Ben Goldacre: Battling Bad Science

Prevodilac: Jelena Nedjic Lektor: Ana Zivanovic-Nenadovic

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

Ja sam doktor, ali sam nekako zalutao u istraživačku oblast

and now I'm an epidemiologist.

i sada sam epidemiolog.

And nobody really knows what epidemiology is.

I niko u principu ne zna šta je epidemiologija.

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

To je nauka koja nas uči šta je u stvarnom svetu

if something is good for you or bad for you.

zaista dobro ili loše za vas.

And it's best understood through example

I najbolje se razume kroz primer

as the science of those crazy, wacky newspaper headlines.

kao nauka o ovim ludim, zabavnim naslovima u novinama.

And these are just some of the examples.

A ovo su samo neki od primera.

These are from the Daily Mail.

Ovo je uzeto iz "Daily Mail"-a.

Every country in the world has a newspaper like this.

Svaka zamlja na svetu ima novine kao što su ove.

It has this bizarre, ongoing philosophical project

Poseduje ovaj čudan, filozofski projekat

koji se bavi podelom svih neživih stvari u svetu

of dividing all the inanimate objects in the world

na one koji ili uzrokuju ili štite od raka.

into the ones that either cause or prevent cancer.

Here are some of the things they said cause cancer:

Ovo su neke za koje je rečeno da uzrokuju rak:

divorce, Wi-Fi, toiletries and coffee.

razvod, "Wi-Fi", sredstva za higijenu i kafa.

Some things they say prevent cancer:

A ovo su neke od stvari koje deluju preventivno:

crusts, red pepper, licorice and coffee.

kore, crvena paprika, sladić i kafa.

So you can see there are contradictions.

Već i sami možete uočiti kontradiktornosti.

Coffee both causes and prevents cancer.

Kafa i uzrokuje i sprečava rak.

As you start to read on, you can see

Kada nastavite da čitate, uočićete

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

da tu možda postoji neka vrsta političke pozadine.

For women, housework prevents breast cancer,

Rad u kući štiti žene od raka dojke,

but for men, shopping could make you impotent.

a kupovina može muškarce učiniti impotentnim.

(Laughter)

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

Tako da znamo da moramo da počnemo

da analiziramo nauku koja stoji iza toga.

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

Ono što se ja nadam da ću vam pokazati

je da analiziranje sumnjivih tvrdnji,

analiziranje dokaza koji podržavaju sumnjive tvrdnje,

isn't a kind of nasty, carping activity;

nije neka vrsta zanovetajuće aktivnosti;

it's socially useful.

već je socijalno korisno,

But it's also an extremely valuable explanatory tool,

i veoma značajno

pomagalo za objašnjavanje.

because real science is about critically appraising the evidence

Jer prava nauka se bavi

kritičnom procenom dokaza iza tvrdnji drugih ljudi.

for somebody else's position.

To je ono što se dešava u akademskim časopisima.

That's what happens in academic journals,

it's what happens at academic conferences --

I na akademskim konferencijama.

Sesije pitanja i odgovora nakon prezentacija rezultata

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

su često vrlo oštre.

And nobody minds that; we actively welcome it.

To nikome ne smeta. Svi se raduju tome.

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

To je kao intelektualna sado-mazo aktivnost.

(Laughter)

Tako da ću vam ja objasniti glavne stvari,

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

glavne karakteristike discipline kojom se bavim -

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

a to je medicina zasnovana na dokazima.

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

Pokazaću vam sve to

i demonstrirati kako to funkcioniše,

exclusively using examples of people getting stuff wrong.

isključivo koristeći primere ljudi koji stvari shvataju pogrešno.

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

Počećemo od najslabijeg tipa dokaza poznatog čovečanstvu,

and that is authority.

a to je autoritet.

U nauci, nas ne interesuje koliko titula imate iza svog imena.

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

U nauci, želimo da znamo iz kojih razloga vi verujete u nešto.

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

Kako vi znate da li je nešto dobro ili loše za nas?

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

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

Ali nismo impresionirani autoritetom,

zato što ga je lako izmisliti.

This is somebody called Dr. Gillian McKeith, PhD,

Ovo osoba se zove Dr. Džilijan MekKit,

ili, po punoj medicinkoj tituli, Džilijan MekKit.

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

(Smeh)

(Laughter)

Naravno, u svakoj zemlji postoji takva osoba.

Again, every country has somebody like this.

She is our TV diet guru.

Ona je naš TV-guru za ishranu.

