Bad Science: Fated to Get Cancer?

There was a recent article that came out of Cancer Research UK, a charity dedicated to raising awareness about cancer prevention titled "More than a quarter of Britons think cancer is a matter of fate," which was then reported on by Agence France-Presse in a reported titled "Cancer is Due to 'Fate'; Britons believe." Each of these publications describes the findings of a survey asking a cross-section of the population if they believe that "they could do anything to reduce their risk of cancer or whether getting the disease was just fate." Overall, they report, 23% of the population believe it is a matter of fate and that their lifestyle choices did not play a role in determining whether or not they get cancer.

I noticed that this story has gotten picked up by a number of members of the medical-science blogosphere and it seems as though there are a number of differing opinions about the interpretation of this study. If there is confusion amongst us, then I'm certain that there is even more confusion among the general public about what exactly this all means. Here, I would like to offer some of my own thoughts on the matter and how it illustrates a number of key points that I often see arising in the field and how it can lead to disagreement.

1) Source: Before we even get to the results of the survey, and even before we make conclusions, we have to examine the source of the information. As a charity driven by donations from people concerned about cancer, I doubt that Cancer Research UK is an unbiased arbiter in the information collection business. I am not surprised that the survey they conduct results in data that supports the need for their own organization. This is why polling services are used by a majority of interests groups, so that they can not be blamed for influencing the results.
Moreover, the original source is a press release and the coverage is based upon the scant information provided in it. This brings up two important faults: a) we do not have access to the original data and methods (see below) and that there was no oversight in the way the survey was conducted (no peer-review) and b) the information has been processed by two people who probably have very little experience in reporting scientific results. I don't know about you, but most of the humanities majors I knew in college loathed their science work [the rant on teaching science in college will be saved for a later time] and would probably have a hard time fairly making conclusions about a report that has an unclear experimental method (again, see below).


2) Experimental Design: What was the exact question posed to Brits in this study? We don't have this information. The wording of such surveys is extremely important, especially when the wording can influence the responses of the participants. Without the wording, we can not know for sure if this report was clear and unbiased. For this and the reasons above, I usually don't read these kinds of report expecting to learn something.

3) Results are open to interpretation: In perhaps my biggest gripe about this report, I feel that the results, as described, are ambiguous. For this, I will draw on a hypothetical example, illustrated below:

In this scenario, we have a total population of 200 people. We assume that the occurrence of spontaneous cancer is low, about 1%. Splitting the groups into smokers (ie lifestyle choice) and non-smokers of 100 each, we would expect that 1 person from each group would get cancer, regardless of any lifestyle choices. We can say that fate was not on their side because there was nothing they could do.

Assuming that smoking raises your risk 10 times, we then would expect 10 out of 100 smokers to develop cancer for a total of 11.

This is where the results become a point of debate. What makes the 1 person in the non-smoking group get cancer - is it fate? In this case, lets assume yes. The difference between her and the 99 other non-smokers was simply a stroke of bad luck. And the 1 smoker who gets cancer who would have gotten cancer anyway? Again, lets say that fate was responsible. Then there are the 10 additional people who got cancer in the smoking group. What made these 10+1 people instead of the other 89 "healthy" smokers is unclear and attributed to chance, or fate* in this case.

As other bloggers correctly indicate, no physician can tell a patient with certainty whether they will get cancer, smoking or not. In fact and to be fair, there is a greater chance that a smoker will not develop cancer (89) than actually get it (11). Making the assumptions above, it is fate that separates the 1 from the 99 in the non-smokers and the 11 from the 89 in the smokers group. Looking at it from this angle, it is valid to claim that fate is responsible for who gets cancer and who doesn't.

But to say that it is fate that dictates the 10 smoking-caused cancers vs. the 1 spontaneous tumor in either group is simply not true. It is the lifestyle choice itself that has given rise to the 10 additional malignancies. Therefore, we can no longer state that fate alone is responsible for cancer, irrespective of behavior.

