经济学人170:替代医疗 往好处想

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　　科学技术

　　Alternative medicine

　　替代医疗

　　Think yourself better

　　往好处想

　　Alternative medical treatments rarely work. But the placebo¹ effect they induce sometimes does

　　替代疗法的治疗效果见效甚微，但是所产生的安慰效果往往有所疗效

　　ON MAY 29th Edzard Ernst, the world's first professor of complementary medicine, will step down after 18 years in his post at the Peninsula Medical School, in south-west England.

　　5月29日，作为世界首位互补性医学专家艾德撒.恩斯特将从位于英国西北部的半岛医学院退休，他在这里曾效力了18年。

　　Despite his job title, Dr Ernst is no breathless promoter of snake oil.

　　跟他的职务头衔相反Dr Ernst 并不是那种推销起蛇油舌灿莲花的人。

　　Instead, he and his research group have pioneered the rigorous study of everything from acupuncture² and crystal healing to Reiki channelling and herbal remedies.

　　其实，他和他的研究团队是缜密研究针灸，水晶疗法，灵气疗法以及草药治疗的先驱。

　　Alternative medicine is big business.

　　替代性医疗是一个很大的商业市场。

　　Since it is largely unregulated, reliable statistics are hard to come by.

　　由于这一市场在很大程度上没有得到监管，所以很难获取可靠的数据统计。

　　The market in Britain alone, however, is believed to be worth around ￡210m, with one in five adults thought to be consumers,

　　然而，该市场仅在伦敦就达到约2亿1千万英镑，其中5个成年人中就有一个是替代性疗法的消费者，

　　and some treatments available from the National Health Service.

　　并且有些疗法还是国家医疗服务制度中所提供的服务项目。

　　Around the world, according to an estimate made in 2008, the industry's value is about $60 billion.

　　根据2008年的评估，该产业在全球的价值约为600亿美元。

　　Over the years Dr Ernst and his group have run clinical trials and published over 160 meta-analyses of other studies.

　　在过去的几年中，恩斯特博士和他的团队进行了临床实践并发表了160多份关于其他研究的再分化分析报告，并有了全然的发现。

　　His findings are stark⁴. According to his Guide to Complementary and Alternative Medicine, around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine, homeopathy and reflexology—are statistically⁵ indistinguishable from placebo treatments.

　　根据其《补充替代医学指南》，在他及其同事所验证的治疗方法中从针灸到草药，从顺势疗法到反射疗法，约有95%在数据统计上等同于安慰疗法。

　　In only 5% of cases was there either a clear benefit above and beyond a placebo, or even just a hint that something interesting was happening to suggest that further research might be warranted.

　　在仅有的5%的病例中，其中要么明显属于非安慰疗法所带来的疗效，要么暗示了有某些有趣的因素使得需要进一步的研究。

　　It was, at times, a lonely experience.

　　这一研究在过去有时很少有人涉足。

　　Money was hard to come by.

　　资金难以筹集。

　　Practitioners⁶ of alternative medicine became increasingly reluctant to co-operate as the negative results piled up, while traditional medical-research bodies saw investigations⁷ into things like Ayurvedic healing as a waste of time.

　　并且由于负面效应的积累越来越多的替代性医疗从业者不愿意参与合作，于此同时传统医疗研究组织也将针诸如对阿育吠陀疗法的研究调查视作是浪费时间。

　　Yet Dr Ernst believes his work helps address a serious public-health problem.

　　而恩斯特博士相信他的工作将有助于解决一系列公共健康问题。

　　He points out that conventional medicines must be shown to be both safe and efficacious before they can be licensed⁸ for sale.

　　他指出传统药品必须在确保安全和有效后才能许可出售。

　　That is rarely true of alternative treatments, which rely on a mixture of appeals to tradition and to the natural wholesomeness⁹ of their products to reassure¹⁰ consumers.

　　但是替代性疗法却不需要，这些疗法依赖于其产品的传统性以及天然健康性的综合体来赢得消费者的放心。

　　That explains why, for instance, some homeopaths can market treatments for malaria¹¹, despite a lack of evidence to suggest that such treatments work, or why some chiropractors can claim to cure infertility¹².

