The Invisible Gorilla

The Invisible Gorilla

George W. Sledge, MD, FASCO

Jul 18, 2010

My thanks to Tony Tolcher of San Antonio for pointing me in the direction of a wonderful new book, The Invisible Gorilla, by Christopher Chabris and Dan Simons. The “Invisible Gorilla” was a psychological experiment conducted a little over a decade ago, in which volunteers were asked to watch a film in which two teams of basketball players, dressed in black and white uniforms, passed a basketball back and forth. The volunteers were told that the purpose of the experiment was to count the number of times the ball was passed.

The real purpose of the experiment was something quite different. A woman in a gorilla suit walks in and through the players, pounds her chest, and walks off. Half the volunteers watching the film failed to see the gorilla: they were so focused on counting the passes that they developed what is known as “inattentional blindness.”

How often do we oncologists miss the Invisible Gorilla? Frequently, I suspect. I remember when the first trial of paclitaxel in breast cancer was submitted to ASCO by Frankie Holmes of M.D. Anderson. Not only did the abstract not get an oral presentation, it didn’t even receive a poster presentation. A drug with a high response rate, reported from a respected institution, the first truly active new chemotherapeutic in a decade, breaking a clinical trials logjam. Talk about a gorilla wandering across the stage, beating its chest, and being ignored! When I served as Scientific Program subcommittee chair for breast cancer, I used this particular “Invisible Gorilla” as the example of the sort of mistake we didn’t want to be known for.

These sort of mistakes can, of course, be intentional, rather than inattentional, blindness—a bad judgment call. But I suspect that the reviewers had been so conditioned by a decade of clinical trial failures that they simply could not recognize a success, or didn’t believe it possible.

What Invisible Gorillas are we missing? I am certain that some of the current examples relate to the health care system, with its multitude of dysfunctionalities and perverse incentives, all of which predispose us (because our survival demands it) to focus on keeping score as the ball is passed back and forth. What Invisible Gorillas do you think we are missing?


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Anees B. Chagpar, MD, MPH

Jul, 24 2010 7:35 AM

It's very true . . . in our quest to get the "right answer", we often focus so completely on the task at hand that we filter out any distractions -- even if they come in the form of large, chest-beating gorrillas! In some instances, this laser-sharp focus can be precisely what is needed, but it may well cause us to miss potentially important events that are seemingly peripheral. I’ve often wondered whether it is possible to be both absolutely focused to ensure accuracy, while at the same time being widely perceptive so as not to miss important "invisible gorillas".
It may be that we are hard-wired to focus on what we consider to be important, which speaks to the power of teamwork and collaboration. Bringing together the individual perceptions of a myriad of people of different vantage points may be what is required . . . Think about doing this task with a group: the “big picture” people will likely spot the gorilla, while the “detail-oriented” people will accurately count the passes. Together, they do better than either group in isolation. The beauty of this, particularly for ASCO members, is that we do this every day: from managing patients in a true multidisciplinary fashion to forming research collaborations that span diverse specialties . . . just think of how many “invisible gorillas” you nearly missed if it weren’t for a colleague pointing them out!

Michael Jordan Fisch, MD, MPH, FASCO

Jul, 25 2010 10:34 PM

An invisible gorilla that jumps around in our everyday clinic experience is emotion. Sometimes, this gorilla is blatantly obvious, and sometimes it hides under a very thin veil (but it is nearly as obvious). This is something that has been pointed out by communication experts such as Robert Buckman, Walter Baile, and others. Why do we miss this particular gorilla? Part of it is inattentional, as we have many tasks and issues to confront other than emotions. Some of it is also intentional, as we may not be as comfortable managing our patients' emotions, we may be worried about stirring up our own emotions. And there is always the ever-present pressure of time. Perhaps we ignore the emotion gorilla because we do not feel that there is enough time to get through the day if that gorilla comes into play on a regular basis.

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