The Economist 文章Word下载.docx
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The Economist 文章Word下载.docx
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Mar26th2016
|
TAIPEI
Fromtheprintedition
TAIWANandChina,whichclaimstheindependentisland-nationaspartofthemotherland,usedtoplayajoylessslogginggamecalled“dollardiplomacy”.Initeachsidecompetedwithlorry-loadsofcashandotherinducementstogetsmall,impoverishedandoftenill-runnationstoswitchtheirdiplomaticallegiance.ItwasagamethatTaiwanwassteadilylosinguntil,asagestureofgoodwillontheascensionofaChina-friendlypresidentinTaiwan,MaYing-jeou,Chinasuddenlysuspendeditin2008.Thescore:
Taiwan22,China172.
YetonMarch17thChinasuddenlyresumedplay,byestablishingdiplomatictieswithGambia,onceaTaiwanally.MrMawasonastatevisittoBelize,oneofTaiwan’ssurvivingfriends,whenthenewsbroke.Hesaiditwasverywrong.InTaiwantherewasoutrage.ThemainlandaffairsministrysaidChina’smoverancontrarytothemutualtrustthatTaiwanandChinahadbuiltupovereightyears.
Butthegameisbeingplayednotagainsthim,butratheragainsthissuccessor,TsaiIng-wen,whotakesofficeonMay20th.SofarasChinaisconcerned,thetroublewithMsTsaiisthatsheheadsaparty,theDemocraticProgressiveParty(DPP),thatunlikeMrMa’sKuomintangiscommitted,atleastonpaper,toTaiwan’sdeclaringformalindependence.
NomatterthatMsTsai,alow-keyformertradelawyerwhowonthepresidentialelectioninJanuaryinalandslide,hasgoneoutofherwaytoreassurenotjustChinabutalsotheUnitedStatesthatsheintendstopursuepeaceandstabilityacrosstheTaiwanStrait.ThatisinstarkcontrasttoherfirebrandpredecessorfromtheDPP,ChenShui-bian,whowaspresidentfrom2000to2008(andthenjailedforcorruption).UnderMrChen,cross-straitrelationsreachedanadir.HisstudiouslyprovocativechampioningofTaiwan’sindependenceevenstrainedTaiwan’stieswiththeUnitedStates,itsdefender.
YetthestickingpointforChinaisthatMsTsaihastodaterefusedtoconcedetoChinesedemandsthathergovernment-in-waitingacceptthatTaiwanislooselypartofChina.Thisisoftenreferredtoasthe“1992consensus”,inwhichbothsidesagreedthattherewasbutoneChina,eventhougheachdisagreedoverwhatexactlythatwas.TheCommunistandproudlyatheistgovernmentinBeijingissointhralltothisbeliefsystemthatitthreatensinvasionshouldformalindependence—ie,anendtothepretencethatthereisonlyoneChina—everbedeclared.Todate,MsTsaihasavoidedevensayingthataconsensuswasreachedin1992.
Itisnotcertainthatthediplomaticgamewillnowresumewithfullintensity.Gambia,animpoverishedwestAfricandictatorship,actuallyseveredtieswithTaiwanin2013.ItwasChinathatforthreeyearsrespectedthetruceandturneddownGambianrequestsforties.RecentlyGambiagotthesignalandbeganlearningthescript.Shortlyafteritsforeignminister,NenehMacDouall-Gaye,signedthepapersinBeijingwithhercounterpart,WangYi,shedeclaredthathercountrylookedforwardtothepeacefulreunificationofChinaandTaiwan.
Now,saysGeorgeTsai,apoliticalscientist(unrelatedtothepresident)attheChineseCultureUniversityinTaipei,theTaiwanesecapital,theballisinMsTsai’scourt.China,hesays,willwaitforherinaugurationspeechforsignalsaboutherintentions.Ifthespeechdoesnot,intheeyesofChineseleaders,rehearseanacceptablecatechism,thediplomaticgamecouldfullyresume,orworse.“Weabsolutelywillnotallow…nationalseparation,”thunderedPresidentXiJinpingrecently.
AformerDPPvice-minister,TungChen-yuan,highlightshowmismatchedthetwosidesnoware.In1992themainland’sGDPwas1.9timeslargerthanTaiwan’s.By2014thegapbetweenthetwoeconomieshadwidenedtonearly20times.ThesedaysChinagetstosettheconditionsthatTaiwanisexpectedtomeetifgoodrelationsaretoexist.
Clinicaltrials
Formynexttrick...
Toomanymedicaltrialsmovetheirgoalpostshalfwaythrough.Anewinitiativeaimstochangethat
PAXILwasablockbuster.Itwasintroducedbyitsinventors,GlaxoSmithKline(GSK),in1992,asanantidepressant.Bytheearly2000sitwasearningthefirmnearly$2billionayear.Itwasbeingprescribedtomillionsofchildrenandteenagersonthebasisofatrial,calledStudy329,whichsuggesteditwasagoodtreatmentfordepressedyoungsters.ButwhenBritishregulatorstookasecondlookatStudy329,in2003,theyconcludedthatithadbeenmisleadinglypresented.NotonlydidPaxildolittletohelpyoungsterswithdepression,itoftenmadethingsworse—totheextentofmakingsomewhotookitsuicidal.In2012theAmericanauthoritiesimposedthebiggestfineinthehistoryofthepharmaceuticalindustry,$3billion,onGSKformisreportingdataonavarietyofdrugs,ofwhichPaxilwasone.
