《经济学人》开刀还是自愈？揭开现代外科手术的“安慰剂效应”
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| 集 | 标题 | 时长 |
|---|---|---|
| P1 | 《经济学人》开刀还是自愈？揭开现代外科手术的“安慰剂效应” | 9:47 |
P1 · 《经济学人》开刀还是自愈？揭开现代外科手术的“安慰剂效应” [C1] p01 原声 (P1)
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字幕摘录
| 时间 | 英文 | 中文 |
|---|---|---|
| 0:02 | Science and Technology | 科学和技术 |
| 0:07 | Surgery | 外科手术 |
| 0:08 | Knives Out | 刀锋出局 |
| 0:10 | Randomised control trials are revealing many surgeries to be unnecessary. | 随机的控制试验表明许多手术是不必要的。 |
| 0:16 | Each year, according to the World Health Organisation, over 300 million operations are conducted worldwide. | 根据世界卫生组织的资料,每年全世界有3亿多个手术。 |
| 0:24 | Patients in the rich world are more likely to go under the knife. | 富裕世界的病人更可能下刀. |
| 0:28 | About 60% of people in England are expected to undergo surgery at least once in their lifetime. | 英国约有60%的人预计一生中至少接受一次手术. |
| 0:35 | Some of these procedures are clearly life-saving, such as organ transplants and emergency caesareans. | 其中一些程序显然可以挽救生命,例如器官移植和紧急剖腹产。 |
| 0:42 | But as the number of other operations continues to grow, some in the field are starting to ask an awkward question. | 但随着其他行动数量的持续增加,一些外地人员开始提出一个尴尬的问题. |
| 0:50 | How many are really necessary? | 到底需要多少个? |
展开字幕全文（89 条）
| 序号 | 英文 | 中文 |
|---|---|---|
| 1 | Science and Technology | 科学和技术 |
| 2 | Surgery | 外科手术 |
| 3 | Knives Out | 刀锋出局 |
| 4 | Randomised control trials are revealing many surgeries to be unnecessary. | 随机的控制试验表明许多手术是不必要的。 |
| 5 | Each year, according to the World Health Organisation, over 300 million operations are conducted worldwide. | 根据世界卫生组织的资料,每年全世界有3亿多个手术。 |
| 6 | Patients in the rich world are more likely to go under the knife. | 富裕世界的病人更可能下刀. |
| 7 | About 60% of people in England are expected to undergo surgery at least once in their lifetime. | 英国约有60%的人预计一生中至少接受一次手术. |
| 8 | Some of these procedures are clearly life-saving, such as organ transplants and emergency caesareans. | 其中一些程序显然可以挽救生命,例如器官移植和紧急剖腹产。 |
| 9 | But as the number of other operations continues to grow, some in the field are starting to ask an awkward question. | 但随着其他行动数量的持续增加,一些外地人员开始提出一个尴尬的问题. |
| 10 | How many are really necessary? | 到底需要多少个? |
| 11 | Answers have long been hard to come by, in part because few randomised controlled trials, or RCTs, | 答案长期以来很难得到,部分原因是很少随机的受控试验,或RCT, |
| 12 | the gold standard type of research used to assess medications, were conducted on surgical procedures | 对用于评估药物的金本位研究类型进行了外科手术 |
| 13 | that made it difficult to know if patients got better more often with surgery than they might have without. | 这使得人们很难知道是否 更多的病人 做手术 比他们可能没有。 |
| 14 | This is now changing. | 现在情况正在改变。 |
| 15 | The number of surgical RCTs funded by Britain's National Institute for Health and Care Research | 由英国国家保健和护理研究所资助的外科RCT数量 |
| 16 | increased from 34 in 2011 to 188 in 2023, and national surgical trials programs are active across Europe, | 从2011年的34个增加到2023年的188个,全欧洲正在积极开展国家手术试验方案。 |
| 17 | as well as in Australia and Canada. | 以及澳大利亚和加拿大。 |
| 18 | The results are upending the field, removing an inflamed appendix, | 其结果正在改善这个领域, 清除一个炎热的附录, |
