Những gì bác sĩ không biết về các loại thuốc họ kê đơn-Ben Goldacre

What doctors don't know about the drugs they prescribe - Ben Goldacre

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[Music] [Music] [Music] [Applause] [Applause] [Applause] hi<00:00:16.800> uh<00:00:17.039> so<00:00:17.520> um<00:00:18.119> this<00:00:18.320> chap<00:00:18.760> here<00:00:19.400> he<00:00:19.520> thinks<00:00:19.760> he hi uh so um this chap here he thinks he hi uh so um this chap here he thinks he can<00:00:20.080> tell<00:00:20.279> you<00:00:20.439> the<00:00:20.560> future<00:00:21.240> his<00:00:21.359> name<00:00:21.480> is can tell you the future his name is can tell you the future his name is Nostradamus<00:00:22.279> although<00:00:22.560> here<00:00:22.680> the<00:00:22.760> son<00:00:22.920> have Nostradamus although here the son have Nostradamus although here the son have made<00:00:23.199> him<00:00:23.320> look<00:00:23.480> a<00:00:23.560> little<00:00:23.720> bit<00:00:23.880> like<00:00:24.039> Sean made him look a little bit like Sean made him look a little bit like Sean conery conery conery and<00:00:27.119> like<00:00:27.320> most<00:00:27.480> of<00:00:27.599> you<00:00:27.760> I<00:00:27.880> suspect<00:00:28.439> I<00:00:28.640> don't and like most of you I suspect I don't and like most of you I suspect I don't really<00:00:29.320> believe<00:00:29.720> that<00:00:30.000> people<00:00:30.160> can<00:00:30.320> see<00:00:30.519> into really believe that people can see into really believe that people can see into the<00:00:30.759> future<00:00:31.039> I<00:00:31.119> don't<00:00:31.359> believe<00:00:31.920> in the future I don't believe in the future I don't believe in precognition<00:00:32.719> and<00:00:32.840> every<00:00:33.000> now<00:00:33.120> and<00:00:33.280> then<00:00:33.399> you precognition and every now and then you precognition and every now and then you hear<00:00:33.840> that<00:00:34.000> somebody<00:00:34.360> has<00:00:34.520> been<00:00:34.680> able<00:00:34.879> to hear that somebody has been able to hear that somebody has been able to predict<00:00:35.239> something<00:00:35.440> that<00:00:35.559> happened<00:00:35.840> in<00:00:35.920> the predict something that happened in the predict something that happened in the future<00:00:36.640> and<00:00:36.800> that's<00:00:37.079> probably<00:00:37.559> because<00:00:38.160> it future and that's probably because it future and that's probably because it was<00:00:38.399> a<00:00:38.520> fluke<00:00:39.000> and<00:00:39.120> we<00:00:39.239> only<00:00:39.600> hear<00:00:40.360> about<00:00:40.600> the was a fluke and we only hear about the was a fluke and we only hear about the flukes<00:00:41.520> and<00:00:41.680> about<00:00:41.879> the<00:00:42.000> freaks<00:00:42.559> we<00:00:42.680> don't flukes and about the freaks we don't flukes and about the freaks we don't hear<00:00:43.120> about<00:00:43.320> all<00:00:43.440> the<00:00:43.600> times<00:00:43.840> that<00:00:44.000> people<00:00:44.280> got hear about all the times that people got hear about all the times that people got stuff<00:00:45.360> wrong<00:00:46.360> now<00:00:46.520> we<00:00:46.760> expect<00:00:47.280> that<00:00:47.440> to<00:00:47.640> happen stuff wrong now we expect that to happen stuff wrong now we expect that to happen with<00:00:48.120> silly<00:00:48.440> stories<00:00:48.800> about<00:00:49.320> precognition with silly stories about precognition with silly stories about precognition but<00:00:50.480> the<00:00:50.680> problem<00:00:51.039> is<00:00:51.800> we<00:00:51.960> have<00:00:52.199> exactly<00:00:52.680> the but the problem is we have exactly the but the problem is we have exactly the same<00:00:53.120> problem<00:00:53.719> in<00:00:54.079> Academia<00:00:55.079> and<00:00:55.239> in<00:00:55.440> medicine same problem in Academia and in medicine same problem in Academia and in medicine and<00:00:56.600> in<00:00:56.760> this<00:00:56.960> environment<00:00:57.879> it<00:00:58.120> costs<00:00:58.920> lives and in this environment it costs lives and in this environment it costs lives so<00:01:00.079> firstly<00:01:00.480> thinking<00:01:00.760> just<00:01:00.879> about so firstly thinking just about so firstly thinking just about precognition<00:01:01.879> as<00:01:01.960> it<00:01:02.079> turns<00:01:02.359> out<00:01:02.840> just<00:01:03.120> last precognition as it turns out just last precognition as it turns out just last year<00:01:03.559> a<00:01:03.680> researcher<00:01:04.119> called<00:01:04.280> Daryl<00:01:04.600> bam year a researcher called Daryl bam year a researcher called Daryl bam conducted<00:01:05.439> a<00:01:05.519> piece<00:01:05.680> of<00:01:05.799> research<00:01:06.159> where<00:01:06.280> he conducted a piece of research where he conducted a piece of research where he found<00:01:06.680> evidence<00:01:07.400> of<00:01:07.600> precognitive<00:01:08.479> powers<00:01:09.119> in found evidence of precognitive powers in found evidence of precognitive powers in undergraduate<00:01:10.200> students<00:01:10.759> and<00:01:10.920> this<00:01:11.040> was undergraduate students and this was undergraduate students and this was published<00:01:11.799> in<00:01:11.920> a<00:01:12.040> peer-reviewed<00:01:12.560> academic published in a peer-reviewed academic published in a peer-reviewed academic journal<00:01:13.560> and<00:01:13.799> most<00:01:13.960> of<00:01:14.080> the<00:01:14.159> people<00:01:14.320> who<00:01:14.479> read journal and most of the people who read journal and most of the people who read this<00:01:14.799> just<00:01:14.880> said<00:01:15.240> okay<00:01:15.520> well<00:01:15.680> fair<00:01:15.960> enough<00:01:16.159> but this just said okay well fair enough but this just said okay well fair enough but I<00:01:16.360> think<00:01:16.479> that's<00:01:16.600> a<00:01:16.680> flute<00:01:17.000> that's<00:01:17.119> a<00:01:17.200> freak I think that's a flute that's a freak I think that's a flute that's a freak because<00:01:17.680> I<00:01:17.759> know<00:01:18.119> that<00:01:18.240> if<00:01:18.360> I<00:01:18.479> did<00:01:18.640> a<00:01:18.799> study because I know that if I did a study because I know that if I did a study where<00:01:19.400> I<00:01:19.520> found<00:01:19.960> no<00:01:20.280> evidence<00:01:20.640> that where I found no evidence that where I found no evidence that undergraduate<00:01:21.400> students<00:01:21.759> had<00:01:21.960> precognitive undergraduate students had precognitive undergraduate students had precognitive powers<00:01:23.280> it<00:01:23.520> probably<00:01:24.000> wouldn't<00:01:24.400> get powers it probably wouldn't get powers it probably wouldn't get published<00:01:25.400> in<00:01:25.520> a<00:01:26.079> journal<00:01:27.079> and<00:01:27.159> in<00:01:27.280> fact<00:01:27.439> we published in a journal and in fact we published in a journal and in fact we know<00:01:27.799> that<00:01:28.000> that's<00:01:28.200> true<00:01:28.920> because<00:01:30.119> several know that that's true because several know that that's true because several different<00:01:30.680> groups<00:01:30.960> of<00:01:31.079> research<00:01:31.439> scientists different groups of research scientists different groups of research scientists tried<00:01:32.200> to<00:01:32.479> replicate<00:01:33.000> the<00:01:33.119> findings<00:01:33.720> of<00:01:33.880> this tried to replicate the findings of this tried to replicate the findings of this precognition<00:01:35.159> study<00:01:35.799> and<00:01:35.920> when<00:01:36.079> they precognition study and when they precognition study and when they submitted<00:01:36.640> it<00:01:36.720> to<00:01:36.880> the<00:01:37.079> exact<00:01:37.399> same<00:01:37.600> journal submitted it to the exact same journal submitted it to the exact same journal the<00:01:38.360> journal<00:01:38.759> said<00:01:39.320> no<00:01:40.320> we're<00:01:40.600> not<00:01:40.840> interested the journal said no we're not interested the journal said no we're not interested in<00:01:41.360> publishing<00:01:42.040> replication<00:01:43.040> we're<00:01:43.280> not in publishing replication we're not in publishing replication we're not interested<00:01:43.920> in<00:01:44.079> your<00:01:44.360> negative<00:01:45.000> data<00:01:46.000> so<00:01:46.200> this