojavnost

which will reduce the rate of complications with flu.

zapletov pri gripi.

Imamo že podatke,

We already have the data

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

ki kažejo, da zmanjša trajanje gripe za nekaj ur.

A to mene ne zanima. Vlade to ne zanima.

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

Zelo mi je žal, če imate gripo, vem da je grozna,

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

ampak ne bomo plačali milijard dolarjev za to,

but we're not going to spend billions of dollars

da bi vaše simptome gripe zmanjšali

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

za pol dneva.

We prescribe these drugs.

Ta zdravila predpisujemo, hranimo jih za nujne primere,

We stockpile them for emergencies

saj razumemo, da bodo zmanjšala raven zapletov,

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

kar pomeni pljučnico, kar pomeni smrt.

which means pneumonia and death.

Cochrane Group za infekcijske bolezni, ki ima sedež v Italiji,

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

se trudi od farmacevtskih podjetij dobiti

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

popolne podatke v uporabni obliki,

out of the drug companies,

da bi lahko sprejeli odločitev,

so they can make a full decision

about whether this drug is effective or not,

ali je to zdravilo učinkovito ali ne,

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

in doslej teh podatkov niso uspeli dobiti.

This is undoubtedly the single biggest ethical problem

To je brez dvoma

največji etični problem

facing medicine today.

današnje medicine.

Ne moremo sprejemati odločitev,

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

če nimamo celostnih informacij.

So it's a little bit difficult from there

Od tu je malo težko

to spin in some kind of positive conclusion.

priti do nekakšnega pozitivnega zaključka.

A rekel bi tole:

But I would say this:

I think that sunlight

mislim, da je sončna svetloba

is the best disinfectant.

najboljše razkužilo.

Vse te stvari se dogajajo vsem na očeh

All of these things are happening in plain sight,

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

in vse so zaščitene

s poljem počasnosti.

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

Mislim, da je od vseh težav v znanosti

ena najboljših stvari, kar jih lahko naredimo,

one of the best things that we can do

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

ta, da dvignemo pokrov,

povrtamo po mehaniki in pogledamo vanjo.

and peer in.

Hvala lepa.

Thank you very much.

(Applause)

(Aplavz)