2023考研英語閱讀開藥就好比抓鬮
Pick your pill out of a hat
開藥就好比抓鬮
Bad Pharma. By Ben Goldacre.
《醫(yī)藥行業(yè)的惡劣行徑》。作者：本戈?duì)栠_(dá)克爾。
Doctors like to project an air of authority whenmaking their clinical decisions. Patients like it too,for it is reassuring to think that one s health is inthe hands of an expert. It would be unsettling if, upon prescribing you a drug, your doctoradmitted that the scientific research about what exactly the drug did, and how effective itwas at doing it, was patchy and distorted, sometimes to the point where nobody has anyreal idea of what effects the drugs they are prescribing are likely to have on their patients.
醫(yī)生診療時(shí)總看上去非常權(quán)威。病人其實(shí)也就喜歡這樣的醫(yī)生想到自己的身體得到了專家的醫(yī)治，心中的石頭就瞬間落了地。如果之前還給你開藥的醫(yī)生現(xiàn)在卻說：該藥物原理和效果的研究是經(jīng)人為修改和捏造的;他甚至還稱：根本就沒人知道藥物對(duì)病人到底有哪些可能的作用你是不是氣得都說不出話了呢?
But that is the reality described in Bad Pharma, Ben Goldacre s new book. A British doctorand science writer, he made his name in 2008 with Bad Science, in which he filleted thecredulous coverage given in the popular press to the claims of homeopaths, reikitherapists, Hopi ear-candlers and other purveyors of ceremonious placebos. Now he hastaken aim at a much bigger and more important target: the $600-billion pharmaceuticalindustry that develops and produces the drugs prescribed by real doctors the world over.
這可不是胡話。本戈?duì)栠_(dá)克爾的新書《醫(yī)藥行業(yè)的惡劣行徑》便如是形容醫(yī)藥行業(yè)的現(xiàn)狀。該作者是一名英國(guó)醫(yī)生和科學(xué)作家，并以2008年出版的《科學(xué)的惡劣行徑》而名聲大噪。在該成名作中，他猶如《皇帝的新裝》中的小孩一般，指證公眾傳媒大肆宣傳的注毒誘發(fā)抗體、氣功物理治療、霍皮耳道滴蠟 等自欺欺人的安慰療法都是偽科學(xué)。而在新書中，他則將觸角伸向危害更為嚴(yán)重的領(lǐng)域：一個(gè)擁有6千億美元市場(chǎng)容量的行業(yè)藥業(yè)。在全球各地，無數(shù)醫(yī)生正開出他們研究生產(chǎn)的各種藥物。
The book is slightly technical, eminently readable, consistently shocking, occasionallyhectoring 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. DrGoldacre describes the routine corruption of what is supposed to be an objective scientificprocess designed to assess whether new drugs work, whether they are better than drugsalready on the market and whether their side effects are a price worth paying for any benefitsthey might convey. The result is that doctors, and the patients they treat, are hobbled byneedless ignorance.
該書以專業(yè)門檻低、可讀性強(qiáng)、時(shí)刻吸引讀者興趣、徹底顛覆藥業(yè)形象、語言咄咄逼人又擊中要害而頗具特色。藥該倒了，他在首頁(yè)便如是寫道：那些本被寄予厚望醫(yī)治病癥的天使，如今卻成了口蜜腹劍的惡魔。客觀的科學(xué)探索過程應(yīng)該具有三個(gè)評(píng)估作用。新藥是否有效?是否優(yōu)于市場(chǎng)上的藥物?副作用與療效之間是否具有較高的性價(jià)比?戈?duì)栠_(dá)克爾博士在書中詳細(xì)描述了藥業(yè)道德腐敗的事實(shí)。醫(yī)生和病人結(jié)果都被藥企擺了一道，然而這種不知情本都可以避免。
So, for instance, pharmaceutical companies bury clinical trials which show bad results for adrug and publish only those that show a benefit. The trials are often run on small numbers ofunrepresentative patients, and the statistical analyses are massaged to give as rosy apicture as possible. Entire clinical trials are run not as trials at all, but as under-the-counteradvertising campaigns designed to persuade doctors to prescribe a company s drug.
比如，那些藥企有選擇性地藏匿一些臨床試驗(yàn)，只公布其中具有正效應(yīng)的結(jié)果。那些不良反應(yīng)通常會(huì)描述成只對(duì)一小部分特定的病人產(chǎn)生作用，而經(jīng)過技術(shù)處理的各種數(shù)據(jù)分析結(jié)果總是極力表現(xiàn)出藥效之好。整個(gè)臨床試驗(yàn)過程根本就變了味，反倒像是地下傳銷花言巧語地唆使醫(yī)生開該公司的藥物。
The bad behaviour extends far beyond the industry itself. Drug regulators, who do get accessto 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 sortsof sharp practice goes uncorrected. Many published studies are not written by theacademics whose names they bear, but by commercial ghostwriters paid by drug firms.Doctors are bombarded with advertising encouraging them to prescribe certain drugs.