　　这解释了为什么一些顺势疗法在疟疾的治疗上具有市场，尽管缺乏证据显示其疗效效，以及为什么脊椎推拿师声称他们可以治疗不育症的原因。

　　Despite this lack of evidence, and despite the possibility that some alternative practitioners may be harming their patients, Dr Ernst also believes there is something that conventional doctors can usefully learn from the chiropractors, homeopaths and Ascended¹³ Masters.

　　虽然缺乏医疗证据以及存在一些替代性疗法从业者伤害患者的可能，但是恩斯特博士相信传统医生仍然可以从脊椎推拿师，顺势疗法以及上师那里学到一些有用的东西。

　　This is the therapeutic¹⁴ value of the placebo effect, one of the strangest and slipperiest phenomena¹⁵ in medicine.

　　作为医学中最奇怪以及最棘手的医疗现象之一，这些东西是安慰疗法的医疗价值所在。

　　Mind and body

　　思想与身体

　　A placebo is a sham¹⁶ medical treatment—a pharmacologically inert¹⁷ sugar pill, perhaps, or a piece of pretend surgery.

　　安慰疗法是一种虚假性医疗方法在药物上使用糖丸，或者进行一次虚假手术。

　　Its main scientific use at the moment is in clinical trials as a baseline for comparison with another treatment.

　　其主要科学应用在于它可以作为其他疗法对比基准的临床实践性。

　　But just because the medicine is not real does not mean it doesn't work.

　　但是不使用真实药物并不代表没有疗效。

　　That is precisely¹⁸ the point of using it in trials: researchers have known for years that comparing treatment against no treatment at all will give a misleading result.

　　这也恰恰是在实践中使用它们的原因：研究者多年以来已经明白将完全不治疗跟某种治疗法做比较往往会产生误导的结果。

　　Giving pretend painkillers¹⁹, for instance, can reduce the amount of pain a patient experiences.

　　比如，假的止疼药可以在一定程度上缓解患者的疼痛。

　　A study carried out in 2002 suggested that fake surgery for arthritis²⁰ in the knee provides similar benefits to the real thing.

　　2002年进行的一次研究显示针对膝部关节炎患者进行一次虚假手术所带来的疗效如同对其进行了一次真实的手术。

　　And the effects can be harmful as well as helpful.

　　并且产生的效果有好有坏。

　　Patients taking fake opiates after having been prescribed the real thing may experience the shallow breathing that is a side-effect of the real drugs.

　　而处方规定需服用鸦片制剂的患者实则服用了假的鸦片制剂后会出现呼吸短促这种真实药物所带来的副作用症状。

　　Besides being benchmarks, placebos²¹ are a topic of research in their own right.

　　除了作为基准，安慰疗法在其自身领域内也是一个研究主题。

　　On May 16th the Royal Society, the world's oldest scientific academy, published a volume of its Philosophical²² Transactions devoted²³ to the field.

　　5月16日，作为世界最悠久的科学研究组织，皇家学会发表了一期此领域的《哲学会报》。

　　One conclusion emerging from the research, says Irving Kirsch, a professor at Harvard Medical School who wrote the preface to the volume,

　　为该会报撰写前言的是来自哈佛医学院的专家欧文.克尔斯，

　　is that the effect is strongest for those disorders²⁴ that are predominantly mental and subjective²⁵, a conclusion backed by a meta-analysis of placebo studies that was carried out in 2010 by researchers at the Cochrane Collaboration²⁶,

　　其称这些研究所得出的一个结论是安慰疗法对于那些主要是脑力和主观紊乱的患者最为有效，这一结论同样得到另一个安慰疗法再分化研究的支持，

　　an organisation²⁷ that reviews evidence for medical treatments.

　　该项研究由医疗证据审核组织科克仑合作所的研究者们在2010年开展。

　　In the case of depression, says Dr Kirsch, giving patients placebo pills can produce very nearly the same effect as dosing them with the latest antidepressant medicines.

　　对于抑郁症病例，克尔斯称给患者服用安慰性药物将产生和给患者服用最新抗抑郁症药物同样的疗效。

　　Pain is another nerve-related symptom susceptible²⁸ to treatment by placebo.

