the Affordable Care,Journal of the American Medical Association；試驗登記不可或缺

A famous Columbia graduate just published an article in The Journal of the American Medical Association.



Paper in a Top Medical Journal Has an Unexpected Author
The JAMA paper highlights some of the successes of the Affordable Care Act
SCIENTIFICAMERICAN.COM|由 RACHAEL RETTNER,LIVESCIENCE 上傳





The JAMA paper highlights some of the successes of the Affordable Care Act

By Rachael Rettner, LiveScience on July 14, 2016It may be the first time a sitting president has authored a complete academic article — with an abstract, findings and conclusions — that's been published in a scientific journal, at least in recent history. Credit: Official White House Photo by Lawrence Jackson


In an unusual move for a sitting president, Barack Obama has published a scholarly paper in a scientific journal.

The paper, which discusses the success and future of the Affordable Care Act (ACA), was published Monday (July 11)in the prestigious medical journal JAMA.

It may be the first time a sitting president has authored a complete academic article — with an abstract, findings and conclusions — that's been published in a scientific journal, at least in recent history. However, several other presidents have written commentaries or opinion pieces that have been published in scientific journals during their presidency, including George W. Bush, who wrote about access to health care in a paper published in JAMA in 2004, and Bill Clinton, who wrote a commentary published in the journal Science in 1997.

Obama's journal article analyzes data gathered from other reports and studies, and highlights some of the successes of the ACA, including a drop in the percentage of Americans who do not have health insurance . After the act became law, the uninsured rate dropped by 43 percent, from 16 percent of Americans in 2010 to 9.1 percent in 2015, the paper says. [The 5 Strangest Presidential Elections in US History]

Still, Obama said, the country continues to face challenges on the way to improving its health care system. "Despite this progress, too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured ," Obama wrote.

To make sure Americans have enough insurance options and to keep insurance costs low, Obama encouraged Congress to revisit the "public option" plan, meaning a government-run insurance plan that would compete in the insurance marketplace alongside private plans. This public option could be available in parts of the country where insurance options are limited, he said.

Obama also recommended policies that could help reduce the cost of prescription drugs, including those that "give the federal government the authority to negotiate prices for certain high-priced drugs."

Obama's article was not peer-reviewed, but it went through several rounds of editing and fact-checking, according to Bloomberg.
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試驗登記不可或缺 2012英國《金融時報》專欄作家蒂姆•哈福德
我剛剛搖了幾次六面骰子，搖出的結果是：6、5、5、6、5。我的問題是：你覺得這個骰子有偏向性嗎？一種思路是，考慮在純隨機情況下只搖出5和6的概率。概率不大：242分之1。在你說我對骰子做了手腳之前，請先讓我說一些剛才忘記提到的事情：除了5和6之外，我還搖出了一次4、三次3、兩次2和一次1。但我對這些結果不感興趣，所以沒告訴你。如果你認為被忽略的結果也具有意義的話，這意味著你開始認識到“試驗登記”(trial register)的重要性——儘管這個詞聽上去有點書呆子。


每天，全球各地的研究人員都在進行隨機對照試驗(RCT)。他們中有些人一絲不苟、孜孜不倦地追求真理，也有些人則為了事關前途的論文或新藥配方的許可而投機取巧。但是，即使單次試驗結果的真實性不容置疑，如果系統性偏向某一特定結果，那麼試驗將毫無意義。


我報告了偏向大數字的搖骰子結果。你或許會不客氣地懷疑，在行業贊助的藥物臨床試驗中，顯示藥物良好效果的試驗更有可能公之於眾。你的懷疑是對的——本•高達可(Ben Goldacre)在新書《壞藥商》(Bad Pharma)中精闢地總結了這種現象。以混亂或災難告終的試驗有可能“失踪”：它​​們的價值也許夠不上發表學術論文，但結果必須記錄下來。如果試驗結果過於枯燥，令研究人員寫不出符合發表標準的論文，同樣會導致試驗“失踪”。


正如我的搖骰子試驗顯示的那樣，如果不看到每一次的試驗，就難以掌握事實的全貌。實現這個目標的方法很可能只有一種：強制登記試驗。進行試驗但扔掉結果或不發表結果的研究人員，應當遭到唾棄。人們在系統評議某一特殊領域時，將能夠查詢登記資料，追踪那些未發表的試驗。


幾年前，國際醫學雜誌編輯委員會(International Committee of Medical Journal Editors)宣布，在其控制下的知名期刊，將不再發表以臨床試驗為基礎、但事先未對試驗進行登記的研究。此舉效果驚人，顯著提高了新試驗的登記率。但不幸的是，西爾萬•馬蒂厄(Sylvain Mathieu)等人2009年在《美國醫學協會雜誌》(Journal of the American Medical Association)上解釋道，在他們檢查的研究中有超過半數無視了這一規則，卻仍然成功發表。未登記就不發表的威脅似乎是空洞的。


那麼，如何對待近年來飽嚐隨機試驗甜頭的經濟學？好消息是，美國經濟學會(American Economic Association)正要為經濟學試驗創立登記制度，將於明年實施。登記目前是自願的，但兩位領先經濟學家——麻省理工學院(MIT)的埃斯特•迪弗洛(Esther Duflo)和耶魯大學(Yale)的迪恩•卡蘭(Dean Karlan) ——對我表示，他們認為很有希望形成強大的社會規範，支持試驗登記。


試驗登記制度對社會科學構成了特殊的挑戰。醫學上的隨機對照試驗旨在測試具體療法的效果，而在社會科學領域，它們更有可能被用於尋找有意思的假說。社會科學的隨機對照試驗往往由學者和實際機構合作進行，試驗可能隨著時間推移而發生變化——臨床試驗則無此特徵。


這使得登記試驗和隨著情況的變化而修改登記內容變得複雜。它令試驗登記制度更難管理，但它也意味著登記制度更加不可或缺。


作者是英國廣播公司廣播四台(BBC Radio 4)《或多或少》(More or Less)節目的主持人譯者/劉鑫