這種道德淪喪還不只是在行業(yè)內(nèi)部。那些能接觸到被藏匿結(jié)果的藥物管理者，卻總是偏袒維護(hù)那些藥企。即使是那些理論研究員，也儼然與藥企成為了一條繩上的兩只螞蚱。他們本應(yīng)該向警方舉報(bào)這些產(chǎn)品。醫(yī)藥行業(yè)刊物常常忽視對(duì)于刊文的基本審查指責(zé)，從而導(dǎo)致各種虛假信息沒有得到應(yīng)有的糾正。很多公開發(fā)表的論文并非由署名的學(xué)者所著，而是那些藥企買通的槍手的作品。醫(yī)生看到種種粉飾過的廣告 后，也很難在開藥的時(shí)候毫不動(dòng)搖。
The danger with a book like this is that it ends up lost in abstract discussion of difficultsubjects. But Dr Goldacre illustrates his points with a plethora of real-world stories andexamples. Some seem almost too breathtaking to be truebut every claim is referencedand backed up by links to research and primary documents. In scenes that could have comestraight from a spy farce, the French journal Prescrire applied to Europe s drug regulator forinformation on the diet drug rimonabant. The regulator sent back 68 pages in which virtuallyevery sentence was blacked out.
這類書在寫作時(shí)容易陷入艱澀內(nèi)容的抽象論述中。戈?duì)栠_(dá)克爾博士很好地避免了這一問題，他使用了大量的事實(shí)論據(jù)來例證他的觀點(diǎn)。有些事例甚至有些不可思議不過每個(gè)引例都有來源說明，并由各類學(xué)術(shù)文獻(xiàn)及基礎(chǔ)理論支持。下面這個(gè)例子不明真相的人可能還以為是哪個(gè)諜戰(zhàn)影視作品的搞怪片段呢。法國(guó)雜志《藥效》曾向歐洲藥監(jiān)部門申請(qǐng)利莫那般的詳細(xì)信息，該部門隨后寄回68頁(yè)材料其中幾乎每句句子都有涂改的痕跡。
And of course, the upshot of all this is anything but abstract: doctors are left ignorant aboutthe drugs they are prescribing, and which will make their patients sick or get well, or evenlive or die. Statins, for instance, lower the risk of heart attacks, and are prescribed to millionsof adults all over the world. But there are several different sorts of statin. Because there islittle commercial advantage to be gained by comparing the efficacy of the differentvarieties, no studies have done so in a useful way.
所以最終的結(jié)論也就不難得出了。醫(yī)生其實(shí)根本不了解他們開出的處方藥。這些藥能不能治好疾病，抑或是否是在傷口上撒鹽，甚至是生死之別，這些都是未知數(shù)。舉例來說，減少心臟病發(fā)病率的藥物斯塔丁，如今在全球各地有數(shù)百萬的成年人服用該藥。但斯塔丁有許多種種類。因?yàn)閰^(qū)分各類斯塔丁藥效的幾乎沒什么商業(yè)價(jià)值，所以就也沒有針對(duì)這一方面的學(xué)術(shù)研究了。
Bereft of guidance, doctors must therefore prescribe specific statins on the basis of littlemore than hunches or personal prejudice. As Dr Goldacre points out, if one drug is even ashade more effective than its competitors, then thousands of people prescribed the inferiorones are dying needlessly every year for want of a bit of simple research. That is ascandal. Worse, the bias and distortions that brought it about are repeated across the entiremedical industry. This is a book that deserves to be widely read, because anyone who doesread it cannot help feeling both uncomfortable and angry.
因?yàn)槿鄙傥墨I(xiàn)資料，醫(yī)生只能根據(jù)自己的臨床經(jīng)驗(yàn)和個(gè)人偏好來決定到底使用哪一種斯塔丁。就如戈?duì)栠_(dá)克爾博士所提到的那樣，假如有一種斯塔丁即使只是比其他的好那么一點(diǎn)點(diǎn)，那么就意味著每年有數(shù)以千計(jì)的病人無辜地徘徊于閻王殿口他們使用了較為劣等的藥物，卻只因沒有這一方面的研究告訴他們?nèi)ビ煤盟帯＿@真是個(gè)醫(yī)藥界的丑聞。更令人后怕的是，導(dǎo)致這一結(jié)果的學(xué)術(shù)造假和捏造在整個(gè)藥業(yè)正一遍又一遍地重復(fù)著。這本書真應(yīng)該讓每個(gè)人都讀一讀每個(gè)人的讀后感都無不爆出兩個(gè)詞匯 ：惡心!憤怒!