interested in your negative data so this interested in your negative data so this is<00:01:46.479> already<00:01:46.960> evidence<00:01:47.520> of<00:01:47.759> how<00:01:48.200> in<00:01:48.320> the is already evidence of how in the is already evidence of how in the academic<00:01:48.840> literature<00:01:49.360> we<00:01:49.439> will<00:01:49.640> see<00:01:50.240> a<00:01:50.560> biased academic literature we will see a biased academic literature we will see a biased sample<00:01:52.320> of<00:01:52.479> the<00:01:52.719> true<00:01:53.119> picture<00:01:53.719> of<00:01:54.000> all<00:01:54.119> of<00:01:54.280> the sample of the true picture of all of the sample of the true picture of all of the scientific<00:01:55.040> studies<00:01:55.600> that<00:01:55.719> have<00:01:55.840> been scientific studies that have been scientific studies that have been conducted<00:01:57.200> but<00:01:57.360> it<00:01:57.479> doesn't<00:01:57.799> just<00:01:58.000> happen<00:01:58.600> in conducted but it doesn't just happen in conducted but it doesn't just happen in the<00:01:58.880> dry<00:01:59.399> academic<00:02:00.079> field<00:02:00.640> of<00:02:00.840> psychology<00:02:01.799> it the dry academic field of psychology it the dry academic field of psychology it also<00:02:02.280> happens<00:02:03.200> in<00:02:03.399> for<00:02:03.680> example<00:02:04.680> cancer also happens in for example cancer also happens in for example cancer research<00:02:06.240> so<00:02:06.439> in<00:02:06.600> March<00:02:07.080> 2012<00:02:08.080> just<00:02:08.280> one<00:02:08.560> month research so in March 2012 just one month research so in March 2012 just one month ago<00:02:09.599> some<00:02:09.759> researchers<00:02:10.319> reported<00:02:10.800> in<00:02:10.879> the ago some researchers reported in the ago some researchers reported in the journal<00:02:11.360> Nature<00:02:12.000> how<00:02:12.200> they<00:02:12.360> had<00:02:12.560> tried<00:02:12.879> to journal Nature how they had tried to journal Nature how they had tried to replicate<00:02:13.760> 53<00:02:14.480> different<00:02:14.959> basic<00:02:15.319> science replicate 53 different basic science replicate 53 different basic science studies<00:02:16.519> looking<00:02:16.800> at<00:02:17.080> potential<00:02:18.040> treatment studies looking at potential treatment studies looking at potential treatment Targets<00:02:19.000> in<00:02:19.440> cancer<00:02:20.440> and<00:02:20.560> out<00:02:20.680> of<00:02:20.879> those<00:02:21.160> 53 Targets in cancer and out of those 53 Targets in cancer and out of those 53 studies<00:02:22.400> they<00:02:22.519> were<00:02:22.680> only<00:02:22.920> able<00:02:23.160> to studies they were only able to studies they were only able to successfully<00:02:24.200> replicate<00:02:25.239> six<00:02:26.239> 47<00:02:26.840> out<00:02:26.959> of successfully replicate six 47 out of successfully replicate six 47 out of those<00:02:27.280> 53<00:02:28.160> were<00:02:28.760> unreplicable those 53 were unreplicable those 53 were unreplicable and<00:02:30.760> they<00:02:31.000> say<00:02:31.720> in<00:02:31.840> their<00:02:32.160> discussion<00:02:33.160> that and they say in their discussion that and they say in their discussion that this<00:02:33.519> is<00:02:33.760> very<00:02:34.000> likely<00:02:34.480> because<00:02:35.280> freaks<00:02:35.840> get this is very likely because freaks get this is very likely because freaks get published<00:02:37.080> people<00:02:37.280> will<00:02:37.440> do<00:02:37.599> lots<00:02:37.800> and<00:02:37.920> lots published people will do lots and lots published people will do lots and lots and<00:02:38.200> lots<00:02:38.400> of<00:02:38.519> different<00:02:38.760> studies<00:02:39.080> and<00:02:39.239> the and lots of different studies and the and lots of different studies and the occasions<00:02:39.879> when<00:02:40.040> it<00:02:40.200> works<00:02:40.720> they<00:02:40.840> will occasions when it works they will occasions when it works they will publish<00:02:41.280> and<00:02:41.400> the<00:02:41.480> ones<00:02:41.680> where<00:02:41.800> it<00:02:41.879> doesn't publish and the ones where it doesn't publish and the ones where it doesn't work<00:02:42.319> they<00:02:42.440> won't<00:02:43.080> and<00:02:43.239> their<00:02:43.599> first work they won't and their first work they won't and their first recommendation<00:02:44.640> of<00:02:44.800> how<00:02:44.879> to<00:02:45.120> fix<00:02:45.440> this recommendation of how to fix this recommendation of how to fix this problem<00:02:46.680> because<00:02:46.879> it<00:02:47.000> is<00:02:47.120> a<00:02:47.319> problem<00:02:47.959> because problem because it is a problem because problem because it is a problem because it<00:02:48.239> sends<00:02:48.480> us<00:02:48.640> all<00:02:48.800> down<00:02:49.040> blind<00:02:49.360> alleys<00:02:50.000> their it sends us all down blind alleys their it sends us all down blind alleys their first<00:02:50.440> recommendation<00:02:50.920> of<00:02:51.040> how<00:02:51.120> to<00:02:51.239> fix<00:02:51.480> this first recommendation of how to fix this first recommendation of how to fix this problem<00:02:52.040> is<00:02:52.159> to<00:02:52.319> make<00:02:52.440> it<00:02:52.640> easier<00:02:53.000> to<00:02:53.200> publish problem is to make it easier to publish problem is to make it easier to publish negative<00:02:53.959> results<00:02:54.319> in<00:02:54.519> science<00:02:55.239> and<00:02:55.319> to negative results in science and to negative results in science and to change<00:02:55.879> the<00:02:56.040> incentives<00:02:56.959> so<00:02:57.120> that<00:02:57.319> scientists change the incentives so that scientists change the incentives so that scientists are<00:02:58.000> encouraged<00:02:58.519> to<00:02:58.760> post<00:02:59.319> more<00:02:59.480> of<00:02:59.760> their are encouraged to post more of their are encouraged to post more of their negative<00:03:00.280> results<00:03:00.959> in<00:03:01.519> public<00:03:02.519> but<00:03:02.680> it negative results in public but it negative results in public but it doesn't<00:03:03.239> just<00:03:03.760> happen<00:03:04.760> in<00:03:04.879> the<00:03:05.040> very<00:03:05.280> dry doesn't just happen in the very dry doesn't just happen in the very dry world<00:03:06.200> of<00:03:06.400> preclinical<00:03:07.319> basic<00:03:07.840> science world of preclinical basic science world of preclinical basic science cancer<00:03:09.120> research<00:03:10.120> it<00:03:10.319> also<00:03:10.640> happens<00:03:11.480> in<00:03:11.640> the cancer research it also happens in the cancer research it also happens in the very<00:03:12.080> real<00:03:12.879> Flesh<00:03:13.159> and<00:03:13.440> Blood<00:03:14.159> of<00:03:14.360> academic very real Flesh and Blood of academic very real Flesh and Blood of academic medicine<00:03:16.040> so<00:03:16.200> in medicine so in medicine so in 1980<00:03:17.879> some<00:03:18.080> researchers<00:03:18.560> did<00:03:18.680> a<00:03:18.760> study<00:03:19.000> on<00:03:19.080> a 1980 some researchers did a study on a 1980 some researchers did a study on a drug<00:03:19.360> called<00:03:19.560> lenide<00:03:20.560> and<00:03:20.760> this<00:03:21.040> was<00:03:21.519> an<00:03:21.640> anti drug called lenide and this was an anti drug called lenide and this was an anti arthic<00:03:22.319> drug<00:03:22.799> a<00:03:22.920> drug<00:03:23.159> that<00:03:23.319> suppresses arthic drug a drug that suppresses arthic drug a drug that suppresses abnormal<00:03:24.280> heart<00:03:24.480> rhythms<00:03:24.879> and<00:03:25.000> the<00:03:25.120> idea<00:03:25.440> was abnormal heart rhythms and the idea was abnormal heart rhythms and the idea was after<00:03:26.159> people<00:03:26.360> have<00:03:26.480> had<00:03:26.599> a<00:03:26.680> heart<00:03:26.879> attack after people have had a heart attack after people have had a heart attack they're<00:03:27.280> quite<00:03:27.440> likely<00:03:27.680> to<00:03:27.760> have<00:03:27.920> abnormal they're quite likely to have abnormal they're quite likely to have abnormal heart<00:03:28.439> rhythms<00:03:28.799> so<00:03:28.959> if<00:03:29.040> we<00:03:29.200> give<00:03:29.360> them<00:03:29.760> a<00:03:29.920> drug