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.
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.
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.
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.
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.
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
Recently, I signed on to Facebook and found that my daughter had tagged me in a picture she took of me relaxing at home slouched on the couch holding a glass of wine. It was nothing scandalous, and I don’t mind that my daughter posted it.
On the other hand, it made me bit uncomfortable to think of that picture being available for the whole world to see. I therefore untagged myself. (For the sake of staying focused on the topic at hand, I am skipping the part about how difficult it was for me to figure out how to remove my name from that picture.) When it comes to Facebook, my daughter and I have different perspectives on privacy.
I just watched a rerun of “the office.” On this show, as on TV and in the movies in general, administrators and supervisors are often portrayed as ignorant buffoons who have no idea what they are doing. True confession – there have been times when I have felt that way about those above me on the organizational ladder. I also understand why others might feel that way about me as a supervisor, particularly when they present me with a multidimensional problem that seems to have no good solution.
On the other hand, there are times as an administrator when the answer is clear immediately. My favorite example, and one that I am privileged to experience often in my current role, is when asked for something by someone who I know is very careful about what they ask for, and has a track record of success when given the support they request. This describes many of my colleagues at Holden Comprehensive Cancer Center. When I receive requests from such colleagues, I don’t ask myself “why should I say Yes” Instead, I ask myself “why would I say No.” On occasion, lack of resources has limited my ability to give a positive response. However, that is the exception and not the rule. Almost without exception, when I say “yes” to such requests, I have not been disappointed.
During the signing of the Declaration of Independence, Benjamin Franklin highlighted the importance of the colonies working together by saying “We must all hang together, or assuredly we shall all hang separately.” This quote came to mind this past week when I was in Washington, D.C., for the Rally for Medical Research.