She has five series of prime-time television,

Ona ima ogromne serijale na najboljim kanalima,

giving out very lavish and exotic health advice.

i daje veoma temeljne i egzotične savete o zdravlju.

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

Završila je neakreditovan doktorski kurs zasnovan na preprisci

negde u Americi.

from somewhere in America.

She also boasts that she's a certified professional member

A takođe se hvali da je sertifikovani profesionalni član

Američke asocijacije konsultanata za ishranu,

of the American Association of Nutritional Consultants,

which sounds very glamorous; you get a certificate.

što zvuči veoma glamurozno i uzbudljivo.

Dobijete sertifikat i sve što ide uz to.

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

Ovaj priprada mojoj preminuloj mački Heti. Bila je očajna mačka.

You go to the website, fill out the form,

Odete na sajt, ispunite formular,

give them $60, it arrives in the post.

platite 60$ i stiže vam poštom.

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

Ali to nije jedini razlog zašto mislimo da je ova osoba idiot.

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

Ona zastupa i mišljenja tipa:

treba da jedete puno tamno-zelenog lišća

they contain chlorophyll and really oxygenate your blood.

jer sadrži puno hlorofila, i on će oksidisati vašu krv.

And anybody who's done school biology remembers

Svako ko je imao časove biologije u školi

that chlorophyll and chloroplasts only make oxygen in sunlight,

se seća da hlorofil i hloroplasti

proizvode kiseonik samo na svetlosti,

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

a kada već pojedete spanać, u vašim crevima je mrak.

Next, we need proper science, proper evidence.

Dalje, neophodna je prava nauka, pravi dokazi.

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

"Crno vino sprečava nastanak raka dojke."

To je naslov u "Daily Telegraph"-u u Velikoj Britaniji.

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

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

"Čaša crnog vina dnevno može vas zaštiti od raka dojke."

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

A onda nađete naučni rad, i shvatite

da je to zaista prava nauka.

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

Opisuje promene u jednom enzimu

koje se dešavaju kada ubacite supstancu izolovanu iz kožice neke sorte grožđa

when you drip a chemical extracted from some red grape skin

na neke ćelije raka

onto some cancer cells

in a dish on a bench in a laboratory somewhere.

negde u laboratoriji, u plastičnoj posudi.

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

To je dobar fenomen za opisivanje u naučnom radu,

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

ali o pitanju o povezanosti vašeg ličnog rizika

za oboljenje od raka dojke i korišćenja crnog vina

if you drink red wine,

it tells you absolutely bugger all.

vam ne govori apsolutno ništa.

Actually, it turns out that your risk of breast cancer

U stvari, ispostavilo se da se rizik razvijanja raka dojki

increases slightly with every amount of alcohol you drink.

pomalo povećava sa svakom čašom alkohola koju popijete.

So what we want are studies in real human people.

Tako da ono što mi želimo su studije na ljudima.

And here's another example.

Ovo je još jedan primer.

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

Ovo je iz članka glavnog britanskog dijetetičara i nutricioniste

u "Daily Mirror"-u,

our second-biggest selling newspaper.

a to su druge najprodavanije novine u našoj zemlji.

"An Australian study in 2001 found that olive oil,

"Australijska studija iz 2001.

in combination with fruits, vegetables and pulses,

je pronašla da maslinovo ulje

u kombinaciji sa voćem, povrćem i vežbanjem

offers measurable protection against skin wrinklings,"

dovodi do značajne zaštite od pojave bora na koži."

and give the advice:

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

A onda vam daju savet:

"Ukoliko jedete maslinovo ulje i povrće, imaćete manje bora."

They helpfully tell you how to find the paper,

Kažu vam kako da pronađete originalan rad.

and what you find is an observational study.

Vi ga pronađete, i tu se radi o opisnoj studiji.

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

Očigledno niko nije u stanju

da se vrati u 1930,

get all the people born in one maternity unit,

okupi sve ljude koji su rođeni u istoj bolnici,

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

i podeli ih u jednu grupu koja jede puno voća, povrća i maslinovog ulja,

half of them eat McDonald's,

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

i drugu, koja se hrani u MekDonaldsu,

a mi potom pratimo koliko bora imaju kasnije.

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

Morate da fotkate kako ljudi izgledaju danas.

And what you find is, of course:

Potom, naravno, zaključite

people who eat veg and olive oil have fewer wrinkles.

da ljudi koji jedu sve to imaju manje bora.

