學者的責任

看到BBC介紹伊波拉,我想起沈旭暉早幾天在一篇文章中說:伊波拉疫苗沒有出現,除了技術困難,也有成本效益考慮:當伊波拉只影響非洲,疫苗便沒有大商機,投資研究恐怕不在優先之列。西方藥廠的道德水平,在非洲早已聲名狼藉。」我不知道他有什麽證據去支持這番言論,他沒有提出來,我會懷疑他是在信口開河。

首先,伊波拉疫苗之所以沒有出現有很多可能性,最大可能就是現時醫學對這種病毒的理解和治療方法沒有重大的突破。世上有很多禍害深遠的病毒,例如愛滋病、非典型肺炎、流行性感冒等等,都沒有根治方法和預防疫苗。假如已經提出了技術問題,那就根本不用說什麽于商機、西方藥廠,這樣衹會讓人懷疑作者胡説八道,不明白科學、經濟學和現實:科技發展不單單是加大投資就能解決問題,科學家解決不了物理、生物和化學的問題,你投資多少錢都沒用。

再者,并不是沒有藥廠願意生產和研究伊波拉疫苗,兩年前就有報導有兩家藥廠已經開始人體測試,但因爲美國國防部下令和資金遭削減停止了這方面的工作。但這不帶代表所有西方國家和藥廠都停止了伊波拉疫苗的研究,加拿大的研究人員已經成功生產出能讓猴子避免病毒感染的實驗性疫苗,并將疫苗捐贈給世界衛生組織。問題是,這款疫苗從未使用在人類身上,因爲使用疫苗就代表要接種伊波拉病毒到人身上,而科學家暫時還不能保證疫苗足夠安全。這是重要的醫學操守,最終要不要進行人體上測試并不是取決于研究資金多寡,至少我希望資金多少并不會影響到這決定。

所以,就算有人證認爲資金是一個問題,我們也得比較其他證據看哪一樣更有解釋力,哪一樣更爲優先。考慮過各種證據,我們可以說:「目前沒有疫苗防止伊波拉,主要原因是實驗性疫苗還沒有通過臨床測試,研究資金的減少或者會對研究進展有阻礙」。這樣就能清晰和中肯地説明問題,也不需將矛頭指向商機、藥廠或「資本主義」。

旭暉在另一篇文章亦提到:在政府效能有限的國度,巫醫承擔醫生、律師、社工、宗教家、玄學家與地方領袖的角色,是必須的社會樞紐。何況祖傳秘方不一定沒價值,只要巫毒教有心現代化,也許和中醫一樣別有洞天。 」這是一種非常奇怪的説法,也再次讓人懷疑沈旭暉的科學知識水平。很多非洲國家的政府的確是能力有限,但這跟當地的經濟發展和科學水平有關,讓巫醫承擔醫生、律師、社工、宗教家、玄學家與地方領袖的角色」是更糟的選擇,因爲讓巫醫掌握這麽大的影響力,他們就會宣揚迷信,控制思想,讓當地人會在愚昧之中。非洲已經有很多巫醫叫人鬣狗獻上身體某部分(結果陽具被吃掉)、指控巫師偷竊陽具并吊死他們、巫醫割去小孩陽具等事件。迷信、不理解科學都會對巫醫自己和大衆的陽具造成極大傷害。

我們也可以說歐洲中世紀的教士和教會也曾「承擔醫生、律師、社工、宗教家、玄學家與地方領袖的角色」,但我們不會鼓勵任何社會再走中世紀那條路,反而應想辦法幫助它們現代化,但注意,不是「巫毒教現代化」。巫毒教本身就是一種因迷信思想而成的一個團體,它怎麽可能現代化呢?如果是說巫醫祖傳秘方現代化,這原則上不是問題,但所需要做的是拿出這些治療方法去進行現代醫學所要求的雙盲測試,如它能通過測試,現代醫學就會將這方法納入醫學的一部分。但留意,這也僅僅是治療方法通過測試,要巫醫的理念通過測試就幾乎是不可能,因爲叫得他做巫醫就説明他的理念不科學—這是「巫醫」的定義

科學思維和批判式思考對我們的社會非常重要。一個教育工作者應注意他在公開場合,尤其是大衆媒體上所發表言論,他有責任用證據和正當的邏輯去支持他的論述,否則,公衆就很容易因爲他的身份而照單全收,因而得出錯誤結論。公衆有能力進行批判式思考,自行去反思和搜集證據當然是更好了,但要普及這種自發性行爲,就有賴教育工作者先行樹立一個良好榜樣。沈旭暉這兩篇文章似乎離上述這個基本要求還有一段距離。

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9 則回應給 學者的責任

  1. chiu 說:

