December 20th, 2013

Researching the Obvious: It Stinks to Have Cancer

Editor’s note: Debra Sherman is an outstanding, exceptionally perceptive health reporter who asked me recently why it is that so many medical research findings seem so unimportant and obvious. She is facing a critical illness and needs research that is useful. Those of us who do research should be asking ourselves if there is real value in the knowledge we are producing. Debra wrote the following thoughtful blog for Reuters and gave us permission to rerun it here. Thanks Debra.  –Harlan Krumholz

Being poor stinks. Having cancer really stinks. You probably can’t do worse than being poor and having cancer.

That seems so obvious, I’m not sure why anyone needs a study to confirm it. But researchers actually looked at this problem and found exactly what anyone might expect: Breast cancer patients with higher incomes were more likely to receive care that followed the guidelines set by the National Comprehensive Cancer Network (NCCN) than patients with lower incomes.

The NCCN is an alliance of 23 of the world’s leading cancer centers that has put together treatment guidelines that are widely recognized and used as the standard of care.

Specifically, researchers found that breast cancer patients with an annual family income of more than $90,000 were twice as likely to receive care that followed the NCCN guidelines for radiation, compared with those whose with incomes below $50,000.

The study looked into disparities in chemotherapy treatments, too. It found that lower income patients were almost five times as likely to receive care that did not follow NCCN guidelines for chemotherapy to treat their breast cancer. Again, not very surprising.

These and other findings came from a field of health research called disparity studies. They touch on an important topic — how poverty and other economic factors can make a difference in access to health care.

But at a time when there are so many vital questions to ask, and research budgets everywhere are under attack, I wonder why well-meaning researchers pick such obvious questions to ask.

Why are there so many obvious studies? Is it easier to get funding? Are they cheaper to execute? Is the bar lower? Or, am I just being too critical and harsh? After all, I am a stage 4 lung cancer patient who’s anxious for answers. I want someone to find a cure already!

I asked Dr. Harlan Krumholz, a Yale physician whose research focuses on improving patient outcomes and health system performance. He is a big wheel in the world of medical research: director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation and the director of the Robert Wood Johnson Clinical Scholars Program at the Yale University School of Medicine.

As far as I know, Krumholz is not sick and he agrees with me. He says that when it comes to medical studies, the pressure may be to produce volume over value.

“High value articles often take patience and resources, both of which may be in short supply by institutions that employ investigators,” Krumholz tells me.

“But the biggest problem may be a research culture that is not often enough asking itself whether the information it produces truly has value for others and will contribute to better lives for patients and the public,” he adds.

The breast cancer treatment study was presented recently at the American Association for Cancer Research Cancer Health Disparities special conference in Atlanta.

To be sure, there were some important studies presented in Atlanta that would seem to advance cancer care and address health disparities.

One such study looked at potential biological factors contributing to racial disparities in prostate cancer incidence and mortality between African American and non-Hispanic white men in the United States. Another examined the genetics of an inherited predisposition to breast cancer. A third looked at genetic alterations to a specific gene family that may be responsible for survival disparities seen between African-American and non-Latino white men with head and neck cancer.

These strike me as potentially useful to patients.

But there still are far too many obvious studies, in my view. And they are everywhere you turn.

Scientific American published a list of the 12 most obvious scientific findings in 2012. According to that list, someone actually spent time and money to determine that calling an ambulance improved heart attack survival. Someone else conducted a study that discovered, amazingly, that smoking pot can make your mind fuzzy.

With research dollars so hard to come by these days, it seems more important than ever that the medical research community take a critical look at what questions need to be asked and answered in order to best serve patients.

2 Responses to “Researching the Obvious: It Stinks to Have Cancer”

  1. Just don’t want this one to get lost… have you seen studies publishing obvious results – do you have any favorites. Why does it happen? Do we sometimes quantify the obvious – and publish articles with very little value of information?

  2. There certainly are studies that are done unnecessarily and that seem to address the obvious. The problem with rejecting such studies or the funding for them is that often we can’t have any degree of scientific certainty about the phenomenon in question unless and until we have done the studies. It can be a real mistake to decide against conducting studies that address what seems to be obvious but that has never been scientifically demonstrated. For example, most biologists were convinced that either cloning of mammals could never be achieved or that cloning would require decades of additional scientific work before it would be successful – until Ian Wilmut and his colleagues cloned Dolly. Similarly, many were convinced that heart transplantation was a waste of scientific research because it was very unlikely to ever be achieved – until Christiaan Barnard did it in 1967.