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?