Challenges to Scientific Expertise: Future Implications for Oncology

Maurie Markman, MD

The continued uncertainties of the current and future status of the COVID-19 pandemic have resulted in a lack of trust in the authority of the scientific establishment in the United States, and elsewhere, as it operates during these difficult times. Some of the top concerns are the eventual development of 1 or more vaccine-resistant mutants, the unknowns associated with the long-awaited return of in-person schooling for yet-to-be vaccinated children, a reduction in social distancing as declining temperatures result in more indoor interactions, and the anticipated uptick in travel during the holiday season. All of these pose difficult scenarios for which the scientific community has few, if any, objectively solid answers to guide policy makers and the general public.

The continued uncertainties of the current and future status of the COVID-19 pandemic have resulted in a lack of trust in the authority of the scientific establishment in the United States, and elsewhere, as it operates during these difficult times. Some of the top concerns are the eventual development of 1 or more vaccine-resistant mutants, the unknowns associated with the long-awaited return of in-person schooling for yet-to-be vaccinated children, a reduction in social distancing as declining temperatures result in more indoor interactions, and the anticipated uptick in travel during the holiday season. All of these pose difficult scenarios for which the scientific community has few, if any, objectively solid answers to guide policy makers and the general public.

Some in the scientific community appear to have made matters worse by rendering strong public statements offering opinions related to the ethics of vaccine booster shots vs sending a much larger proportion of vaccine product to countries that, for several reasons, continue to have woefully inadequate immunization rates.¹ The issue is not the right of individual scientists to voice their personal opinions regarding this topic but rather the training or expertise that members of the scientific community possess to provide expertise related to ethical considerations.

Additionally, there is continuing uncertainty about the origin of the SARS-COV-2 virus and the disquieting evidence of potential conflict of interest among several highly regarded members of the scientific community in expressing their thoughts on the relation of the outbreak to an accidental lab leak.^2-4

Finally, science does not follow a well-defined script. What may be considered the best available evidence today can easily and appropriately change tomorrow based on newer or more robust studies, extended observations associated with previously reported results, or even challenges to the quality, objectivity, or honesty of prior investigative efforts. The scientific process is just that, a process. Simple definitive answers may not be available, as critically relevant and potentially complex public health questions and recommendations—no matter how strongly evidence based—may conflict with the values, beliefs, and economic welfare of individuals, families, and societal groups.

The concern highlighted here is for how the overall response to the COVID-19 pandemic by the scientific community may ultimately affect the views of the American public, both the authority of public health officials and objectively validated clinical science in the cancer arena.

Today, in the United States, we continue to see the proliferation of effective but ever more expensive antineoplastic strategies. As many cancers become more like chronic diseases where treatment may be delivered for years rather than months, it is increasingly clear this system will not be sustainable. One possible solution will be major changes in societal attitudes regarding cancer prevention (eg, vaccination) and personal lifestyle.

A recent modeling report has suggested that elimination of cervi-cal cancer in this country will be possible within the next several decades. This projection assumes an effective nationwide human papillomavirus vaccination strategy and societal efforts to reduce poverty-related disparities in many regions of the country.⁵ Clearly, the clinical and economic effect associated with successful strategies would be substantial. Leaders in cancer care and scientific establish-ments are best positioned to helm such an effort, assuming the public puts its trust in their recommendations.

Or consider for a moment a recent report from the World Health Organization that claimed as many as 4% of all cancer cases world-wide in 2020 resulted from alcohol consumption, with almost half of this total due to individuals who drank excessively.⁶ This analy-sis suggested that in 39% of men who developed esophageal cancer and 4.5% of women who developed breast cancer, alcohol consump-tion played an influential role. Imagine the effect on the number lives lost from a meaningful reduction in heavy alcohol consump-tion. Who should lead this effort other than the cancer clinical and research community?

Similarly, the influence of obesity on cancer risk has been well documented in scientific literature, with one-third of the world popu-lation considered to be either overweight or obese.⁷ The incidence of several cancers, including endometrial, esophageal, pancreatic, kidney, thyroid, colon, and postmenopausal breast cancers, has been shown to increase in individuals with excessive body mass. Again, imagine the potential effect of a coordinated decade-plus national/international campaign to modify diets and establish economic incentives to produce food products that will reverse the deadly trend.

Leaders of the cancer establishment should be in the forefront of efforts to make these difficult but essential changes. But this can happen only if the public puts its trust and faith in scientifically based pronouncements and objectively validated and nonpolitically motivated recommendations of that leadership.

Refrences

1. Vogel G. Unethical? unnecessary? the booster debate intensifies. Science. 2021;373(6558):949-950. doi:10.1126/science.373.6558.949
2. Oreskes N. The lab-leak theory of COVID’s origin is not totally irrational. Scientific American. September 1, 2021. Accessed September 16, 2021. https://www.scientificamerican.com/article/the-lab-leak-theory-of-covids-origin-is-not-totally-irrational
3. Bloom JD, Chan YA, Baric RS, et al. Investigate the origins of COVID-19. Science. 2021;372(6543):694. doi:10.1126/science.abj0016
4. Editors of the Lancet. Addendum: competing interests and the origins of SARS-Cov-2. Lancet. 2021;397(10293):2449-2450. doi:10.1016/S0140-6736(21)01377-5
5. Spencer JC, Brewer NT, Coyne-Beasley T, Trogdon JG, Weinberger M, Wheeler SB. Reducing poverty-re-lated disparities in cervical cancer: the role of HPV vaccination. Cancer Epidemiol Biomarkers Prev. Published online September 9, 2021. doi:10.1158/1055-9965.EPI-21-0307
6. Rumgay H, Shield K, Charvat H et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol. 2021;22(8):1071-1080. doi:10.1016/S1470-2045(21)00279-5
7. Basen-Engquist K, Chang M. Obesity and cancer risk: recent review and evidence. Curr Oncol Rep. 2011;13(1):71-76. doi:10.1007/s11912-010-0139-7