Stop the Madness

Sometimes I wonder whether the purpose of some cancer research is to beef up biosketches of investigators while contributing to the growth of the medical publishing industry.

Other times I am sure of it.

As a seasoned advocate reviewer for three different breast cancer funding organizations, I’m asked to review the overall impact I believe an application may have on achieving the goal of the particular funding program.  I assess this representing the breast cancer community in total, not my particular medical situation. 

As I read each proposal, I seek answers to questions like these: “So what if this is study funded?  What eventual difference might the research findings make in the lives of patients?”  Sometimes the answers are difficult to find in basic science proposals, but it’s not impossible. 

Each applicant writes what they believe the impact of their study will be if funded and if their hypothesis is correct.  The idea is to make a difference by moving the science ahead in order to one day reduce incidence, improve quality or quantity of live, and/or prevent deaths.  Each program announcement is very clear about the objectives of this section of the application. 

One investigator, who I will call Dr. Nyt (Naïve Yet Truthful), enthusiastically stated in his Impact Statement that if funded, his research would generate two, maybe three manuscripts which would impact his career prospects, and would also put him in a position to get additional funding so he could publish additional studies.

That was the essence of his idea about the overall impact of his work.  That he would publish more articles and further his career.

There is a lot of truth to Dr. Nyt’s comments. 

It’s what many may think, but never write.

If you don’t publish, you don’t keep your job, no less move up.  You don’t Pass Go.  Ever.

Another part of peer review for some funding programs for less experienced scientists, is to review the potential of each applicant to become an independent breast cancer researcher.  During peer review discussion, much energy is put toward questions like these:

For someone at that level, does the fact that they only have four published articles give them a lower rating? 

What if the applicant was first author on all four publications? 

What if the applicant has never been first author, but has been co-author of ten published articles? 

What if the ten articles were published in “low quality” journals?

What if the applicant has only published two articles and is working to get approval on five more? Does that mean they aren’t very productive? 

Little is said about the quality of the contributions the articles may have to scientific progress and how these published articles may eventually influence clinical practice.

The reward system favoring publishing over impact is fraught with long term issues, issues that may have decelerated progress. Focusing on publishable studies may have delayed the groundwork needed to develop new therapies that could extend lives, improve the quality of lives or reduce deaths from breast cancer. The extreme emphasis on publishing may also have discouraged many promising investigators from pursuing a career in the field.

Scientists know this.  In academic settings they play the game because they have to.  It’s the old “publish or perish” — you’re only as good as your last published article, only if it’s accepted by a high-quality journal.  And publishing in any journal is better than not publishing at all.

Over the past six weeks, eight fabulous breast cancer advocates – my friends – have died of metastatic breast cancer.

How many new journals have gone to print over those six weeks?

How many articles have been published? 

How many of those are the career-sustaining articles that will likely go nowhere, except for citations in the next round of articles? 

How many of them end with “in order to know for sure, we need more studies?” 

I fully realize I’m an outsider making observations based on what I see and what I learn about.  In school, I didn’t excel in biology and couldn’t stand following the scientific method.  I’m no expert.

Alone, I have very little power to change anything.  That frustrates me.  People are dying.

Many advocates believe that if we just spent a lot more money on research, we would be closer to ending the death spiral in metastatic breast cancer.  Maybe we could. I’m certainly not against more funding.

But I’m not convinced that by only increasing funding for breast cancer research, we will achieve better outcomes for patients.

There’s more to it than that.

Until we fully examine and change the reward systems for scientists, it will be more difficult to achieve the progress we all want in order to stop our friends and family from dying. 

Let’s stop the madness.