Ben Goldacre: Battling Bad Science

翻译人员: Chunxiang Qian 校对人员: Yuanyuan Ji

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

我是名医生，又另起炉灶做研究

and now I'm an epidemiologist.

如今我是名流行病学家

And nobody really knows what epidemiology is.

没有人真正知道什么是流行病学

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

流行病学是了解现实世界里

if something is good for you or bad for you.

某种东西对我们是有益还是有害的科学

And it's best understood through example

了解它最好的方法就是例子了

as the science of those crazy, wacky newspaper headlines.

特别是那些疯狂古怪的报纸头条

And these are just some of the examples.

这里有几个例子

These are from the Daily Mail.

首先来看每日邮报。每个国家都有像这样的报纸

Every country in the world has a newspaper like this.

它们的一项长期而古怪的哲学使命就是

It has this bizarre, ongoing philosophical project

把这世上所有的事物

of dividing all the inanimate objects in the world

分成致癌和防癌两类

into the ones that either cause or prevent cancer.

Here are some of the things they said cause cancer:

这些是最近发布的致癌的东西：

离婚，无线网，梳妆用品还有咖啡

divorce, Wi-Fi, toiletries and coffee.

这些是防癌的：

Some things they say prevent cancer:

面包皮，红辣椒，甘草和咖啡

crusts, red pepper, licorice and coffee.

你已经发现了自相矛盾之处

So you can see there are contradictions.

咖啡既致癌又防癌

Coffee both causes and prevents cancer.

如果继续读下去

As you start to read on, you can see

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

你会开始怀疑这类报道是否别有用心

For women, housework prevents breast cancer,

“女人们，做家务能预防乳腺癌”

but for men, shopping could make you impotent.

“购物可能导致男人性无能”

(Laughter)

那么我们就要

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

揭开这些说法一看究竟

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

我要说明的观点是

揭穿骗人的说法

以及它们背后的证据

isn't a kind of nasty, carping activity;

这不是卑鄙的吹毛求疵行为

it's socially useful.

这是对社会有用的

But it's also an extremely valuable explanatory tool,

也是极有价值的

阐述工具

because real science is about critically appraising the evidence

因为真正的科学

是批判性地评估他人提出的论据

for somebody else's position.

这是就学术期刊的评审方法

That's what happens in academic journals,

也是学术会议上的常事

it's what happens at academic conferences --

会场发言完毕后的提问环节

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

常常是场血战

And nobody minds that; we actively welcome it.

没人会介意，我们反而十分欢迎

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

就像是自愿的智力上的SM一样

(Laughter)

我将展示给你们的

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

东西是

我研究领域和核心内容和特色-

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

循证医学

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

我将给各位讲解

并展示那些出了纰漏的例子

exclusively using examples of people getting stuff wrong.

是如何欺骗大众的

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

首先是最不堪一击的证据来源

权威人士

and that is authority.

在科学面前，你名字后面有多少头衔并不重要

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

我们在乎的是你确信某事的原因是什么

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

你是怎么知道什么对我们有益

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

什么又有害？

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

不过我们早就对权威不感冒了

因为如今权威的身份太容易伪造

This is somebody called Dr. Gillian McKeith, PhD,

这是个叫Gillian McKeith的博士（医生？）

加上她的医学头衔嘛，也就是Gillian McKeith

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

（笑声）

(Laughter)

每个国家都有这样一个人

Again, every country has somebody like this.

她是电视饮食节目大师

She is our TV diet guru.

She has five series of prime-time television,

上五个黄金档的系列节目

giving out very lavish and exotic health advice.

放出丰富又充满异域风情的保健意见

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

结果发现她的学历是不知美国哪儿的

一个不可信的函授博士

from somewhere in America.

She also boasts that she's a certified professional member

她还吹牛说她是美国营养咨询师协会的

持证专业人员

of the American Association of Nutritional Consultants,

这听起来大有来头

which sounds very glamorous; you get a certificate.

