Monthly Archives: November 2014

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.


When I give a talk about cancer research, I like to highlight both the diversity of cancer research and that it is a continuum. One way to do this is by showing a scale that, going from smallest to largest, includes cancer research focused at the level of molecules, cells, tissues, organs, patients, clinical trials, cohorts, and communities. Much cancer research spans various points on this scale. I can take any two points on this scale, and talk about an important research project at Holden based on those two points. For example, molecular epidemiology involves taking samples from a large number of individuals in a group of cancer patients and evaluating them at the molecular level in order to improve our ability to predict how specific changes in genes might impact an outcome. Identifying new cancer drugs requires we screen large numbers of compounds to see which have the most promising effects on cancer cells, then after appropriate testing in the laboratory, assess the effects of these new drugs on patients in a clinical trial. Continue reading

The Academic Difference: George Weiner On How America’s Cancer Centers Are More Valuable Than Ever

Last week, I had the honor beginning a 2-year term as President of the Association of American Cancer Institutes (AACI).  Instead of writing a separate blog this week, I am copying an editorial that appeared in The Cancer Letter describing a new initiative of the AACI that goes by the name of  “The Academic Difference.”

This is reprinted with permission from The Cancer Letter.

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