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本帖最后由 cscnake 于 2024-11-21 01:40 编辑
哦哦绝了，我以前看古装电视剧时看到“封弥誊录”制度还真没联想到随机双盲原则！
至于你说的李景均是“随机双盲对照试验之父”，首次“在医疗领域提出这一想法”，我还是不敢立刻相信，毕竟这么重要的成就在AJHG和Journal of Genetics的C.C.Li的讣告里都没有提到。所以我又顺着你发的北京生命科学研究所的那篇文章进行了些搜索。我搜了那篇文章里多次出现和引用的E. B. Spiess，也就是Eliot B. Spiess写的CC纪念文章：https://doi.org/10.1093/genetics/169.1.9。这篇纪念文里提到：
The details of C. C.'s life and work are fully covered in the references mentioned. Some achievements, however, are particularly noteworthy:
1. His service as a biostatistician in programming clinical trials for cancer chemotherapy involving veterans hospitals in the eastern United States was unprecedented. In the 1950s, large-scale clinical trials had no statistical design. C. C., sponsored by the National Institutes of Health, proposed randomized trials that played a vital role in changing the attitude of physicians toward large clinical trials.
我想这应该就是北京生命科学研究所文章说的事情。但是看上面引文里的意思，我不确定他是想强调是CC在整个医疗领域“首创”了这些原则，还是“在大规模临床试验中”首次提出这些原则。于是又搜索到了Eliot在1983年发表于American Journal of Medical Genetics的称赞CC的文章《Ching Chun Li, Courageous Scholar of Population Genetics, Human Genetics, and Biostatistics: A Living History Essay》（DOI: 10.1002/ajmg.1320160419）。这里的记载就详细多了，我大段引用一下：
In the mid-1950s a responsibility that took much time but carried much practical significance was his service as chief biostatistician for a cancer chemotherapy group involving 25 Veterans Administration Hospitals in the eastern U.S.A. C.C.’s task was to design a project of clinical trials in which various chemicals (eg, nitrogen mustard) were to be compared for effectiveness on patients with bronchogenic carcinoma, Hodgkin disease, lymphosarcoma, and melanoma.
In those days large scale clinical trials were rare and without statistical design. C .C. outlined his ideas of randomization, necessitating “blind trials” by physicians in charge as basic to the procedure. These practices were unknown to the VAH physicians then, and they objected: “Do you mean that I don’t even know what I give to my patients? You mean that the drug to be administered will be determined by a random number and not by the physician in charge? That is ridiculous, unethical, and totally unacceptable.” Most painful of all, these procedures hurt egos that were accustomed to making all decisions. What an uproar! If it were not for unwavering support from the NIH officials present at the meeting, C.C. might have been thrown out. NIH threatened to withdraw support from the study unless the physicians would comply with C.C.’s protocol. They knew that money is much more persuasive than scientific merit.
Finally the project got started, and the physicians were anxious to know the treatment results. Among just a few patients, two or three died, and the staff doctors wanted Li to tell them which treatment was best. But C.C. pointed out that there was a long way to go before anything would be reasonably certain. They wanted to know how many patients had to show results before conclusions could be drawn; and C.C. explained that the number of patients is not an absolute fixed number, in fact it depends on the magnitude and variation of the drug effects. One physician figured that since Li did not know, he should go to Bethesda and ask his boss. At the next meeting he was apparently satisfied and happy; he told C.C. that all they needed was 36 patients! Such was their desire for a magic number and quick results.
The situation is drastically different these days. Clinical trials are quite frequent and biostatisticians are no longer accused of not being able to provide ready answers. Physicians now seem all sold on the principle of randomization and blindness in clinical trials. In fact they are now accustomed to double-blindness and triple blindness. They no longer feel hurt by not making decisions about administering drugs. C.C. can take credit for playing a vital role in accomplishing this important change in attitude from the pioneer days.
看起来很清楚，Eliot是想称赞CC将随机双盲的原则和科学的实验设计带到了大规模临床试验中，并不是想说是CC首创了这些原则。作为一名遗传学、统计学家，CC说服的对象是医师（physicians)而不是NIH的官员。Eliot认为他的主要功绩是促进了这些原则在大规模临床试验中的推广和促进了医师观念的进步。
至于是谁首次“在医疗领域提出”随机、双盲、对照这些原则，要知道科学、医学研究是一个循序渐进、不断假设和检验的过程，重要的原则的提出肯定有迹可循。根据我搜到的这篇文章《Evolution of Clinical Research: A History Before and Beyond James Lind》（PMCID: PMC3149409 PMID: 21829774），在二十世纪五十年代之前医学领域就已经有完全随机试验、双盲试验、对照试验，而医学领域的相关原则自然是更早地被人提出了（例如Claude Bernard在1865年的书《Introduction to the Study of Experimental Medicine》就提出医学实验中要盲实验者）。
就像Eliot写的那样，CC Li对于这些原则在大规模临床试验中的推广、对于医师观念的进步的功绩十分巨大。但是把前人的一些功绩和成果也扣在他头上是不是有点不够实事求是？ |
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楼主: stillwmxz
沪公网安备 31010702007642号 )
发表于 2024-11-20 10:58
由信的人转移支付就好了，庙里卖的香或许毫无意义烧了但也是产业也是就业是税收
。
而且我还是植物分类的，偏见比你们还深
之前看人说信火神派恰附子结果没搞熟中毒什么的 看了下附子炮制方法就。。。挺科学的 基本就高温破坏生物碱 
现在就感觉说中医有用不科学 说中医没用也不科学 科学发展不往玄学走就行 