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

Ali to je zbog toga što su oni

čudaci, oni nisu normalni, oni su kao vi,

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

oni dolaze na događaje kao što je ovaj.

(Laughter)

Oni su elegantni, bogati i manje je verovatno

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

da se bave poslovima na otvorenom prostoru,

less likely to do manual labor,

manja je verovatnoća da se bave fizičkim radom,

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

imaju bolju socijalnu podršku, manje je verovatno da puše -

for a host of fascinating, interlocking

tako da iz mnogo fascinirajućih, povezanih

social, political and cultural reasons,

socijalnih, političkih i kulturoloških razloga,

they're less likely to have wrinkles.

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

je manja verovatnoća da će imati bore.

(Laughter)

To ne znači da su razlog tome povrće ili maslinovo ulje.

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

Idealno, želite da obavite studiju.

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

Svi misle da su dobro upoznati sa konceptom studija.

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

Studije su veoma stare.

Prvo istraživanje datira iz perioda Biblije - Danijel 1:12.

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

Veoma je jasno - analizirate grupu ljudi, podeljenu u dve pod-grupe,

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

jedna dobije jedan tretman, a druga drugi tretman,

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

i nakon nekog vremena analizirate ih

I'm going to tell you about one trial,

i vidite šta im se desilo.

which is probably the most well-reported trial

Objasniću vam sada jednu studju,

koja je verovatno medijski najpropraćenija

in the UK news media over the past decade.

This is the trial of fish oil pills.

u Britaniji tokom protekle decenije.

Radi se o izučavanju efekata pilula ribljeg ulja.

The claim: fish oil pills improve school performance and behavior

Tvrdnja: riblje ulje poboljšava uspeh u školi

in mainstream children.

They said, "We did a trial.

i ponašanje kod prosečne dece.

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

Rekoše: "Uradili smo studiju.

Sve prethodne studije su dale pozitivne rezultate

That should ring alarm bells:

i znamo da će i ova biti pozitivna."

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

To je izjava koja zove na opreznost.

Either you've rigged it by design,

Jer ukoliko već znate odgovor, ne bi trebalo ni da radite studiju.

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

Ili nameštate rezultate studije dizajnom,

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

ili već imate dovoljno podataka, tako da nema potrebe da istražujete.

They were taking 3,000 children,

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

Evo šta su oni uradili.

Okupili su 3.000 dece,

i planirali su da im daju pilule ribljeg ulja, šest dnevno,

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

i godinu dana kasnije, bi analizirali njihove rezultate na školskim ispitima

and compare their performance

against what they predicted their exam performance would have been

i potom bi uporedili te rezultate

sa onima koje su očekivali da će dobiti

if they hadn't had the pills.

ukoliko nisu uzimali pilule.

Now, can anybody spot a flaw in this design?

Da li iko uočava grešku u ovom dizajnu?

(Laughter)

Ni jednom profesoru metodologije kliničkih studija

And no professors of clinical trial methodology

are allowed to answer this question.

nije dozvoljeno da odgovori na ovo pitanje.

So there's no control group.

Tu nema kontrole, ne postoji kontrolna grupa.

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

Zvuči poprilično tehnički.

To je tehnički izraz.

The kids got the pills, and their performance improved.

Klinci su uzimali pilule i njihovi rezultati u školi su se poboljšali.

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

Šta bi drugo mogao da bude uzrok tome osim pilula?

Oni su stariji. Mi se svi razvijamo tokom vremena.

They got older; we all develop over time.

And of course, there's the placebo effect,

Takođe, postoji tu i placebo efekat.

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

To je jedan od najfascinantnijih fenomena

u celokupnoj medicini.

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

Ne radi se samo o pozitivnom uticaju

pilula na vaše rezultate i bol koji osećate.

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

Tiče se i naših verovanja i očekivanja,

kulturološkog smisla tretmana.

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

A to je pokazano u čitavoji seriji fascinantnih studija

comparing one kind of placebo against another.

u kojima je jedan placebo upoređivan sa drugim.

So we know, for example,

Tako da znamo, na primer, da dve pilule šećera dnevno

that two sugar pills a day are a more effective treatment

imaju veći efekat na uklanjanje čireva na želucu

for gastric ulcers

than one sugar pill.

od jedne pilule dnevno.

Dve pilule sećera dnevno su efektnije od jedne dnevno.

Two sugar pills a day beats one a day.

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

To je nečuveno i smešno otkriće, ali je tačno.

