June, 2016

Corrective Wisdom

By Michael J. Katin, MD

On June 3 the largest cancer-related meeting in the world will convene in Chicago. The American Society of Clinical Oncology's annual meeting has changed dramatically over half a century, with its first meeting, on April 9, 1965, at the Bellevue-Stratford Hotel in Philadelphia, consisting of three lectures in one evening session. It is symbolic that ASCO's first meeting was held in the same city in which the United States of American began (stretching details somewhat), but somewhat frightening that at that time Legionella pneumophila was probably already growing in the cooling tower of the Bellevue-Stratford Hotel and possibly already causing illness although it was not recognized until the American Legion convention in 1976, after which 182 Legionnaires were hospitalized and 34 died. If the population of bacteria, amount of air circulating, and optimal temperatures for incubation had all coincided at a different time, it is possible that not only could ASCO have been wiped out in its infancy but the disease would currently be known as Oncologists' Disease rather than Legionnaires' Disease.

Getting back to this year's, preferably disease-free, meeting....it is of interest as to why the term "Collective Wisdom" was selected considering that it has already been the descriptive name for several other venues. For example, it is critical in the evolution of the modern Chinese state. The Constitution of the Communist Party of China explains that "Deng Xiaoping Theory is the outcome of the integration of the basic tenets of Marxism-Leninism with the practice of contemporary China and the features of the times, a continuation and development of Mao Zedong Thought under new historical conditions; it represents a new stage of development of Marxism in China, it is Marxism of contemporary China and it is the crystallized, collective wisdom of the Communist Party of China. It is guiding the socialist modernization of China from victory to victory." The Mastermind Advisory Board uses the phrase "Collective Wisdom Ignites Success." Possibly ASCO is hoping for the same degree of control and success achieved by the People's Republic of China, but probably the use of that term was much more innocent. The most probable tribute (and, possibly, infringement) is to the Center for Collective Wisdom, an organization whose members "design processes and develop resources to help funders, systems, and multi-sector initiatives achieve and sustain profound community impact." It hopes to allow participants to "find ideas and inspiration to support your passion in the world." If that doesn't sound like ASCO, nothing does.

The Center for Collective Wisdom was founded by John Ott and Rose Pinard. It is totally irrelevant to mention that John N. Ott (no relation) was a banker who early in the 20th century became involved with time-lapse photography and developed techniques used in documentaries to which we were all exposed in elementary school. It was Dr. Ott who made it possible to watch grass grow even if one were not in a government job. It is of even more irrelevant interest that Dr. Ott then became interested in the effect of light on plants and then, eventually, on humans, producing natural daylight spectrum indoor lighting. He was also possibly responsible for the success of the Cincinnati Reds Big Red Machine in the 1970's (check it out). Ironically (or is everything connected?) John G. Ott and Rose Pinard co-founded Luminescence Consulting prior to their setting up the Center for Collective Wisdom!

Regardless of why ASCO selected "Collective Wisdom" as its theme for 2016, it might as well be recognized that what is regarded as "collective wisdom" has already generated several programs that will determine the course of the Medical Oncology specialty for the future. Ironically (or is everything connected?) an organization called Collective Evolution, which has as its goal to create change by raising consciousness, has highlighted the existence of the 21st Century Cures Act. This legislation, a result of collective wisdom but sponsored specifically by Congressman Fred Upton (who's famous both for light bulb legislation and for his niece ), is intended to speed up FDA approval of drugs by shortcutting the safeguards on which we have come to depend. This will result in getting drugs to market faster and then finding out what they do---similar to the Affordable Care Act. Interestingly, it happens to be the only piece of medically-related legislation to have a musical tribute.

Collective wisdom has also generated the I-SPY trials, with the question again raised as to the design of programs in order to get catchy acronyms. Adaptive clinical trials are now the way to go, generating much more interest and support than adaptive radiation therapy. The I-SPY programs are an example of taking decisions on drug development (NOT in any way including radiation therapy or other modalities) out of the realm of personal preference and whims and having a fixed plan of analysis to more rapidly determine toxicity and, then, efficacy, including integration of information from molecular profiling. These programs are orchestrated by the Quantum Leap HealthCare Collaborative, which, interestingly, is headed by a physician, its co-founder, Laura Esserman, MD, MBA, and she is the only physician on the nine-person board of directors. Four of the board members have MBAs, however, going along with the determination that this work is too important to be left to scientists and clinicians. The I-SPY programs seem to have done a very good job in having materials for marketing to the public, including providing an opportunity to donate. This opportunity is provided despite the fact that the program is sponsored by multiple drug companies and philanthropic organizations. Whatever happened to the NCI? Presumably this is the equivalent of SpaceX and Virgin Galactic doing projects that we all would have expected NASA to be doing, somewhat of a fitting analogy considering the Moonshot Initiative proposed by President Obama in January.

With all of this collective wisdom circulating around, it will be interesting to see what programs the Annual Meeting of the American Society of Clinical Oncology may propose. It is probable that their practices will, for the most part, go on as usual, with concentration on treating patients following the most favorable NCR guidelines.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including June 1, 2016, this leaves 6,058 days to his goal.