    Dear 山中,
    i respect your demand on 學者的責任, and it would be good if mr 沈旭暉 gives 證據去支持這番言論. however being in the medical field for nearly 30 years, i can verify that // 「伊波拉疫苗沒有出現,除了技術困難,也有成本效益考慮:當伊波拉只影響非洲,疫苗便沒有大商機,投資研究恐怕不在優先之列。西方藥廠的道德水平,在非洲早已聲名狼藉。」// is very true. in order to avoid your criticism of me being 順口開河, let me give you the evidence, which is found in your words //兩年前就有報導指有兩家藥廠已經開始人體安全測試,// which you referred to, ie the article" Commercial ebola vaccine ‘unlikely’ say researchers dated 12/08/2012 By Matt McGrath Science reporter, BBC World Service."

    your criticism of mr 沈旭暉 are :
    1 ) 假如已經提出了技術問題,那就根本不用說什麽于商機、西方藥廠,這樣衹會讓人懷疑作者胡説八道,不明白科學、經濟學和現實:i interpret you imply there lack of ebola vaccine is more a technical problem, rather than an investment-return issue, right ?
    if so, the BBC article says : //Scientists say their understanding of the nature of the virus has markedly improved over the past decade. But the chances of turning that knowledge into a vaccine are very dependent on money. //
    clear enough ? it is not knowledge problem, it is all money issue.

    2 ) mr 沈旭暉 gives gives no evidence to support //除了技術困難,也有成本效益考慮:當伊波拉只影響非洲,疫苗便沒有大商機,投資研究恐怕不在優先之列。//
    Here is the evidence from BBC article, //Larry Zeitlin is the president of Mapp Biopharmacueticals, a small company involved in the development of a therapy for ebola. He says that since the disease is sporadic and extremely deadly, it limits the numbers of people who are affected. But it also limits the commercial potential of any therapy. “I think it’s unlikely that a large pharmaceutical company would get involved," he explained."There isn’t a huge customer base and big pharma is obviously interested in big profits. ….This uncertainty over funding and the absence of interest from large pharmaceutical firms is leading some scientists to argue that a preventative vaccine might never see the light of day. //
    isn’t it clear that //矛頭指向商機、藥廠或「資本主義」// as the main cause of no ebola vaccine ?

    3 ) //再者,并不是沒有藥廠願意生產和研究伊波拉疫苗// you are attacking a point that mr 沈旭暉 did not make, for what he wrote was //疫苗便沒有大商機,投資研究恐怕不在優先之列。// i intepret that he did not say there is No drug company doing research with ebola vaccine, but only it is not the priority of many commercial pharmaceutical ccompany. and in fact the small company doing it, Mapp Biopharmacueticals, is funded by US pentagon, clearly support the idea of non-profit making of ebola vaccine.

    i have no comment regarding witch doctor, maybe mr 沈旭暉 will reply.
    Thanks for reading.

    Chiu

    • 山中 說:

      Chiu,

      1) I’m not saying investment is not a problem. I am saying that if we want to understand the problem, we need to weigh evidence to see which can give better explanation. Witnesses suggest investment is a problem, that could be true, but other evidence suggests that there is a technical limit and human safety trail cannot be conducted yet. So, combining the two, we can offer are more nuanced conclusion, one that emphases on the safety issue instead of money, as I have done above and contrary to what 沈旭暉 implied. If anyone wants to argue that it is the money, then they just need to offer more evidence.

      2) No, it is not clear that it is an investment problem. Witness’ statement is not that reliable, and we need to compare that statement with other evidence.

      3) All I am showing here is that Western governments and co. are still working on it. If the lack of commercial opportunity leads to the lack of vaccine, then, we need to ask, why are they still doing research for so long and producing some experimental vaccine? It is obvious that money is not a problem of the first order. While the lack of it might slow the process, but more of it won’t necessarily make the experimental vaccine safe to use.

      • DL 說:

        Dear chiu, I couldn’t agree you more — the following sources would also prove that mr. 沈旭暉 said 「伊波拉疫苗沒有出現,除了技術困難,也有成本效益考慮:當伊波拉只影響非洲,疫苗便沒有大商機,投資研究恐怕不在優先之列。西方藥廠的道德水平,在非洲早已聲名狼藉。」was not 信口開河 at all:

        ‘No Market’: Scientists Struggle to Make Ebola Vaccines, Treatments
        http://www.nbcnews.com/storyline/ebola-virus-outbreak/no-market-scientists-struggle-make-ebola-vaccines-treatments-n167871

        Limited Market for Ebola Vaccine Hinders Development
        http://www.raredr.com/articles/Limited-Market-Ebola-Vaccine

        The Cost of AIDS Drugs: A Moral Imperative
        https://blogs.commons.georgetown.edu/journal-of-health-sciences/issues-2/previous-volumes/vol-3-no-1-march-2006/the-cost-of-aids-drugs-a-moral-imperative/

        • 山中 說:

          So DL has no understanding of what good evidence is, as he cited two stories that restate the words of a Dr. Sina Bavari. And still cannot read “懷疑" in the sentence “懷疑他是在信口開河" That’s not surprising.

