Who Can We Trust if We Are Departing from Science?
ANDREAS M KAISER
Professor & Chief, Division of Colorectal Surgery, City of Hope National Medical Center - Colorectal surgery, robotic surgery, laparoscopic surgery, TEMS/TAMIS, continent ileostomy, sacral nerve stimulation
The contrast between science and politics could not have been a starker one than in 2024. Science examines and reexamines data and evidence and learns from experiment or trial failures and successes with the goal to make progress, broaden knowledge and find new treatments and cures – for others. As a matter of fact, there have been lots of successes in cancer care including surgical technology and strategy, but we are humble enough to know that a lot more needs to be done: build on what we know to explore what we don’t know. In contrast, a politically tumultuous year 2024 with little prospects for betterment in 2025 focused on seeking or retaining power at any price and with any tool. Intentional generation, tolerance and propagation of misinformation, fear mongering, and specific targeting and maligning of weaker individuals or communities have become normalized and are being used to manipulate public opinion. Education and knowledge acquisition rather than being broad have become subject to being filtered, bent, and curated for the purpose of message alignment.
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Covid after 7 million COVID deaths worldwide and 1.2 million alone in the USA since 2020 remained somewhat present. But aren’t we lucky that overall, it moved to the back of our minds – thanks to broad vaccination efforts. We are proud of great successes that surgery may achieve in individuals but humbly recognize that on a larger scale they pale to the good achieved by vaccinations against multiple very real threats humanity faced through the centuries. Smallpox, polio, tetanus, rabies, meningitis, diphtheria, yellow fever, hepatitis B and many more including most recently the Covid could be prevented or even be eradicated thanks to sophisticated research and highly effective vaccines that worldwide protected so many from detriment. But weird conspiracies and baseless negative statements from top contenders’ megaphones threaten the public’s justified confidence into vaccines.
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Info sources have increasingly been hijacked and dominated by a few reckless individuals and their armies of facilitators who do not care about others, about humanity, about saving rather than destroying lives but who have nothing in mind but their own person, position, and power, their own religion or believes, their own selfish goals. Both on the global and on a national level, we fail to exercise discourse to understand other positions, discuss differences, and work out compromises. Differences can very well coexist. Proper and respectful interactions with each other in tone and substance with willingness to listen to otherness have often been sacrificed to echo chambering on not so smart “smartphones”. Wherever I look, I see people stare into their phones (to endless TikToks?) rather than talking to surrounding individuals.
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Meanwhile, we, the medical professionals, continue to care about individual lives and try to save or prolong as many as possible, one life at a time, one after another. Sometimes on long days, with very little sleep. Because we love our patients, the diversity of different lives, and our dedicated profession.
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I worry what will happen if we stop relying on science but let untrained “leaders” propagate their evidence-free opinions and destroy our solid safety networks. It took decades to build our sophisticated healthcare system, which unquestionably is far from perfect but generally is highly capable of approaching miracles. It would simply be unimaginable if I as a surgeon intentionally ignored scientific data, reviews and accumulated evidence and instead suggested that all those data were false and that those who dare to say so should be prosecuted, jailed or hanged. Or if I told our rectal cancer patients incorrectly to immediately proceed with surgery when we all should know that in the era of precision medicine and precision surgery, a collaborative interdisciplinary approach with chemotherapy and radiation or in selected patients with immunotherapy may in fact achieve much better results and sometimes even allows to avoid surgery.
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Cancer does not respect order, does not respect well-being, does not respect life. Neither do untruths! But who do we trust? Can I trust coworkers who openly support proven lies?
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A diagnosis of cancer immediately sets off anxiety, rocky times, pains, and demands significant sacrifices by the patients and their loved ones. The value of having trust in your care team cannot be overemphasized. This inevitably requires the ability to distinguish truth from untruths based on: Common sense, an inquisitive mind, perseverance and curiosity, the strength to acknowledge errors and defeat, and the creativity to work out solutions rather than chanting simple slogans against perceived stumbling blocks.
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As I stated numerous times, we have the challenge and the privilege to see our cancer patients when they are particularly vulnerable, both physically and emotionally. We need to maintain solid knowledge and skills, cultivate the art of our guild and put each individual patient into the center to define a specific and tailored care strategy with realistic optimism. Our patients and families entrust us with balancing the risk of a major surgery - the most direct “intrusion” to their body’s integrity – with the mutual humble hope for success.
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Beyond the challenges in my job, I am very proud of my family as each and every one contributes to bettering the world in one or the other way, through educating our youth, music, medicine, or through planning better cities but most importantly through the display of an ethical character.
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Medicine and surgery in particular, to the present day, remain a wonderful and fulfilling call to duty for the honor to help. It has been an enormous privilege for me to participate in our patients’ care! My thank you goes out to them for the trust in me, in my team, and in our institution City of Hope which has evolved into a national organization, the 5th best cancer center in the USA with the mothership and main hub in Duarte, California, and hubs in Orange County, Chicago, Phoenix, and Atlanta.
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My asks every year are to engage in face-to-face interactions rather than virtual ones, to look for what we share and not what divides us, to find solutions and compromise, and to show a heart for the weak. We appreciate the support from patients and their families in helping us help others.
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I hope you had a peaceful Holiday Season and wish you all the best for New Year!
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Andreas M Kaiser, MD?FACS FASCRS?
Professor of Surgery?
Chief, Division of Colorectal Surgery
City of Hope National Medical Center (NCI-CCC)
1500 E. Duarte Road, Belardi Pavilion, Suite 2230
Duarte, CA 91010
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