heart rhythms so if we give them a drug heart rhythms so if we give them a drug that<00:03:30.319> suppresses<00:03:30.760> abnormal<00:03:31.159> heart<00:03:31.319> rhythms that suppresses abnormal heart rhythms that suppresses abnormal heart rhythms this<00:03:31.959> will<00:03:32.200> increase<00:03:32.640> the<00:03:32.760> chances<00:03:33.400> of<00:03:33.560> them this will increase the chances of them this will increase the chances of them surviving<00:03:35.480> early<00:03:35.760> on<00:03:35.879> in<00:03:35.959> its<00:03:36.120> development surviving early on in its development surviving early on in its development they<00:03:36.640> did<00:03:36.760> a<00:03:36.879> very<00:03:37.040> small<00:03:37.280> trial<00:03:37.840> just<00:03:37.959> under<00:03:38.239> a they did a very small trial just under a they did a very small trial just under a 100<00:03:38.840> patients<00:03:39.680> 50<00:03:40.000> patients<00:03:40.360> got<00:03:40.519> lenide<00:03:41.159> and 100 patients 50 patients got lenide and 100 patients 50 patients got lenide and of<00:03:41.480> those<00:03:41.640> patients<00:03:42.080> 10<00:03:42.519> died<00:03:43.480> another<00:03:43.760> 50 of those patients 10 died another 50 of those patients 10 died another 50 patients<00:03:44.439> got<00:03:44.599> a<00:03:44.720> dummy<00:03:45.040> Placebo<00:03:45.720> sugar<00:03:45.959> pill patients got a dummy Placebo sugar pill patients got a dummy Placebo sugar pill with<00:03:46.360> no<00:03:46.599> active<00:03:46.879> ingredient<00:03:47.560> and<00:03:47.720> only<00:03:48.040> one with no active ingredient and only one with no active ingredient and only one of<00:03:48.400> them<00:03:48.680> died<00:03:49.239> so<00:03:49.439> they<00:03:49.640> rightly<00:03:49.959> regarded of them died so they rightly regarded of them died so they rightly regarded this<00:03:50.560> drug<00:03:51.120> as<00:03:51.239> a<00:03:51.640> failure<00:03:52.640> and<00:03:52.760> its this drug as a failure and its this drug as a failure and its commercial<00:03:53.239> development<00:03:53.640> was<00:03:53.799> stopped<00:03:54.280> and commercial development was stopped and commercial development was stopped and because<00:03:54.720> its<00:03:54.879> commercial<00:03:55.280> development<00:03:55.680> was because its commercial development was because its commercial development was stopped<00:03:56.280> this<00:03:56.439> trial<00:03:56.959> was<00:03:57.239> never stopped this trial was never stopped this trial was never published published published unfortunately<00:04:01.040> over<00:04:01.239> the<00:04:01.439> course<00:04:01.680> of<00:04:01.879> the unfortunately over the course of the unfortunately over the course of the next<00:04:03.000> five<00:04:04.000> 10<00:04:04.560> years<00:04:05.560> other<00:04:05.799> companies<00:04:06.200> had next five 10 years other companies had next five 10 years other companies had the<00:04:06.480> same<00:04:06.720> idea<00:04:07.239> about<00:04:07.439> drugs<00:04:08.040> that<00:04:08.120> would the same idea about drugs that would the same idea about drugs that would prevent<00:04:08.599> arhythmia<00:04:09.159> in<00:04:09.280> people<00:04:09.439> who've<00:04:09.599> had prevent arhythmia in people who've had prevent arhythmia in people who've had heart<00:04:10.000> attacks<00:04:10.680> these<00:04:10.840> drugs<00:04:11.079> were<00:04:11.239> brought heart attacks these drugs were brought heart attacks these drugs were brought to<00:04:11.599> Market<00:04:11.959> they<00:04:12.040> were<00:04:12.200> prescrib<00:04:12.599> very<00:04:12.799> widely to Market they were prescrib very widely to Market they were prescrib very widely because<00:04:13.280> heart<00:04:13.519> attacks<00:04:13.959> are<00:04:14.120> a<00:04:14.239> very<00:04:14.560> common because heart attacks are a very common because heart attacks are a very common thing<00:04:16.639> and<00:04:16.799> it<00:04:16.919> took<00:04:17.239> so<00:04:17.479> long<00:04:17.680> for<00:04:17.840> us<00:04:18.000> to<00:04:18.239> find thing and it took so long for us to find thing and it took so long for us to find out<00:04:19.199> that<00:04:19.400> these<00:04:19.600> drugs<00:04:20.199> also<00:04:20.639> caused<00:04:21.239> an out that these drugs also caused an out that these drugs also caused an increased<00:04:21.840> rate<00:04:22.000> of<00:04:22.199> death<00:04:22.800> that<00:04:23.040> before<00:04:23.360> we increased rate of death that before we increased rate of death that before we detected<00:04:24.120> that<00:04:24.320> safety<00:04:24.680> signal<00:04:25.639> over<00:04:25.960> a detected that safety signal over a detected that safety signal over a 100,000<00:04:27.720> people<00:04:28.400> died<00:04:29.039> unnecessary<00:04:29.600> neily<00:04:30.280> in 100,000 people died unnecessary neily in 100,000 people died unnecessary neily in America<00:04:31.440> from<00:04:31.600> the<00:04:31.759> prescription<00:04:32.520> of<00:04:32.720> anti-ar America from the prescription of anti-ar America from the prescription of anti-ar rythmic rythmic rythmic drugs<00:04:35.840> now<00:04:36.080> actually<00:04:36.400> in drugs now actually in drugs now actually in 1993<00:04:39.520> the<00:04:39.639> researchers<00:04:40.240> who<00:04:40.400> did<00:04:40.600> that<00:04:40.759> 1980 1993 the researchers who did that 1980 1993 the researchers who did that 1980 study<00:04:41.680> that<00:04:41.800> early<00:04:42.039> study<00:04:42.280> published<00:04:42.639> a<00:04:42.759> mayor study that early study published a mayor study that early study published a mayor Cula<00:04:43.520> an<00:04:43.720> apology<00:04:44.400> to<00:04:44.560> the<00:04:44.720> scientific Cula an apology to the scientific Cula an apology to the scientific community<00:04:45.960> in<00:04:46.120> which<00:04:46.280> they<00:04:46.400> said<00:04:46.680> when<00:04:46.800> we community in which they said when we community in which they said when we carried<00:04:47.240> out<00:04:47.440> our<00:04:47.639> study<00:04:48.280> in<00:04:48.440> 1980<00:04:49.120> we<00:04:49.280> thought carried out our study in 1980 we thought carried out our study in 1980 we thought that<00:04:49.639> the<00:04:49.720> increased<00:04:50.120> death<00:04:50.320> rate<00:04:50.479> that that the increased death rate that that the increased death rate that occurred<00:04:50.880> in<00:04:50.960> the<00:04:51.039> lenide<00:04:51.560> group<00:04:52.080> was<00:04:52.240> an occurred in the lenide group was an occurred in the lenide group was an effect<00:04:52.639> of<00:04:53.320> chance<00:04:54.320> the<00:04:54.440> development<00:04:54.800> of effect of chance the development of effect of chance the development of lenide<00:04:55.360> was<00:04:55.440> abandoned<00:04:55.840> for<00:04:55.919> commercial lenide was abandoned for commercial lenide was abandoned for commercial reasons<00:04:56.520> and<00:04:56.639> this<00:04:56.759> study<00:04:56.960> was<00:04:57.120> never reasons and this study was never reasons and this study was never published<00:04:57.880> it's<00:04:58.039> now<00:04:58.199> a<00:04:58.320> good<00:04:58.520> example<00:04:58.840> of published it's now a good example of published it's now a good example of publication<00:04:59.800> bias<00:05:00.440> that's<00:05:00.600> the<00:05:00.720> technical publication bias that's the technical publication bias that's the technical term<00:05:01.320> for<00:05:01.440> the<00:05:01.600> phenomenon<00:05:02.120> where term for the phenomenon where term for the phenomenon where unflattering<00:05:03.400> data<00:05:04.160> gets<00:05:04.639> gets<00:05:04.919> lost<00:05:05.400> gets unflattering data gets gets lost gets unflattering data gets gets lost gets unpublished<00:05:06.400> is<00:05:06.520> left<00:05:06.840> missing<00:05:07.440> in<00:05:07.639> action unpublished is left missing in action unpublished is left missing in action and<00:05:08.600> they<00:05:08.720> say<00:05:08.919> the<00:05:09.039> results<00:05:09.440> described<00:05:09.880> here and they say the results described here and they say the results described here might<00:05:10.240> have<00:05:10.440> provided<00:05:11.039> an<00:05:11.280> early<00:05:11.639> warning<00:05:12.320> of