The following article is quoted from the book 「Factfulness」 written by Hans Rosling and the public data posted on the WHO website.
本文所述內容摘錄自Hans Rosling所著「真確」一書及世界衛生組織網站所發布的公開信息。
本期主題：借鑑真實數據┊14年伊波拉病毒疫情的啟示 Factfulness is recognizing that a single perspective can limit your imagination, and remembering that it is better to look at problems from many angles to get a more accurate understanding and find practical solutions.真確 – 是認知到單一視角對想像力的限制；是記得從不同角度去看待問題，以得到更精確的理解及找到實際的解決方式。– Factfulness, Hans Rosling
The Spanish flu that spread across the world in the wake of the First World War killed 50 million people—more people than the war had, although that was partly because the populations were already weakened after four years of war. As a result, global life expectancy fell by ten years, from 33 to 23.西班牙型流感在1918年曾造成全世界約5億人感染(相當於當時全球人口的三分之一)及5千萬人死亡，也因同時經歷4年多的第一次世界大戰，許多人已力不從心，得流感致死的人數遠遠超過因戰爭死亡的人數。當時的全球平均壽命從33歲降低至23歲，少了整整10年。
The numbers behind the official World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) 「suspected Ebola cases」 curve were far from certain. Suspected cases means cases that are not confirmed. There were all kinds of issues: for example, people who at some point had been suspected of having Ebola but who, it turned out, had died from some other cause were still counted as suspected cases. As fear of Ebola increased, so did suspicion, and more and more people were 「suspected.」 As the normal health services staggered under the weight of dealing with Ebola and resources had to move away from treating other life-threatening conditions, more and more people were dying from non-Ebola causes. Many of these deaths were also treated as 「suspect.」 So the rising curve of suspected cases got more and more exaggerated and told us less and less about the trend in actual, confirmed cases.在2014年伊波拉病毒疫情爆發時，世界衛生組織(WHO)及美國疾病管制局(USCDC)無法確認疑似感染伊波拉病毒的病例數據。有很多原因會影響數據的準確性，例如：曾出現疑似感染的症狀但最後因其他原因而死亡的患者，仍會被列為疑似案例。人們對伊波拉病毒的恐慌和疑慮甚囂塵上，越來越多人被列為「疑似案例」。當醫療資源因應對伊波拉疫情而必須暫緩治療其他重大疾病時，越來越多人因為其他傷病而死。因而疑似案例急遽增加，人們無法從中確定真正確診的患者數據。
When a problem seems urgent the first thing to do is not to cry wolf, but to organize the data.遇到刻不容緩的問題時，應該開始立刻收集並處理數據，而不是大喊著「狼來了」。
If you can’t track progress, you don’t know whether your actions are working. We had hundreds of healthcare workers from across the world flying in to take action, and software developers constantly coming up with new, pointless Ebola apps (apps were their hammers and they were desperate for Ebola to be a nail). But no one was tracking whether the action was working or not.如果我們不能追蹤處理的進度，我們就無法得知開展的行動是否有效果。我們有來自世界各地的醫護人員參與疫情救治，有許多軟體開發商實時更新上架但不足以對症下藥的疫情相關小程序，但卻沒有人能真正的掌握有哪些行動是有具體的正面成效。
The data came back showing that the number of confirmed cases had reached a peak two weeks earlier and was now dropping. Meanwhile, in reality, the Liberian people had successfully changed their behavior, eliminating all unnecessary body contact. There was no shaking hands and no hugging. This, and the pedantic obedience to strict hygiene measures being imposed in stores, public buildings, ambulances, clinics, burial sites, and everywhere else was already having the desired effect.重新梳理數據後，專家發現確診病例已在兩周前達到最高峰，並逐漸降低。同時在受疫情影響的西非國家賴比瑞亞，人民完全改變生活習慣，隔絕一切不必要的肢體接觸。為阻止疫情傳播，人們不再握手及擁抱，並加強貫徹在商店、公共環境、救護車、醫療院所、及墓地等場所的衛生條件。
I sent the falling curve to the World Health Organization and they published it in their next report. But the CDC insisted on sticking to the rising curve of 「suspected cases.」 They felt they had to maintain a sense of urgency among those responsible for sending resources. I understand they were acting from the best of intentions, but it meant that money and other resources were directed at the wrong things. More seriously, it threatened the long-term credibility of epidemiological data.專家將梳理過後的確診病例降低曲線發給世界衛生組織，後者將其發布於報告中。但美國疾病管制局仍堅持使用急遽增加的疑似案例曲線，認為維持緊張的狀態才可被優先分配到所需資源。此舉雖非居心叵測，卻會使資金及資源被不當分配。更嚴重的是影響了感染病數據的長期可信度。