Pick your pill out of a hat
開藥就好比抓鬮
Bad Pharma. By Ben Goldacre.
《醫(yī)藥行業(yè)的惡劣行徑》。作者：本戈?duì)栠_(dá)克爾。
Doctors like to project an air of authority whenmaking their clinical decisions. Patients like it too,for it is reassuring to think that one s health is inthe hands of an expert. It would be unsettling if, upon prescribing you a drug, your doctoradmitted that the scientific research about what exactly the drug did, and how effective itwas at doing it, was patchy and distorted, sometimes to the point where nobody has anyreal idea of what effects the drugs they are prescribing are likely to have on their patients.
醫(yī)生診療時(shí)總看上去非常權(quán)威。病人其實(shí)也就喜歡這樣的醫(yī)生想到自己的身體得到了專家的醫(yī)治，心中的石頭就瞬間落了地。如果之前還給你開藥的醫(yī)生現(xiàn)在卻說：該藥物原理和效果的研究是經(jīng)人為修改和捏造的;他甚至還稱：根本就沒人知道藥物對(duì)病人到底有哪些可能的作用你是不是氣得都說不出話了呢?
But that is the reality described in Bad Pharma, Ben Goldacre s new book. A British doctorand science writer, he made his name in 2008 with Bad Science, in which he filleted thecredulous coverage given in the popular press to the claims of homeopaths, reikitherapists, Hopi ear-candlers and other purveyors of ceremonious placebos. Now he hastaken aim at a much bigger and more important target: the $600-billion pharmaceuticalindustry that develops and produces the drugs prescribed by real doctors the world over.
這可不是胡話。本戈?duì)栠_(dá)克爾的新書《醫(yī)藥行業(yè)的惡劣行徑》便如是形容醫(yī)藥行業(yè)的現(xiàn)狀。該作者是一名英國(guó)醫(yī)生和科學(xué)作家，并以2008年出版的《科學(xué)的惡劣行徑》而名聲大噪。在該成名作中，他猶如《皇帝的新裝》中的小孩一般，指證公眾傳媒大肆宣傳的注毒誘發(fā)抗體、氣功物理治療、霍皮耳道滴蠟 等自欺欺人的安慰療法都是偽科學(xué)。而在新書中，他則將觸角伸向危害更為嚴(yán)重的領(lǐng)域：一個(gè)擁有6千億美元市場(chǎng)容量的行業(yè)藥業(yè)。在全球各地，無數(shù)醫(yī)生正開出他們研究生產(chǎn)的各種藥物。
The book is slightly technical, eminently readable, consistently shocking, occasionallyhectoring 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. DrGoldacre describes the routine corruption of what is supposed to be an objective scientificprocess designed to assess whether new drugs work, whether they are better than drugsalready on the market and whether their side effects are a price worth paying for any benefitsthey might convey. The result is that doctors, and the patients they treat, are hobbled byneedless ignorance.
該書以專業(yè)門檻低、可讀性強(qiáng)、時(shí)刻吸引讀者興趣、徹底顛覆藥業(yè)形象、語言咄咄逼人又擊中要害而頗具特色。藥該倒了，他在首頁(yè)便如是寫道：那些本被寄予厚望醫(yī)治病癥的天使，如今卻成了口蜜腹劍的惡魔。客觀的科學(xué)探索過程應(yīng)該具有三個(gè)評(píng)估作用。新藥是否有效?是否優(yōu)于市場(chǎng)上的藥物?副作用與療效之間是否具有較高的性價(jià)比?戈?duì)栠_(dá)克爾博士在書中詳細(xì)描述了藥業(yè)道德腐敗的事實(shí)。醫(yī)生和病人結(jié)果都被藥企擺了一道，然而這種不知情本都可以避免。
So, for instance, pharmaceutical companies bury clinical trials which show bad results for adrug and publish only those that show a benefit. The trials are often run on small numbers ofunrepresentative patients, and the statistical analyses are massaged to give as rosy apicture as possible. Entire clinical trials are run not as trials at all, but as under-the-counteradvertising campaigns designed to persuade doctors to prescribe a company s drug.
比如，那些藥企有選擇性地藏匿一些臨床試驗(yàn)，只公布其中具有正效應(yīng)的結(jié)果。那些不良反應(yīng)通常會(huì)描述成只對(duì)一小部分特定的病人產(chǎn)生作用，而經(jīng)過技術(shù)處理的各種數(shù)據(jù)分析結(jié)果總是極力表現(xiàn)出藥效之好。整個(gè)臨床試驗(yàn)過程根本就變了味，反倒像是地下傳銷花言巧語地唆使醫(yī)生開該公司的藥物。
The bad behaviour extends far beyond the industry itself. Drug regulators, who do get accessto 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 sortsof sharp practice goes uncorrected. Many published studies are not written by theacademics whose names they bear, but by commercial ghostwriters paid by drug firms.Doctors are bombarded with advertising encouraging them to prescribe certain drugs.
