Addressing complex, painful, inescapable truths

I spent an evening last week doing two things that, at first, I thought were unrelated.

First, I viewed a preview of “Cancer: The Emperor of All Maladies,” a PBS documentary based on the book by Siddhartha Mukherjee. His preview was sponsored by the Iowa Cancer Consortium, The American Cancer Society, The Iowa Department of Public Health and Iowa Public Television. It included excerpts from the 3 part PBS documentary by producer Ken Burns that starts tonight, March 30 and runs through Wednesday, April 1. The preview was followed by a panel discussion. My fellow panelists and I made brief statements, and then entertained a range of outstanding questions from the audience.

Continue reading

Beautiful hypothesis – ugly fact

Dr. Laura Rogers, a post-doc in my research lab, likes to start her presentations during our weekly research laboratory meetings with a quote. One she used a few months back was from Thomas Huxley, a renowned British biologist from the 1800s, who said, “The great tragedy of science – the slaying of a beautiful hypothesis by an ugly fact.” It was a very appropriate quote for Laura to use given the results we were discussing that day.

As Huxley’s quote illustrates, Laura wasn’t the first scientist to see a beautiful hypothesis slain by an ugly fact, and she will not be the last.

Continue reading

Hope Without Hype

Last week, I had the honor of moderating a panel discussion on Capitol Hill on behalf of the Association of American Cancer Institutes and the American Association for Cancer Research. This panel was sponsored by the congressional cancer caucus and focused on the importance of the nation’s premier cancer research centers. In such settings, it can be challenging to talk about the vital importance of the work done at our cancer centers in a way that highlights the hope without appearing to be resorting to hype.

Continue reading

Onco-Ecosystems

Environmental biologists have studied it for years – cancer biologists are just starting to think about it – and it has the potential to result in a fundamental change in our understanding of cancer. I am talking about ecosystems.

We all learned in elementary school that diversity helps an ecosystem thrive. Bees need flowers so they can make honey from the nectar. Flowers need bees for pollination. Neither would be able to exist without each other.

How does this concept apply to cancer? Our traditional view of cancer is that cancer cells within a tumor are the same. One cell starts growing out of control, pushes out the normal cells, and the result is cancer. Indeed, we talk about cancer as being “monoclonal,” i.e. all cells being the same. A major goal of cancer research over the past decade has been to understand the changes in genes that drive the monoclonal growth of cancer cells. In some cases, such as chronic myelogenous leukemia and some cases of melanoma, we have identified the gene that causes the cancer to behave badly, and have been able to treat the cancer successfully by targeting the product of the rogue gene.

Continue reading

The value of being a general science nerd

I have always been, and probably will always be, a science nerd.

I look forward every month to receiving my issue of Scientific American (yes, I still get a hard copy), and often read it cover to cover.  I enjoy learning about scientific advances, and scientific controversies, in other fields.

Being a scientific nerd runs in the family.  My older son is pursuing theater as a career, but is an avid science reader and has an amazing depth and breadth of scientific understanding.  When he is on stage playing a scientist, he is not just reading lines, he really knows what he is talking about.  My daughter is finishing medical school this year.  Professionally, she is surrounded by the science of medicine, but also has a growing menagerie of fresh water and salt water creatures growing in her aquaria at home.   Care for her miniature coral reef and axolotl (a primitive amphibian native to Mexican lakes) has required that she acquire some knowledge of marine biology.  My younger son is a wild-land firefighter who received a master’s degree studying the burning properties of duff (the stuff that accumulates on the ground around a tree in the forest).  It was great fun reading the fire science posters on the walls at the University of Idaho when he was studying there.

Continue reading

Attention Deficit

I am writing this on a weekend morning. It is really cold outside, and there is nothing on my calendar for a few hours. Instead of doing something productive, I find myself curled up on the couch in front of the fireplace surfing the web on my laptop. I am having no trouble finding totally useless but entertaining sites – a few thoughtful, some silly, and all too many outrageous. I know this is keeping me from more important projects (such as getting our family photos in order or writing a cancer research grant) but I am having a hard time focusing. My wife, who has experienced my channel flicking when I have the TV remote, knows this side of me all too well.

Continue reading

A smile, a laugh, a cry, and when medically permitted, a hug

People of different faiths have varied perspectives on the value and meaning of the December holidays. Getting past the commercialization can also be a challenge. Nevertheless, with the possible exception of individuals who are humbug down to the core, we are all affected positively by the spirit of giving, receiving, and togetherness this time of year. I am not speaking here about giving and receiving “stuff,” but giving, receiving, and being together in a much more profound sense.

Continue reading

Cancer teamwork in the Big 10

I spent time during my education and training at The Ohio State and the University of Michigan before arriving in Iowa City 25 years ago. I have close family members with ties to essentially all the other Big 10 schools. This time of year, we discuss the past season and bowl games, and argue about whose football team is overrated or underrated. When you are connected with a Big 10 school, you hear a lot about football.  Collaborative cancer research is generally not part of the Big 10 discussion. However, we are working to change that.

Continue reading

Perception and Reality

I, like most of you, am relieved that the flood of political advertisements has stopped now that the election is behind us. The political ads were full of sound bites and statements, both positive and negative, that were purported to be based on fact, but in truth did a very poor job reflecting reality. These ads were designed to persuade, not to educate. Indeed, in politics, perception often trumps reality. The factual truth doesn’t result in votes, it is the perception of truth that counts. Whether we are talking about climate change, the Affordable Care Act, immigration, medical marijuana or support for cancer research, politics is based on perception. Guilt or innocence in a court of law is also based on the ability to persuade since determining the factual truth is often complex. Excellence in changing perception is one reason so many lawyers go into politics.

Those of us in medicine and science like to think we are different. For us, reality trumps perception. We believe that facts are facts. Even the best marketing or the most heart-felt desire for a different outcome is not going to change a cancer diagnosis. In the laboratory, a negative result in a well-designed experiment evaluating a promising hypothesis requires the scientist to reassess that hypothesis, even if the hope was that the experiment would turn out differently.

I am not trying to say that doctors and scientists are in some way superior moral beings because we believe in facts. Yes, basing decisions on absolute truth is a fundamental principle of medicine and science. In reality, results of tests or experiments are often equivocal, and even the best doctors and scientists revert to opinion and perception to decide on the next steps. As a doctor, I try to explain to a patient why I believe they should follow my medical advice, even when the facts available to support that decision are limited. As a researcher, I write a grant with the goal of enhancing the perception that my ideas are worth pursuing.

In politics and law, even more so than in medicine and science, simple “yes/ no” answers are difficult to come by. Available data is usually complex, and determining how reality should impact policy is far from clear. I spend a fair amount of time working with policymakers and always try to keep this in mind. For me to believe that this time is well-spent, I start with the understanding that political advertising that has bombarded me for the past several months does not fully reflect the depth of thought that our political leaders use to make policy. I need to assume that the best politicians understand the distinction between perception and reality and rely on reality and facts as a foundation for decision-making.

There is no doubt that there is a full spectrum of politicians with respect to how they understand the balance between perception and reality. As an advocate, I adjust my approach to talking to policymakers based on where I think they sit on this spectrum. For some, I focus on providing facts to make them aware of reality. Others seem less influenced by facts. For those individuals, I do my best to change their perception of what they view as reality.

After all, when it comes to setting policy that impacts us all, the reality is that perception is reality.