Wednesday, December 15, 2010

The Seminar

A fictionalized, factual event.

What happened that February day is a remembrance of sorts, a conditional reminder of human desire and it’s failing. There was a loss of innocence, the dawn of a new understanding and all because of a man who dared to ask the question.

The podium was a two-step, navy-blue platform in front of a tall opaque blue-black curtain that formed the backdrop. Two huge screens draped the sides of the podium for those seated in the far back corners of the hall. The eight ornate chandeliers that dotted the beautifully carved ceiling of this majestic banquet hall were dimmed. The walls were replete with lit sconces of similar beauty adorning the great hall interspersed between each massive exit door. There were several hundred of us sitting in rows in this massive hall that seemed to stymie any attempt at creating an echo especially given its enormous size. One could hear the occasional cough and clearing of the throat or the clink of the pitcher of water decanting into a glass amidst the murmur..

The man who stood behind the dais had both his hands clenched around its edges as if squeezing every bit of energy to comply with the restraints of the time limit. He was done with his last slide presentation at the end of his allotted time, just when the green light on the dais had turned red. With that flourish of color that briefly illuminated his face, he stepped back and let his hands fall to his sides.

“Ladies and gentlemen, there will be a brief question and answer period that entails ten questions. Please answer the questions on the electronic device provided in front of you.”

After the Q&A session had concluded the moderator, a tall man with thick-rimmed glasses stood up and introduced himself. He rifled trough the questions, that had been provided instantaneously graphed into 3D Plots showing how the audience had responded to the multiple choice answers provided. Most of the answers seemed to follow a pattern of acceptance until the eighth question. This question asked if the audience was inclined to agree with experiment A that had been presented by Dr. Good to which 40% had answered in the affirmative and then the next question number nine, which asked the same question about experiment B that Dr. Great had presented to which another 40% agreed. The last question number ten, which asked, “Do you disagree with the two experiments?” was answered in the affirmative by the remaining 20% of the audience.

The lights flickered for a moment and then they came unglued to a full blaze. Everyone exited the room for a coffee break. The cacophony that followed this crowd could be heard easily in the adjoining corridors as the acoustic suppression tiles failed their leitmotif. All forms of expressions with hand gestures and body movements were in display. The supporters of the two experiments were firmly enshrined in their halls of decision.

Soon the coffee break was over and the gathering moved as a uniform controlled herd back through the portals of entry into the banquet hall. “So,” The moderator said as he cleared his throat from the remains of the cookie that he had just consumed with his coffee, “We will have ten minutes of questions from the audience and then present another set of questions for you to answer before starting the next item on the agenda.”

Several hands flew into the air and one by one agreements for each experiment were emphasized by the audience The questions were more like affirmations and as the preceding person asked the same question that the next one was contemplating, the upraised hands went down like dominoes. I noticed the person seated next to me raised his hand. 

He had been furiously working on the electronic devise in his hands.  When presented with the microphone, he proceeded to ask,  “Well if the data is robust on both sides and experiment A, states that the treatment was a success while experiment B shows no benefit by a different author there is something amiss here. Isn’t it? How can two supposedly very well designed and executed studies looking at benefit of the same drug in a given disease show dissimilar results?” He took a deep breath, “Unless there was bias?” The murmur in the hall became palpably uncomfortable amongst this august gathering of intellectually prone clinicians. The discomfiture shed it’s fear onto the two experimenters who now sat on the podium to the right of the dais where the moderator stood ready to answer any questions. But they were not expecting this. Both clasped their hands in unison and one actually crossed his legs.

“Well gentlemen how would you answer that question?”

There were excuses and replaying of the slides from the presentation as if to highlight the importance of the study and the rigor through which the study participants had been subjected and the data collection that had been reviewed by statisticians and worked through by the mathematical modeling software. The commotion seemed to abate as the discussion had taken up more time then intended. The moderator then asked for dimming of the lights and questions number 8,9 and 10 were asked again. The results were different. Now the answer to question number 10 was grossly skewed. Almost 80% were unsure of the two experiment results. The moderator displayed a graph on the screen and the audience broke out into spontaneous applause. The two experimenting authors seem to shrink into their seats with beads of sweat glistening on their respective foreheads.

The two boats of opposing opinions in this sea of knowledge, driven together by the clash of objectivity now were reduced to a raft-like state of a few wooden pieces bobbing up and down aimlessly. The passengers had bailed onto some other unsinkable Titanic that they hoped would carry them to their destination. Yet the lesson learnt was to question the improbable. Sometimes it is the minority opinion that breaks the stranglehold of conformity.

Medicine is the deep and wide ocean where complex thoughts, conflicting views and desires require careful scrutiny. A well-developed idea wins the stage for a brief moment then is readily obscured by a new paradigm. Time deems a hastily won contest a failure. It is the hard-fought intellectual enterprise that withstands the test.

The day ended with more presentations and much aplomb but it belonged to the lone voice that had surfaced and dared to look reality in her face.

Must we not question the seeds that may protect the very elements of our existence one day? Do we not lend ourselves to a critique on substance? Is it not ours to protect the future of the next generation? The answer to all the questions is an unqualified yes!

As the gentlest of gentle souls, I knew, who dwarfed the medical community once, said, “Go forth and question!”

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