這種道德淪喪還不只是在行業(yè)內(nèi)部。那些能接觸到被藏匿結(jié)果的藥物管理者，卻總是偏袒維護(hù)那些藥企。即使是那些理論研究員，也儼然與藥企成為了一條繩上的兩只螞蚱。他們本應(yīng)該向警方舉報(bào)這些產(chǎn)品。醫(yī)藥行業(yè)刊物常常忽視對(duì)于刊文的基本審查指責(zé)，從而導(dǎo)致各種虛假信息沒有得到應(yīng)有的糾正。很多公開發(fā)表的論文并非由署名的學(xué)者所著，而是那些藥企買通的槍手的作品。醫(yī)生看到種種粉飾過的廣告 后，也很難在開藥的時(shí)候毫不動(dòng)搖。
The danger with a book like this is that it ends up lost in abstract discussion of difficultsubjects. But Dr Goldacre illustrates his points with a plethora of real-world stories andexamples. Some seem almost too breathtaking to be truebut every claim is referencedand backed up by links to research and primary documents. In scenes that could have comestraight from a spy farce, the French journal Prescrire applied to Europe s drug regulator forinformation on the diet drug rimonabant. The regulator sent back 68 pages in which virtuallyevery sentence was blacked out.
這類書在寫作時(shí)容易陷入艱澀內(nèi)容的抽象論述中。戈?duì)栠_(dá)克爾博士很好地避免了這一問題，他使用了大量的事實(shí)論據(jù)來例證他的觀點(diǎn)。有些事例甚至有些不可思議不過每個(gè)引例都有來源說明，并由各類學(xué)術(shù)文獻(xiàn)及基礎(chǔ)理論支持。下面這個(gè)例子不明真相的人可能還以為是哪個(gè)諜戰(zhàn)影視作品的搞怪片段呢。法國(guó)雜志《藥效》曾向歐洲藥監(jiān)部門申請(qǐng)利莫那般的詳細(xì)信息，該部門隨后寄回68頁(yè)材料其中幾乎每句句子都有涂改的痕跡。
And of course, the upshot of all this is anything but abstract: doctors are left ignorant aboutthe drugs they are prescribing, and which will make their patients sick or get well, or evenlive or die. Statins, for instance, lower the risk of heart attacks, and are prescribed to millionsof adults all over the world. But there are several different sorts of statin. Because there islittle commercial advantage to be gained by comparing the efficacy of the differentvarieties, no studies have done so in a useful way.
所以最終的結(jié)論也就不難得出了。醫(yī)生其實(shí)根本不了解他們開出的處方藥。這些藥能不能治好疾病，抑或是否是在傷口上撒鹽，甚至是生死之別，這些都是未知數(shù)。舉例來說，減少心臟病發(fā)病率的藥物斯塔丁，如今在全球各地有數(shù)百萬的成年人服用該藥。但斯塔丁有許多種種類。因?yàn)閰^(qū)分各類斯塔丁藥效的幾乎沒什么商業(yè)價(jià)值，所以就也沒有針對(duì)這一方面的學(xué)術(shù)研究了。
Bereft of guidance, doctors must therefore prescribe specific statins on the basis of littlemore than hunches or personal prejudice. As Dr Goldacre points out, if one drug is even ashade more effective than its competitors, then thousands of people prescribed the inferiorones are dying needlessly every year for want of a bit of simple research. That is ascandal. Worse, the bias and distortions that brought it about are repeated across the entiremedical industry. This is a book that deserves to be widely read, because anyone who doesread it cannot help feeling both uncomfortable and angry.
因?yàn)槿鄙傥墨I(xiàn)資料，醫(yī)生只能根據(jù)自己的臨床經(jīng)驗(yàn)和個(gè)人偏好來決定到底使用哪一種斯塔丁。就如戈?duì)栠_(dá)克爾博士所提到的那樣，假如有一種斯塔丁即使只是比其他的好那么一點(diǎn)點(diǎn)，那么就意味著每年有數(shù)以千計(jì)的病人無辜地徘徊于閻王殿口他們使用了較為劣等的藥物，卻只因沒有這一方面的研究告訴他們?nèi)ビ煤盟帯＿@真是個(gè)醫(yī)藥界的丑聞。更令人后怕的是，導(dǎo)致這一結(jié)果的學(xué)術(shù)造假和捏造在整個(gè)藥業(yè)正一遍又一遍地重復(fù)著。這本書真應(yīng)該讓每個(gè)人都讀一讀每個(gè)人的讀后感都無不爆出兩個(gè)詞匯 ：惡心!憤怒!
