Mammography and the acute discomfort of change

As I write this, I am attending the 2014 meeting of the American Association for Cancer Research (AACR, Twitter hashtag #AACR14) in San Diego. Basically, it’s one of the largest meetings of basic and translational cancer researchers in the world. I try to go every year, and pretty much have succeeded since around 1998 or 1999. As an “old-timer” who’s attended at least a dozen AACR meetings and presented many abstracts, I can see various trends and observe the attitudes of researchers involved in basic research, contrasting them to that of clinicians. One difference is, as you might expect, that basic and translational researchers tend to embrace new findings and ideas much more rapidly than clinicians do. This is not unexpected because the reason scientists and clinical researchers actually do research is because they want to discover something new. Physicians who are not also researchers become physicians because they want to take care of patients. Because they represent the direct interface between (hopefully) science-based medicine and actual patients, they have a tendency to be more conservative about embracing new findings or rejecting current treatments found not to be effective.

While basic scientists are as human anyone else and therefore just as prone to be suspicious and dismissive of findings that do not jibe with their scientific world view, they can (usually) eventually be convinced by experimental observations and evidence. As I’ve said many times before, the process is messy and frequently combative, but eventually science wins out, although sometimes it takes far longer than in retrospect we think it should have, an observations frequently exploited by advocates of pseudoscience and quackery to claim that their pseudoscience or quackery must be taken seriously because “science was wrong before.” To this, I like to paraphrase Dara O’Briain’s famous adage that just because science doesn’t know everything doesn’t mean you can fill in the gaps with whatever fairy tale that you want. But I digress (although only a little). In accepting the validity of science that indicates either that a medical intervention that was commonly used either doesn’t help, doesn’t help as much as we thought it did, or can even be harmful, they have to contend with the normal human reluctance to admit to oneself that what one was doing before might not have been of value (or might have been of less value than previously believed) or that, worst of all, might have caused harm. Or, to put it differently, physicians understandably become acutely uncomfortable when faced with evidence that the benefit-risk profile of common treatment or test might not be as favorable as previously believed. Add to that the investment that various specialties have in such treatments, which lead to financial conflicts of interest (COI) and desires to protect turf (and therefore income), and negative evidence can have a hard go among clinicians.
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