MUSINGS OF A CANCER DOCTOR: Noble Dreams
2011; Wolters Kluwer; Volume: 33; Issue: 20 Linguagem: Inglês
10.1097/01.cot.0000407727.80548.bb
ISSN1548-4688
Autores Tópico(s)Palliative Care and End-of-Life Issues
ResumoGEORGE W. SLEDGE JR., MD, Immediate Past President of the American Society of Clinical Oncology, is Ballve-Lantero Professor of Oncology and Professor of Medicine and Pathology at Indiana University Simon Cancer Center.: Write to him about this essay or other topics at [email protected], or add comments directly on his OT blog, at http://bit.ly/OT-SledgeLike many scientists who have no chance whatsoever of winning a Nobel Prize, I have an inordinate fascination with the award. The Prize is, for science geeks, the Super Bowl for smart people. Well, sort of: you have to imagine a Super Bowl where the outcome is determined by the vote of a secret committee from a country that generally doesn't field very good teams, based on their analysis of a game played a decade or two ago. So it's not a perfect analogy, I know, but then nothing is quite like the Nobel. This year's award for Physiology or Medicine (its somewhat arcane title) went to three immunology researchers, including the discoverer of dendritic cells. The Physics prize went to three US-born researchers who studied the expansion of the universe (the cool subject of dark energy). The Chemistry prize was awarded to an Israeli chemist for the discovery of quasicrystals, with their beautiful forms reminiscent of medieval Islamic mosaics. The prize for Literature went to Tomas Tranströmer; Peace went to Ellen Johnson Sirleaf, Leymah Gbowee, and Tawakkul Karman for their work for women's rights, and Economics went to Thomas Sargent and Christopher Sims, but let's stick with the science prizes for the moment. The prizes have their oddities. This year's awards suggest some of them. The prize is only given to the living. One of this year's winners, Ralph Steinman, died on the Friday prior to the announcement on Monday of pancreatic cancer, but the Nobel Committee decided a few hours later that the award would stand. How sad to have missed that phone call from Stockholm. The “living scientist only” rule has resulted in some obvious miscarriages of justice (Oswald Avery for DNA) and some interesting might-have-beens (Rosalyn Franklin to join Watson and Crick?). The prize is also limited to three winners per year in a category. In an era when science is increasingly a team sport, knowing whom to award must be increasingly problematic. The two groups that discovered dark matter were clearly consortia of investigators. Physics papers from CERN can have dozens or even a hundred names on them these days. Do you give an award for being an effective chairman of the board? Hard call, I'm sure, and maybe time to change that rule, not that the prize committee cares what I think. But science has changed in the last century. There have also been some flagrant fouls in the storied history of the prize. Lise Meitner in physics and G.N. Lewis in chemistry are the two most obvious examples. What was the Prize Committee thinking? Those who have studied the Nobel Prize in depth point to some obvious politics in the science awards, and of course the politics of the Peace and Literature prizes clearly represent the biases of a small intellectual elite in Sweden and Norway, whether or not you agree with the result. No Peace Prize for Mahatma Gandhi, but one for Yasser Arafat? No Literature Prize for Chekov or Mark Twain? And of course there have been times when the Prize was well deserved but not necessarily for the reason stated. Einstein got his, but not for Special Relativity, and not for General Relativity (on a par with Newton's Principia, certainly), but for the photoelectric effect. Forget e = mc2, forget the space-time continuum, it's the CCDs in digital cameras that matter. Huh? Still, this is kvetching. As Paul McCartney said on hearing complaints about song selection on the White Album, “At the end of the day it's the bloody Beatles' White Album. Shut up!” You wouldn't mind belonging to that club even if they left out a few people you thought ought to belong, or invited in a few crazies. Or would you? What good is the Prize, either to its winners or to the rest of us? I like to celebrate excellence as much as the next guy, but what does the prize mean for a winner? First, of course, is the fact that winners frequently don't get the prize until they are pretty far past their peak, often at the end of their productive careers. The most notorious case of this was Peyton Rous, who discovered the viral etiology of cancer in 1911 and had to wait until 1966 to receive the prize. No joy there. But what of scientists who are still active? The Prize itself is smaller than a lot of research awards, though at least it comes to an individual rather than an institution: no indirects, though the Philistines at