Science vs Practice

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Bernard Fisher, MD

“ASCO members must base therapeutic decision-making on information obtained using scientific methodology.”

—Bernard Fisher, MD

My  year as President was a busy one.  Aside from continuing my research and directing the activities of the National Surgical Adjuvant Breast and Bowel Project, I was drowned by the vast amount of information that was sent to me by ASCO headquarters.

At the onset of my Presidency, I discovered that a crisis was brewing regarding ASCO’s mission. Since subsequent Annual Meetings of the Society were no longer to be held in conjunction with the American Association for Cancer Research, many members felt that ASCO was abandoning its scientific objectives and directing its course toward private-practice issues. On the other hand, private-practice oncologists were concerned that ASCO was not providing them with a platform for discussing their problems related to reimbursement, government affairs, and education of oncologists.

During my tenure, I was more concerned with ASCO’s relation with research. I firmly believed that the future vitality, integrity, and justification for the Society would depend on how well research enveloped its membership. I thought that a widening gap between physicians and investigators could not only threaten the welfare of patients, but as clinicians got further away from science, the hope for progress in curing and preventing cancer would diminish. In my Presidential address, I noted a statement by Nobel Laureate Sir Peter Medewar, indicating that to deride any aspect of science, be it fundamental, basic, or clinical, is the ultimate foolishness, the last word in poverty of spirit and meanness of mind.

While I was less than enthusiastic about ASCO’s role in the public issues arena, I did believe that ASCO should be used as a bully pulpit to express its positions on selected public issues related to its major goal, ie, promoting medical care based on science.  Two decades later, I still maintain that all members of ASCO must have the same objectives relating to the prevention and cure of cancer: They must base therapeutic decision-making on information obtained using scientific methodology rather than empiricism, anecdotalism, and inductivism, which, unfortunately, continue to be used by too many physicians. ■

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