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View from the Other Side of the Stethoscope: Scientific Fiasco

Harpham, Wendy S. MD

doi: 10.1097/01.COT.0000415272.31887.b6
Opinion
WENDY S

WENDY S

"Have you heard about this?" my husband asks.

I look up from my Saturday morning coffee. "What?"

"Here." He's pointing to a front-page headline as he hands over the first section of the Wall Street Journal.

I literally gasp while reading that researchers' "work has been undermined by the contamination and misidentification of cancer cell lines used in research labs around the world" (WSJ 4/21/12)

We're not talking about one rotten apple. "A fifth to a third or more of cancer cell lines tested were mistakenly identified—with researchers unwittingly studying the wrong cancers, slowing progress toward new treatments and wasting precious time and money," Amy Dockser Marcus noted in her article.

After I finish reading the story, my husband asks what I think. Too shocked to answer, I can't imagine what clinicians will tell patients at the bedside. I'm wondering what I'll say when soliciting support for Wendy's Eagles, a team of fundraising walkers in the Dallas Lymphomathon.

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A Scientific Problem

As if the technical issue of contaminated and misidentified cell lines wasn't enough, researcher Stanley Gartler has been sounding the alarm since 1966, when his newly developed technique for distinguishing cell lines identified 18 of 20 supposedly unique cell lines to be HeLa cells, the celebrated line of cervical cancer cells.

For over 40 years the problem remained a collective secret, unaddressed by researchers who ignored or denounced irrefutable evidence. Some of the researchers interviewed for the WSJ article seemed more invested in pointing fingers than checking their cell lines. Adding insult to injury, modern researchers could have verified their cell lines using short tandem repeat (STR) profiling, an inexpensive—$200—DNA technique.

Surely this tragedy will find its way into the history books if, as per the WSJ account of leading scientists: "One of the biggest obstacles to finding a cancer cure may not be the many defenses nature affords malignancies but the reluctance of scientists to address the problem."

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A PR Problem

People support cancer research to nourish their hope of a tomorrow with better therapies. The WSJ revelation makes cancer researchers appear less concerned with finding answers than with shielding from scrutiny their grant-garnering, résumé-building publications. How will this PR fiasco—one that dwarfs the recent Komen commotion—impact public funding of clinical trials?

When patients consider clinical trials as a treatment option, one particular hope motivating those who enroll is that researchers will learn something, even if that "something" is the study drug doesn't work. If this news story jeopardizes patients' trust in all research, what will happen to patient enrollment in clinical trials?

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Resurrecting Science

My husband refills my coffee. "Here's your answer," he says, sliding another section of the WSJ in front of me that's opened to a book review by one of my favorite journalists, Matt Ridley. "Read this."

So I do. In a review of Games Primates Play by Dario Maestripieri, Ridley presents the author's thesis that in certain settings you can predict whether primates—apes or people—will cooperate or compete. To illustrate, he examines professional peer review where, in an effort to prevent reciprocal cooperation, authors' names are known while reviewers' remain anonymous. As predicted, some reviewers use their appraisal as ammunition to hurt the competition. Maestripieri concludes that "Anonymity alters the cost-benefit balance in favor of competition; transparency alters it in favor of cooperation."

Transparency. Resolution of the scientific and PR problems depends on transparency regarding every detail of the discovery process. Not surprisingly, steps to foster increased transparency are underway: The American Type Culture Collection (ATCC) guidelines provide standards for the authentication and documentation of cancer cell lines, as well as a central repository and database. I expect professional guidelines are being rewritten right now, requiring researchers worldwide to authenticate cell lines to receive grants or to have their work published.

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Healing Clinician-Patient Bonds

In a world filled with peddlers of pseudo- and junk science, much of my survivorship work involves advocating for science. So today's news hits home, especially with the Dallas Lymphomathon just weeks away.

How will it change my pitch to potential supporters of Wendy's Eagles? In most cases, it won't. But not because I'm afraid to bring up a problem that affects some of the studies supported by advocacy organizations such as the Lymphoma Research Foundation. I won't because the problem is being addressed and because a healing perspective can't be captured in a sound bite.

When I do mention it, I'll share what I'm posting on my Healthy Survivorship blog (5/8/12), an ongoing project devoted to exploring how modern patients overcome the many challenges to getting good care and living as fully as possible:

"While shocked and upset by the discovery, my confidence in treatment recommendations based on data from Phase III clinical trials remains strong, because these are studies of treatments used on people, not cell lines. My confidence in all clinical research remains strong, too. The WSJ article did not expose a problem with the scientific method, but rather, with the lack of adherence to the rigorous standards for authentication and documentation demanded by good research.

"As a Healthy Survivor—namely, a survivor who gets good care and lives as fully as possible—I know the power of science lies in its ability to uncover truths about what things are and how they work. I know that disappointing study results and dead ends are unavoidable in the pursuit of truths about cancer and how best to treat it. And I know that science demands complete transparency, because transparency is how we learn from our mistakes.

"As a Healthy Survivor, I choose to look forward, not back, confident that this shocking news will not only eliminate the problem of misidentified cell lines, but also increase the demand by politicians and the public for complete transparency.

"As a Healthy Survivor, I will continue to look to the future of cancer care with unbridled hope, because science-based hope is stronger than that based on observation, anecdote, or wishful thinking.

© 2012 Lippincott Williams & Wilkins, Inc.
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