might have provided an early warning of might have provided an early warning of trouble trouble trouble ahead<00:05:15.520> now<00:05:15.680> these<00:05:15.800> are<00:05:16.000> stories<00:05:16.520> from<00:05:16.880> basic ahead now these are stories from basic ahead now these are stories from basic science<00:05:18.160> these<00:05:18.319> are<00:05:18.840> stories<00:05:19.840> from<00:05:20.840> 20<00:05:21.400> 30 science these are stories from 20 30 science these are stories from 20 30 years years years ago<00:05:23.840> the<00:05:24.000> academic<00:05:24.319> publishing<00:05:24.639> environment ago the academic publishing environment ago the academic publishing environment is<00:05:25.160> very<00:05:25.400> different<00:05:25.840> now<00:05:26.720> there<00:05:26.880> are<00:05:27.360> academic is very different now there are academic is very different now there are academic journals<00:05:28.120> like<00:05:28.280> trials<00:05:28.720> the<00:05:28.840> Open<00:05:29.080> Access journals like trials the Open Access journals like trials the Open Access Journal<00:05:30.000> which<00:05:30.120> will<00:05:30.319> publish<00:05:30.800> any<00:05:31.039> trial Journal which will publish any trial Journal which will publish any trial conducted<00:05:31.759> in<00:05:31.960> humans<00:05:32.600> regardless<00:05:33.120> of conducted in humans regardless of conducted in humans regardless of whether<00:05:33.440> it<00:05:33.560> has<00:05:33.680> a<00:05:33.840> positive<00:05:34.440> or<00:05:34.560> A<00:05:34.680> negative whether it has a positive or A negative whether it has a positive or A negative result<00:05:36.000> but<00:05:36.199> this<00:05:36.639> problem<00:05:37.639> of<00:05:37.800> negative result but this problem of negative result but this problem of negative results<00:05:38.639> that<00:05:38.800> go<00:05:39.039> missing<00:05:39.400> in<00:05:39.600> action<00:05:40.400> is results that go missing in action is results that go missing in action is still<00:05:40.880> very<00:05:41.160> prevalent<00:05:41.960> in<00:05:42.080> fact<00:05:42.319> it's<00:05:42.600> so still very prevalent in fact it's so still very prevalent in fact it's so prevalent<00:05:43.800> that<00:05:43.919> it<00:05:44.120> cuts<00:05:44.680> to<00:05:44.880> the<00:05:45.120> core<00:05:45.880> of prevalent that it cuts to the core of prevalent that it cuts to the core of evidence-based evidence-based evidence-based medicine<00:05:50.000> so<00:05:50.199> this<00:05:50.280> is<00:05:50.400> a<00:05:50.560> drug<00:05:50.840> called medicine so this is a drug called medicine so this is a drug called reboxetine<00:05:51.800> and<00:05:51.919> this<00:05:52.000> is<00:05:52.080> a<00:05:52.199> drug<00:05:52.440> that<00:05:52.600> I reboxetine and this is a drug that I reboxetine and this is a drug that I myself<00:05:53.080> have<00:05:53.280> prescribed<00:05:53.759> it's<00:05:53.880> an myself have prescribed it's an myself have prescribed it's an anti-depressant<00:05:54.800> and<00:05:54.919> I'm<00:05:55.039> a<00:05:55.120> very<00:05:55.280> nerdy anti-depressant and I'm a very nerdy anti-depressant and I'm a very nerdy doctor<00:05:56.000> so<00:05:56.319> I<00:05:56.440> read<00:05:56.639> all<00:05:56.759> of<00:05:56.880> the<00:05:57.000> studies<00:05:57.360> that doctor so I read all of the studies that doctor so I read all of the studies that I<00:05:57.639> could<00:05:58.039> on<00:05:58.199> this<00:05:58.360> drug<00:05:58.919> I<00:05:59.039> read<00:05:59.199> the<00:05:59.280> one I could on this drug I read the one I could on this drug I read the one study<00:05:59.880> that<00:06:00.000> was<00:06:00.160> published<00:06:00.639> that<00:06:00.720> showed study that was published that showed study that was published that showed that<00:06:01.120> robotin<00:06:01.800> was<00:06:02.000> better<00:06:02.319> than<00:06:02.520> Placebo<00:06:03.360> and that robotin was better than Placebo and that robotin was better than Placebo and I<00:06:03.600> read<00:06:03.759> the<00:06:03.880> other<00:06:04.160> three<00:06:04.400> studies<00:06:04.759> that<00:06:04.840> were I read the other three studies that were I read the other three studies that were published<00:06:05.360> that<00:06:05.440> showed<00:06:05.680> that<00:06:05.800> rootine<00:06:06.319> was published that showed that rootine was published that showed that rootine was just<00:06:06.680> as<00:06:06.840> good<00:06:07.199> as<00:06:07.360> any<00:06:07.599> other just as good as any other just as good as any other anti-depressant<00:06:08.560> and<00:06:08.720> because<00:06:09.240> this<00:06:09.400> patient anti-depressant and because this patient anti-depressant and because this patient hadn't<00:06:09.880> done<00:06:10.039> well<00:06:10.160> on<00:06:10.280> those<00:06:10.400> other hadn't done well on those other hadn't done well on those other antidepressants<00:06:11.080> I<00:06:11.120> thought<00:06:11.240> well<00:06:11.360> robotin antidepressants I thought well robotin antidepressants I thought well robotin just<00:06:12.360> as<00:06:12.520> good<00:06:12.680> it's<00:06:12.840> one<00:06:13.000> to<00:06:13.160> try<00:06:13.840> but<00:06:13.960> it just as good it's one to try but it just as good it's one to try but it turned<00:06:14.400> out<00:06:14.840> that<00:06:15.000> I<00:06:15.080> was<00:06:15.440> misled<00:06:16.440> in<00:06:16.639> fact turned out that I was misled in fact turned out that I was misled in fact seven<00:06:17.440> trials<00:06:17.800> were<00:06:17.960> conducted<00:06:18.440> comparing seven trials were conducted comparing seven trials were conducted comparing reboxetine<00:06:19.840> against<00:06:20.080> a<00:06:20.199> dummy<00:06:20.479> Placebo<00:06:20.919> sugar reboxetine against a dummy Placebo sugar reboxetine against a dummy Placebo sugar pill<00:06:21.800> one<00:06:21.960> of<00:06:22.080> them<00:06:22.240> was<00:06:22.479> positive<00:06:22.840> and<00:06:22.960> that pill one of them was positive and that pill one of them was positive and that was<00:06:23.280> published<00:06:23.759> but<00:06:23.919> six<00:06:24.120> of<00:06:24.240> them<00:06:24.400> were was published but six of them were was published but six of them were negative<00:06:25.240> and<00:06:25.400> they<00:06:25.520> were<00:06:25.720> left negative and they were left negative and they were left unpublished<00:06:28.319> three<00:06:28.599> trials<00:06:28.919> were<00:06:29.039> published unpublished three trials were published unpublished three trials were published comparing<00:06:29.720> robotin<00:06:30.240> against<00:06:30.440> other comparing robotin against other comparing robotin against other anti-depressants<00:06:31.280> in<00:06:31.400> which<00:06:31.560> rootine<00:06:32.319> was anti-depressants in which rootine was anti-depressants in which rootine was just<00:06:32.680> as<00:06:32.840> good<00:06:33.080> and<00:06:33.240> they<00:06:33.360> were<00:06:33.560> published<00:06:34.240> but just as good and they were published but just as good and they were published but three<00:06:35.000> times<00:06:35.360> as<00:06:35.520> many<00:06:35.759> patients<00:06:36.199> worth<00:06:36.400> of three times as many patients worth of three times as many patients worth of data<00:06:37.080> was<00:06:37.440> collected<00:06:38.400> which<00:06:38.560> showed<00:06:38.919> that data was collected which showed that data was collected which showed that robotin<00:06:39.759> was<00:06:40.080> worse<00:06:40.440> than<00:06:40.599> those<00:06:40.759> other robotin was worse than those other robotin was worse than those other treatments<00:06:41.840> and<00:06:42.039> those<00:06:42.240> trials<00:06:42.919> were<00:06:43.160> not treatments and those trials were not treatments and those trials were not published<00:06:45.440> I<00:06:46.120> felt published I felt published I felt misled<00:06:48.919> now<00:06:49.039> you<00:06:49.199> might<00:06:49.360> say<00:06:49.520> well<00:06:49.680> that's<00:06:49.800> an misled now you might say well that's an misled now you might say well that's an extreme<00:06:50.199> and<00:06:50.360> unusual<00:06:50.759> example<00:06:51.039> and<00:06:51.160> I