Conclusion:
These kinds of studies may lead to confusing results. We can go back and forth on this all day depending on our interpretation, but ultimately it is the experiment and conclusions drawn are flawed from the get-go. We need to be cautious of our source of information and not let these press releases do more damage than good when their results are not scientifically sound.

* A note on "fate": Simply because something is unknown, does not mean it is due to fate or chance. There are many phenomena that we do not quite understand completely and tumorigenesis is one of them. Many things that used to be considered fate or luck now have scientific explanations. Take, for instance, the people who can have repeated unprotected sexual intercourse with an HIV+ partner without acquiring the virus (akin to not developing cancer despite smoking). An uninformed observer would say that these people are not fated to get AIDS. However, in reality, these many of these people are descendants from survivors of the Bubonic Plague in Europe. The disease selected for a genetic polymorphism that made some people resistant to viral infection and this allele remains today. I suspect that the susceptibility of some people (the 10) over others (the 89) will soon become clear in time with a biologic rational rather than pure fate.

Reference List of Words

MudPhud - Shorthand/slang term for person holding both MD and PhD degrees. Also, MudFud.
MSTP - Medical Scientist Training Program; NIH-funded dual degree (MD/PhD) program.
Pre-Med - Person who aspires to enter into medical school.
PI - Abbreviation for Principal Investigator.
Principal Investigator - usually the head of a lab who directs the research
SDN - Student Doctor Network (excellent resource for medical school information).

Note: this post will continue to be edited as I go along and I feel the need to add terms.

Graduate School Survival Guide

Thanks to Ronald T. Azuma for putting together this informative and humorous survival guide for graduate school. I won't copy and paste his entire guide (not sure if thats even legal, much less ethical), but if his website ever goes down just let me know and I can post it here since I have a saved copy on my computer.

Graduate School Survival Guide

I think there are some points to garner from reading this. First, that you should be really sure about your decision to pursue a PhD (MD or not). Second, to know that academia is fraught with politics, so organization, communication, and planning are vital to your success. Take a tip from your business buddies and learn about networking early on in your career - those contacts will be useful in the long run! Third, be sure to show initiative.

Lord of the Rings: An Allegory for a PhD

Its good to know that there are others out there struggling as much as you in the graduate years. I'll try to keep posting 'em as I find 'em.

Source: http://www.jacobite.org.uk/dave/odd/lotr.html

The story starts with Frodo: a young hobbit, quite bright, a bit dissatisfied with what he's learnt so far and with his mates back home who just seem to want to get jobs and settle down and drink beer. He's also very much in awe of his tutor and mentor, the very senior professor Gandalf, so when Gandalf suggests he take on a short project for him (carrying the Ring to Rivendell), he agrees.

Frodo very quickly encounters the shadowy forces of fear and despair which will haunt the rest of his journey and leave permanent scars on his psyche, but he also makes some useful friends. In particular, he spends an evening down the pub with Aragorn, who has been wandering the world for many years as Gandalf's postdoc and becomes his adviser when Gandalf isn't around.

After Frodo has completed his first project, Gandalf (along with head of department Elrond) proposes that the work should be extended. He assembles a large research group, including visiting students Gimli and Legolas, the foreign postdoc Boromir, and several of Frodo's own friends from his undergraduate days. Frodo agrees to tackle this larger project, though he has mixed feelings about it. ("'I will take the Ring', he said, 'although I do not know the way.'")

Very rapidly, things go wrong. First, Gandalf disappears and has no more interaction with Frodo until everything is over. (Frodo assumes his supervisor is dead: in fact, he's simply found a more interesting topic and is working on that instead.) At his first international conference in Lorien, Frodo is cross-questioned terrifyingly by Galadriel, and betrayed by Boromir, who is anxious to get the credit for the work himself. Frodo cuts himself off from the rest of his team: from now on, he will only discuss his work with Sam, an old friend who doesn't really understand what it's all about, but in any case is prepared to give Frodo credit for being rather cleverer than he is. Then he sets out towards Mordor.

