COMMENTARY

The Rise of Identity Onco-Politics Is Impairing Our Objectivity

H. Jack West, MD

Disclosures

February 03, 2021

How we interpret data is far from objective when the answers it provides are entwined with our identity. Whether we're Republican or Democrat, climate change believer or anti-vaxxer, we are essentially immune to facts that would undermine our positions. What's more, when challenged by contrary views, we're liable to fall even deeper into our convictions.

Journalist/author and Vox founder Ezra Klein lays out an articulate if troubling explanation of this process in his recent book, Why We're Polarized. Klein relays an explanation of "identity-protective cognition" by Yale law professor Dan Kahan, who states, "As a way of avoiding dissonance and estrangement from valued groups, individuals subconsciously resist factual information that threatens their defining values."

As physicians and oncologists, we may like to think this only extends to how the public consumes political or other emotionally charged news, but we are certainly not above the fray. I would argue that our interpretation and presentation of medical evidence is increasingly sensationalized, spun, and consumed in a new world of "identity onco-politics" based on how we self-categorize ourselves, whether overtly or not.

In practice, this means that our commentary, both online and in live programs, tends to fall along well-defined "party lines." For example, for those committed to ever more narrowly defined molecular testing, broader use of immunotherapy, or promotion of liquid biopsies or stereotactic body radiation therapy for oligometastatic disease, they can be predictably expected to advocate on behalf of that data. And just as predictably, those from the opposition can be expected to chime in to castigate it. While it makes for good drama, I'm increasingly concerned that turning every topic into a polarizing debate creates an "us vs them" mentality.

As in politics, this problem is partially a reflection of the media landscape. Consider the redundant tweets sent continuously from experts finding yet another way to support their pet cause. Then there's the befuddling compulsion of every science journalist to ask a study's lead investigator to offer key quotes about their work, as if they weren't the most biased person to speak to that subject. Wouldn't it be far more influential to replace this one-sided discussion with a more nuanced one guided by those whose careers aren't propelled by promoting or refuting this work?

It's also fair to ask, what is the harm in hearing the same arguments from the same people every day? In short, it pushes away those who are not already converts. And, I'd argue that it's led to a crisis of confidence in good science itself.

Clinical research results often lead to conclusions in shades of gray, yet experts and professional societies tend to reduce them to black and white. This certainly generates more heat than light. By distilling complex ideas into identity onco-politics, we can easily mobilize our base; at the same time, however, we undermine our credibility among those skeptical of hearing nothing more than the party line.

H. Jack West, MD, associate clinical professor and executive director of employer services at City of Hope Comprehensive Cancer Center in Duarte, California, regularly comments on lung cancer for Medscape. Dr West serves as web editor for JAMA Oncology; edits and writes several sections on lung cancer for UpToDate; and leads a wide range of continuing education programs and other educational programs, including hosting the audio podcast West Wind.

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