| 19 | an operation that around 5 to 10% of people have had at some point in their life | 大约5%至10%的人在生命的某个阶段做过手术 |
| 20 | has turned out to be no better for most patients than a course of antibiotics. | 对大多数病人来说 并不比抗生素更好 |
| 21 | Trials comparing different surgical techniques have also revealed that cheaper and less complex operations can be more effective. | 比较不同外科手术技术的试验也表明,更便宜和不太复杂的手术可以更加有效. |
| 22 | Most striking, the data show that some widely used surgical procedures, such as spinal fusions and rotator cuff repairs, | 最引人注目的是,数据显示,一些广泛使用的外科手术程序,如脊椎聚变和转动器袖口修理, |
| 23 | have effects indistinguishable from placebo or non-surgical care, such as physiotherapy. | 其效果与安慰剂或非手术护理无法区分,如理疗. |
| 24 | Worse, some types of surgery may do more harm than good. | 更糟糕的是,某些类型的手术可能伤害大于伤害。 |
| 25 | A trial in Britain found that prostate cancer surgery had no effect on patient mortality 15 years on, | 在英国的一次试验发现 前列腺癌手术 对15年的病人死亡率没有影响 |
| 26 | but worsened sexual and urological problems. | 但性与泌尿问题更严重 |
| 27 | A finished trial of a common knee procedure, meanwhile, | 同时完成普通膝盖程序的审判, |
| 28 | concluded that patients who had real surgery had more problems in the affected knee 10 years on | 诊断出,真正接受手术的病人在10年后,在受影响膝盖上出现更多的问题。 |
| 29 | than those who had had sham surgery, anesthesia followed by a superficial incision. | 而不是那些做过假手术的人, 麻醉术,然后是表面切除术。 |
| 30 | David Ring, an orthopedic surgeon at the University of Texas at Austin, | David Ring 德克萨斯大学奥斯丁分校的骨科医生 |
| 31 | reckons that most operations in his field may be unnecessary. | 认为他领域的大部分行动可能都是不必要的. |
| 32 | Surgery itself, it would seem, could use a major intervention. | 外科手术本身似乎需要重大的干预。 |
| 33 | If so many operations are unnecessary, how to explain the fact that patients often leave the operating table feeling better? | 如果这么多手术是不必要的,如何解释病人常常离开手术台感觉更好? |
| 34 | In a study published in 2022 in JAMA, a journal, researchers pooled data from 100 surgical trials covering 32 interventions. | 2022年在JAMA出版的期刊中,研究人员汇集了100次手术试验的数据,涵盖32项干预措施. |
| 35 | They found that two-thirds of the improvement patients felt after surgery was due, on average, | 他们发现三分之二的改善病人 在手术后感觉 平均, |
| 36 | either to the body healing on its own or else to the placebo effects of feeling cared for and prepped for surgery. | 或身体自行愈合 或安慰剂效果 感觉护理和准备手术。 |
| 37 | Only one-third of the benefit, in other words, came from the procedure itself. | 换言之,只有三分之一的福利来自程序本身。 |
| 38 | Surgeons think they're effective because they are administering a potent placebo, | 外科医生认为他们很有效 因为他们正在服用强效安慰剂 |
| 39 | says Seth Leopold, an orthopedic surgeon at the University of Washington. | 塞斯·利奥波德 华盛顿大学的整形外科医生 |
| 40 | In a landmark trial on 165 patients in 2002, led by Bruce Mosley from the Baylor College of Medicine in Houston, | 在2002年对165名病人进行的划时代的审判中,由休斯顿贝勒医学院的布鲁斯·莫斯利领导, |
| 41 | the surgical team even splashed water in a dish to mimic the sound of tissue debris being flushed out from the knee joint. | 手术队甚至把水洒进盘子里 模仿膝关节被冲出组织碎片的声音 |
| 42 | Though patients were under general anesthesia, the study team were mindful the placebo effect might depend on stimuli registered by the unconscious brain. | 虽然患者处于一般麻醉状态,但研究小组注意到安慰剂效应可能取决于无意识大脑的刺激。 |
