Twitter Storm Over 'Reprehensible Behavior' at Conference Podium

Roxanne Nelson, RN, BSN

February 22, 2022

Twitter was all abuzz over an exchange that occurred last week during the question and answer discussion that followed oral abstract presentations at the Genitourinary Cancers Symposium (GUCS) 2022, held in San Francisco and also online. One of the panelists was accused of being less than professional in handling questions from the floor.

It began with a tweet from Sumanta Pal, MD, of the City of Hope, when he called out the behavior, although he did not identify the perpetrator.

"Yesterday we saw some reprehensible behavior emanating from the @ASCO #GU22 podium, with a well known investigator insulting (in a manner deeply imbued w microaggressions) an esteemed colleague at the mic. It's a teachable moment & the lesson is simple: be kind to ur colleagues."

It was not immediately clear what had occurred, and several people asked him to identify the people involved. One physician responded, "If it was bad enough to infer and share on Twitter, name the name."

But even without details, the post provoked a reaction.

Erika Hamilton, MD, wrote, "I am not aware of this incident, but I always wonder....if someone would do that from the podium, what would they/have they done and said when they didn't think everyone was watching?"

Another tweet questioned why there were no codes of conduct in place, so that situations like this one wouldn't happen.

"Is about time professional societies had codes of conduct in place for invited speakers, moderators of sessions etc," wrote Deborah Verran. "Then if it is breached the individual concerned is not invited back. This kind of incident also needs to be mentioned as part of the conference feedback process."

As the number of clinicians chiming in increased, it soon became apparent that others were aware of the incident, and one posted a video clip, putting the mystery to rest.

Moderator Quips, "Behave...Children"

The exchange occurred immediately following the oral abstract presentations on prostate cancer on Thursday, February 17. Two of these abstracts featured new data from large clinical trials investigating the use of PARP inhibitors in metastatic prostate cancer, which had slightly different results, leading to some debate, as reported by Medscape Medical News. The PROpel trial with olaparib showed a benefit in all patients, irrespective of gene mutation status, but the MAGNITUDE trial with niraparib showed a benefit only in patients with gene alterations, and especially in those with BRCA1/2 mutations.

The invited discussant, Celestia Higano, MD, from the University of British Columbia, compared and contrasted the two trials and the differing results.

During the question and answer session that followed, Neeraj Agarwal, MD, from the Huntsman Cancer Institute, University of Utah, directed a question to Fred Saad, MD, who had presented the results of the PROpel trial.

"As a practicing oncologist, I am very intrigued by the different results of the MAGNITUDE and PROpel trials. I am trying to figure out what do I do in my practice," Agarwal began.

He continued on, explaining that he didn't think that olaparib and niraparib were that different from one another for the two studies to have such differing results, when both of the drugs were given in combination with abiraterone.

The inclusion criteria for PROpel stipulated that patients undergo testing by ctDNA to determine if they were biomarker positive or not, but he pointed out that it is possible for testing to miss patients who might otherwise be positive for homologous recombination repair (HRR) gene alterations. He posed the question, could some of the patients deemed biomarker negative in fact have been positive but whose status was not detected by ctDNA testing?

At that point, Higano interrupted him before he had completed his question and asked, "Can I make a comment? Were you listening to my discussion?"

She then continued, pointing out that "you can't talk about comparing olaparib and niraparib ― these two trials had two very different populations."

She emphasized that this was about the combinations in the populations being studied and not about olaparib and niraparib. "I clearly wasn't very clear," she said.

Agarwal then repeated that he wanted to know what to do with his patients and asked again about the accuracy of ctDNA testing.

"That's a good question," Higano said, "But the other comments you made weren't."

At that point, the moderator chimed in. "Let's all calm down...children."

After a brief applause following the moderator's comment, Saad then addressed the question.

When the video clip of this exchange was posted, a flood of tweets poured in, supporting Pal's initial summation of the situation.

Alison Birtle tweeted, "I'm even more appalled having seen this exchange. Unacceptable. You don't humiliate either the speaker or the delegate and the questions were entirely valid in my opinion. Basically what do I do tomorrow with these data so why ask were you listening. That's just rude."

Another commented: "It's absolutely not a proper way to behave. Whether it's behind the scenes or to your face. You can hear the arrogance from everyone including the moderator with his children comment. This is the true face of medicine," tweeted Jason Kovac.

Jarey Wang, MD, PhD, however, liked the moderator's input. "Love it. 'Let's all calm down children.' Good for the moderator."

Several of the physicians who commented thought that the issue should have been addressed at the time it happened. Don S. Dizon, MD, wrote, "Calling out microagressions as they occur is so important. And very difficult. Agree, the teachable moment must be met with bravery. But it should happen in real time too."

After 2 days of bantering on Twitter, with the thread growing increasingly longer and with the vast majority of posts supporting Pal's initial assessment, Higano finally entered the discussion and defended her comments.

"What you do not know is that the questioner and I are good colleagues," she tweeted. "I have been involved in two of his academic promotions. My main concern was his comment re: how the two trials could have 'so different results with the same combination.' I sought to rectify wrong message."

There were no direct replies to Higano's tweet.

Perhaps the line to draw under this affair is the tweet from Simon Kim, MD, MPH, who wrote: "We can do better!"

Genitourinary Cancers Symposium (GUCS) 2022.

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