Pamalire a Zosatheka

Harry, Lord Monchensey, wabwerera kunyumba kwawo atatha zaka zisanu ndi zitatu akukondwerera tsiku lobadwa la amayi ake okalamba mu Kuyanjananso Pabanja, TS Masewera a 1939 a Eliot mu vesi. Kalanga, akupita ku misala chifukwa chodziona kuti ndi wolakwa: Paulendo wapanyanja chaka chatha, mkazi wa Harry "adakwera bwato pakati pamvula yamkuntho" ndikutha pakati pamafunde. “Simungalingalire kuti wina aliyense angamire mofulumira chonchi,” akutero Harry. Amadzizunza yekha kuti mwina adamukankhira kunyanja ndipo adamupangitsa kuti amwalire, "... kufuna kumuchotsa / Kumupangitsa kuti akhulupirire kuti adachita ..." Achibale ake, atasowa thandizo komanso nkhawa Pazovuta zam'mutu wa Harry, lingalirani kuitanira dokotala kwawo kuti akaonane. Agogo a Harry a Agatha, mwina okayikira, akuti, "Osachita zabwino izi / Koma kuti pasadzasiyidwe kanthu / M'mbali mwa zosatheka."

Anali Archibald L. Cochrane, wothandizira kugwiritsa ntchito mayesero olamulidwa mosasinthika komanso omwe dzina la database la Cochrane lidatchulidwa, yemwe adatchulira mawu a Eliot. Polemba za kafukufuku wasayansi mwazonse, m'mbuyomu Kuchita bwino ndi Kuchita bwino: Maganizo Osawerengeka pa Zaumoyo , (1971), Cochrane adayitanitsa azachipatala kuti "... asiye kugwiritsa ntchito 'malire a zosatheka' ..." (tsamba 85)

Kafukufuku wonenepa kwambiri ali pa "malire a zosatheka" chifukwa, "Ngakhale zaka makumi angapo zafukufuku pazomwe zimayambitsa mliri wa kunenepa kwambiri, tikuwoneka kuti sitili pafupi ndi yankho pano kuposa pomwe kulemera kwa thupi kunayamba kulembedwa zaka makumi angapo zapitazo . ” (Hebert et al, Zochitika Zachipatala za Mayo , 2013) "Bwalo lakumvetsetsa kwathu / ndi malo oletsedwa kwambiri," akutero a Chorus kumapeto kwa sewero la Eliot. Kodi tingatani kuti timvetse bwino zomwe tili pano?

Kubwerera chapakatikati pa zaka za m'ma 1950, wofufuza wina wa a Johns Hopkins, powerenga momwe zinthu zina zimasulidwira m'manyuzipepala ake, analemba kuti, "Mwina palibe vuto lomwe wasayansi aliyense akukumana nalo lero lopambana kuposa kuyesetsa kuthana ndi kusefukira kwa kafukufuku wasayansi, ngakhale munthu atakhala wochepa kwenikweni. ” (Galasi, Sayansi, 1955) Zida zinali zachikale komanso zosasimbika malinga ndi zaka za m'ma 2000: lero tili ndi kuthekera kopezanso zinthu zopitilira zomwe asayansi angaganize, koma "kuyesetsa kuthana ndi kusefukira kwa kafukufuku wasayansi, ngakhale mkati mwa ukatswiri wake" wakula kwambiri zoipa. Ndi nkhani imodzi, monga ndidalemba zaka zisanu ndi zitatu zapitazo mu blog yanga yoyamba, magazini oposa 250 aukadaulo, osaphatikizira, mwachitsanzo, magazini azachuma kapena ogula, amaphatikizanso zolemba zokhudzana ndi kunenepa kwambiri. (Baier Et al, International Journal of Kunenepa Kwambiri, 2010) Tili pachiwopsezo chodzazidwa ndi madzi ndipo ngati mkazi wa Harry, kutayika panyanja, kapena "kutayika pofalitsa." (Garg neri Al, Impso Padziko Lonse, 2006) Kodi ndi mavuto ati ena omwe akukhudzidwa ndikufufuza zambiri?