| 43 | The trial found that the surgery was no better in alleviating pain than the sham operation. | 审判发现手术在减轻疼痛方面并不比假手术好. |
| 44 | Natural healing is also powerful if slow acting. | 如果动作缓慢,自然愈合也很有力。 |
| 45 | In the 2022 study in JAMA, the researchers compared real and sham surgeries with standard non-surgical care for a subset of procedures on which data were available. | 在JAMA的2022年研究中,研究人员将真实的和虚假的手术与标准的非手术护理相比较,比较了有数据的子集程序. |
| 46 | They found that the placebo effect could explain only a small part of the improvement in the sham surgery group, | 他们发现安慰剂效应只能解释 假手术组的一小部分改进 |
| 47 | most of the benefit came instead from natural improvement. | 大部分好处来自自然改善。 |
| 48 | Achieving changes in clinical practice has proved difficult. | 事实证明,很难改变临床做法。 |
| 49 | Surgeons continue to perform some operations that have been shown to be no better than placebo surgery at the same rate as before. | 外科医生继续做一些手术,这些手术被证明不比安慰剂手术好,手术速度与以前相同. |
| 50 | They find it hard to believe that something which they have been doing for years and seems to help their patients is in fact useless, | 他们觉得很难相信 他们已经做了很多年 并且似乎帮助病人的东西 实际上是没用的 |
| 51 | says Ian Harris, a surgeon at the University of New South Wales in Sydney. | 说伊恩·哈里斯是悉尼新南威尔士大学的外科医生 |
| 52 | That occasionally leads to what he describes as outlandish criticisms. | 这偶尔会导致他形容的无稽之谈。 |
| 53 | In 2014, for example, a group of surgeons wrote a commentary on the use of sham surgery in trials in Arthroscopy, a medical journal, | 例如,2014年,一组外科医生在医学期刊Arthroscopy上撰写了一篇关于假外科手术在审判中使用的评论, |
| 54 | in which they worried that patients who may not be of entirely sound mind are selected as research subjects and research performed on such individuals would not be generalizable to mentally healthy patients. | 他们担心,可能心智不健全的病人被选为研究对象,对这些人进行的研究不会对精神健康病人普遍适用。 |
| 55 | You have to remember surgeons have no uncertainty, says Jane Blaseby, a surgeon at the University of Bristol who has conducted many such trials. | 你必须记住外科医生没有不确定性,简·布雷斯比说,布里斯托尔大学的外科医生曾做过许多这样的试验. |
| 56 | They always know what's best, she adds, archly. | 她补充道,他们总是知道什么是最好的 |
| 57 | This certainty is not always justified. | 这种确定性并不总是合理的。 |
| 58 | Research has shown that, for one common type of knee surgery, surgeons' predictions about whether a patient will improve is as good as flipping a coin. | 研究表明,对于一种常见的膝盖外科手术,外科医生对病人是否会改善的预测与翻钱币一样好. |
| 59 | 瑞典隆德大学的Stefan Lomander说, | |
| 60 | because the patients who return for check-ups are mostly those who got better. | 因为那些回来接受检查的病人 大多是病情好转的病人 |
| 61 | Moreover, many of these returning patients do not want to disappoint their doctors, says Dr. Lomander, | 此外,许多回国的病人不想让医生失望,洛曼德医生说: |
| 62 | which may in part be why surgeons often feel procedures are more successful than their patients do. | 部分原因可能是外科医生往往感到手术比病人更成功。 |
| 63 | For Dr. Blaseby, convincing her colleagues to enroll their patients on randomized controlled trials required teaching them to | 对于Blaseby博士来说,说服她的同事让他们的病人参加随机控制的试验,需要教他们 |
| 64 | confidently be unconfident, she says. | 她说,她很自信 |
| 65 | Such trials required them to tell patients that an operation they had been doing for years might not be the right choice for them. | 这种试验要求他们告诉病人,他们已经做了多年的手术,对他们来说可能不是正确的选择。 |
