The Dumbing Down of US Oncologists

John L. Marshall, MD


July 13, 2010

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I'm John Marshall from Georgetown University Lombardi Comprehensive Cancer Center, again with another installment of our Medscape video blog. Thanks for signing in. I've been really struggling over the last 5 years with the fact that all of the major clinical research that has happened, particularly in GI [gastrointestinal] cancers, has been led by Europeans, performed by Europeans, and usually with European patients; colorectal cancer -- outstanding work there, gastric cancer, pancreatic cancer, hepatocellular cancer. You name it. They all have been done by European investigators and led by a very vibrant group of clinicians and translational researchers. They are really taking the lead in this clinical research world.

So, I'm thinking: why is this? There are few other observations that I have that kind of go along with this. I just got back from a wonderful meeting in Barcelona. It was a wonderful meeting and it was in Barcelona; a twofer. It was a GI cancer meeting and there were 3500 people who attended this meeting. It was huge. It was 3 days. There were fabulous speakers. The content was remarkable, and people from all over the world -- not the United States; all over the rest of the world -- came to this meeting; 3500 people. This meeting has been in existence for about 10 years, and it started a year after we had a similar meeting start here in the United States. It was the same basic organizing committee, the same basic program, and the one in the United States that was held last year had under 100 people attend. Why is this? Why is the rest of the world flocking to these meetings, and we in the United States aren't really showing up at all? Of course these things are multifaceted, but I think one of the most important parts of this is that the rules outside the United States are not nearly as strict around pharma support. Almost all of those 3500 people who came to that meeting in Barcelona were being brought there sponsored by pharmaceutical support.

Now, we can talk about the influence that that has on people's practice and the like, and of course that's the dirty side, if you will, of pharmaceutical money. The other side is that money enabled a huge group of people, young and old, to come and gather and really drill down on these important new clinical research issues. You are educating a large number of people throughout the world; not the US doctors. The same is true at ASCO [American Society of Clinical Oncology]. The same is true for all our meetings. Our US doctors are not going to these meetings. They're not engaged because they're so busy worrying about their practices, and frankly they're unwilling to pay their own money to go to these meetings.

So, what I think we're seeing is a dumbing down of the US oncology world. We've become very basic and very simple when the rest of the world is challenging and trying to move forward cancer medicine. We've become complacent and happy with what we've got, and we are clinging to what we've got. We've got to shift this in some way back. Yes, the pharma money is an important piece of why there's been this shift. Now, maybe we need to come up with better answers in the United States. Maybe we need to actually fight back against these restrictions on our accessing this sponsored money, this funding from outside of our world. But there's also another component to that in the United States, and that's one of innovation. We are known for being innovators, but the reality is our clinical research has not been very innovative over the last several years. When our investigators from cooperative groups submit clinical trials to our regulatory bodies, there's a very conservative approach at our regulatory bodies so that they're saying no, we can't do those kinds of clinical trials; that's too "out there." We're not really willing to push the envelope. This I-SPY 2 clinical trial for breast cancer is just an incredibly cool clinical trial. It took the moving of mountains to do what we all knew in the end was the right kind of clinical trial to do.

I think these things in many ways are connected. We've become so conservative, so careful about what we're doing, and we've lost sight of where we're headed. We need to educate our folks. How are we going to do this if we remove this pharma money? How are we going to allow innovation in a medical world that so desperately needs new ways of thinking? Our European colleagues have figured this out, and they're leading the way. We've got to decide: are we just going to watch and consume what they produce, or are we going to get back in the game and play as leaders in the medical community? That's food for thought. Have a great summer. This is John Marshall from Medscape at Georgetown University. Thanks.


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