The last and darkest period of Frodo's journey clearly represents the writing-up stage, as he struggles towards Mount Doom (submission), finding his burden growing heavier and heavier yet more and more a part of himself; more and more terrified of failure; plagued by the figure of Gollum, the student who carried the Ring before him but never wrote up and still hangs around as a burnt-out, jealous shadow; talking less and less even to Sam. When he submits the Ring to the fire, it is in desperate confusion rather than with confidence, and for a while the world seems empty.

Eventually it is over: the Ring is gone, everyone congratulates him, and for a few days he can convince himself that his troubles are over. But there is one more obstacle to overcome: months later, back in the Shire, he must confront the external examiner Saruman, an old enemy of Gandalf, who seeks to humiliate and destroy his rival's protege. With the help of his friends and colleagues, Frodo passes through this ordeal, but discovers at the end that victory has no value left for him. While his friends return to settling down and finding jobs and starting families, Frodo remains in limbo; finally, along with Gandalf, Elrond and many others, he joins the brain drain across the Western ocean to the new land beyond.

Difference between MD and PhD

I found this good, although not entirely accurate post, over on the SDN forums.

By ScottishChap
M.D. - harder to get into, easier to get through, science classes just scratch the surface, can get by by memorizing like a parrot, not treated as a colleague, expensive, independent thought is dangerous, program lasts 4 years, instructors can't mess with the class mean without repercussions, students whine a lot more, students assume all Ph.D. students are unhappy med school rejects. Overall: subject matter is one inch deep and 10 miles wide.

Ph.D. - easier to get into, harder to get through, science classes take it as deep as current knowledge permits, will fail if all you do is memorize, treated more as a colleague, inexpensive, independent thought is rewarded, program lasts 3-7 years, instructors can make exams hard enough that the mean is 40% without repercussions, students whine much less, students assume all M.D. students are snooty and arrogant. Overall: subject matter is 10 miles deep and one inch wide.

Now, where does that leave us MD/PhDs??

Getting Scooped

Success in academic medicine is largely measured by publications. In fact, we live by the code: Publish or Perish. This means that you either show your abilities in research by publishing articles in peer-reviewed journals or else you will be deemed unproductive, incompetent, and ultimately irrelevant in the eyes of your colleagues.

There is TREMENDOUS pressure to publish. Not only are you concerned that about showing some productivity (it can be years between publications), but you will also be intimately worried about the possibility of someone beating you to the punch and publishing the same findings first. Researchers call this "getting scooped." This is bad news because it means your research project has just gone from being cutting-edge to yesterday's news. Novelty is lost and it looks like the other guys thought of it first (regardless if you did or not), so they can then claim all the credit.

It may seem uncommon, given the immensity of science, that two or more groups would be working on the exact same research project at the exact same time. Heck, it might even seem counterproductive for research dollars to be spent investigating the same thing. [Note: I'll save the debate about competition in science for another post.] However, it actually happens all the time. Just think of Elisha Gray. Who is Elisha Gray? Exactly. He's the guy that got scooped by Alexander Graham Bell in inventing the telephone. Bell made it to the patent office only a few hours before Gray. Point of the story: Don't be like Gray, don't get scooped. Of course, this means living in perpetual fear whenever you start a project because you are worried about whether someone will have already started on it and thus have a head start on you. Or, there are always those people out there who work day and night, sacrificing body and soul, in pursuit of scooping other people (aka Gunners).

Although most academians claim to be collegial, I know few who are entirely open with their ideas and data, simply because of the possibility of being scooped. There will always be the eager grad student/post-doc/PI sniffing around for the latest great idea to steal and publish without recognizing the origin (unless of course she praises himself for her ingenuity). As an aspiring researcher, you should be mindful of this fact because you don't want to share more information than you want to, but you still want to maintain collaborations. I'll admit its a tricky balancing act that will take some time to learn and you'll probably get burned a few times before you know when to pipe-up.