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

Znamo na osnovu tri različite studije urađene na tri različite vrste bola

that a saltwater injection is a more effective treatment

da je injektiranje slane vode efektivniji tretman za tretiranje bola

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

u odnosu na pilulu šećera, na lažnu pilulu

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

bez ikakvih medicinskih svojstava -

ne zato što injekcija ili pilule dovode do nekih fizičkih promena u telu,

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

već zato što injekciju doživljavamo kao mnogo drastičniju intervenciju.

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

Dakle, znamo da naša verovanja i iščekivanja

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

mogu biti manipulisana

i zbog toga radimo studije

gde kontrolišemo efekat placeba -

where one half of the people get the real treatment,

u kojima jedna polovina ljudi dobija pravi tretman,

and the other half get placebo.

But that's not enough.

a druga placebo.

Ali to nije dovoljno.

What I've just shown you are examples

Ono što sam vam upravo pokazao su primeri veoma jednostavnih načina

of the very simple and straightforward ways

pomoću kojih novinari i prodavci suplemenata hrani

that journalists and food supplement pill peddlers and naturopaths

i naturopate

can distort evidence for their own purposes.

mogu da izmene dokaze u svoje svrhe.

What I find really fascinating

Ono što mene zaista fascinira

is that the pharmaceutical industry uses exactly the same kinds

jeste da farmaceutska industrija

koristi upravo iste vrste trikova i izuma,

of tricks and devices,

ali malo sofisticiranije verzije,

but slightly more sophisticated versions of them,

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

ne bi li izobličila dokaze koje daju doktorima i pacijentima,

and which we use to make vitally important decisions.

i koje mi koristimo kako bismo doneli važne odluke.

So firstly, trials against placebo:

Prvo o studijama koje kontrolišu efekat placeba:

everybody thinks a trial should be a comparison

svi misle da znaju kako one treba da izgledaju -

of your new drug against placebo.

upoređivanje vašeg novog leka i efekta placeba.

But in a lot of situations that's wrong;

Ali u stvari je to u mnogim situacijama pogrešno.

often, we already have a good treatment currently available.

Jer već imamo veoma dobre dostupne lekove,

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

ne želimo da znamo da li je taj alternativni tretman

bolji ni od čega.

is better than nothing,

Želimo da znamo da li je bolji

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

od najboljeg tretmana koji trenutno postoji.

And yet, repeatedly, you consistently see people doing trials

A opet, iznova i iznova, vi stalno slušate o studijama

still against placebo.

koje koriste placebo kao komparator.

And you can get licensed to bring your drug to market

Možete dobiti i licencu da vaš lek pustite na tržište

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

samo sa podacima koji pokazuju da je tretman bolji ni od čega,

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

a to je beskorisno za doktora poput mene koji pokušava da donese odluku.

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

You can also rig your data

Ali to nije jedini način da namestite svoje rezultate.

by making the thing you compare your new drug against

Možete ih promeniti

really rubbish.

tako što komparator sa kojim upoređujete vaš novi lek

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

potpuno obezvredite.

Možete dati niže doze konkurentnog leka,

so people aren't properly treated.

tako da ne lečite ljude na pravi način.

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

A možete dati i preveliku dozu,

so people get side effects.

And this is exactly what happened

tako da ljudi pokažu mnogo kontraindikacija.

with antipsychotic medication for schizophrenia.

To se upravo desilo

u slučaju anti-psihotičkih lekova za šizofreniju.

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

Pre 20 godina, nova generacija anti-psihotičkih lekova se pojavila

the promise was they would have fewer side effects.

i obećavala je manje kontra-efekata.

Tako da su ljudi počeli sa izučavanjem tih novih lekova

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

i upoređivanjem istih sa starim,

But they gave the old drugs in ridiculously high doses:

ali su stare lekove primenjivali u smešno velikim dozama -

20 milligrams a day of haloperidol.

20mg haloperidola dnevno.

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

A odavno je poznato da ukoliko

primenite lek u visokim dozama,

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

doći će do više kontraindikacija i vaš novi lek će imati bolji efekat.

Interesantno je da se pre 10 godina istorija ponovila,

Ten years ago, history repeated itself,

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

kada je risperidonu,

a to je jedan od prvih lekova nove generacije anti-psihotika,

came off copyright, so anybody could make copies.

istekla licenca, tako da je svako mogao da ga sintetiše.