extreme and unusual example and I extreme and unusual example and I wouldn't<00:06:51.440> want<00:06:51.520> to<00:06:51.639> be<00:06:51.800> guilty<00:06:52.160> of<00:06:52.319> the<00:06:52.440> same wouldn't want to be guilty of the same wouldn't want to be guilty of the same kind<00:06:52.840> of<00:06:53.080> cherry-picking<00:06:54.000> and<00:06:54.199> selective kind of cherry-picking and selective kind of cherry-picking and selective referencing<00:06:55.759> that<00:06:55.879> I'm<00:06:56.080> accusing<00:06:56.520> other referencing that I'm accusing other referencing that I'm accusing other people<00:06:57.120> of<00:06:57.800> but<00:06:57.919> it<00:06:58.039> turns<00:06:58.280> out<00:06:58.440> that<00:06:58.560> this people of but it turns out that this people of but it turns out that this phenomenon<00:06:59.000> of<00:06:59.120> public<00:06:59.639> bias<00:06:59.919> has<00:07:00.080> actually phenomenon of public bias has actually phenomenon of public bias has actually been<00:07:00.479> very<00:07:00.720> very<00:07:00.919> well<00:07:01.160> studied<00:07:01.919> so<00:07:02.120> here<00:07:02.240> is been very very well studied so here is been very very well studied so here is one<00:07:02.639> example<00:07:03.000> of<00:07:03.120> how<00:07:03.240> you<00:07:03.440> approach<00:07:03.759> it<00:07:04.240> the one example of how you approach it the one example of how you approach it the classic<00:07:04.720> Model<00:07:05.080> is<00:07:05.400> you<00:07:05.560> get<00:07:05.680> a<00:07:05.759> bunch<00:07:05.960> of classic Model is you get a bunch of classic Model is you get a bunch of studies<00:07:06.360> where<00:07:06.440> you<00:07:06.560> know<00:07:06.680> that<00:07:06.800> they've<00:07:07.000> been studies where you know that they've been studies where you know that they've been conducted<00:07:07.720> and<00:07:07.919> completed<00:07:08.479> and<00:07:08.560> then<00:07:08.680> you<00:07:08.800> go conducted and completed and then you go conducted and completed and then you go and<00:07:09.080> see<00:07:09.560> if<00:07:09.720> they've<00:07:09.919> been<00:07:10.120> published and see if they've been published and see if they've been published anywhere<00:07:11.080> in<00:07:11.199> the<00:07:11.360> academic<00:07:11.759> literature<00:07:12.479> so anywhere in the academic literature so anywhere in the academic literature so this<00:07:12.840> took<00:07:13.199> all<00:07:13.360> of<00:07:13.520> the<00:07:13.639> trials<00:07:14.000> that<00:07:14.120> had this took all of the trials that had this took all of the trials that had ever<00:07:14.400> been<00:07:14.560> conducted<00:07:14.919> on<00:07:15.120> antidepressants ever been conducted on antidepressants ever been conducted on antidepressants that<00:07:16.240> were<00:07:16.440> approved<00:07:16.840> over<00:07:17.000> a<00:07:17.240> 15-year<00:07:17.919> period that were approved over a 15-year period that were approved over a 15-year period by<00:07:18.639> the<00:07:18.759> FDA<00:07:19.479> they<00:07:19.599> took<00:07:19.800> all<00:07:19.919> of<00:07:20.000> the<00:07:20.120> trials by the FDA they took all of the trials by the FDA they took all of the trials which<00:07:20.560> were<00:07:20.720> submitted<00:07:21.120> to<00:07:21.240> the<00:07:21.360> FDA<00:07:21.759> as<00:07:21.879> part which were submitted to the FDA as part which were submitted to the FDA as part of<00:07:22.120> the<00:07:22.280> approval<00:07:22.800> package<00:07:23.440> so<00:07:23.639> that's<00:07:23.800> not of the approval package so that's not of the approval package so that's not all<00:07:24.280> of<00:07:24.360> the<00:07:24.479> trials<00:07:24.759> that<00:07:24.879> were<00:07:25.039> ever all of the trials that were ever all of the trials that were ever conducted<00:07:25.680> on<00:07:25.840> these<00:07:26.000> drugs<00:07:26.639> because<00:07:26.840> we<00:07:26.960> can conducted on these drugs because we can conducted on these drugs because we can never<00:07:27.400> know<00:07:27.639> if<00:07:27.759> we<00:07:27.960> have<00:07:28.199> those<00:07:28.680> but<00:07:28.800> it<00:07:28.879> is never know if we have those but it is never know if we have those but it is the<00:07:29.120> one<00:07:29.479> that<00:07:29.560> were<00:07:29.680> conducted<00:07:30.039> in<00:07:30.120> order<00:07:30.319> to the one that were conducted in order to the one that were conducted in order to get<00:07:30.599> the<00:07:30.720> marketing<00:07:31.120> authorization<00:07:32.120> and<00:07:32.280> then get the marketing authorization and then get the marketing authorization and then they<00:07:32.520> went<00:07:32.680> to<00:07:32.800> see<00:07:33.000> if<00:07:33.120> these<00:07:33.319> trials<00:07:33.639> had they went to see if these trials had they went to see if these trials had been<00:07:33.919> published<00:07:34.240> in<00:07:34.319> the<00:07:34.440> peer-reviewed been published in the peer-reviewed been published in the peer-reviewed academic<00:07:35.560> literature<00:07:35.960> and<00:07:36.120> this<00:07:36.199> is<00:07:36.360> what academic literature and this is what academic literature and this is what they<00:07:36.680> found<00:07:37.440> it<00:07:37.520> was<00:07:37.680> pretty<00:07:37.840> much<00:07:37.960> a<00:07:38.120> 50/50 they found it was pretty much a 50/50 they found it was pretty much a 50/50 split<00:07:39.520> half<00:07:39.639> of<00:07:39.800> these<00:07:39.919> trials<00:07:40.240> were<00:07:40.400> positive split half of these trials were positive split half of these trials were positive half<00:07:41.199> of<00:07:41.319> them<00:07:41.440> were<00:07:41.599> negative<00:07:42.199> in<00:07:42.759> reality half of them were negative in reality half of them were negative in reality but<00:07:43.879> when<00:07:44.039> they<00:07:44.199> went<00:07:44.639> to<00:07:44.800> look<00:07:44.960> for<00:07:45.120> these but when they went to look for these but when they went to look for these trials<00:07:46.440> in<00:07:46.560> the<00:07:46.680> peer-reviewed<00:07:47.280> academic trials in the peer-reviewed academic trials in the peer-reviewed academic literature<00:07:48.560> what<00:07:48.680> they<00:07:48.800> found<00:07:49.039> was<00:07:49.120> a<00:07:49.240> very literature what they found was a very literature what they found was a very different<00:07:50.159> picture<00:07:51.159> only<00:07:51.639> three<00:07:52.240> of<00:07:52.360> the different picture only three of the different picture only three of the negative<00:07:52.840> trials<00:07:53.720> were negative trials were negative trials were published<00:07:55.720> but<00:07:55.960> all<00:07:56.240> but<00:07:56.479> one<00:07:57.240> of<00:07:57.360> the published but all but one of the published but all but one of the positive<00:07:57.840> trials<00:07:58.199> were<00:07:58.360> published positive trials were published positive trials were published now<00:08:00.080> if<00:08:00.199> we<00:08:00.360> just<00:08:00.560> flick<00:08:01.080> back<00:08:01.240> and<00:08:01.479> forth now if we just flick back and forth now if we just flick back and forth between<00:08:02.680> those<00:08:02.919> two<00:08:03.560> you<00:08:03.680> can<00:08:03.800> see<00:08:04.039> what<00:08:04.159> a between those two you can see what a between those two you can see what a staggering<00:08:05.319> difference<00:08:05.720> there<00:08:05.879> was<00:08:06.120> between staggering difference there was between staggering difference there was between reality<00:08:07.639> and<00:08:07.840> what<00:08:08.120> doctors<00:08:08.960> patients reality and what doctors patients reality and what doctors patients commissioners<00:08:10.400> of<00:08:10.560> health<00:08:10.840> services<00:08:11.599> and commissioners of health services and commissioners of health services and academics<00:08:12.360> were<00:08:12.520> able<00:08:12.759> to<00:08:12.919> see<00:08:13.360> in<00:08:13.479> the academics were able to see in the academics were able to see in the peer-reviewed<00:08:14.400> academic<00:08:14.800> literature<00:08:15.639> we peer-reviewed academic literature we peer-reviewed academic literature we