大規模的造假意味着我們無法相信來自中國的研究

Imagine a therapy that supposedly cures most ailments and for which almost 100 per cent of all the published studies conclude is effective — in other words, a panacea which has been tested but never faulted by science. This can only mean that the treatment in question is a miracle cure which is useful for every single condition and in every single setting. Would we not all love to know such a therapy?

想象下一種可以治癒大多數疾病的療法，幾乎所有發表的研究中得出的結論都是有效的，換句話說，這是一種久經檢驗但從未被科學質疑過的靈丹妙藥。這隻能意味着我們提到的這個治療是一種奇蹟，它對不同情況下的每一種病症都有效。我們不是都會喜歡這種療法嗎？

Simple common sense tells us, however, that such miracle cures cannot exist — unless, of course, we consider the wide range of treatments that fall under the umbrella of Traditional Chinese Medicine.

然而，常識告訴我們，這種奇蹟是不可能存在的——除非，當然啦，我們認爲中醫治療覆蓋的範圍是很廣泛的。

Take acupuncture, for instance. Most traditional acupuncturists will try to convince you that acupuncture is a veritable panacea, a treatment that works for anything and everything ranging from acne to zoster. In case you find this hard to believe, go on the internet and try to find a single condition for which acupuncture is not claimed to be effective.

以鍼灸爲例。大部分傳統鍼灸師會試圖說服你，鍼灸是一個名副其實的萬能藥，治療的範圍，從痤瘡到帶狀皰疹。如果你不信，上網去搜搜病例看看鍼灸是不是聲稱很有效。

What is more, acupuncture trials hardly ever generate negative findings — at least those that originate from China. We and others have shown that Chinese trials of acupuncture as good as never suggest that acupuncture does not work. This has led to the bizarre situation where one does no longer need to read the paper reporting a new Chinese study because one already knows what it shows, namely that acupuncture is effective. If that is so, one does not even need to conduct the study, since one already knows the outcome before the research has started.

更妙的是，鍼灸試驗沒有產生任何負面的結果——至少那些源自中國的信息是這麼說的。我們和其他一些人於是明白了中國的鍼灸實驗是從來不會認爲無效的。如果這樣的話，你何必還要進行研究呢，在研究之前已經知道結果了啊。

Perhaps you think the ‘Western’ scientists who disclosed this baffling phenomenon are chauvinists who, for one reason or another, want to discredit Chinese science. In this case, you would probably want to wait for a team of Chinese researchers repeating our investigations.

也許你認爲西方科學家質疑這一令人困惑的現象是因爲沙文主義或其他啥原因好抹黑中國。在這種情況下，你可能想等待一隊中國研究人員複覈下我們的調查。

Wait no more.

不用在等了。

Chinese researchers identified all randomised controlled trials (RCTs) of acupuncture published in Chinese journals. A total of 840 RCTs were included in their assessment, and 838 of them (99.8 per cent) reported positive results. Only two trials (0.2 per cent) reported negative results. The authors concluded: ‘Publication bias might be a major issue in RCTs on acupuncture published in Chinese journals … which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.’

中國研究人員確認了中國期刊上發佈的有關鍼灸的所有隨機對照試驗。共有840個隨機對照試驗及評價，其中838例（99.8個百分點）報道結果有效。只有兩個試驗（百分之0.2）報告結果無效。作者得出的結論是：在中國期刊發表關於鍼灸隨機對照試驗結果的主要問題是太偏頗了……很明顯的先入爲主（認爲有效）。我們建議，以後所有實驗都應該提前在國際實驗註冊備案。

For many years I, too, had been inclined to give my Chinese colleagues the benefit of the doubt and assumed that publication bias — the phenomenon where negative results tend to remain unpublished — might be the explanation. If so, trial registration would indeed be the answer. But think of it: publication bias might provide a reason for a preponderance of positive findings but it cannot truly explain that close to zero per cent of negative results see the light of day. There must be other factors involved.

多年來我一直致力於給我的中國同事灌輸質疑的好處，以及發表的文章一邊倒——也可能是負面的情況根本沒有被報道出來。如果是這樣的話，實驗前在國際實驗註冊備案是個不錯的辦法。再回過頭來看看，公佈的實驗結果一邊倒的表示有效，負面效果幾乎爲零，對此沒有個清楚明瞭的解釋。肯定還有其他因素。

One obvious explanation could be that many or most of the Chinese studies are — dare I say it? — dodgy to the point of being fraudulent. This allegation seems so outlandish that I would never have voiced it, unless there is some pretty solid evidence to back it up.

