经济学人下载:开药就好比抓阄 Pick your pill out of a hat

Books and Arts; Book Review;The drug industry；
文艺；书评;药业；

Pick your pill out of a hat；
开药就好比抓阄；

Bad Pharma. By Ben Goldacre.
《医药行业的恶劣行径》。作者：本·戈尔达克尔。

Doctors like to project an air of authority when making their clinical decisions. Patients like it too, for it is reassuring to think that one's health is in the hands of an expert. It would be unsettling if, upon prescribing you a drug, your doctor admitted that the scientific research about what exactly the drug did, and how effective it was at doing it, was patchy and distorted, sometimes to the point where nobody has any real idea of what effects the drugs they are prescribing are likely to have on their patients. 

医生诊疗时总看上去非常权威。病人其实也就喜欢这样的医生——想到自己的身体得到了专家的医治，心中的石头就瞬间落了地。如果之前还给你开药的医生现在却说：该药物原理和效果的研究是经人为修改和捏造的；他甚至还称：根本就没人知道药物对病人到底有哪些可能的作用（包括开药的医生自己都不知道）——你是不是气得都说不出话了呢？

But that is the reality described in “Bad Pharma”, Ben Goldacre's new book. A British doctor and science writer, he made his name in 2008 with “Bad Science”, in which he filleted the credulous coverage given in the popular press to the claims of homeopaths, reiki therapists, Hopi ear-candlers and other purveyors of ceremonious placebos. Now he has taken aim at a much bigger and more important target: the $600-billion pharmaceutical industry that develops and produces the drugs prescribed by real doctors the world over.

这可不是胡话。本·戈尔达克尔的新书《医药行业的恶劣行径》便如是形容医药行业的现状。该作者是一名英国医生和科学作家，并以2008年出版的《科学的恶劣行径》（Bad Science）而名声大噪。在该成名作中，他犹如《皇帝的新装》中的小孩一般，指证公众传媒大肆宣传的“注毒诱发抗体”、“气功物理治疗”、“霍皮耳道滴蜡”等自欺欺人的安慰疗法都是伪科学。而在新书中，他则将触角伸向危害更为严重的领域：一个拥有6千亿美元市场容量的行业——药业。在全球各地，无数医生正开出他们研究生产的各种药物。

The book is slightly technical, eminently readable, consistently shocking, occasionally hectoring and unapologetically polemical. “Medicine is broken,” it declares on its first page, and “the people you should have been able to trust to fix [its] problems have failed you.” Dr Goldacre describes the routine corruption of what is supposed to be an objective scientific process designed to assess whether new drugs work, whether they are better than drugs already on the market and whether their side effects are a price worth paying for any benefits they might convey. The result is that doctors, and the patients they treat, are hobbled by needless ignorance.

该书以“专业门槛低、可读性强、时刻吸引读者兴趣、彻底颠覆药业形象、语言咄咄逼人又击中要害”而颇具特色。“药该倒了，”他在首页便如是写道：“那些本被寄予厚望医治病症的天使，如今却成了口蜜腹剑的恶魔。”客观的科学探索过程应该具有三个评估作用。新药是否有效？是否优于市场上的药物？副作用与疗效之间是否具有较高的性价比？戈尔达克尔博士在书中详细描述了药业道德腐败的事实。医生和病人结果都被药企摆了一道，然而这种不知情本都可以避免。

So, for instance, pharmaceutical companies bury clinical trials which show bad results for a drug and publish only those that show a benefit. The trials are often run on small numbers of unrepresentative patients, and the statistical analyses are massaged to give as rosy a picture as possible. Entire clinical trials are run not as trials at all, but as under-the-counter advertising campaigns designed to persuade doctors to prescribe a company's drug.