　　疼痛是另一种容易得到安慰性治疗的神经性症状。

　　Here, patients' expectations influence the potency²⁹ of the effect.

　　在这里，患者的期望值可以影响治疗的效果。

　　Telling someone that you are giving him morphine provides more pain relief than saying you are dosing him with aspirin—even when both pills actually contain nothing more than sugar.

　　告诉患者你给他们服用的是吗啡要比告诉他们服用的是阿司匹林具有更好的阵痛效果其实两种药物的成分都只是糖。

　　Neuro-imaging shows that this deception³⁰ stimulates³¹ the production of naturally occurring painkilling³² chemicals in the brain.

　　神经元成像显示这种欺骗行为可以促进大脑中自然分泌的阵痛化学物质的产生。

　　A paper in Philosophical Transactions by Karin Meissner of Ludwig-Maximilians University in Munich concludes that placebo treatments are also able to affect the autonomic nervous system, which controls unconscious functions such as heartbeat, blood pressure, digestion³³ and the like.

　　来自路德维希马克西米利安慕尼黑大学的卡琳.梅斯诺在《哲学会报》上发表的一份论文称安慰疗法同样可以影响控制诸如心跳，血压，消化等等这些无意识功能的自主神经系统。

　　Drama is important, too. Placebo injections are more effective than placebo pills, and neither is as potent³⁴ as sham surgery.

　　表演在安慰疗法中也很重要。安慰性注射虽然比安慰药丸有效果，但是却没有虚假手术来得见效。

　　And the more positive a doctor is when telling a patient about the placebo he is prescribing, the more likely it is to do that patient good.

　　并且在向患者描述疗效的时候，医生显得越积极，对于患者来说安慰治疗的疗效越好。

　　Despite the power of placebos, many conventional doctors are leery of prescribing them.

　　尽管安慰疗法有着强大的力量，但是很多常规医生仍怀有猜疑。

　　They worry that to do so is to deceive their patients.

　　他们担心这种做法是在欺骗患者。

　　Yet perhaps the most fascinating results in placebo research—most recently examined by Ted³ Kaptchuk and his colleagues at Harvard Medical School, in the context of irritable-bowel syndrome—is that the effect may persist even if patients are told that they are getting placebo treatments.

　　然而，也许在安慰治疗研究中最引人入胜的研究结果便是即使患者之道他们所接受的是安慰治疗，其疗效却依然存在，这一发现由来自哈佛医学院的泰德.凯普扎克及其同事近期在过敏性肠综合症的研究中所确认。

　　Unlike their conventional counterparts, practitioners of alternative medicine often excel at harnessing the placebo effect, says Dr Ernst.

　　恩斯特博士称与常规医生不同，替代性疗法的从业者善于利用安慰治疗的疗效。

　　They offer long, relaxed consultations³⁵ with their customers.

　　他们会在轻松的气氛下向患者提供咨询。

　　And they believe passionately³⁶ in their treatments, which are often delivered with great and reassuring³⁷ ceremony.

　　并且他们对于治疗工作充满热情，使用杰出而令人放心的医疗方式进行治疗。

　　That alone can be enough to do good, even though the magnets, crystals and ultra-dilute solutions applied³⁸ to the patients are, by themselves, completely useless.

　　仅此已足够，而那些用在患者身上的磁铁，水晶以及高稀释溶液本身就没有什么用处。

　　1.alternative a.两者择一的；供选择的

　　We have the alternative plans of having a picnic or taking a boat trip.

　　我们在去野餐或者去乘船旅游两个计划中只能选一。

　　2.placebo n.安慰剂；安慰话

　　The placebo has been found to work with a lot of different cases.

　　人们已发现安慰剂能在很多不同的病例中发挥作用。

　　3.complementary a.补充的；互补的

　　His personality is complementary to hers.

　　他的个性与她的相反相成。

　　4.rigorous a.严格的；严厉的

　　The planes have to undergo rigorous safety checks.

　　这些飞机得接受非常严格的安全检查。

　　5.crystal n.水晶；结晶体

　　I lost my crystal necklace at the party.

　　我在晚会上丢失了水晶项链。

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