Everybody wanted to show their drug was better than risperidone,

Svi su želeli da dokažu da je njihov novi lek bolji od risperidona,

so you see trials comparing new antipsychotic drugs

tako da je došlo do gomile studija o novim anti-psihoticima

against risperidone at eight milligrams a day.

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

koji su upoređivani sa risperidonom u dozi od 8mg dnevno.

but very much at the high end of normal.

To nije luda doza leka, nije nezakonita,

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

ali jeste na gornjoj granici normale.

Tako da će sigurno vaš novi lek izgledati bolje.

And so it's no surprise that overall,

industry-funded trials are four times more likely

Tako da uopšteno gledajući nije iznenađujuće

što studije koje finansira industrija

to give a positive result

than independently sponsored trials.

imaju 4 puta više izgleda da dođu do pozitivnih rezultata

u odnosu na nezavisno sponzorisane studije.

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

Ali - i to je jedno veliko ali -

(Laughter)

(Smeh)

it turns out,

ispostavlja se,

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

da kada pogledate metode koje se koriste u studijama koje finansira industrija,

that they're actually better than independently sponsored trials.

one su u stvari bolje

u odnosu na nezavisno finansirane studije.

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

A opet, oni uvek uspeju da dođu do rezultata koji žele.

So how does this work?

Pa kako to funkcioniše?

(Laughter)

Kako bismo mogli da objasnimo ovaj čudan fenomen?

How can we explain this strange phenomenon?

Well, it turns out that what happens

Ispostavlja se da nekako

is the negative data goes missing in action;

negativni rezultati nestanu u akciji,

it's withheld from doctors and patients.

ne pokazuju se doktorima i pacijentima.

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

A to je najznačajniji momenat cele priče.

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

To je na vrhu piramide dokaza.

Neophodno je da imamo sve podatke o određenom tretmanu

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

kako bismo znali da li je zaista efektan.

to know whether or not it really is effective.

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

Postoje dva načina pomoću kojih možete uočiti

da li su neki podaci nestali u akciji.

You can use statistics or you can use stories.

Možete koristiti statistiku ili se oslanjati na priče.

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

Ja lično više volim statistiku, tako da ću to obrazložiti prvo.

This is a funnel plot.

Ovo je tzv grafik-levak.

A funnel plot is a very clever way of spotting

To je veoma pametan način da uočimo

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

da li su male studije sa negativnim rezultatima nestale tokom procesa.

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

Ovo je grafik svih studija

koje su sprovedene za određeni tretman.

As you go up towards the top of the graph,

Kako se penjete ka vrhu grafika,

what you see is each dot is a trial.

ono što vidite je da svaka tačka predstavlja jednu studiju.

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

Kako se krećete ka vrhu, ovo su velike studije, sa manje grešaka.

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

Manja je verovatnoća da su one slučajno lažno pozitivne ili negativne.

So they all cluster together.

Grupisane su zajedno.

The big trials are closer to the true answer.

Velike studije su bliže pravom odgovoru.

Then as you go further down at the bottom,

A onda kako se spuštate ka dnu grafika,

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

vidite, na ovoj strani grafika su lažno negativni,

and over on this side, spurious false positives.

a na ovoj strani su lažno pozitivni rezultati.

Ukoliko postoje određene sklonosti u objavljivanju studija,

If there is publication bias,

if small negative trials have gone missing in action,

ukoliko su male studije sa negativnim rezultatima nestale,

you can see it on one of these graphs.

možete to uočiti u jednom od ovih grafika.

So you see here that the small negative trials

Ovde možete videti da su male studije sa negativnim rezultatima

that should be on the bottom left have disappeared.

koje bi trebalo da su u donjem levom uglu, nestale.

This is a graph demonstrating the presence of publication bias

Ovaj grafikon pokazuje pristrasnost u publikacijama

in studies of publication bias.

u studijama o pristrasnosti u objavljivanju.

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

Ja mislim da je to najsmešnija šala u epidemiologiji koju ćete čuti.

(Laughter)

That's how you can prove it statistically.

Ovako to možete statistički pokazati,

But what about stories?

Well, they're heinous, they really are.

ali šta se dešava sa pričama?

E pa one su gnusne, zaista jesu.

This is a drug called reboxetine.

Ovo je lek reboksetin.

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

Ovaj lek sam ja prepisivao pacijentima.

A ja sam pravi doktor-štreber.

And I'm a very nerdy doctor.

I hope I go out of my way

Mislim da dajem sve od sebe da pročitam i razumem literaturu.

to try and read and understand all the literature.

Pročitao sam studije o tom leku. Sve su bile pozitivne.