比如，那些药企有选择性地藏匿一些临床试验，只公布其中具有正效应的结果。那些不良反应通常会描述成只对一小部分特定的病人产生作用，而经过技术处理的各种数据分析结果总是极力表现出药效之好。整个临床试验过程根本就变了味，反倒像是地下传销——花言巧语地唆使医生开该公司的药物。

The bad behaviour extends far beyond the industry itself. Drug regulators, who do get access to some of the hidden results, often guard them jealously, even from academic researchers, seeming to serve the interests of the firms whose products they are supposed to police. Medical journals frequently fail to perform basic checks on the papers they print, so all sorts of sharp practice goes uncorrected. Many published studies are not written by the academics whose names they bear, but by commercial ghostwriters paid by drug firms. Doctors are bombarded with advertising encouraging them to prescribe certain drugs.

这种道德沦丧还不只是在行业内部。那些能接触到被藏匿结果的药物管理者，却总是偏袒维护那些药企。即使是那些理论研究员，也俨然与药企成为了一条绳上的两只蚂蚱。他们本应该向警方举报这些产品。医药行业刊物常常忽视对于刊文的基本审查指责，从而导致各种虚假信息没有得到应有的纠正。很多公开发表的论文并非由署名的学者所著，而是那些药企买通的枪手的作品。医生看到种种粉饰过的“广告”后，也很难在开药的时候毫不动摇。

The danger with a book like this is that it ends up lost in abstract discussion of difficult subjects. But Dr Goldacre illustrates his points with a plethora of real-world stories and examples. Some seem almost too breathtaking to be true—but every claim is referenced and backed up by links to research and primary documents. In scenes that could have come straight from a spy farce, the French journal Prescrire applied to Europe's drug regulator for information on the diet drug rimonabant. The regulator sent back 68 pages in which virtually every sentence was blacked out. 

这类书在写作时容易陷入艰涩内容的抽象论述中。戈尔达克尔博士很好地避免了这一问题，他使用了大量的事实论据来例证他的观点。有些事例甚至有些不可思议——不过每个引例都有来源说明，并由各类学术文献及基础理论支持。下面这个例子不明真相的人可能还以为是哪个谍战影视作品的搞怪片段呢。法国杂志《药效》（Prescrire）曾向欧洲药监部门申请利莫那般（rimonabant，消化类药物）的详细信息，该部门随后寄回68页材料——其中几乎每句句子都有涂改的痕迹。

And of course, the upshot of all this is anything but abstract: doctors are left ignorant about the drugs they are prescribing, and which will make their patients sick or get well, or even live or die. Statins, for instance, lower the risk of heart attacks, and are prescribed to millions of adults all over the world. But there are several different sorts of statin. Because there is little commercial advantage to be gained by comparing the efficacy of the different varieties, no studies have done so in a useful way.

所以最终的结论也就不难得出了。医生其实根本不了解他们开出的处方药。这些药能不能治好疾病，抑或是否是在伤口上撒盐，甚至是生死之别，这些都是未知数。举例来说，减少心脏病发病率的药物斯塔丁（Statin），如今在全球各地有数百万的成年人服用该药。但斯塔丁有许多种种类。因为区分各类斯塔丁药效的几乎没什么商业价值，所以就也没有针对这一方面的学术研究了。

Bereft of guidance, doctors must therefore prescribe specific statins on the basis of little more than hunches or personal prejudice. As Dr Goldacre points out, if one drug is even a shade more effective than its competitors, then thousands of people prescribed the inferior ones are dying needlessly every year for want of a bit of simple research. That is a scandal. Worse, the bias and distortions that brought it about are repeated across the entire medical industry. This is a book that deserves to be widely read, because anyone who does read it cannot help feeling both uncomfortable and angry. 

因为缺少文献资料，医生只能根据自己的临床经验和个人偏好来决定到底使用哪一种斯塔丁。就如戈尔达克尔博士所提到的那样，假如有一种斯塔丁即使只是比其他的好那么一点点，那么就意味着每年有数以千计的病人无辜地徘徊于阎王殿口——他们使用了较为劣等的药物，却只因没有这一方面的研究告诉他们去用好药。这真是个医药界的丑闻。更令人后怕的是，导致这一结果的学术造假和捏造在整个药业正一遍又一遍地重复着。这本书真应该让每个人都读一读——每个人的读后感都无不爆出两个词汇 ：恶心！愤怒！