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Books and Arts; Book Review;The drug industry；
Pick your pill out of a hat；
Bad Pharma. By Ben Goldacre.
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.
醫生診療時總看上去非常權威。病人其實也就喜歡這樣的醫生——想到自己的身體得到了專家的醫治，心中的石頭就瞬間落了地。如果之前還給你開藥的醫生現在卻說：該藥物原理和效果的研究是經人為修改和捏造的；他甚至還稱：根本就沒人知道藥物對病人到底有哪些可能的作用（包括開藥的醫生自己都不知道）——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 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.
這可不是胡話。本·戈爾達克爾的新書《醫藥行業的惡劣行徑》便如是形容醫藥行業的現狀。該作者是一名英國醫生和科學作家，并以2008年出版的《科學的惡劣行徑》（Bad Science）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。而在新書中，他則將觸角伸向危害更為嚴重的領域：一個擁有6千億美元市場容量的行業——藥業。在全球各地，無數醫生正開出他們研究生產的各種藥物。
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.
該書以“專業門檻低、可讀性強、時刻吸引讀者興趣、徹底顛覆藥業形象、語言咄咄逼人又擊中要害”而頗具特色。“藥該倒了，”他在首頁便如是寫道：“那些本被寄予厚望醫治病癥的天使，如今卻成了口蜜腹劍的惡魔。”客觀的科學探索過程應該具有三個評估作用。新藥是否有效？是否優于市場上的藥物？副作用與療效之間是否具有較高的性價比？戈爾達克爾博士在書中詳細描述了藥業道德腐敗的事實。醫生和病人結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 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，那些藥企有選擇性地藏匿一些臨床試驗，只公布其中具有正效應的結果。那些不良反應通常會描述成只對一小部分特定的病人產生作用，而經過技術處理的各種數據分析結果總是極力表現出藥效之好。整個臨床試驗過程根本就變了味，反倒像是地下傳銷——花言巧語地唆使醫生開該公司的藥物。
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.
這種道德淪喪還不只是在行業內部。那些能接觸到被藏匿結果的藥物管理者，卻總是偏袒維護那些藥企。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。他們本應該向警方舉報這些產品。醫藥行業刊物常常忽視對于刊文的基本審查指責，從而導致各種虛假信息沒有得到應有的糾正。很多公開發表的論文并非由署名的學者所著，而是那些藥企買通的槍手的作品。醫生看到種種粉飾過的“廣告”后，也很難在開藥的時候毫不動搖。
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.
這類書在寫作時容易陷入艱澀內容的抽象論述中。戈爾達克爾博士很好地避免了這一問題，他使用了大量的事實論據來例證他的觀點。有些事例甚至有些不可思議——不過每個引例都有來源說明，并由各類學術文獻及基礎理論支持。下面這個例子不明真相的人可能還以為是哪個諜戰影視作品的搞怪片段呢。法國雜志《藥效》（Prescrire）曾向歐洲藥監部門申請利莫那般（rimonabant，消化類藥物）的詳細信息，該部門隨后寄回68頁材料——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 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.
所以最終的結論也就不難得出了。醫生其實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。舉例來說，減少心臟病發病率的藥物斯塔丁（Statin），如今在全球各地有數百萬的成年人服用該藥。但斯塔丁有許多種種類。因為區分各類斯塔丁藥效的幾乎沒什么商業價值，所以就也沒有針對這一方面的學術研究了。
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.
因為缺少文獻資料，醫生只能根據自己的臨床經驗和個人偏好來決定到底使用哪一種斯塔丁。就如戈爾達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點，那么就意味著每年有數以千計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去用好藥。這真是個醫藥界的丑聞。更令人后怕的是，導致這一結果的學術造假和捏造在整個藥業正一遍又一遍地重復著。這本書真應該讓每個人都讀一讀——每個人的讀后感都無不爆出兩個詞匯 ：惡心！憤怒！