The Addictive Personality of a Scientist

I expect to post a number of times about my decision to pursue a combined degree program (MD/PhD). Basically, I am interested in both science and medicine and I expect to use both in my career, so thats why I'm going to school for both. I'll talk about my interest in medicine later, but I wanted to post this great article from 1990 in Science, talking about the personality of a scientist. For me and most of my friends who like to be holed up in a lab somewhere at ungodly hours in the night, we fit the description pretty well.

Science

30 November 1990

Volume 250

Number 4985

The Addictive Personality

Science: Dr. Noitall, you are the world’s greatest authority on addition, the seer that everyone consults, the man who got Sherlock Homes to kick his cocaine habit.

Dr.Noitall: A vast understatement of my true worth.

Science: Could you describe the addictive personality?

Dr.Noitall: An addictive person is one who has a compulsion to behave in ways that his or her family members consider detrimental to their interest. An addictive person will frequently conceal the extent of his addiction, will lie to his family about it, is immune to logical arguments to correct the error of his ways, and foregoes income that would require abandoning their addiction.

Science: Are we talking about a dope addict or alcoholic?

Dr.Noitall: No, I am describing a scientist. It is well known that work habits of scientists are addictive, leaving their spouses in tears, their children pleading, “Come home, Mommy (or Daddy),” and involve long hours in hostile instrument laboratories or cold rooms, exposed to noxious gases and radioactivity-conditions that no sane person would choose.

Science: But surely these individuals are paid handsomely for undergoing these hazardous conditions.

Dr.Noitall: This is the peculiar paradox. The profession is poorly paid because there are hundreds of applicants for every good position. Because of the psychic income that is exploited by our oppressive society, a scientist will accept pay that would make a movie star weep.

Science: But many of these individuals are academics who have the advantages of long summers off and light teaching loads.

Dr.Noitall: Academic freedom is the freedom not to take a vacation. Far from taking summers off, these individuals would rather develop films in the darkroom than sit on the beaches of Waikiki.

Science: But surely these individuals have a record of stable homes, paying their bills and other behavior not typical of an addict.

Dr.Noitall: That depends on how you define good behavior. These individuals tend to curl up with a copy of the Physical Review Letters, Journal of the American Chemical Society, or Journal of Biological Chemistry, rather than doing household chores or acting like good Americans who stay glued to the television set.

Science: So far, however you merely described an individual who works to keep his job.

Dr.Noitall: No, these individuals are definitely masochistic. They volunteer to serve on review panels that send them hundreds of incredibly detailed project proposals which must be read and evaluated. They sit through endless thesis defenses, volunteer to edit journals and serve on visiting committees for other schools when they have too much to do at home. They then complain bitterly that they are too busy.

Science: Is it apparent that these individuals could do well in other occupations?

Dr.Noitall: They are addicted to scientific logic, which makes it impossible for them to act like a trial lawyer who sues the city of New York for negligence when a drunken man falls off a subway platform, or a politician who claims one can increase services and pay lower taxes, or a movie star who testifies before Congress on carcinogens but does not know the difference between valium and valine.

Science: Is there any behavioral characteristic that can explain this obsessive conduct?

Dr.Noitall: Basically scientists have failed to grow up. They are all children, eternally curious, eternally trying to find out how the pieces of the puzzle fit together, eternally asking Why, and then irritatingly asking Why again when they get the answer to the first question.

Science: But can’t this addiction be cured by some new program or drugs and therapy?

Dr.Noitall: There is no evidence of hereditary characteristics of family environment to produce a scientist; therefore we have few handles on the potential cures, but the most glaring fact is that society cannot afford to cure these individuals. Their obsession is responsible for most of the progress of mankind and therefore the last thing we need at this moment is to turn these addictive scientists into well-adjusted television watchers. It is well worth giving them the tiny bit more money they need to stay addicted to science and to attract new compulsive personalities to their work. Society is addicted to scientists as scientists are addicted to science. – Daniel E. Koshland, Jr.