一张证书就能解决一切

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

这是我死掉的猫Hetti的证。她可一点都不乖

你只要到网站主页填张表

You go to the website, fill out the form,

交60美元，证书就寄到你家去

give them $60, it arrives in the post.

这不是我们认为她是个蠢货的唯一原因

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

她还说

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

你应该吃大量的暗绿色叶子

they contain chlorophyll and really oxygenate your blood.

因为它们含有大量叶绿素，能给你的血液提供氧气

只要学过生物学的人都知道

And anybody who's done school biology remembers

叶绿素和叶绿体

that chlorophyll and chloroplasts only make oxygen in sunlight,

只通过光合作用产生氧气

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

如果你把菠菜吃下去，胃里肯定一片漆黑

接下来，我们需要正确的科学，正当的证据

Next, we need proper science, proper evidence.

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

“红酒能防止乳腺癌”

这是英国每日电讯报的头条

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

“每天一杯红酒能防止乳腺癌”

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

你读了报纸

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

会觉得真是科学的

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

其解释说，在一个什么实验室里

when you drip a chemical extracted from some red grape skin

一个凳子上有个装着癌细胞的碟子

你把红葡萄皮的提取物滴在细胞上

onto some cancer cells

in a dish on a bench in a laboratory somewhere.

就有个酶发生变化

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

在一个有科学性的报纸上

如此描述是很有用

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

但是至于你喝红酒患乳腺癌风险的事

它只字没提

if you drink red wine,

它什么都没说

it tells you absolutely bugger all.

事实上，如果你每喝一次酒

Actually, it turns out that your risk of breast cancer

患乳腺癌的机率

increases slightly with every amount of alcohol you drink.

都会相应轻微地上升

So what we want are studies in real human people.

我们需要的是针对人进行的研究

And here's another example.

这是另一个例子

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

来自英国每日镜报的人气营养师

镜报是我们全国销售量第二的报纸

our second-biggest selling newspaper.

“2001年澳大利亚一项研究

"An Australian study in 2001 found that olive oil,

表明橄榄油与水果，蔬菜和豆子一起食用

in combination with fruits, vegetables and pulses,

对皮肤防皱有可观的效果”

offers measurable protection against skin wrinklings,"

然后他们开出建议：

and give the advice:

“如果你使用橄榄油和蔬菜，你的皱纹就会减少”

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

他们还给出文献出处

They helpfully tell you how to find the paper,

如果你去找该论文，会发现它是个观察性研究

and what you find is an observational study.

显然没有人

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

能回到1930年

找到在同一个产科出生的所有人群样本

get all the people born in one maternity unit,

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

让一半人大量食用水果蔬菜和橄榄油

另一半吃麦当劳

half of them eat McDonald's,

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

然后看看他们长了多少皱纹

你得存照纪录人们的样子

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

当然你发现

And what you find is, of course:

吃水果蔬菜和橄榄油的人皱纹少

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 --

但那是因为吃水果蔬菜和橄榄油的人

他们是怪胎，不正常，和你一样；

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

他们来参加这样的活动

(Laughter)

他们优雅，富有，不大可能从事户外工作

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

很少从事体力劳动

less likely to do manual labor,

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

他们有更好的社会基础，不大抽烟－

所以是因为整体关联的

for a host of fascinating, interlocking

社会政治文化的缘故

social, political and cultural reasons,

他们较不易产生皱纹

they're less likely to have wrinkles.

这不意味着是蔬菜或橄榄油的功劳

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

（笑声）

(Laughter)

做试验往往是最好的选择

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

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

每个人都觉得这是他们熟悉的话题

试验是老话题。第一个试验是圣经里－《但以理书》第一章第十二节

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

非常简单－找一群人，分两组

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

用不同的方式分别对待两组人

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

之后你跟着他们

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

看他们都怎么样了

我要给你讲的试验

I'm going to tell you about one trial,

也许是过去十年间英国媒体上

which is probably the most well-reported trial

曝光率最高的试验

in the UK news media over the past decade.

这就是关于鱼肝油胶囊的试验

This is the trial of fish oil pills.