Sincethen,Study329hasbecomeoneofthebest-knownexamplesofapieceofacademicsleight-of-handcalled“outcomeswitching”.Thisisaprocedureinwhichthequestionsthatascientificstudywassetuptoanswerareswappedpartwaythroughforadifferentlot.Study329setouttomeasuretheimpactofPaxiloneightdifferentvariables,allbasedaroundhowparticipantsscoredonavarietyofdepressiontests.Noneshowedthatitwasanybetterthanaplacebosugarpill,buttheresearcherswhowrotethepapercameupwith19newmeasures.Mostofthoseshowednobenefiteither,butfourdid.Inthepaper,thosefourwerepresentedasiftheyhadbeenthemainmeasuresallalong.
Outcomeswitchingisagoodexampleofthewaysinwhichsciencecangowrong.Thisisahottopicatthemoment,withfieldsfrompsychologytocancerresearchgoingthrougha“replicationcrisis”,inwhichpublishedresultsevaporatewhenpeopletrytoduplicatethem.Now,ateamofresearchersattheCentreforEvidence-BasedMedicine,atOxfordUniversity,havesetupaprojectcalledCOMPare,inthehopeofdoingsomethingaboutit.
GoCOMPare
Outcomeswitchingcansometimesbedoneforgoodreasons:
participantsmayrefusetofillinalongform,forinstance,meaningthatnodatacanbecollectedfromit.Butitcanalsoletunscrupulousresearchersgoon“fishingexpeditions”toprovewhatevertheywant.Collectenoughdata,andcorrelationsthatlookstatisticallysignificantwillappearbychance.Pickthemoutaftertheeventandyouhave,unlessyoure-testtodemonstratethattheywerenotflukes,provednothing.
Study329finishedin1998.Thesedays,suchshenanigansaresupposedtobeimpossible.AmericanandEuropeanregulatorsrequiretrialstoberegisteredbeforetheybegin,completewithinformationaboutwhattheywillbeinvestigatingandhowtheywillgoaboutit,sothatresearcherscanchecktheircolleagueshavedonewhattheypromisedtodo.Butenforcementislax.Ameta-analysis—astudyofstudies—publishedin
BMCMedicine
in2015foundthat31%ofclinicaltrialsdidnotsticktothemeasurementstheyhadplannedtouse.Anotherpaper,publishedin
PLOSONE,alsoin2015,examined137medicaltrialsoverasix-monthperiodandfoundthat18%hadalteredtheirprimaryoutcomeshalfwaythroughthetrial,while64%haddonethesamewithsecondary,less-importantmeasuresofsuccess.
TheCOMPareteam’s
results
aresimilar.TheyanalysedalltheclinicaltrialsreportedbetweenOctoberandJanuaryinthefivemostprestigiousmedicaljournals—specifically,the
NewEnglandJournalofMedicine,the
JournaloftheAmericanMedicalAssociation,theLancet,
AnnalsofInternalMedicine
andthe
BMJ—lookingforevidenceofoutcomeswitching.
INTERACTIVE:
Clinicaltrialsimulator-Runyourowntrialsandplaythesysteminfavourofyourowndrug
Thatcametoatotalof67differenttrials.Ofthose,ninewereperfect—theyhaddoneexactlywhattheyhadsaidtheywoulddo,oriftheyhadchangedtheirmeasurements,theyhadsaidsoplainlyandgiventheirreasons.Theother58,though,hadflaws.Betweenthemtheycontained300outcomesthatshouldhavebeenreportedbutwerenot,while357newoutcomes,notspecifiedinthedocumentsdescribingwhatthetrialwouldbedoing,weresilentlyadded.
Wherepreviousresearchhasmerelydescribedtheproblem,saysBenGoldacre,aBritishdoctorandepidemiologistwhoisleadingtheproject,COMParehopestodosomethingaboutit.Foreveryimperfecttrial,theteamwrotealettertotheeditorsoftherelevantjournal,pointingouttheinconsistencieswiththeaimofsettingtherecordstraight.
Sofar,responseshavebeenmixed.Of58lettersCOMParehassentoutsincetheprojectbegan,sevenhavebeenpublished.Another16wererejectedbythejournals,whoarguedeitherthattheproblemwasinsignificantorthatattentive,industriousreaderscouldworkoutforthemselveswhathadhappened.Theresthaveseeminglybeenignored.
DrGoldacre—whohasbuiltareputationasacrusaderforopenscience—sayssomejournals’responsessurprisedhim.Hepointsoutthatallfivehavesigneduptoguidelinesthatrequirethemtopoliceoutcomeswitchingandtomakesurepaperstheypublishdonotengageinit.TheCOMPareteamplanstocollatetheresponsesintoanotherscientificpaper,tobepublishedshortly.“Iwouldregardthisasaprovocationstudy,”saysDrGoldacre,usingtheimmunologicalmeaningoftheterm.“Whenyouprovokethesystem,theresponsesyougettellyoualotabouthowthesystemworks.Butwe’renotdoingthistobeprovocativeandsnide,we’redoingittounderstandthepathology.”
Lex_China:
heavylifting
AtthispointinChina’seconomiccycle,stabilisationofanydataseriesshouldbegoodnews.Growth,therefore,shouldbeevenbetter.
Overth
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