Right now I’m sitting in the back of a hotel meeting room near Washington, DC, where two dozen physicians are rehearsing for a presentation to the regulatory authorities. They are debating what point they are trying to prove.
The question has to do with the use of a certain methodology to measure, in clinical trials, the efficacy of a class of drugs.
There is no agreement amongst those currently engaged in the discussion as to what the point is. Does the proposed methodology relate to clinical outcomes? Will it yield usable data? Should it be used only in high risk patients? Should it be mentioned in the label?
These people have been working on this issue for months, and yet here they are, not quite clear on what point they are arguing.
Because the key point in this situation is difficult to understand, and even more difficult to explain, they are instead discussing the relative value of certain pieces of evidence.
Evidence of what they are not sure, but they have evidence, so they are determined to use it. And maybe the debate will lead them to what they can and cannot claim.
It is interesting to consider whether, in situations like this, we determine our point by wrestling with our evidence and beating it into a clear point, or whether we decide what point we think we want to make and then test it against the evidence we have in our possession.
It seems to be me that rehearsal, or debate, is the forum in which we test our hypotheses against our evidence. It is the trial by fire, the stress test, by which we learn if we ourselves, and others, hear the ring of truth in our talk. If we have trouble making our evidence support our point, we must change our point, not our evidence.
Although if we want, and if we have time, we can look for more evidence to support our point, except in this case—in this room, at this moment—we don’t have time, and we’re still trying to agree on the claim that we want to make.
I think the key point is buried in our pile of data, like a needle in a haystack, and while we can see it glistening through the stalks, we can’t quite reach it with our mental tweezers, or find the right words that would pull it, like a magnet, out of the confusion.