一個明顯的解釋是中國的很多研究或者說絕大部分研究——我爲啥這麼說呢？——他們(的實驗)不可靠且不誠實。如果沒有確鑿的證據，我絕對不會發出這樣粗魯的指控。

A recent survey of Chinese clinical trials has revealed fraudulent practice on a massive scale. China’s food and drug regulator carried out a year-long review and concluded that more than 80 per cent of clinical studies are ‘fabricated’. The investigators uated data from 1,622 clinical trial programmes of drugs awaiting approval by the regulator. Much of the data were found to be incomplete, failed to meet analysis requirements or were untraceable. Some institutions were suspected of deliberately hiding or deleting records of adverse effects, and tampering with evidence that did not meet expectations. ‘Clinical data fabrication was an open secret even before the inspection,’ an unnamed Chinese hospital director was quoted as saying. Contract research organisations seem to have become ‘accomplices in data fabrication due to cutthroat competition and economic motivation’.

最近對中國臨牀實驗的調查顯示了他們有大規模的欺詐行爲。中國食品藥物監管部門進行了長達一年的回顧總結，百分之80以上的臨牀研究數據爲“捏造”的。研究人員評估了1622個等待監管機構批准的臨牀試驗方案的數據。大亮的數據被認爲是不完整的，不符合要求或無法進行追蹤分析的。甚至一些機構涉嫌故意隱瞞或刪除不利影響的記錄，並篡改證據以符合預期結果。一位不願透露姓名的中國醫院主任說：“在審覈前，“製做”臨牀數據已經就是個公開的祕密了”。合同研究組織，由於激烈的競爭以及經濟利益，成爲了數據造假的共犯。CRO----合同研究組織，20世紀80年代初起源於美國，它是通過合同形式爲製藥企業、醫療機構、中小醫藥醫療器械研發企業、甚至各種政府基金等機構在基礎醫學和臨牀醫學研發過程中提供專業化服務的一種學術性或商業性的科學機構。

The human rights activist Mai Ke went one step further, claiming that there is an ‘all-pervasive culture of fakery’ across all products made in the country. ‘It’s not just the medicines,’ he told Radio Free Asia. ‘In China, everything is fake, and if there’s a profit in pharmaceuticals, then someone’s going to fake them too.’

人權專家Mai Ke進一步補充道“在這個國家的產品製造業中有一種無處不在的造假文化，不僅是藥物，”他告訴自由亞洲電臺“在中國，啥都有假貨，如果藥品有利可圖，就有人會去造假。”

Crucially, he stressed that the problem also extends to Traditional Chinese Medicines: ‘It’s just harder to regulate the fakes with traditional medicines than it is with Western pharmaceuticals, which have strict manufacturing guidelines.’

最重要的是，他強調，這種現象也蔓延到了中醫藥：“比起西醫傳統的中醫藥監管起來難度要高的多，因爲西藥有嚴格的生產標準。”

Academic ethics is an underdeveloped field in China; this leads to a culture that is accepting of academics manipulating data. ‘I don’t think that the 80 per cent figure is overstated,’ another Chinese insider commented.

學術道德是中國一個欠發達的領域；這導致了一種文化，對學者操縱數據比較寬容。另一位中國內部人士評論說，我認爲80%的數字沒有誇大。

Considering data fabrication on such an epidemic scale, it seems much easier to understand the above-mentioned phenomenon, where nearly 100 per cent of Chinese acupuncture studies generate positive findings. Such trials heavily pollute the worldwide evidence, particularly because the Chinese trials constitute a major chunk of the current evidence base in this area.

考慮到這樣大規模的數據造假，上述鍼灸實驗近乎百分百有效的現象就不難理解了。這些實驗數據嚴重污染了世界範圍內的數據庫，尤其是現有的這類大部分由中國實驗數據構成的數據庫。

If we agree that data fabrication has seriously detrimental effects, we must ask what we can do about it. I feel we have little choice but to distrust the evidence that originates from China. At the very minimum, we must scrutinise it thoroughly and sceptically. Whenever it looks too good to be true, we ought to discard it as unreliable.

如果我們都贊同數據庫造假會導致嚴重的影響，我們必須思考下能做些什麼。我們的選擇不多，除了質疑中國的實驗數據。至少，我們要詳細的深入檢查和質疑。無論何時，什麼東西看起來好得不像話了，我們就應該把它當做不靠譜的東西拋棄掉。