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发表于 2008-10-26 17:56
将科学引入替代医学替代医学存在着不被重视，缺乏可靠的科学评估标准，草药中有效成分不稳定等等问题，美国政府部门NIH的介入，对替代医学是机遇还是挑战，We will see!
Applying Science to Alternative Medicine
将科学引入替代医学
By WILLIAM J. BROADPublished: September 29, 2008
WILLIAM J. BROAD撰写
2008年9月29日发布
More than 80 million adults in the United States are estimated to use some form of alternative medicine, from herbs and megavitamins to yoga and acupuncture. But while sweeping claims are made for these treatments, the scientific evidence for them often lags far behind: studies and clinical trials, when they exist at all, can be shoddy in design and too small to yield reliable insights.
在美国，据估计有超过8000万的成年人正使用着某种形式的替代医学，从中草药和大剂量维生素，到瑜伽与针灸。但是尽管对于这些替代医学的治疗存在着广泛的需求，支持这些疗法的科学依据却远远滞后于需求的发展：目前业已存在的各种形式的研究和临床试验，大多存在着实验设计上的缺陷或是样本量太小以至于不能产生值得信赖的结论。
Now the federal government is working hard to raise the standards of evidence, seeking to distinguish between what is effective, useless and harmful or even dangerous.
现在联邦政府正在致力于为科研证据制定规范的标准，从而使我们得以区分在替代医学中什么是有效的，无用的，有害的，甚至是危险的。
“The research has been making steady progress,” said Dr. Josephine P. Briggs, director of the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. “It’s reasonably new that rigorous methods are being used to study these health practices.”
“这项研究正在取得稳步的进展，”Josephine P. Briggs博士说道，他是国家补充与替代医学研究中心的主任，该研究中心是美国国立卫生研究院（NIH）的分支。“这是非常合理的创新，我们将严谨的研究方法用于研究这些健康相关的实践方法。”
The need for rigor can be striking. For instance, a 2004 Harvard study identified 181 research papers on yoga therapy reporting that it could be used to treat an impressive array of ailments — including asthma, heart disease, hypertension, depression, back pain, bronchitis, diabetes, cancer, arthritis, insomnia, lung disease and high blood pressure.
在研究中，对于严谨的需要可能是非常令人吃惊的。例如，哈佛大学在2004年进行了一项关于瑜伽疗法的研究，它在对目前已报道的181篇关于瑜伽疗法的研究论文进行了研究后，得出这样一项结论，即瑜伽可以用于治疗一系列令人产生深刻印象的疾病 — 包括哮喘，心脏病，高血压，抑郁症，腰痛，支气管炎，糖尿病，癌症，关节炎，失眠，肺部疾病和血压升高。
It turned out that only 40 percent of the studies used randomized controlled trials — the usual way of establishing reliable knowledge about whether a drug, diet or other intervention is really safe and effective. In such trials, scientists randomly assign patients to treatment or control groups with the aim of eliminating bias from clinician and patient decisions.
它证明在这些研究中仅仅只有40%采用了随机化对照试验— 该方法是用于获得关于一个药物、食物或是其它干预措施是否真的安全有效的可靠知识最常用方法。在这样的实验中，科学家们随机将患者分人治疗或是对照组以消除临床医生或者是病人的选择偏倚。
Sat Bir S. Khalsa, the study’s author and a sleep researcher at the Harvard Medical School, said an added complication was that “the vast majority of these studies have been small,” averaging 30 or fewer subjects per arm of the randomized trial. The smaller the sample size, he warned, the greater the risk of error, including false positives and false negatives.
Sat Bir S. Khalsa，该研究的作者之一，也是哈佛大学医学院的睡眠疾病研究员，说还有一种复杂的附加情况就是：“这些研究中的绝大部分都是非常小规模的研究，”每个随机化试验的每个组平均只有30个或是更少的受试者。样本量越小，他警告说，发生错误的概率就越大，包括假阳性和假阴性。
Critics of alternative medicine have seized on that weakness. R. Barker Bausell, a senior research methodologist at the University of Maryland and the author of “Snake Oil Science” (Oxford, 2007), says small studies often have a built-in conflict of interest: they need to show positive results to win grants for larger investigations.
针对替代医学的批评正是抓住了这个弱点。R. Barker Bausell，马里兰大学的方法学高级研究员和“蛇油科学”（牛津大学出版社，2007年）一书的作者，评论说，小规模的研究常常都有内在的利益冲突：他们需要得出阳性结果，从而为更大规模研究获取资金。
“All these things conspire to produce false positives,” Dr. Bausell said in an interview. “They make the results extremely questionable.”
“所有的这些合力促成了虚假阳性结果的产生，”Bausell博士在某次访谈中说道。“他们使得这些结论变得极度令人怀疑。”
That kind of fog is what Dr. Briggs and the National Center for Complementary and Alternative Medicine, with a budget of $122 million this year, are trying to eliminate. Their trials tend to be longer and larger. And if a treatment shows promise, the center extends the trials to many centers, further lowering the odds of false positives and investigator bias.
在今年Briggs博士和国家补充与替代医学研究中心，正打算用1.22亿美元的预算，去进行一项研究以消除这些困惑。他们的试验将会有更大的规模，并且持续更长的时间。并且如果一项治疗达到了预期的疗效，该中心还将会把这些实验延伸到多中心，进一步降低假阳性率的OD值和研究偏倚。
For instance, the center is conducting a large study to see if extracts from the ginkgo biloba tree can slow the progression of Alzheimer’s disease. The clinical trials involve centers in California, Maryland, North Carolina and Pennsylvania and recruited more than 3,000 patients, all of them over 75. The study is to end next year.
例如，该中心现在正在进行一项大型研究，以确定银杏树的提取物是否能够减慢阿尔茨海默氏症的进程。该临床试验包括了设在加利福尼亚，马里兰，北卡罗来纳和宾夕法尼亚等多个研究中心的超过3000名病人，他们的年龄都在75岁以上。这项研究预计在明年结束。
Another large study enrolled 570 participants to see if acupuncture provided pain relief and improved function for people with osteoarthritis of the knee. In 2004, it reported positive results. Dr. Brian M. Berman, the study’s director and a professor of medicine at the University of Maryland, said the inquiry “establishes that acupuncture is an effective complement to conventional arthritis treatment.”
另外一项大型研究招募了570位参与者以确定针灸是否能够减轻患有膝盖骨关节炎患者的疼痛并改善其运动功能。在2004年，该研究报道了阳性结果。Brian M. Berman博士，该研究的主任和马里兰大学的医学教授说该项探究“证明了针灸是传统关节炎治疗的一项有效补充。”
In an interview, Dr. Briggs said another good way to improve clinical trials was to ensure product uniformity, especially on herbal treatments. “We feel we have really influenced the standards,” she said.
在一次访谈中，Briggs 博士说另外一种改善临床试验的好方法就是确保产品的均一性，尤其是在中草药治疗中。“我们觉得我们确实已经影响了这些标准，”她说。
Over the years, laboratories have found that up to 75 percent of the samples of ginkgo biloba failed to show the claimed levels of the active ingredient. Scientists doing a clinical trial have a large incentive to fix that kind of inconsistency.
在数年时间中，实验室发现有接近75%的银杏树提取物的样本没能达到它们所宣称的活性成分级别。做临床实验的科学工作者受到很多激励去解决这项矛盾。
[ 本帖最后由 MP4 于 2008-10-26 17:58 编辑 ] |
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