| 66 | Encouragingly, younger surgeons are more open to change. | 令人鼓舞的是,年轻的外科医生更愿意改变。 |
| 67 | Studies in America and Australia, for example, have found that the probability that a surgeon stops performing a procedure a trial has shown ineffective, | 例如,在美国和澳大利亚进行的研究发现,外科医生停止执行审判程序的可能性已经显示无效, |
| 68 | decreases with time, and when trial results reinforce each other, skepticism becomes less tenable. | 随着时间的流逝,当审判结果相互强化时,怀疑主义变得不那么可行。 |
| 69 | The nature of a country's health system also plays a role. | 一个国家的保健系统的性质也发挥了作用。 |
| 70 | Disfavored operations decline faster in countries where surgeons are salaried, as in Britain and Scandinavia, | 在外科医生有薪酬的国家,如英国和斯堪的纳维亚,不良手术下降得更快。 |
| 71 | than in countries such as America where they are paid per operation and act as small businesses. | 而不是像美国这样的国家,在这些国家,他们得到的每个业务和作为小企业。 |
| 72 | Shoulder surgeries to remove a bone spur fell from 28,000 in Britain in 2016-17 to 5,720 in 2019-20, | 清除骨刺的肩部手术从2016-17年的28,000起下降到2019-20年的5,720起, |
| 73 | after trials found that the procedure was no better in alleviating pain than sham surgery. | 试验后发现,该程序在减轻疼痛方面并不比假手术更好。 |
| 74 | In America the procedure remained popular. | 在美国,这种程序仍然很流行。 |
| 75 | But it is not just surgeons who need to trust the data. | 但不只是外科医生需要信任数据。 |
| 76 | A growing number of patients insist on surgery on the basis of inconclusive tests. | 越来越多的患者坚持以无结论的检验为基础进行手术. |
| 77 | All too often, says Dr. Ring, scans reveal abnormalities that are little more than tissue tears, as natural a byproduct of aging as wrinkles and grey hair. | 环博士说, 扫描显示的异常 几乎不只是组织眼泪, 作为衰老的副产品,就像皱纹和灰色头发。 |
| 78 | What's more, he says, these things are unlikely to be what is causing patients problems. | 而且,他说,这些事情 不太可能是造成病人问题的原因。 |
| 79 | A growing number of studies, in fact, show that the abnormalities in knees, backs and shoulders that orthopedic surgeons try to fix | 事实上,越来越多的研究显示 整形外科医生试图修复膝盖、背部和肩部的异常 |
| 80 | are very common in people who have no symptoms at all. | 在没有症状的人中很常见 |
| 81 | But the promise of a quick fix is hard to resist. | 但速修之约难拒. |
| 82 | It is becoming more and more difficult to say no to the patient, says Dr. Lomander. | 罗曼德医生说,越来越难拒绝病人了。 |
| 83 | In America some surgeons fear their patients will leave them a bad review online | 在美国,一些外科医生担心他们的病人 会给他们留下一个糟糕的网络评论 |
| 84 | and insurance companies still cover ineffective procedures for fear of losing customers to their competitors. | 保险公司仍然承担无效的程序,因为害怕让客户失去竞争对手。 |
| 85 | Even more trials should help doctors hold their ground more firmly. | 更多的试验应有助于医生更坚定地站稳脚跟。 |
| 86 | For now, most non-essential surgical techniques remain untested against either sham surgery or non-surgical interventions. | 目前,大多数非必要的外科手术技术仍未经过假手术或非外科手术的检验。 |
| 87 | A review in 2020 found that just 1% of the RCTs on common surgical procedures conducted for chronic musculoskeletal pain | 2020年的一项审查发现,只有1%的慢性肌肉骨骼疼痛的普通外科手术RCT |
| 88 | compared doing the surgery to not performing the procedure at all. | 而不是做手术 完全不做手术。 |
| 89 | To fulfill their Hippocratic promise of doing no harm, surgeons must be prepared to ask how much good they are actually doing. | 为了兑现希波克拉底的不伤害承诺,外科医生必须准备好问他们到底做了多少好事。 |
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