Choyamba, "Sizinthu zonse zasayansi zomwe zimapangidwa mofanana." (Ioannidis, Mankhwala a PLOS 2018) Mwachitsanzo, pakuwunika kwawo za "zachinyengo zamankhwala," Ioannidis ndi anzawo ( European Journal of Kufufuza Kwachipatala , 2017) adapeza kuti pali zolemba pafupifupi 17 miliyoni mkati mwa injini zosaka za PubMed zomwe zimakhudza anthu, ndipo zikuwoneka kuti pafupifupi zolemba miliyoni imodzi zimawonjezedwa chaka chilichonse. Imeneyi si nkhani yabwino kwenikweni, chifukwa zambiri zomwe zili munkhanizi ndizosocheretsa, zosadalirika, kapena "zosadalirika." Kuphatikiza apo, akuti Ioannidis et al (2017) ambiri mwa omwe amawerenga maphunzirowa sadziwa ngakhale izi, ndipo ngakhale atakhala, ambiri alibe luso lokwanira kuti athe kuwunika maphunziro omwe akuwerenga.

Ioannidis ( European Journal of Epidemiology, 2018) adatinso chidwi ndi omwe amatchedwa MateyuZotsatira : Mapepala omwe atchulidwa kwambiri akupitilizabe kutchulidwa. Merton (PA) Sayansi , 1968) adalongosola izi, zomwe zidatchulidwa kuti za m'Baibulo Bukhu la Mateyu (25.9): "Pakuti kwa yense amene ali nazo, kudzapatsidwa, ndipo adzakhala nazo zochuluka; koma kwa iye amene alibe, adzalandidwa ngakhale chimene ali nacho. "M'mawu ena, akufotokoza Merton, asayansi" odziwika bwino "amapitilirabe kuzindikira pomwe iwo" omwe sanadziyike chizindikiro " iwo.

Ofalitsa nkhani ndi amene amachititsa vutoli, nthawi zambiri chifukwa chouza anthu zachipatala, nthawi zina kuchokera kwa "olamulira" otchuka pawailesi yakanema omwe amapereka "umboni," ambiri mwa iwo amakhala "osakwanira komanso osalondola kwenikweni." (Ioannidis Et al, 2017). Popeza kuti sayansi ndiyomwe ili pagulu, iyenera kufotokozedwera kwa ena: "ndizomwe timatanthauza popereka chithandizo ku sayansi-china chake choperekedwa ku thumba lodziwitsa anthu zambiri. Pamapeto pake, sayansi ndi gawo lodziwitsidwa pagulu komanso logwirizana. (Kroeger neri Al, American Journal of Clinical Nutrition , 2018) Ofalitsa nkhani komanso ofufuza eni ake, ngakhale ali ndi zolinga zabwino, ngakhale zolinga zolungama, nthawi zina amanamizira kapena kukokomeza, kaya mosazindikira kapena mosazindikira, zonena za asayansi, mwachitsanzo, zomwe Cope ndi Allison adalemba moyenera kukondera chipewa choyera . ( Acta Paediatrica , 2010; International Journal of Kunenepa Kwambiri , 2010) (Zambiri pa kukondera chipewa choyera, onani blog yanga 53) Madokotala, odwala, ndi mabanja awo, chifukwa chake, nthawi zambiri amakhala opanda mwayi wowunika njira zamankhwala.

Vuto lina lalikulu lakhala kulimbikira m'mabuku a kuganiza zakunenepa kwambiri ngati matenda amodzi omwe ali ndi chidziwitso chimodzi. (Hebert et al, 2013; SR Karasu, American Journal of Lifestyle Medicine, 2013), ngakhale Stunkard ndi Wolff, koyambirira kwa ma 1950, ( Mankhwala a Psychosomatic , 1958) adanena kuti panalibe chifukwa chofotokozera zamatsenga. Kuphatikiza apo, m'malo moyamikira zovuta zazikulu kwambiri za kunenepa kwambiri, ofufuza ambiri amagawaniza kunenepa kwambiri mchilankhulo chawo. Mwachitsanzo, madokotala amawona kunenepa kwambiri ngati matenda, mwachitsanzo, matenda omwe ayenera kuchiritsidwa; akatswiri azachikhalidwe amatha kuwona ngati chitsanzo cha kusiyanasiyana kwamthupi; atsogoleri achipembedzo, monga chitsanzo cha makhalidwe oipa ndi kudzisangalatsa; anthropologists, matenda a chitukuko; ma genetic, monga matenda amtundu; akatswiri osintha zamoyo, monga oyenera kapena osayenera kutengera chilengedwe, ndi zopereka kuchokera ku mabakiteriya, mavairasi, poizoni wosokoneza endocrine, pakati pa ena; akatswiri a sayansi ya zakuthambo, monga kusamvana kwamagetsi kutsatira malamulo a thermodynamics; ndi akatswiri amisala ndi akatswiri amisala, ngati vuto lodziletsa kapena kusuta. (SR Karasu, 2013; SR Karasu, American Journal of Lifestyle Medicine , 2014.) (Kuti mumve zambiri za "zilankhulo" zosiyanasiyana onani blog yanga 26, Babele Wotalika .)