这个说法是鱼肝油胶囊能提高大部分学生的在校表现

The claim: fish oil pills improve school performance and behavior

和行为习惯

in mainstream children.

他们说“我们做过试验

They said, "We did a trial.

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

之前都显示正面结果，我们可以肯定这次也是”

这是个警示

That should ring alarm bells:

如果你已经知道一个试验的结果，那还进行干什么

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

或者说如果实验设计就存在人为操纵性

Either you've rigged it by design,

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

或者你已经有足够的数据那就没有必要再随机挑选更多的人了

试验是这样进行的：

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

They were taking 3,000 children,

他们找了三千名儿童

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

给他们大个儿的鱼肝油药片

每天6个

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

一年以后，他们去测量他们的在校测试表现

and compare their performance

并把在校测试表现和

against what they predicted their exam performance would have been

在没有摄入鱼肝油的情况下他们预期的测试表现

进行对比

if they hadn't had the pills.

Now, can anybody spot a flaw in this design?

你看出了设计缺陷吗？

(Laughter)

临床医学试验方法论的教授

And no professors of clinical trial methodology

are allowed to answer this question.

不允许回答这个问题

So there's no control group.

是的，没有对照组！

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

这听上去挺技术范儿

这是个术语

The kids got the pills, and their performance improved.

食用了药片的孩子表现提高了

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

不然还能怎样呢？

他们长大了，我们都会随着时间不断发展

They got older; we all develop over time.

And of course, there's the placebo effect,

当然，这里还有安慰效应在起作用

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

安慰效应是医学上最不可思议的玩意之一

不仅仅是吃一个药片，你的表现提升，痛苦缓解这么简单

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

而是关乎我们的信念和期待

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

这就是治疗的文化意义

大量研究已经通过不同的安慰剂对照试验

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

展示了这种效应

comparing one kind of placebo against another.

So we know, for example,

我们知道，比如说，每天2个糖丸

that two sugar pills a day are a more effective treatment

比一个糖丸在治疗胃溃疡上

for gastric ulcers

更有效

than one sugar pill.

每天2个糖丸胜过每天1个糖丸

Two sugar pills a day beats one a day.

这是个令人吃惊的荒唐发现，但这是真的

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

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

针对3种不同的痛症的3个研究显示

盐水注射比食用糖丸对痛症更有效

that a saltwater injection is a more effective treatment

糖丸里头根本没有药－

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

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

并不是说注射或者药丸对身体有任何物理影响

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

而是因为感觉上注射是一种更强力的手段

我们知道我们的信念和期待

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

是可被操纵的

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

这就是为什么试验上

需要安慰剂对照组－

where one half of the people get the real treatment,

这样一半人接受真正的治疗

and the other half get placebo.

一半人得到安慰剂

But that's not enough.

但这并不够

What I've just shown you are examples

我刚刚展示的是非常简单直观的例子

of the very simple and straightforward ways

记者、保健食品商贩

that journalists and food supplement pill peddlers and naturopaths

和理疗家

can distort evidence for their own purposes.

都能为各自的目的歪曲证据

What I find really fascinating

真正令人惊讶的是

is that the pharmaceutical industry uses exactly the same kinds

制药产业

用一样的手段和方式

of tricks and devices,

只不过更加隐秘精巧

but slightly more sophisticated versions of them,

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

来歪曲他们给医生和患者的证据

而那些是我们用来做重要决定的证据

and which we use to make vitally important decisions.

So firstly, trials against placebo:

首先，安慰剂对照组：

谁都知道要用新药

everybody thinks a trial should be a comparison

和安慰剂对照组做试验

of your new drug against placebo.

但是很多情况下这是错的

But in a lot of situations that's wrong;

因为通常我们目前已经有一个有效的治疗方法

often, we already have a good treatment currently available.

所以我们想要知道的不是你的新疗法

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

比坐以待毙强

is better than nothing,

我们想知道的是它是不是比目前的疗法更有效

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

但是你总是看到他们做

And yet, repeatedly, you consistently see people doing trials

安慰剂对照试验

still against placebo.