were<00:08:16.680> misled<00:08:17.680> and<00:08:17.840> this<00:08:17.960> is<00:08:18.120> a<00:08:18.520> systematic were misled and this is a systematic were misled and this is a systematic flaw<00:08:20.400> in<00:08:20.560> the<00:08:20.840> core<00:08:21.639> of flaw in the core of flaw in the core of medicine<00:08:23.680> in<00:08:23.879> fact<00:08:24.240> there<00:08:24.360> have<00:08:24.479> been<00:08:24.639> so<00:08:24.800> many medicine in fact there have been so many medicine in fact there have been so many studies<00:08:25.360> conducted<00:08:25.720> on<00:08:25.879> publication<00:08:26.440> bias studies conducted on publication bias studies conducted on publication bias now<00:08:27.919> over<00:08:28.159> a<00:08:28.319> hundred<00:08:28.800> that<00:08:28.919> they've<00:08:29.080> been now over a hundred that they've been now over a hundred that they've been collected<00:08:29.599> in<00:08:29.720> a<00:08:29.879> systematic<00:08:30.440> review collected in a systematic review collected in a systematic review published<00:08:31.280> in<00:08:31.560> 2010<00:08:32.560> that<00:08:32.680> took<00:08:33.039> every<00:08:33.320> single published in 2010 that took every single published in 2010 that took every single study<00:08:33.919> on<00:08:34.120> publication<00:08:34.640> the<00:08:34.800> bias<00:08:35.320> that<00:08:35.479> they study on publication the bias that they study on publication the bias that they could<00:08:35.800> find<00:08:36.680> publication<00:08:37.240> bias<00:08:37.560> affects could find publication bias affects could find publication bias affects every<00:08:38.320> field<00:08:38.599> of<00:08:39.039> medicine<00:08:40.039> about<00:08:40.440> half<00:08:40.640> of every field of medicine about half of every field of medicine about half of all<00:08:40.959> trials<00:08:41.279> on<00:08:41.479> average<00:08:42.080> go<00:08:42.320> missing<00:08:42.640> in all trials on average go missing in all trials on average go missing in action<00:08:43.560> and<00:08:43.680> we<00:08:43.800> know<00:08:43.959> that<00:08:44.200> positive action and we know that positive action and we know that positive findings<00:08:45.320> are<00:08:45.519> around<00:08:45.920> twice<00:08:46.279> as<00:08:46.440> likely<00:08:46.680> to findings are around twice as likely to findings are around twice as likely to be<00:08:47.000> published<00:08:47.720> as<00:08:47.920> negative be published as negative be published as negative findings<00:08:50.160> this<00:08:50.279> is<00:08:50.440> a<00:08:50.880> cancer<00:08:51.839> at<00:08:52.000> the<00:08:52.240> core<00:08:52.839> of findings this is a cancer at the core of findings this is a cancer at the core of evidence-based<00:08:53.680> medicine<00:08:54.440> if<00:08:54.560> I<00:08:54.720> flipped<00:08:55.080> a evidence-based medicine if I flipped a evidence-based medicine if I flipped a coin<00:08:56.000> 100<00:08:56.440> times<00:08:57.160> but<00:08:57.360> then<00:08:57.560> withheld<00:08:58.279> the coin 100 times but then withheld the coin 100 times but then withheld the results<00:08:58.880> from<00:08:59.040> you<00:08:59.279> you<00:08:59.519> from<00:08:59.800> half<00:09:00.000> of<00:09:00.160> those results from you you from half of those results from you you from half of those tosses<00:09:01.160> I<00:09:01.240> could<00:09:01.440> make<00:09:01.560> it<00:09:01.760> look<00:09:02.000> as<00:09:02.120> if<00:09:02.279> I<00:09:02.440> had tosses I could make it look as if I had tosses I could make it look as if I had a<00:09:02.760> coin<00:09:03.000> that<00:09:03.160> always<00:09:03.440> came<00:09:03.640> up<00:09:03.920> heads<00:09:04.440> but a coin that always came up heads but a coin that always came up heads but that<00:09:04.680> wouldn't<00:09:04.920> mean<00:09:05.079> that<00:09:05.200> I<00:09:05.320> had<00:09:05.440> a that wouldn't mean that I had a that wouldn't mean that I had a two-headed<00:09:06.000> coin<00:09:06.279> that<00:09:06.360> would<00:09:06.480> mean<00:09:06.640> that<00:09:06.760> I two-headed coin that would mean that I two-headed coin that would mean that I was<00:09:06.959> a<00:09:07.160> chancer<00:09:07.920> and<00:09:08.040> you<00:09:08.160> were<00:09:08.320> an<00:09:08.440> idiot<00:09:08.760> for was a chancer and you were an idiot for was a chancer and you were an idiot for letting<00:09:09.120> me<00:09:09.279> get<00:09:09.480> away<00:09:09.720> with<00:09:10.200> it<00:09:11.200> but<00:09:11.519> this<00:09:12.000> is letting me get away with it but this is letting me get away with it but this is exactly<00:09:13.000> what<00:09:13.200> we<00:09:13.440> blindly<00:09:14.160> tolerate<00:09:15.000> in<00:09:15.200> the exactly what we blindly tolerate in the exactly what we blindly tolerate in the whole<00:09:15.920> of<00:09:16.240> evidence-based<00:09:17.240> medicine<00:09:18.240> and<00:09:18.399> to whole of evidence-based medicine and to whole of evidence-based medicine and to me<00:09:19.920> this<00:09:20.440> is<00:09:21.440> research<00:09:22.320> misconduct<00:09:23.320> if<00:09:23.480> I me this is research misconduct if I me this is research misconduct if I conducted<00:09:24.200> one<00:09:24.519> study<00:09:25.040> and<00:09:25.160> I<00:09:25.320> withheld<00:09:26.240> half conducted one study and I withheld half conducted one study and I withheld half of<00:09:26.640> the<00:09:26.800> data<00:09:27.160> points<00:09:27.560> from<00:09:27.800> that<00:09:27.959> one<00:09:28.279> study of the data points from that one study of the data points from that one study you<00:09:28.959> would<00:09:29.320> rightly<00:09:29.720> accuse<00:09:30.160> me<00:09:30.640> essentially you would rightly accuse me essentially you would rightly accuse me essentially of<00:09:31.800> research<00:09:32.480> fraud<00:09:33.480> and<00:09:33.720> yet<00:09:33.959> for<00:09:34.120> some of research fraud and yet for some of research fraud and yet for some reason<00:09:35.000> if<00:09:35.120> somebody<00:09:35.560> conducts<00:09:36.279> 10<00:09:36.680> studies reason if somebody conducts 10 studies reason if somebody conducts 10 studies but<00:09:37.600> only<00:09:37.880> publishes<00:09:38.399> the<00:09:38.640> five<00:09:38.959> that<00:09:39.120> give but only publishes the five that give but only publishes the five that give the<00:09:39.480> result<00:09:39.839> that<00:09:40.000> they<00:09:40.160> want<00:09:40.839> we<00:09:40.959> don't the result that they want we don't the result that they want we don't consider<00:09:41.600> that<00:09:41.720> to<00:09:41.839> be<00:09:42.000> research<00:09:42.640> misconduct consider that to be research misconduct consider that to be research misconduct and<00:09:43.800> when<00:09:44.000> that<00:09:44.240> responsibility<00:09:44.959> is<00:09:45.160> diffused and when that responsibility is diffused and when that responsibility is diffused between<00:09:46.240> a<00:09:46.440> whole<00:09:46.720> network<00:09:47.160> of<00:09:47.399> researchers between a whole network of researchers between a whole network of researchers academics<00:09:49.399> industry<00:09:49.959> sponsors<00:09:50.880> Journal academics industry sponsors Journal academics industry sponsors Journal editors<00:09:51.880> for<00:09:52.040> some<00:09:52.279> reason<00:09:52.760> we<00:09:52.880> find<00:09:53.160> it<00:09:53.320> more editors for some reason we find it more editors for some reason we find it more acceptable<00:09:54.360> but<00:09:54.560> the<00:09:54.720> effect<00:09:55.040> on<00:09:55.279> patients<00:09:56.000> is acceptable but the effect on patients is acceptable but the effect on patients is damning<00:09:58.480> and<00:09:58.600> this<00:09:58.720> is<00:09:58.880> happen<00:09:59.120> happening damning and this is happen happening damning and this is happen happening right<00:10:00.560> now right now right now today<00:10:03.120> this<00:10:03.240> is<00:10:03.360> a<00:10:03.519> drug<00:10:03.760> called<00:10:03.959> Tamiflu today this is a drug called Tamiflu today this is a drug called Tamiflu Tamiflu<00:10:05.040> is<00:10:05.120> a<00:10:05.240> drug<00:10:05.680> which<00:10:05.880> governments Tamiflu is a drug which governments Tamiflu is a drug which governments around<00:10:06.480> the<00:10:06.560> world<00:10:06.800> have<00:10:06.959> spent<00:10:07.399> billions<00:10:08.240> and around the world have spent billions and around the world have spent billions and billions<00:10:08.959> of<00:10:09.200> dollars<00:10:09.760> on<00:10:09.959> stockpiling<00:10:10.959> and billions of dollars on stockpiling and billions of dollars on stockpiling and we've<00:10:11.240> stockpiled<00:10:11.839> Tamiflu<00:10:12.760> in<00:10:13.040> panic<00:10:13.920> in<00:10:14.040> the we've stockpiled Tamiflu in panic in the we've stockpiled Tamiflu in panic in the belief<00:10:14.480> that<00:10:14.600> it<00:10:14.680> will<00:10:14.880> reduce<00:10:15.320> the<00:10:15.440> rate<00:10:15.600> of belief that it will reduce the rate of belief that it will reduce the rate of complications<00:10:16.880> of<00:10:17.360> influenza<00:10:18.360> complications complications of influenza complications complications of influenza complications is<00:10:19.000> a<00:10:19.160> medical<00:10:19.519> euphemism<00:10:20.079> for<00:10:20.240> pneumonia<00:10:21.160> and

