The research decision paradigm shift

CURE invited Kathleen (Kat) Werner, a breast cancer survivor, to serve as a guest blogger during the 33rd annual San Antonio Breast Cancer Symposium, December 8-12. You can read her full story here.There were two unique presentations today that were less about heady science and more about changing the paradigm of research and how doctors practice. It was a refreshing perspective on the big picture and how we can change direction to make bigger strides in research rather than the small baby steps that make some feel like we are standing still while the cancer world spins around us.The morning talk was by Dan Ariely, an Israel-born professor of psychology and behavioral economics who teaches at Duke University. I'll admit I had never heard of him when he stepped up to the podium. His talk was a fascinating glimpse into a non-cancer specific examination of the decision-making practice that can be applied to health care providers and how they consult with their patients. I wish he had had more time to speak, because he only just touched on the issues he has published in his bestsellers, Predictably Irrational and Upside of Irrationality. He explores that we are often trained into what becomes our "gut reaction," and that this instinct can often be guided by so many other societal pressures, and often it is flat-out wrong. He challenged the audience of researchers, advocates and health care providers to consider a paradigm shift from status quo or standard practice and really think of what is best for each patient rather than what is easy, takes less work or may be counterintuitive. He gave an example of something called, "The Jam Study" in which people where given 24 choices as opposed to six choices of jam and the sheer quantity of choices made the person less likely to buy jam at all. The argument could be made that this is a study of people's choice in fruit preserves and not something nearly as important as major health care decisions, but his data actually proves otherwise.Health care providers need to be mindful that a balance needs to be struck with patients in providing good viable options, but overwhelming the patient, without coming alongside them to make sure they are properly educated, can cause the patient to shut down and refrain from really considering the details and real cost of all options. In the afternoon, Dr. George Sledge from Indiana University Simon Cancer Center (and current president of ASCO, the American Society of Clinical Oncology) gave the William L. McGuire Memorial Lecture (a honor given once a year in memory of Dr. McGuire, one of the founders of SABCS.) By the title, "What would Bill do? Channeling your inner McGuire" it would seem, at first glance, like a witty discussion on the state of where research is going. Dr. Sledge did not mince words in really laying out some priority changes that need to happen within breast cancer research if we want to get serious about finding cures. His seven point "rules" touched on some important issues that are being ignored by many researchers. His primary issue was the respect we need to have for the tissue sample itself; keeping it long term, obtaining demographics around it and collecting normal breast tissue for comparison. (For the record, Susan G. Komen for the Cure has established the Komen Tissue Bank at Indiana University for exactly this purpose.) Dr. Sledge also spoke to the importance of the research environment both in practice and the people who practice it. He chided the room to be serious in pushing for clinical trials rather than becoming dependent on diagnostic studies. He also sang the praises of how he had surrounded himself with "excellence" but working alongside great researchers who were always willing to challenge the status quo. Most importantly, Dr. Sledge reminded us that, "The clinic is the final laboratory." This tremendously important issue calls to mind that just because something works in cell lines, mouse models or data sets, does not mean it will work in the human patient. The media is quick to jump on data showing huge promise in these models (see the excitement over breast cancer vaccine studies) but the reality is, we just have not seen most of these exciting advancements in the human being. Last time I checked I was not a rodent, and thankfully my research validity did not die after 14 days when I was dissected for research. These are, of course, important stepping stones in the research process, but they need to be considered for what they are--simply a start.Kathleen "Kat" Werner is a cancer research advocate after being diagnosed with breast cancer at age 31. She travels the country and sits at the table with private and government agencies, fighting for the best treatments for newly diagnosed women and ultimately a cure for breast cancer. She lives is Blacksburg, Virginia with her husband of 11 years, Jeff, and her three young children. Read her blog, "Next Generation Research Advocate."