And you can get licensed to bring your drug to market

这样你就能拿到许可证进入市场了

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

而试验数据只显示此药只不过比什么都没有好点

这对像我一样的医生要做决定一点帮助都没有

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

这还不是操纵数据的唯一手段

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

你还可以通过

You can also rig your data

将你的新药和真的废物做对照试验

by making the thing you compare your new drug against

来操纵数据

really rubbish.

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

你可以将对照药物剂量控制在非常低的水平

这样人们没有得到适当的治疗

so people aren't properly treated.

也可以将对照药物剂量控制在非常高的水平

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

这样就产生副作用

so people get side effects.

And this is exactly what happened

治疗精神分裂症的安定药

with antipsychotic medication for schizophrenia.

就是这么干的

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

20年前，一批新的安定药面世

有承诺说它们的副作用更低

the promise was they would have fewer side effects.

人们就对这些新药做了试验

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

跟旧的药对比

But they gave the old drugs in ridiculously high doses:

但他们使用的旧药剂量无比之高－

每天20毫克的氟哌丁苯

20 milligrams a day of haloperidol.

毫无疑问

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

如果这么大的剂量

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

肯定会导致更多的副作用从而让新药看上去更好

10年前，历史重演，有趣的是

Ten years ago, history repeated itself,

当利培酮，这一第二代抗精神病药的先锋

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

产权到期的时候，谁都可以进行生产

came off copyright, so anybody could make copies.

Everybody wanted to show their drug was better than risperidone,

每个人都想展示他们的药比利培酮好

接着你就看到一堆新的抗精神病药的对照试验

so you see trials comparing new antipsychotic drugs

和每天8毫克的利培酮对照

against risperidone at eight milligrams a day.

这个剂量不算疯狂，不是违法

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

但绝对超出正常

but very much at the high end of normal.

所以你肯定能让新药表现更好

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

果不其然

And so it's no surprise that overall,

industry-funded trials are four times more likely

制药业赞助的试验

比私人赞助试验得到正面结果（阳性结果）的机率

to give a positive result

than independently sponsored trials.

要高出4倍

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

但是－这是一个很大的但是－

(Laughter)

（笑声）

结果是

it turns out,

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

如果你查看制药业赞助的试验使用的方法

反而比私人赞助试验的方法

that they're actually better than independently sponsored trials.

更好

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

不过他们总能得到他们想要的结果

So how does this work?

那这是怎么回事？

(Laughter)

怎么解释这一奇怪现象？

How can we explain this strange phenomenon?

Well, it turns out that what happens

实际情况是

is the negative data goes missing in action;

负面结果的数据完全丢失；

it's withheld from doctors and patients.

医生和患者扣留着这些信息

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

这是整个过程里最重要的一个方面

这是证据金字塔的塔尖

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

我们需要一个疗法的所有数据

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

才能知道它是否有效

to know whether or not it really is effective.

有两种方法你可以发现

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

是否有数据丢失

可以用统计学，或者事例

You can use statistics or you can use stories.

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

我个人倾向统计学，所以我首先做的就是

This is a funnel plot.

漏斗图分析

A funnel plot is a very clever way of spotting

漏斗图是个非常好的方法

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

来查看是否有少量负面结果丢失

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

这是针对某项疗法的

所有试验图表

As you go up towards the top of the graph,

图片上部

what you see is each dot is a trial.

每一个点是一个试验

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

越往上，试验规模越大，误差也就越小

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

也就是越少随机的假阳性和假阴性结果 (阳性即表示试验结果是肯定治疗药物的疗效的，译者注）

So they all cluster together.

它们会聚集在一起

The big trials are closer to the true answer.

越大的试验越接近事实

Then as you go further down at the bottom,

越往下

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

可以发现，这一边是伪造的假阴性结果

and over on this side, spurious false positives.

那边是伪造的假阳性结果

如果有发表偏倚（有统计学意义的结果更易被发表）

If there is publication bias,

如果得出负面结果的小规模试验数据丢失

if small negative trials have gone missing in action,

you can see it on one of these graphs.