death<00:10:25.560> now<00:10:25.680> when<00:10:25.839> the<00:10:25.959> cockrane<00:10:26.640> systematic death now when the cockrane systematic death now when the cockrane systematic reviewers<00:10:28.440> were<00:10:28.640> trying<00:10:28.839> to<00:10:29.120> collect reviewers were trying to collect reviewers were trying to collect together<00:10:29.839> all<00:10:30.000> of<00:10:30.160> the<00:10:30.320> data<00:10:30.680> from<00:10:30.920> all<00:10:31.079> of<00:10:31.200> the together all of the data from all of the together all of the data from all of the trials<00:10:31.640> that<00:10:31.760> had<00:10:31.920> ever<00:10:32.120> been<00:10:32.279> conducted<00:10:32.680> on trials that had ever been conducted on trials that had ever been conducted on whether<00:10:33.000> tamilo<00:10:33.560> actually<00:10:33.800> did<00:10:34.000> this<00:10:34.120> or<00:10:34.320> not whether tamilo actually did this or not whether tamilo actually did this or not they<00:10:34.920> found<00:10:35.160> that<00:10:35.320> several<00:10:35.600> of<00:10:35.760> those<00:10:35.920> trials they found that several of those trials they found that several of those trials were<00:10:36.760> unpublished<00:10:37.639> the<00:10:37.760> results<00:10:38.120> were were unpublished the results were were unpublished the results were unavailable<00:10:39.000> to<00:10:39.160> them<00:10:39.519> and<00:10:39.639> when<00:10:39.760> they unavailable to them and when they unavailable to them and when they started<00:10:40.240> obtaining<00:10:41.040> the<00:10:41.200> writeups<00:10:41.680> of<00:10:41.839> those started obtaining the writeups of those started obtaining the writeups of those trials<00:10:42.480> through<00:10:42.720> various<00:10:43.000> different<00:10:43.240> means trials through various different means trials through various different means through<00:10:43.720> Freedom<00:10:44.000> of<00:10:44.160> Information<00:10:44.560> at through Freedom of Information at through Freedom of Information at requests<00:10:45.200> through<00:10:45.480> harassing<00:10:46.040> various requests through harassing various requests through harassing various different<00:10:46.880> organizations<00:10:47.880> what<00:10:48.040> they<00:10:48.200> found different organizations what they found different organizations what they found was<00:10:49.160> inconsistent<00:10:50.160> and<00:10:50.279> when<00:10:50.399> they<00:10:50.519> tried<00:10:50.720> to was inconsistent and when they tried to was inconsistent and when they tried to get<00:10:50.959> hold<00:10:51.120> of<00:10:51.200> the<00:10:51.279> clinical<00:10:51.639> study<00:10:51.959> reports get hold of the clinical study reports get hold of the clinical study reports the<00:10:52.680> 10,000<00:10:53.560> Page<00:10:53.839> Long<00:10:54.440> documents<00:10:55.079> that<00:10:55.200> have the 10,000 Page Long documents that have the 10,000 Page Long documents that have the<00:10:56.000> the<00:10:56.240> the<00:10:56.399> best<00:10:56.720> possible<00:10:57.079> rendition<00:10:57.839> of the the the best possible rendition of the the the best possible rendition of the<00:10:58.160> information<00:10:59.120> they<00:10:59.240> were<00:10:59.399> told<00:10:59.880> they the information they were told they the information they were told they weren't<00:11:00.399> allowed<00:11:01.000> to<00:11:01.240> have<00:11:01.440> them<00:11:01.839> and<00:11:01.959> if<00:11:02.040> you weren't allowed to have them and if you weren't allowed to have them and if you want<00:11:02.320> to<00:11:02.480> read<00:11:02.880> the<00:11:03.040> full<00:11:03.680> correspondence<00:11:04.680> and want to read the full correspondence and want to read the full correspondence and the<00:11:05.040> excuses<00:11:05.600> and<00:11:05.760> the<00:11:05.880> explanations<00:11:06.519> given the excuses and the explanations given the excuses and the explanations given by<00:11:06.880> the<00:11:07.040> drug<00:11:07.320> company<00:11:07.920> you<00:11:08.079> can<00:11:08.240> see<00:11:08.480> that by the drug company you can see that by the drug company you can see that written<00:11:08.959> up<00:11:09.399> in<00:11:09.680> this<00:11:09.880> week's<00:11:10.240> edition<00:11:10.920> of written up in this week's edition of written up in this week's edition of plus

medicine<00:11:15.519> and<00:11:15.639> the<00:11:15.760> most<00:11:15.920> staggering<00:11:16.360> thing medicine and the most staggering thing medicine and the most staggering thing of<00:11:16.680> all<00:11:16.800> of<00:11:17.079> this<00:11:18.040> to<00:11:18.680> me<00:11:19.680> is<00:11:19.839> that<00:11:20.000> not<00:11:20.160> only<00:11:20.440> is of all of this to me is that not only is of all of this to me is that not only is this<00:11:20.760> a<00:11:20.959> problem<00:11:21.279> not<00:11:21.399> only<00:11:21.600> do<00:11:21.760> we<00:11:21.959> recognize this a problem not only do we recognize this a problem not only do we recognize that<00:11:22.560> this<00:11:22.680> is<00:11:22.800> a<00:11:22.959> problem<00:11:23.839> but<00:11:23.959> we've<00:11:24.160> had<00:11:24.279> to that this is a problem but we've had to that this is a problem but we've had to suffer<00:11:25.120> fake<00:11:25.639> fixes<00:11:26.200> we've<00:11:26.399> had<00:11:26.600> people suffer fake fixes we've had people suffer fake fixes we've had people pretend<00:11:28.079> that<00:11:28.240> this<00:11:28.320> is<00:11:28.440> a<00:11:28.560> problem<00:11:28.800> that<00:11:29.120> been pretend that this is a problem that been pretend that this is a problem that been fixed<00:11:29.639> first<00:11:29.800> of<00:11:29.920> all<00:11:30.200> we<00:11:30.320> had<00:11:30.480> trials fixed first of all we had trials fixed first of all we had trials registers<00:11:31.320> and<00:11:31.440> everybody<00:11:31.680> said<00:11:31.880> oh<00:11:32.000> it's registers and everybody said oh it's registers and everybody said oh it's okay<00:11:32.519> we'll<00:11:32.680> get<00:11:32.839> everyone<00:11:33.079> to<00:11:33.240> register okay we'll get everyone to register okay we'll get everyone to register their<00:11:33.760> trials<00:11:34.440> well<00:11:34.639> they'll<00:11:34.800> post<00:11:35.000> the their trials well they'll post the their trials well they'll post the protocol<00:11:35.560> they'll<00:11:35.720> say<00:11:35.880> what<00:11:36.000> they're<00:11:36.120> going protocol they'll say what they're going protocol they'll say what they're going to<00:11:36.360> do<00:11:36.560> before<00:11:36.800> they<00:11:37.000> do<00:11:37.200> it<00:11:37.519> and<00:11:37.639> then to do before they do it and then to do before they do it and then afterwards<00:11:38.120> we'll<00:11:38.279> be<00:11:38.360> able<00:11:38.519> to<00:11:38.639> check<00:11:38.800> and afterwards we'll be able to check and afterwards we'll be able to check and see<00:11:39.040> if<00:11:39.120> all<00:11:39.240> the<00:11:39.320> trials<00:11:39.639> which<00:11:39.760> have<00:11:39.880> been see if all the trials which have been see if all the trials which have been conducted<00:11:40.360> and<00:11:40.519> completed<00:11:41.120> have<00:11:41.279> been