Microphone Moment

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio

Entering Monday’s oral abstract session at the 2016 ASH Annual Meeting, my goals were twofold: to see some great science that may influence how I care for my patients and to support my colleague – a faculty member a couple of years out of fellowship. It wasn’t that long ago (or so I keep telling myself, though in truth more than a decade has passed) when I was in his shoes, and I remember how much it meant to me to see my senior colleagues – my mentors – in the audience when I gave my first oral presentation.

By that point in the meeting, I had already logged about 60,000 steps, and I was only averaging about five hours of sleep each night, so my drive to be there for him had to overcome some basic physiologic deficits. Nevertheless, I walked past the bouncers at the room’s entrance (who eyed my badge suspiciously before letting me enter), frantically scanned the seated attendees for my colleague, and made a beeline for the open chair near him just before the session began. When his name was announced, those of us around him gave him reassuring smiles and the “thumbs-up” sign as he made the long walk to the stage to get started.

My stomach churned. At this point in my career, I die a thousand-fold more deaths when my junior colleagues give presentations than I do for myself – mostly because I want them to love research as much as I do and would hate for a flubbed talk to corrupt that joy. Plus, I am probably reliving some of my own fears when I had to make that same long walk.

I needn’t have worried, though; his homily was masterful, his slides clean, and his interpretation of results measured. The audience applauded and was invited to come to a microphone to ask questions.

These five minutes reserved at the end of a talk, during which any attendee can probe the ins and outs of the research being described, are critical to the checks and balances of science. We are collectively obligated to police ourselves, to correct erroneous conclusions or reign in inflated ones, to uncover methodologic flaws or illuminate hazy results, and occasionally to ask for clarity regarding how the research fits in the greater context of the disease being studied. Many forces come into play in scientific presentations, not the least of which are related to career advancement, advocacy, economic drivers, and politics; it is our duty to ensure the science is pure.

The first question came from one of the moderators, and it was spot-on, asking whether my colleague’s results were any better than what had been seen historically. His response was a good one, and the moderator seemed satisfied.

The next inquiry came from an audience member, a well-recognized leader in our field. He started by quoting a pithy phrase about learning from our mistakes, then launched into a minutes-long, withering oration that started with a review of the research he himself had conducted decades ago (with the implication that my colleague was naïve for embarking on such a project without recognizing this previous work) and ended with the conclusion that my colleague’s work fell short.

My heart raced, and I felt my face flush. My first reaction was to castigate myself. Had I misled my junior colleague about this research? Had we missed something in our review of what had been studied previously? I thought we had incorporated conclusions from the other studies when we designed his project. Were we in any way harming our patients by asking them to participate? We were so cautious with how we monitored this research, incorporating plenty of early-stopping rules, and patients appeared to do well …

I looked around to other members of the audience who were giving each other knowing glances. Then I remembered a piece of advice we give our fellows and junior colleagues as they prepare their ASH presentations: Your audience is always smarter than you think, about both the science being discussed and the many ulterior motives that can play into the presentation and the questions that follow. Seeing what had occurred, the audience was siding with my colleague.

My self-flagellation turned to deep disappointment. My junior colleague had started his research as a fellow and felt that he had a chance to make a real difference in the lives of patients with cancer, at least based on the preliminary results he was presenting. He was so honored to have been asked to give an oral presentation on his project, as if others in our field were embracing him – with the implied nod that his work was important. Instead of encouraging my colleague or providing guidance on ways to refine his research, this well-recognized leader tried to bolster his own reputation and denigrated my colleague in the process.

My junior colleague maintained a quiet smile throughout the mini-speech and thanked the questioner when it was over, reassuring him that we were aware of his past studies, quickly reviewing how this research differed, and reminding him that these results were only preliminary. He was respectful, composed, and on point. I couldn’t have been prouder.

The moderator apologized to the handful of other people waiting to ask questions, as the five minutes allotted for questions about my colleague’s presentation had been exhausted. The session had to move on.

It is such a privilege to attend scientific meetings like those held by ASH, to learn about the sophisticated research that quickly defines our evolving understanding of hematology and cancer biology and that informs our standards for patient care. We have the opportunity to educate, to be educated, and to mentor the people who will one day care for us as we enter our dotage. Let’s not allow the temptation for self-aggrandizement to undercut that privilege.

The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.

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