I read the trials on this.

They were all positive, all well-conducted.

Bile su veoma dobro izvedene.

I found no flaw.

Nisam pronašao nijednu manu.

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

Na nesreću, ispostavilo se

da su mnoge studije bile povučene.

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

U stvari, 76% studija koje su ispitivale ovaj lek

nisu pokazane doktorima i pacijentima.

were withheld from doctors and patients.

Sada ako porazmislite o tome,

Now if you think about it,

if I tossed a coin a hundred times,

ukoliko bih ja bacio novčić 100 puta,

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

i ukoliko mi je dozvoljeno da sakrijem od vas

rezultate 50% bacanja,

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

onda mogu i da vas ubedim

da imam novčić sa dve glave.

If we remove half of the data,

Ukoliko sakrijemo polovinu podataka,

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

nikada nećemo znati koji je pravi efekat nekog leka.

A ova priča nije izuzetak.

And this is not an isolated story.

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

Otprilike polovina studija o anti-depresivima je nedostupna,

ali problem je mnogo veći od toga.

but it goes way beyond that.

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

"Nordic Cochrane Group" je pokušavala da dođe do podataka

to bring it all together.

kako bi sagledali celu sliku.

The Cochrane Groups are an international nonprofit collaboration

"Cochrane Groups" je neprofitna internacionalna kolaboracija

that produce systematic reviews

koja se bavi sistematskim pregledom svih podataka koji su ikada pokazani.

of all of the data that has ever been shown.

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

Neophodno je da oni imaju pristup svim podacima iz studija.

But the companies withheld that data from them.

Ali kompanije čine te rezultate nedostupnim,

So did the European Medicines Agency --

kao i Evropska medicinska agencija (EMA)

u periodu od tri godine.

for three years.

This is a problem that is currently lacking a solution.

Ovo je problem za koji trenutno ne postoji rešenje.

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

Kako bih vam dočarao njegove razmere, obajsniću vam priču o leku "Tamiflu",

which governments around the world

za koji su vlade širom sveta

have spent billions and billions of dollars on.

potrošile milijarde i milijarde dolara.

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

A potrošili su pare na osnovu obećanja

da ovaj lek smanjuje stopu

which will reduce the rate of complications with flu.

komplikacija povezanih sa gripom.

We already have the data

Već imamo podatke

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

koji pokazuju da smanjuje trajanje simptoma gripa za nekoliko sati.

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

Ali meni, ni vladama uopšte nije stalo do toga.

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

Žao mi je ako imate grip, znam da je to odvratno,

but we're not going to spend billions of dollars

ali mi nećemo potrošiti milijarde dolara

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

kako bismo smanjili trajanje simptoma vašeg gripa

za pola dana.

We prescribe these drugs.

Mi prepisujemo te lekove, čuvamo ih za hitne slučajeve

We stockpile them for emergencies

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

na osnovu saznanja da će umanjiti brojne komplikacije,

a to su upala pluća i smrt.

which means pneumonia and death.

Ogranak "Cochraine Group"-e za infektivne bolesti,

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

sa sedištem u Italiji, pokušavao je da dođe

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

do svih podataka u formatu dostupnom za analizu od kompanija

out of the drug companies,

so they can make a full decision

kako bi mogla da donesu odluku o tome

about whether this drug is effective or not,

da li je ovaj lek efektivan ili ne

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

i nije uspela da dođe do tih informacija.

This is undoubtedly the single biggest ethical problem

Ovo je bez ikakve sumnje

najveći etički problem

facing medicine today.

sa kojim se medicina danas suočava.

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

Mi ne možemo da donosimo odluke

ukoliko neke informacije nisu dostupne.

So it's a little bit difficult from there

Tako da je malo teško doći

to spin in some kind of positive conclusion.

do pozitivnog zaključka.

But I would say this:

Ali ja bih rekao sledeće:

I think that sunlight

mislim da je transparentnost

is the best disinfectant.

najbolje dezinfekciono sredstvo.

Sve ove stvari se dešavaju na očigled svih nas

All of these things are happening in plain sight,

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

i zaštićene su

silom monotonije.

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

Mislim da pored svih problema koji postoje u nauci,

jedna od najboljih stvari koje možemo da uradimo je

one of the best things that we can do

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

da podignemo poklopac,

sagledamo i razmotrimo problematiku koju smo tu uočili.

and peer in.

Thank you very much.

Hvala vam mnogo.

(Applause)

(Aplauz)