依據Rozen 團隊主張2003 年之前與2003 年之後馬兜鈴酸的暴露比例並沒有因法令禁止而下降,本文將進行對研究論文「Aristolochic acids andtheir derivatives are widely implicated in liver cancers in Taiwan and throughoutAsia」以2003 年法令禁止使用含馬兜鈴酸植物為切點,依據其研究目的、研究方法、研究結果及結論以流行病學的觀點評述。
1Graduate Institute of Integrated Medicine of China Medical University, Taichung, Taiwan
2Proteomics core lab of China Medical University Hospital, Taichung, Taiwan
3School of Chinese Medicine of College of Chinese Medicine of China Medical University,
Taichung, Taiwan
4Department of Chinese Medicine of China Medical University Hospital, Taichung, Taiwan
5Center for Integrating Taiwan National Adverse Chinese Medicine Reactions Reporting
System and Training on Reporting, Taipei, Taiwan
【Summary】
Science Translational Medicine published article “Aristolochic acids andtheir derivatives are widely implicated in liver cancers in Taiwan and throughoutAsia”, has made statements for no difference in the prevalence or in the numbersor proportion of aristolochic acid mutational signatures in Taiwan hepatocellularcarcinomas (HCC) before and after 2003, when Taiwan government legallybanned herbal remedies containing aristolochic acid. This upraises concerns ifpublic is consistency using aristolochic acid contained herbals. The aim of thisarticle is to comment and illustrate underlying bias in this published researchresults.
Authors did not take time trend analysis into consideration in the finalanalysis and reported no percentage difference for the prevalence of aristolochicacid mutational signature by using the cut-point 2003, before and after. However,when two additional alternative cut-points were selected, a decreasing trendfrom 71.4% in 2006 to 63.6% in 2012 for the attributable proportion of detectedAA mutational signature was found. And, cross country comparisons are harshly evaluated by using sample collected from just two north medical centersare bizarre and overestimate its inferences, with poor disclosure of relativeinformation and conspicuously disregard of denominator for each country otherthan Taiwan.
It is suggested to go through the process of conjecture and refutation toscientific articles back and forth, in order to efficiently prevent misclassificationand biases.
Keywords:aristolochic acid, mutational signature, herbal remedies, paper critique, hepatocellular carcinomas