the IRS take out a big bite. Getting the Prize exposes you to a lot of distractions, and probably a fair number of kooks, but certainly more speaking invitations than there are days in the year. You get the award, presumably, because you we creative and focused, but I cannot imagine that receiving the Prize does anything for your focus. Nor is the average study section likely to shower you with money just because you were awarded a Nobel. In fact, knowing some study sections, it might attract punishment by the envious and the mediocre. This is particularly true because the peer review process rarely rewards the sort of creativity that generates true breakthroughs, as opposed to solid incrementalism. And how about the rest of us? What do prizewinners teach the hoi polloi? I have met a few Nobel laureates, though I can't claim any deep insights into the character of the average laureate. I suspect that this is because there is no average laureate. Some that I have met are wicked smart, some a tad eccentric (actually, deeply weird in one case), and some just seem like nice, decent, hard-working scientists who had the good luck to get there first. Maybe that's the lesson, in part. Winning the Prize is, at least in part, about choosing the right problem, and getting into new territory before everyone else. But what constitutes “the right problem”? How do you, viewing the unfertilized oocyte of a scientific question, visualize the adult organism it might become? The world is full of pretty baubles, few of which are valuable gemstones. Ig Nobel Which brings us to the Ig Nobel Prizes. The Ig Nobels are given out shortly before the “real” Nobel Prizes every year in a ceremony at Harvard. They are chosen to honor ridiculousness, but typically chosen from the ranks of real scientists. This year's Ig Nobels will stand for the rest: the physiology prize went for work entitled “No evidence of contagious yawning in the red-footed tortoise Geochelone carbonaria.” This year's biology prize went for “Beetles on the bottle: male buprestids mistake stubbies for females (Coleptera.)” This groundbreaking work demonstrated the attraction of males of a particular species of beetles for short-necked brown beer bottles lying beside the road, at the expense of the females of the species. Both works were published in bona fide peer-reviewed journals, as did most of this year's other winners. You laugh, as do I, but the Ig Nobel's raise a serious question in a decidedly unserious way. Scientists pursue questions not to win a Nobel, but because the questions are interesting. When does a scientific question cross over from the ridiculous to the sublime? What makes a problem a great problem, as opposed to a slightly absurd contribution? The creative process can lead the same investigator in very different directions. Isaac Newton discovered the laws of celestial mechanics, and of optics, but he spent as much or more time on alchemy. Last year's winners of the Physics Prize had previously won the Ig Nobel for their invention of Gecko tape. Previously science laureates have included a German Nazi party member and an American racist: one can be smart without being either wise or virtuous. Mentoring Matters One important lesson involves the importance of mentoring. An outsized proportion of laureates trained under other laureates. Mentoring matters. Why is this? It might suggest the importance of “old boys” networks, where lucky protégées get better scores on their first R01 applications. It may be just be that smart people attract smart people. Less cynically, it may be that some people can see further and think better, that this is the basis for groundbreaking work, and is behavior that can be passed on: teachable magic, if you will. If this is the case, being the sorcerer's apprentice is the first step towards, not just the academic success of cronyism, but scientific greatness. Is the prize important? Maybe. We need heroes, scientists as much as anyone. Teaching the lesson that excellence is obtainable through the rational application of the human mind has value. But I remember one of my favorite stories, told by Robert Hughes in his book Barcelona. In medieval Catalonia there was an annual competition among the bards. Each would come to Barcelona and vie for the prize in front of a jury of their peers, which would then decide which was the best singer of tales. Third prize was a silver violet. Second prize was a golden rose. First prize, wonderfully, was a real rose. What was the meaning of that rose? One possibility is that nothing we do will ever match nature's inherent beauty and level of perfection. But the other possibility is my preferred one: long after the rose has faded, a great work lives on. More from George Sledge More from George Sledge on HisOTBlog! Recent Posts: Social Values in Medicine Blacksmiths On Privacy Lives Lost http://bit.ly/OT-Sledge
Referência(s)