conducted and completed have been conducted and completed have been published<00:11:42.079> but<00:11:42.240> people<00:11:42.440> didn't<00:11:42.680> bother<00:11:42.959> to published but people didn't bother to published but people didn't bother to use<00:11:43.320> those<00:11:43.560> registers<00:11:44.360> and<00:11:44.440> so<00:11:44.600> then<00:11:44.760> the use those registers and so then the use those registers and so then the international<00:11:45.360> Committee<00:11:45.639> of<00:11:45.720> medical international Committee of medical international Committee of medical journal<00:11:46.200> editors<00:11:46.560> came<00:11:46.680> along<00:11:46.880> and<00:11:47.000> they<00:11:47.079> said journal editors came along and they said journal editors came along and they said oh<00:11:47.440> well<00:11:47.720> we<00:11:47.839> will<00:11:48.000> hold<00:11:48.200> the<00:11:48.320> line<00:11:48.560> we<00:11:48.680> won't oh well we will hold the line we won't oh well we will hold the line we won't publish<00:11:49.240> any<00:11:49.399> journals<00:11:50.040> we<00:11:50.160> won't<00:11:50.399> publish publish any journals we won't publish publish any journals we won't publish any<00:11:50.839> trials<00:11:51.560> unless<00:11:51.880> they've<00:11:52.079> been any trials unless they've been any trials unless they've been registered<00:11:52.720> before<00:11:53.000> they<00:11:53.160> began<00:11:54.040> but<00:11:54.279> they registered before they began but they registered before they began but they didn't<00:11:54.680> hold<00:11:54.880> the<00:11:55.000> line<00:11:55.240> in<00:11:55.600> 2008<00:11:56.079> a<00:11:56.200> study<00:11:56.480> was didn't hold the line in 2008 a study was didn't hold the line in 2008 a study was conducted<00:11:57.160> which<00:11:57.279> showed<00:11:57.600> that<00:11:58.000> half<00:11:58.160> of<00:11:58.279> all conducted which showed that half of all conducted which showed that half of all the<00:11:58.560> trans<00:11:59.079> published<00:11:59.480> by<00:11:59.680> journals<00:12:00.279> edited the trans published by journals edited the trans published by journals edited by<00:12:00.959> members<00:12:01.279> of<00:12:01.440> the by members of the by members of the icmj<00:12:03.560> weren't<00:12:03.959> properly<00:12:04.320> registered<00:12:04.720> and<00:12:04.839> a icmj weren't properly registered and a icmj weren't properly registered and a quarter<00:12:05.320> of<00:12:05.440> them<00:12:05.560> weren't<00:12:05.920> registered<00:12:06.760> at quarter of them weren't registered at quarter of them weren't registered at all<00:12:07.519> and<00:12:07.639> then<00:12:07.880> finally<00:12:08.440> the<00:12:08.560> FDA<00:12:08.959> Amendment all and then finally the FDA Amendment all and then finally the FDA Amendment Act<00:12:09.720> was<00:12:09.959> passed<00:12:10.279> a<00:12:10.399> couple<00:12:10.639> of<00:12:10.800> years<00:12:11.000> ago Act was passed a couple of years ago Act was passed a couple of years ago saying<00:12:11.680> that<00:12:11.880> everybody<00:12:12.200> who<00:12:12.360> conducts<00:12:12.720> a saying that everybody who conducts a saying that everybody who conducts a trial<00:12:13.079> must<00:12:13.279> post<00:12:13.480> the<00:12:13.600> results<00:12:13.880> of<00:12:14.040> that trial must post the results of that trial must post the results of that trial<00:12:14.639> within<00:12:15.079> one<00:12:15.440> year<00:12:16.040> and<00:12:16.160> in<00:12:16.279> the<00:12:16.399> bmj<00:12:17.399> in trial within one year and in the bmj in trial within one year and in the bmj in the<00:12:17.760> first<00:12:18.079> edition<00:12:18.440> of<00:12:18.680> January<00:12:19.160> 2012<00:12:20.120> you the first edition of January 2012 you the first edition of January 2012 you can<00:12:20.360> see<00:12:20.560> a<00:12:20.720> study<00:12:21.040> which<00:12:21.199> looks<00:12:21.440> to<00:12:21.600> see<00:12:22.079> if can see a study which looks to see if can see a study which looks to see if people<00:12:22.600> kept<00:12:23.199> to<00:12:23.399> that<00:12:23.560> ruling<00:12:24.160> and<00:12:24.279> it<00:12:24.399> turns people kept to that ruling and it turns people kept to that ruling and it turns out<00:12:24.839> that<00:12:25.000> only<00:12:25.360> one<00:12:25.920> in<00:12:26.399> five<00:12:27.120> have<00:12:27.320> done<00:12:27.880> so out that only one in five have done so out that only one in five have done so this<00:12:30.639> is<00:12:30.800> a this is a this is a disaster<00:12:32.800> we<00:12:33.079> cannot<00:12:33.480> know<00:12:34.079> the<00:12:34.279> true<00:12:34.880> effects disaster we cannot know the true effects disaster we cannot know the true effects of<00:12:35.760> the<00:12:35.880> medicines<00:12:36.600> that<00:12:36.760> we<00:12:37.040> prescribe<00:12:38.040> if<00:12:38.199> we of the medicines that we prescribe if we of the medicines that we prescribe if we do<00:12:38.519> not<00:12:38.760> have<00:12:39.040> access<00:12:39.880> to<00:12:40.199> all<00:12:40.800> of<00:12:41.000> the do not have access to all of the do not have access to all of the information<00:12:42.639> and<00:12:42.800> this<00:12:42.920> is<00:12:43.160> not<00:12:43.600> a<00:12:44.079> difficult information and this is not a difficult information and this is not a difficult problem<00:12:44.920> to problem to problem to fix<00:12:47.320> we<00:12:47.480> need<00:12:47.639> to<00:12:47.959> force<00:12:48.639> people<00:12:49.639> to<00:12:49.920> publish fix we need to force people to publish fix we need to force people to publish all<00:12:50.959> trials<00:12:51.959> conducted<00:12:52.399> in<00:12:52.800> humans<00:12:53.800> including all trials conducted in humans including all trials conducted in humans including the<00:12:54.279> older<00:12:54.519> trials<00:12:54.880> because<00:12:55.079> the<00:12:55.199> FDA the older trials because the FDA the older trials because the FDA Amendment<00:12:55.959> Act<00:12:56.160> only<00:12:56.399> asks<00:12:56.680> that<00:12:56.760> you<00:12:56.880> publish Amendment Act only asks that you publish Amendment Act only asks that you publish the<00:12:57.279> trials<00:12:57.720> conducted<00:12:58.120> after<00:12:58.360> 200<00:12:59.279> and<00:12:59.399> I the trials conducted after 200 and I the trials conducted after 200 and I don't<00:12:59.680> know<00:12:59.880> what<00:13:00.120> world<00:13:00.399> it<00:13:00.560> is<00:13:00.760> in<00:13:00.880> which don't know what world it is in which don't know what world it is in which we're<00:13:01.199> only<00:13:01.480> practicing<00:13:01.839> medicine<00:13:02.199> on<00:13:02.279> the we're only practicing medicine on the we're only practicing medicine on the basis<00:13:02.639> of<00:13:02.800> trials<00:13:03.120> that<00:13:03.240> completed<00:13:03.639> in<00:13:03.760> the basis of trials that completed in the basis of trials that completed in the past<00:13:04.399> two<00:13:04.839> years<00:13:05.839> we<00:13:05.959> need<00:13:06.079> to<00:13:06.240> publish<00:13:06.600> all past two years we need to publish all past two years we need to publish all trials<00:13:07.160> in<00:13:07.360> humans<00:13:07.959> including<00:13:08.399> the<00:13:08.480> older trials in humans including the older trials in humans including the older trials<00:13:09.279> for<00:13:09.519> all<00:13:09.720> drugs<00:13:10.000> in<00:13:10.199> current<00:13:10.519> use<00:13:11.279> and trials for all drugs in current use and trials for all drugs in current use and you<00:13:11.560> need<00:13:11.720> to<00:13:11.880> tell<00:13:12.320> everyone<00:13:12.800> you<00:13:13.079> know<00:13:14.079> that you need to tell everyone you know that you need to tell everyone you know that this<00:13:14.360> is<00:13:14.440> a<00:13:14.720> problem<00:13:15.399> and<00:13:15.519> that<00:13:15.639> it<00:13:15.800> has<00:13:16.040> not this is a problem and that it has not this is a problem and that it has not been<00:13:16.760> fixed<00:13:17.760> thank<00:13:17.920> you<00:13:18.079> very been fixed thank you very been fixed thank you very [Applause] [Applause] [Applause] [Music]

much

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