Making decisions based on facts we don’t like

Every day at Holden Comprehensive Cancer Center, we cancer specialists and researchers make decisions and recommendations based on facts we don’t like.  A patient’s cancer has recurred.  A treatment is not working.  The patient lacks the gene that would make them eligible for a promising clinical trial.  A highly promising research grant is not funded.  We can’t ignore the bad news.  Instead, we accept it, and do our best despite the bad news.

In addition to bad news, we also have to deal with uncertainty.  Many situations arise where there is no clear right answer.  We need to be honest in identifying what we know and what we don’t know, and putting the risks and benefits of pursuing different approaches based on uncertain data in perspective.  An example is deciding whether a given patient should receive adjuvant chemotherapy after surgical removal of a cancer.  We know that the additional therapy can reduce the chance of the cancer returning but that the therapy can also have side effects.  Are the side effects of the proposed therapy worth the potential benefit for an individual patient?

Open and honest dialog is vital.  We make a recommendation to each patient based on his or her specific needs. We describe to the patient what the facts (good, bad or uncertain) tell us.  The best doctors accept the facts they don’t like, understand uncertainty, balance risks and benefits, and discuss the pros and cons of different approaches thoughtfully with their patients so together they can make the right decision.

The same should be true in public policy.  Truly outstanding leaders accept the facts they don’t like, understand uncertainty, balance risks and benefits, and discuss the pros and cons of different approaches thoughtfully with their constituents.  This rational approach to leadership is not very apparent these days in our national political dialog.  Bad news is labeled as “fake news” even when the facts are irrefutable.  Uncertainty is either ignored or exaggerated based on predetermined opinions.  There is so much shouting and name-calling that balanced discussion of risks and benefits either never takes place or gets drowned out.  “Winning” or “losing” appears to have become more important than helping those in need.

Decision making in cancer, and decision making at the national policy level, are now on a collision course.  Proposed changes in the Affordable Care Act would have a major negative impact on our ability to support cancer prevention, early detection and therapy for millions of Americans who would lose their health care coverage.  Our ability to continue to make progress in cancer research is at great risk due to the proposed 18% cut in funding for the National Institutes of Health that provides much of the support for cancer research at Holden and other cancer research centers.  This would result in major and long lasting damage as current productive teams that took years to build would get broken up, and  bright, young researchers would decide to pursue other careers.

The approach to decision making at the bedside of a cancer patient, and in making public policy, should not be so different.  Both need to start with the facts whether we like them or not.  Here are some about cancer that should help drive policy decisions that will impact on cancer medicine and cancer research.

  • Cancer not only causes incredible pain and suffering, but also has a huge negative economic impact on the country due to lost productivity.
  • Cancer prevention and early detection cost money, but are less expensive in the long run than cancer therapy and reduce pain and suffering caused by cancer.
  • Cancer research, including research supported by the federal government, is vital if we are to continue to make progress.
  • The Preamble to the Constitution of the United States says the Constitution was established to “… insure domestic tranquility, provide for the common defence, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity.” Continued efforts to reduce the burden of cancer now and for future generations certainly fit wells with this purpose.

So, let’s ask political leaders to view policy making the same way an outstanding oncologist views decision making for a cancer patient who is in need.  Let’s ask them to understand the facts and accept the facts they don’t like, understand the risks and benefits of various decisions based on facts that sometimes are complicated, discuss the pros and cons of different approaches thoughtfully with their constituents, and most importantly, make decisions based on the information at hand with the goal of helping those they serve.

There is not always a single right answer, but policy makers owe it to us to go about making decisions the right way.   After all, for both oncologists and politicians, the lives of those served depend on it.

Leave a Reply

Your email address will not be published. Required fields are marked *