A problem-solving organization should not be allowed to decide what data to publish. The people trying to solve a problem on the ground, who will always want more funds, should not also be the people measuring progress. That can lead to really misleading numbers.負責解決問題的機構不應被授權決定信息的發布與否。所有前線作業的人都希望有更充裕的資源，這些人不適合同時負責評估行動的成效。如此會使具誤導性的數據增加。
Hotheaded claims often entrap the very activists who are using them. The activists defend them as a smart strategy to get people engaged, and then forget that they are exaggerating and become stressed and unable to focus on realistic solutions. People who are serious about the issue must keep two thoughts in their heads at once: they must continue to care about the problem but not become victims of their own frustrated, alarmist messages. They must look at the worst-case scenarios but also remember the uncertainty in the data. In heating up others, they must keep their own brains cool so that they can make good decisions and take sensible actions, and not put their credibility at risk.一頭熱的論述是兩面刃，發布這些論述的人容易劃地自限。雖然激進的言論更能鼓動人們關注，誇大的內容會加深讀者的焦慮及不再關注實際解決辦法。人們在思考問題時必須保持平衡的思維：持續關切問題的進展，但不故步自封於悲觀的警示宣言。我們必須警戒最可能發生的危害，但保持理性清澈的抉擇及實用的行動，避免誇大不實的言論對信心及聲譽的損害。
It was data—the data showing that suspected cases were doubling every three weeks—that made me realize how big the Ebola crisis was. It was also data—the data showing that confirmed cases were now falling—that showed me that what was being done to fight it was working. Data was absolutely key. And because it will be key in the future too, when there is another outbreak somewhere, it is crucial to protect its credibility and the credibility of those who produce it. Data must be used to tell the truth, not to call to action, no matter how noble the intentions.在伊波拉病毒疫情中，每三周番一倍的疑似案例數據讓人們正視疫情的嚴重度；而逐漸減少的確診案例證實疾控行動的具體成效。不論過往的疫情或是現行的疫情，真實的呈現數據才能得到最重要的理論依據。必須維持數據本身的可信度及梳理數據的人的可信度。數據必須用來呈現真實情況，而無論初心為善，不將數據用以背書行動。
Serious experts on infectious diseases agree that a new nasty kind of flu is still the most dangerous threat to global health. The reason: flu’s transmission route. It flies through the air on tiny droplets. A person can enter a subway car and infect everyone in it without them touching each other, or even touching the same spot. An airborne disease like flu, with the ability to spread very fast, constitutes a greater threat to humanity than diseases like Ebola or HIV/AIDS. Protecting ourselves in every possible way from a virus that is highly transmissible and ignores every type of defense is worth the effort, to put it mildly.感染性疾病中影響全球人類健康最甚的就是頑劣的流感，因為流感可經空氣中的微粒傳播。一個具傳染力的患者可在一列地鐵中傳染一整車的人，即使彼此沒有實際接觸或交叉接觸。可經由空氣傳播的傳染性疾病可在短時間內影響遠超過伊波拉或愛滋病的人群數量。對抗這種高傳染性的疾病，人們需要的不僅是儘可能的保護自己和他人的健康而已。
When you are called to action, sometimes the most useful action you can take is to improve the data.
░░░往期回顧 Featured Articles ░░░
☑️藥物研發全過程戰略諮詢
佈局海外-藥企進軍歐美市場的戰略規劃(一)
臨床研究監查稽查檢查實操問題解惑 1┊2┊3┊4┊5┊6┊7┊8
FDA新藥開發會議-WS衛森醫藥諮詢主管合伙人彼得·希曼博士的兩項倡議
風險管理攻略(一)研發項目及臨床試驗的風險管理
風險管理攻略(二)PEST分析模型
風險管理攻略(三)FEMA失效模式與影響分析
風險管理攻略(四)風險評估與戰略性稽查計劃
風險管理攻略(五)RACI分工模型表
藥物開發全過程質量管理-高階流程圖
☑️國際監管動態
FDA生物研究監查項目(BIMO)數據分析
FDA基於風險的監查(RBM)更新指南Q&A
FDA藥審中心(CDER)的藥品生命周期安全性數據管理
FDA加強全球性藥品檢查項目以確保仿製藥安全
FDA+MHRA: QMS & QbD
FDA+MHRA: GCP檢查程序類型及聯合檢查合作模式
FDA的GCP檢查案例分析-對稽查軌跡的審核思維
☑️藥物研發質量體系
從ICH Q10淺談藥品質量體系
Quality by Design (QbD) 質量源於設計
Kaizen！今天你進步了嗎？
受控文件管理好，臨床試驗才可靠
建多少不如建得巧的質量體系
質量體系初始培訓
藥物警戒初級培訓┊進階培訓
獨立數據監察委員會(一)┊(二)┊(三)┊(四)
臨床試驗的現場啟動考察(SIV)要點
面對來自監管機構檢查的準備及工作要點(一)
☑️申辦者質量體系中的委外業務管理
委外業務管理的來龍去脈(一)┊(二)
委外業務管理的來龍去脈(三)CRO質量協議
委外業務管理的來龍去脈(四)委外前的考慮
☑️近期法規時事
每月更新中國重點醫藥政策中英對照版NOV 2018┊DEC 2018┊JAN 2019┊FEB 2019┊MAR 2019┊APR 2019┊MAY 2019┊JUN 2019 ┊JUL 2019┊AUG 2019
☑️研究焦點分析