          Here is the abstract of a 2009 peer-reviewed paper: “Ebola virus infection is a highly lethal disease for which there are no effective therapeutic or preventive treatments. Several vaccines have provided immune protection in laboratory animals, but because outbreaks occur unpredictably and sporadically, vaccine efficacy cannot be proven in human trials, which is required for traditional regulatory approval." Emphasis mine.

          Here is another one from 2003: “Ebola virus and HIV present challenges for vaccine development because natural immunity to these viruses is difficult to find, and there are no immune correlates of protection in humans. Modern molecular genetic, virologic and immune analyses have been used to rationally identify promising approaches based on animal model and human clinical studies. Improved vaccine candidates have been defined for HIV, and a promising Ebola vaccine have conferred protection in non-human primates. Further evaluation in humans will allow an assessment of their potential efficacy and point the way to the development of more successful vaccines."

          Another from 2003: “Vaccine development has been fraught with obstacles, primarily of a biosafety nature. Case reports of acutely ill patients with EHF showing improvement with the transfusion of convalescent plasma are at odds with animal studies demonstrating further viral replication with the same treatment."

          Here is a news story: “Tekmira, a Burnaby pharmaceutical company is working on producing the world’s first treatment of the Ebola virus, but the clinical human trials were halted by the FDA last month due to safety concerns."

          Another news story: “But scientists say they are beginning to close in on ways to stop the virus. Several promising vaccines and medications are under development, although all are still years from availability, said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases (NIAID)…There’s one problem with all these medical research efforts, however: researchers likely will have to wait for a future Ebola outbreak to test any vaccine or treatment." Emphasis mine.

          If you can actually read the words above, you will find that they have a couple experimental vaccines but they have never been tested on human, and because 1) it is not safe; 2) they don’t have the opportunity. Are you suggesting that money should come before safety or provide the scientists a sample of human test subjects or weaken regulatory standards?

          If “投資研究恐怕不在優先之列", then how did the scientists keep researching for so long? How did they produce some results and experimental vaccines? How come we don’t have a HIV vaccine when there is such a huge market for it?

          • DL 說:

            //If “投資研究恐怕不在優先之列”, then how did the scientists keep researching for so long?//
            I believed that something could be doing for quite a long time doesn’t necessary mean that it’s 在優先之列 such as Mount Rushmore National Memorial or Basílica i Temple Expiatori de la Sagrada Família in Barcelona, Spain, they have been doing for quite a long time.

            //How come we don’t have a HIV vaccine when there is such a huge market for it?//
            something doesn’t happen usually would not cause by only one reason, multiple factors could be the causes such as mentioned by mr. 沈旭暉:「伊波拉疫苗沒有出現,除了技術困難,也有成本效益考慮….」

  2. chiu 說:

    Dear 山中 ,

    agree with you regarding the level ( or weight) of difference evidence in scientific world, ( ie peer review is more weighty than personal opinion, even so called professional opinion) and your quote of various ebola vaccine studies. However reading your writings on this topic and your reference, i still would like to present my alternative understanding , for the sake of intellectual exchange.

    there are many researches doing many different researches, some are sponsored by big pharmaceuticals, some are by academic, so able to find studies on ebola vaccine is not the issue, nor does it refute the statement //“投資研究恐怕不在優先之列”// by mr 沈旭暉. whether any vaccine is 在優先之列 is judged by the amount of money the big pharmaceuticals put into 投資研究, eg compared ebola against HIV, Flu, swine Flu etc, and also reflected by the amount of research papers on that topic. without any figure at hand, i bet money into HIV vaccine is by far >>> ebola vaccine, right ?

    we all agree that ebola vaccine is not developed due to 1) relative small number of patients, 2 ) sporadic outbreak, 3 ) in africa mainly, and 4 ) technical difficulties not related to technology, but mainly to 1), and 2 ). in contrast HIV vaccine is more a technical challenge than money issue.

    thanks for reading,

    Chiu

    • 山中 說:

      I’m not saying money is not a problem. It can be. And there are companies who want to make the vaccine now, but they got shot down by the health agencies. The thing is, if we place undue focus on the pharmas, it would skew our view on the safety issue and get ourself misinformed.

  3. chiu 說:

    Dear 山中 ,
    yes, agree that more money should be devoted to good reseachers to produce safe vaccine and drugs for the benefit of human. unfortunately, looking at the conflicts occuring right in front of our eyes, eg islamic terror state, israel-palestine, ukraine etc, with so much evils committed and money used in war machine, wonder will human ever get our priority right ?
    very sad….
    Chiu

  4. 山中 說:

    Reblogged this on 山中雜記 and commented:

    報導指西非塞拉利昂/獅子山的伊波拉危機完全是可以避免的。伊波拉之所以蔓延到塞拉利昂,是因爲幾内亞的一個巫醫聲稱她的治愈伊波拉,引起塞拉利昂的信眾跨境去追隨她,於是疫情一發不可收拾。一個人的愚昧無知造成上千人的痛苦和死亡,我希望沈旭暉可以出來說清楚巫醫是什麽一回事。

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