Palinso zovuta zamatekinoloje, zina mwa sayansi komanso zina zamaphunziro a kunenepa kwambiri. Makamaka omwe amapezeka m'maphunziro a kunenepa kwambiri ndikuti kafukufuku wosachita mosasinthika amaposanso maphunziro owongoleredwa, ndipo kugwiritsa ntchito chilankhulo mosasamala, makamaka kuchokera ku maphunziro owonerawa. (Trepanowski ndi Ioannidis, Kupita Patsogolo pa Zakudya Zabwino, 2018)

Zolakwitsa zowerengera ndizofala kwambiri pakati pa maphunziro a kunenepa kwambiri. "Mukazunza deta yanu mokwanira, adzakuwuzani chilichonse chomwe mukufuna kumva," komanso "monga mitundu ina yazunzo, sizimakusiyirani milandu mukazichita mwaluso ... ndipo zitha kukhala zovuta kutsimikizira ngakhale pali umboni wonamizira . ” (Zogulitsa, NEJM, 1993) Allison ndi anzawo (George et al, Kunenepa kwambiri, 2016) adazindikira zolakwika khumi zowerengeka zomwe zimawonedwa pakufufuza kwamanenepa. Chimodzi mwazolakwika kwambiri m'mabuku onenepa kwambiri ndikuganiza kuti kulowererapo kumakhala kothandiza pomwe kafukufukuyu sakugwirizana ndi izi. (Brown ndi al, Kukula kwa National Academy of Science , 2018) Zina mwazolakwika zomwe zimachitika ndi monga kusamalira kapena kunyalanyaza zomwe zasowa kapena kusachita bwino ndi omwe sanamalize maphunziro, osanyalanyaza kutsimikizira, komanso kunyalanyaza zomwe akutanthauza. Kutsimikizira kutsimikiza ndichizolowezi cha ofufuza kuti awunike zotsatira zawo mosiyana kapena pang'ono pang'ono pomwe zotsatira zawo zikugwirizana ndi ziyembekezo zawo zoyambirira kapena mogwirizana ndi malingaliro awo oyamba. Kugonjetsedwa mpaka kutanthauza ndi zochitika zowerengera zomwe zimachitika poyesa mobwerezabwereza pamutu womwewo, ndipo palibe gulu lolamulira lofanizira kusiyana kulikonse kuchokera pazoyambira. Miyeso ikasinthidwa pakuwunikanso mobwerezabwereza, (ndipo nthawi zambiri pomwe maphunziro amasokonekera pang'ono kuchokera pazovuta) ofufuza amatha kuganiza molakwika kuti kusinthaku kudachitika chifukwa cholowererapo. Mwanjira ina, kubwerera m'ndondomekoyo "kumangodzionetsera ngati chithandizo." (Kahathuduwa et al, Matenda a shuga, kunenepa kwambiri ndi kagayidwe kabwino ka thupi , 2018)

Kuphatikiza apo, kafukufuku wonenepa kwambiri wavutitsidwa ndi zovuta za muyeso wolakwika, kuphatikiza zomwe zimakhudzana ndi kudzidziwitsa nokha za kulemera kwa thupi, kutalika, kudya chakudya, komanso kuchita masewera olimbitsa thupi. "Ngakhale umodzi uli wonenepa kwambiri kapena ayi, kusiyana pakati pa mayiko awiriwa sikunasinthidwe." Mwanjira ina, thanzi la anthu "limawonekera ngati kupitilira ... (Galea, Quarterly ya Milbank , 2018) "Timazitcha thanzi tikapanda kupeza chizindikiro / Matenda. Thanzi ndilosakhalitsa, "akutero dokotala m'masewero a Eliot.