你可以在这些图表中找到

So you see here that the small negative trials

这里可以看见，应该在图表左下的

that should be on the bottom left have disappeared.

得出负面结果的小规模试验不见了

这个图表展示的是关于发表偏倚的研究里

This is a graph demonstrating the presence of publication bias

出现的发表偏倚

in studies of publication bias.

我觉得这是你听过的最有意思的

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

关于“流行病”的笑话

(Laughter)

这就是统计证明方法

That's how you can prove it statistically.

那事例法呢？

But what about stories?

Well, they're heinous, they really are.

那个就比较可恶了

This is a drug called reboxetine.

有种药叫瑞波西汀(抗抑郁药)

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

我曾给一位病人开过这个药

而我是个超级书呆子的医生

And I'm a very nerdy doctor.

I hope I go out of my way

我寄希望于阅读和理解所有文献

to try and read and understand all the literature.

我读了试验资料，都是正面结果，都是正规操作

I read the trials on this.

They were all positive, all well-conducted.

没发现漏洞

I found no flaw.

但不幸的是

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

很多试验结果被扣留

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

此药有76％的

试验结果都

被医生和病人保留

were withheld from doctors and patients.

你想想

Now if you think about it,

if I tossed a coin a hundred times,

如果我把硬币扔一百次

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

我可以保留一半结果

不告诉你

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

然后我就能说服你

我的硬币两面都是人头像

If we remove half of the data,

如果去掉一半数据

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

我们绝不可能知道这些药的真正的效果

这不是个偶发事件

And this is not an isolated story.

针对抗抑郁症药的试验数据有一半左右都被保留

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

事实比着更糟

but it goes way beyond that.

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

Nordic Cochrane集团曾尝试

收集那些被保留的数据

to bring it all together.

Nordic Cochrane是个国际性非盈利团体机构

The Cochrane Groups are an international nonprofit collaboration

提供对所有公开数据的系统性的评论

that produce systematic reviews

of all of the data that has ever been shown.

他们需要所有试验数据的查看权限

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

但是制药商保留了数据结果

But the companies withheld that data from them.

So did the European Medicines Agency --

欧洲药物管理局也这样

做了3年

for three years.

This is a problem that is currently lacking a solution.

这个问题目前没有解决方案

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

为了告诉你们这个问题的严重性，给你们举一个叫达菲的药的例子

which governments around the world

各国政府

have spent billions and billions of dollars on.

花了巨资在此药上

他们承诺

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

这个药能降低

which will reduce the rate of complications with flu.

流感的并发症几率

我们已有数据显示

We already have the data

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

它能减少几小时流感症状的持续时间

我不关心这个，政府也不关心

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

很抱歉你得流感了，我知道那很糟糕

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

但我们不可能花上百万美元

but we're not going to spend billions of dollars

只为了减少半天你的

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

流感症状

We prescribe these drugs.

我们开药，在急诊室有大量存货

We stockpile them for emergencies

觉得这能降低并发症数

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

也就是说肺炎或者死亡

which means pneumonia and death.

位于意大利的Cochrane尝试着

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

从制药公司获取

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

关于该药的所有有用数据

out of the drug companies,

以便他们判断

so they can make a full decision

about whether this drug is effective or not,

此药是否有效

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

他们没能拿到信息

This is undoubtedly the single biggest ethical problem

毫无疑问

这是如今医学界面临的

facing medicine today.

一个重大道德问题

没有信息

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

我们无法做决定

So it's a little bit difficult from there

据此想得出些正面结论

to spin in some kind of positive conclusion.

是有些困难

但是我想说：

But I would say this:

I think that sunlight

阳光是

is the best disinfectant.

最好的杀菌剂

日光之下无新事

All of these things are happening in plain sight,

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

这些事物都受

一种单调的力场所保护

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

我认为，对于所有科学问题

我们能做的最好的就是

one of the best things that we can do

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

掀开事物的表层

摸清来去一窥究竟

and peer in.

非常感谢

Thank you very much.

(Applause)

（掌声）