<International Circulation>: What kind of studies does it eliminate?

　　《国际循环》：哪种类型的文献会被淘汰？
　　Prof. Oparil: For instance， studies that generally give treatment， drug A versus drug B， but there is not a particular threshold for how it affects hypertension or for what the drug does.  If there is no threshold and no goal it doesn’t satisfy the questions that we have.

　　Oparil教授：例如，常见的比较两种药物药效的治疗研究，但如果未设定特定的阈值来研究这些药物如何治疗高血压，若没有明确的阈值或目标，那我们的研究就不能合理解决这些问题。
　　<International Circulation>:Why do you think there have not been evidence-base medicine guidelines until now?

　　《国际循环》：为何您认为目前尚无循证医学的指导原则？
　　Prof. Oparil: The discipline of evidence-based medicine is still evolving.  It is a whole industry with a company doing literature searches or reviews， another company that is doing testing of levels of evidence.  These entities are different and did not exist before.  The way we are doing things depends on randomized control trials.  The first randomized control trial on hypertension was the Veterans Affairs collaborative study in the 1960s with nothing done in this way before that time.  They are very expensive studies to conduct so there were only a few in the early times of EBM.  Real randomized controlled trials with hundreds of thousands of patients are difficult to do and are not that common.  A trial might have 20 or more papers about it but most of them are post-hoc analyses， which are not included for what we do.  Doctors often think they know a lot so they read a paper or hear a talk and are quick to give their opinion about it and proceed from that.  Years ago studies were much simpler， individuals with an infection where one group got penicillin and those who didn’t died.  Now that we have a lot of treatments that have marginal benefits or all these blood pressure drugs， it is much more difficult and complicated to know whether one is better than the other.  You can design studies that show some benefit but to know from the hard evidence whether it prevents you from having a heart attack or stroke is more complex.

　　Oparil教授：循证医学（EBM）的指导原则仍在不断向前推进。它是由一家公司进行文献检索或评论，另一家公司进行文献水平测试所形成的一个系统工业。这些实体是以往所没有的。我们的研究方法取决于随机对照试验。第一项针对高血压的随机对照试验是Veterans Affairs于20世纪60年代开展的合作性研究，在此以前没有任何相关研究。该研究的费用极其昂贵，因此在早期EBM仅开展了少数几项研究，真正的包括成百上千患者的随机对照试验是很难进行的。一个试验可能写出20页或更多的论文，但绝大多数是事后分析，这并不包括在我们的研究范围内。医生往往认为他们已经懂得很多，所以他们阅读文献或参加会谈时，会迅速发表他们的观点并继续往下走。多年前的研究要简单得多，比如，在感染的患者中，接受青霉素治疗的患者组未出现死亡病例。如今许多降压治疗的效果多样，或包括多种降压药物，这使得研究更加困难复杂，很难评价何种药物的药效优于其它药物。你可以为某种疗效而设计研究，但想获得确凿的证据证实这种治疗是否可以预防心脏病发生或卒中则是复杂的。
　　<International Circulation>:  How much more do you think we are going to keep seeing these large randomized control studies?

　　《国际循环》：那您认为我们将继续进行哪些工作，从而可以进行这些大型的随机对照研究？
　　Prof. Oparil: We are going to see fewer.  In hypertension we will not see very many.  There are no new drugs recently other than this new renal denervation.   There may be some new drugs but I am not sure what they are specifically.

　　Oparil教授：我们将会看到越来越少的大型研究。像高血压方面的研究，我们就不会看到很多。目前除了新型的肾脏去神经治疗以外，尚无其它新型药物。可能会有其它药物，但我不能确定它们是不是特异性治疗药物。
　　<International Circulation>:  Now that we are finally getting into better practices with EBM， is this a bad thing?

　　《国际循环》：既然我们最终获得更好的EBM方面的实践，这是一件坏事么？
　　Prof. Oparil:  In hypertension there probably will not be too much more unless there are new approaches.  For other things like the late breaking trials of anti-thrombotic agents， which is an important area.  There will also be more lipid studies because there are new approaches and mechanisms involved.  The statins are the gold standard now but other drugs that increase HDL levels and do other things will need to be tested.  If something new comes along it is natural want to adopt it.  Many people interested in evidence-based medicine are the payers， like insurance companies， and the government， the biggest payer.  One can be fooled very easily and spend a lot of money and resources on things that don’t actually do anything.

　　Oparil教授：在高血压指导原则中，可能不会有太多实践，除非有新的方法。对于其它像最新的抗血栓药物突破性试验，这则是一个重要领域。此外，将会有更多的脂质研究，因为会出现新的方法和作用机制。目前他汀类药物仍是金标准，但其它提高HDL水平的药物或其它作用的药物都将进行研究。如果有新的药物出现，很自然地会去采纳它。许多对循证医学感兴趣的人是研究资助者，如保险公司，政府这一最大的资助者。但人们可以很容易就被愚弄，花费大量的金钱和资源在事实上未做任何工作的研究上。