Kusakwanira kwa izi kwadzetsa zomwe ofufuza ena amatcha "pseudoscience." (Trepanowski ndi Ioannidis, 2018; Archer et al, Mavuto Apano mu Cardiology , 2016; Woponya mivi ndi ena, MALOChimodzi, 2013) Mwachitsanzo, kuyesa kuwunika momwe zakudya zilili, monga kusanthula kwadongosolo kuti azindikire momwe amagwiritsidwira ntchito ndikuwunika kulumikizana pakati pa kuchuluka kwa ma caloriki ndi kuchuluka kwa kunenepa mzaka 40 zapitazi, kwadzetsa chidziwitso cha "chinyengo" chomwe ndi " wovuta thupi. ” Zomwe zatoleredwa ndi Centers for Disease Control kuchokera kwa anthu a NHANES a anthu wamba, osakhazikika ku US adalira malipoti osakwanira komanso osokeretsa okhudzana ndi kudya omwe adalepheretsanso kuchuluka kwa anthu aku US, kuphatikiza alendo osadziwika, opanda pokhala, ndi iwo omwe amakhazikika. Schoeller et al, m'kalata yolembedwa ndi atsogoleri 17 pankhani yakufufuza za kunenepa kwambiri, adalemba momwe zadutsa zaka 20 kuchokera pomwe Schoeller iyemwini adapeza "kukondera kwakukulu komanso zolakwika," mwachitsanzo, "zolakwika zakupha" - makamaka zomwe sizinachitike ya kudya kwa kalori pakufufuza kwamanenepa kwambiri. Osakhulupirika, mchitidwe wodziwonetsera wekha udakalipobe m'maphunziro a kunenepa kwambiri. (Schoeller ndi al, American Journal of Clinical Nutrition , 2013; Dhurandhar neri Al, Zolemba pa Zakudya Zakudya , 2016)

Kudalira sayansi yazakudya kumachepa pomwe kafukufuku wina atulutsa chomera kuti ndi chowopsa kenako china chimanena kuti chakudyacho chimapindulitsanso. Ioannidis amatchula kusinthaku koopsa Proteus chodabwitsa , kutsatira mulungu wachi Greek yemwe amatha kusintha mawonekedwe ake mosavuta. ( Mankhwala a PLoS , 2005) Komanso, kafukufuku wonenepa kwambiri amakhala ndi zovuta chifukwa pafupifupi mitundu yonse yazakudya imagwirizana (Ioannidis, JAMA 2018): sikuti timangodya chakudya, mafuta, ndi mapuloteni athu m'njira zosiyanasiyana, koma zakudya zathu zimatiyambitsa masauzande amankhwala, zoipitsa, ndi poizoni zomwe zimapangitsa kuti zisasokoneze zomwe zingapangitse chinthu chimodzi kuchokera kwa ena, komanso monga kupatula kuwonekera kwachilengedwe ndi zina monga kusintha moyo, maphunziro, chikhalidwe cha anthu ndi zina, ndi zina zambiri. Kutsatira njira yodyera nthawi zambiri kumakhala kovutirapo kapena gulu lolamulira lingatengere zoyeserera zoyeserera. (Trepanowski ndi Ioannidis, 2018)

Anthu akuyenera kukhala okayikira, alemba Marion Nestle, m'buku lake Chowonadi Chosasangalatsa: Momwe Makampani Odyera Amadyera Sayansi Yomwe Timadya (2018) nthawi iliyonse kafukufuku akasankha chakudya, chakumwa, chowonjezera, kapena chilichonse chomwe chimayambitsa kapena kuchepetsa chiopsezo cha kunenepa kwambiri, matenda amtima, mtundu wa 2 shuga kapena khansa. (tsamba 228) Nestle amatcha zotsatira zosangalatsa za phindu la zakudya zosakwatiwa zikachotsedwa "pazakudya" zawo chopatsa thanzi. (tsamba 54) Popeza timadya zakudya zonse mophatikiza ndi zina, sizingakhale zomveka kuvomereza kuti chakudya chimodzi chimakhala ndi zabwino zachilendo komanso zapadera pa thanzi lathu.

Pakafukufuku waposachedwa kwambiri, Schoenfeld ndi Ioannidis ( American Journal yaMatenda Opatsirana , 2013) adadzutsa funso lokhumudwitsa ngati chilichonse chomwe timadya chimakhudzana ndi khansa. Ofufuzawa adasankha zophatikizira 50 pamasamba osavuta m'buku lophika lotchuka ndipo adapeza 40 mwa zosakaniza (80 peresenti) zomwe zidafotokozedwa munkhani zomwe zimapereka umboni woti chiwopsezo cha khansa chikuwonjezeka kapena chatsika, ngakhale pali umboni wochepa wowerengera. Khansa ya m'mimba, yomwe idawonetsedwa mu 45 peresenti ya kafukufukuyu, ndi omwe amaphunziridwa kwambiri. Kupitilira apo, mayesero olamulidwa ndi anthu nthawi zambiri amalephera mobwerezabwereza kupeza zotsatira za mankhwala pazakudya zomwe maphunziro owonera anali atanenapo kale za mabungwe olimba, ndipo ngakhale kuwunika kwa meta nthawi zina kumakondera ndikumasuliridwa molakwika. (Schoenfeld and Ioannidis, 2013) "Ngati titenga zenizeni, ngati tiwonjezera kapena kuchepetsa kudya zakudya zilizonse zingapo patsiku, khansa imatha padziko lonse lapansi." (Brown ndi al, Kupita Patsogolo pa Zakudya Zabwino , 2014)

