A Criticism of the Career Critics

Long before the millennium and the days of Twitter doom scrolling, perhaps even before the iPhone or Blackberry thumbs, early in my career, I sat deep in the cushions of a tastefully decorated hotel lounge, somewhere in western Canada, enjoying a selection of tasty beverages at the end of a long day of meetings. A group of fellow blood cancer aficionados were heartily enjoying a lively, yet so far friendly, debate with a more senior, sometimes controversial, always entertaining colleague, henceforth the big deal hematologist (BDH).

Encouraged by proximity and camaraderie, in what I thought to be good-natured ribbing, I began, in retrospect overzealously, poking fun at some of the more suspect claims BDH had presented earlier in the day. Such jocularity landed with a sudden thud when, in an awkward turn of events, the BDH morphed, obviously irritated and with eyes bulging, pointedly asked in increasingly louder staccato accompanied by a good deal of COVID-19-negative, 1990s spittle: “And what exactly have you contributed?” Reddening, I fell silent and at the first inconspicuous moment made myself as small as possible and snuck off to bed.

It was what we might now call a teachable moment, and one I think should not be missed on a new generation of hematologists. I promised my younger self I would focus on producing positive contributions and avoiding unnecessary negativity.

Fast forward and I have become interested in, and a little disappointed by, the frequency with which younger hematologists are rejecting the “old academic paths” of basic research, clinical trials, or education as a career, leaving a potential future deficit in discovery and innovation. Some new career directions with a focus on quality/safety, survivorship, outcomes measurement, and other examples are no doubt leading us closer to hematologic nirvana; however, I am persuaded here to comment on another recently emerging alternate career path: that of the professional oncology critic.

The roots of this first surfaced with a series of harsh tweets regarding blood cancer clinical trials. The general theme was bad trial design, propagated by pharma to their distinct advantage, and enabled by complicit or clueless hematologists more concerned with self-promotion than helping patients. The bluntness of the tweeting and the subsequent attention it provoked encouraged the cycle to repeat with the same self-assurance evoking the righteousness of the commentary, and it was hard to ignore.

As our politicians have learned to our despair, controversy, an attack philosophy, and abrasive rejection of any counterargument build social media followers the way a train wreck, or a very public downfall of a celebrity, attracts those who delight in such spectacles. In self-reinforcing cycles, as both delighted and horrified eyeballs became followers of the circus, an “influencer” derives notoriety, and the professional critic career path is rewarded and replicated by others of a new generation. Some celebrate and value this independent criticism as overdue and well-intended; some find it obnoxious, particularly coming from colleagues who have no experience in clinical trials and who are often anything but collegial.

Of course, professional, well-regarded critics abound and are widely read and even enjoyed in other fields such as the arts, sports, and restaurants, most of whom can’t act, can’t play, and can’t cook, much as our emerging hematology tweeters have not demonstrated any aptitude for clinical research, so perhaps it is inevitable that our world is not immune.

For me, I am just saddened and compelled to recycle my own lived experience and ask, like the BDH of yesteryear: For those who choose the path of manufactured controversy or divisive rhetoric over improving the lives of our patients, “What exactly have you contributed?”

Keith Stewart, MBChB, MBA, is a hematologist at Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.

His opinions are personal and not those of his employer.