Kaya cholinga chake chachikulu ndi chiyani, kafukufuku wazakudya amatchedwa "m'gulu lazovuta kwambiri zasayansi" (Ioannidis ndi Trepanowski, JAMA , 2018) chifukwa chakusokonekera kwachuma komwe kumachitika chifukwa cha mafakitale kapena njira zina zopezera ndalama, komanso zomwe ochita kafukufuku angasankhe komanso zomwe amakonda (monga vegan, wopanda gluten, ndi zina) pazomwe amadya kapena zomwe zimawathandiza. (Brown et al, 2014) Ofufuza ambiri amakhulupirira kuti ndi "lingaliro loyera komanso lachikale" kuti kulandira ndalama kuchokera kumakampani kumachepetsa zotsatira. (Ioannidis, 2018) M'malo mwake, Allison et al adapeza, poyang'ana m'manyuzipepala azachipatala apamwamba kwambiri, mayesero omwe amayendetsedwa mwachisawawa anali ofanana ngakhale atalandira ndalama. (Kaiser et al, International Journal of Kunenepa Kwambiri, 2012)

Nestle, komabe, akupereka chenjezo, "Ndiloleni ndinene kuti mbiri yanga ndi makampani azakudya sizowononga ayi; ndizotheka kuchita kafukufuku wothandizidwa ndi mafakitale ndikusunga kudziyimira pawokha komanso umphumphu. Koma ndalama zamakampani azakudya nthawi zambiri zimakhudza mosayenerera. "(Nestle, 2018, p. 6) Ananenanso," (ndipo) ... zikuwonetsa kuti funso lofufuzira ndikutanthauzira kumafunikira kuyang'anitsitsa koposa. " (tsamba 71) Kwa Nestle, payenera kukhala kusiyana pakati pa kutsatsa ndi makampani azakudya ndi sayansi. Komanso, Nestle akuwona mikangano yazachuma chosangalatsanso mosiyana ndi mikangano yopanda ndalama Izi zimatha kudalira zikhulupiriro, zikhumbo, ndi malingaliro omwe amasiyanasiyana kwambiri kuchokera kwa wofufuza wina.

Ngakhale sizodziwika kwenikweni kwa omwe amapanga maphunziro azakudya, ofufuza sanafunikire kukhala owonekera pomasula zomwe adalemba, zomwe zimapangitsa kuti maphunziro ambiri sangayesedwe. Nestle (2018, p. 169) akukumbukira nthabwala kuyambira zaka zapitazo pamene anali kumaliza maphunziro a sayansi ya zamoyo ku Berkeley, "Usabwereze kuyesera komwe kumagwira ntchito poyesa koyamba." Pofuna kuthana ndi vutoli ndikusunga ndikupangitsa kuti izi zitheke, Hardwicke ndi Ioannidis ( PLOS Mmodzi , 2018) akhazikitsa njira-ya Deta Likasa - malo osungira zinthu zapaintaneti posunga zosaphika, kulimbikitsa kusokonekera kwa asayansi, ndikuwonekeratu kuwonekera pakati pa maphunziro.

Mfundo Yofunika

Monga mkazi wa Harry ku T.S. Masewero a Eliot, asesa ndikumira, tonse tikumira munyanja yosindikiza. Kafukufuku wochuluka kwambiri wonenepa kwambiri amatulutsa zidziwitso zabodza-zasayansi chifukwa cha njira zopanda pake, kuyeza kolakwika komanso kosadalirika, komanso kusankhana chifukwa chotsutsana. Ioannidis wanena kuti kafukufuku payokha amafunikira kafukufuku wake, zomwe iye ndi anzawo adayitanitsa kafukufuku wa meta monga njira yotsimikizira, kuyesa, ndi kupindulitsa pakufufuza. ( PLOS Biology, 2018) Mu sayansi, nthawi zina pamakhala mzere wabwino pakati pa kukayikira kwabwino komanso kunamizira komanso kukokomeza kusatsimikizika kwasayansi. (Allison ndi al, Wasayansi waku America, 2018) Ngakhale "zomwe timamvetsetsa" nthawi zambiri zimawoneka ngati "malo oletsedwa," ofufuza sangachitire mwina koma kungoyenda momwe angathere kupyola chidziwitso komanso kutali ndi "malire osatheka"