UK, US, Catalonian and German researchers are short listed for a share of funding by Cancer Research UK and the US National Cancer Institute on the molecular biology linking senescence and cancer, leveraging the inability of senescence cells to duplicate with cancer cells where replication is the essence of the pathology. Senolytics are processes that eliminate senescent cells. The biology is complex and the technologies nascent. The principal investigators – Jesus Gill at Imperial College London, Scott Lowe at Memorial Sloan Kettering Cancer, New York and Manuel Serrano at Institute for Biomedicine Barcelona – are established specialist researchers leading an international team of biomedical scientists.
My role is to influence behaviour, to facilitate the translation of our work to clinical practice, ameliorate the widespread resistance to vaccination and fears of conspiracies and imputed corruption in civic institutions that infect and undermine public health and trust.
I aspire to achieve this by accessing and interpreting the heuristics that homo sapiens uses to take decisions, not all of which achieve optimum results, as analysed by Daniel Kahneman and Amos Tversky, recognised with a Nobel award for Kahneman twenty years ago, after Tversky’s death.
There is controversy about Kahneman’s work, reservations about replication and a basic weakness in theoretical foundations of what can appear as a string of anecdotes lacking pattern or coherence. My first step is a conference to review the application of this work in marketing, public policy and social media manipulation of clicks, and to introduce three areas of interest: first, the application to our research, of which more below, secondly, to iatrogenics (harm caused by health care institutions) and behaviour associated with the inception of cancer pathology, both consequences of human decision procedures, and thirdly, to identify neural events associated with heuristics.
METHODOLOGY
My method emulates and partially replicates Colin Foad et al. accessing nuance and ambivalences in surveys of public opinion on covid policies: Foad goes further than the frustrating single choice ‘tick box’ of common surveys.
Abstract of Foad’s study:
‘Public support for covid policy measures remains high, at risk of oversimplifying views. A two stage survey was carried out at a six month interval in the UK. Significant side effects are identified and found unacceptable on a cost-benefit analysis. The threat of covid is judged by the policy response and not by personal threat. Polling data only offer one simple perspective and not the ambivalence many people feel. The symbiotic relationship of policy and opinion impacts such policies. A power analysis indicated sample population size.’
I propose a first stage of a focus group (n=12) for a preliminary indication of reactions to our technology, followed by a survey (n=200) in depth as stage one and a second six months later of the same population. Recruitment is current via Prolific, and the experience will be managed in Qualtrics. The attraction of senescence is as an explanatory phenomenon that underlies a range of cancers.
First is a conference on the contribution of behavioural science to health research, curative and preventative. There is much to discuss in respect of replication and application of theory and practice developed over two decades since Kahneman’s Nobel award. His behavioural economics is widely applied in social media manipulation to maximise clicks, public policy nudging and in marketing, without sufficient attention to its problems, its anecdotal character with little connection to an underlying theory which I and others, at University College London for example, attempt to connect to neural events. A conference will contribute to fundamental theory. I have approached academic institutions including the UK Royal Society, Edinburgh where Foad is currently located, and UCL, where there are interested academics.
The second initiative is a limited exercise of focus groups and one to one discussion to get some indication of patient attitudes to our research and translation to clinical practice, to help develop the third stage, a survey of sufficiently large numbers to take account of the statistical variables identified in the second stage. These exercises will feed through to publication and conference(s) announcing our outcomes.
According to CRUK, 40% of cancers are associated with life stye choices. NHS England records thousands of deaths each year from iatrogenic events. Both are a product of human behaviour and choices. There is a considerable literature available in behavioural economics, the paradigm shift from economic decisions as rational and fully informed to recognising human use of heuristics, not all of which produce optimal choices. Health research is dominated by biomedicine. I suggest a rational distribution of health research efforts and resources to reflect the diversity of phenomena associated with cancer: biological, environmental and behavioural.
As a concise explanation, I repeat the Wikipedia entry on Nudge, a derivative from the Kahneman and Tversky’s behavioural economics widely practiced in public policy, social media and marketing.
‘Nudge: Improving Decisions about Health, Wealth, and Happiness is a book written by University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein, first published in 2008. In 2021, a revised edition was released subtitled The Final Edition. The book draws on research in psychology and behavioural economics to defend libertarian paternalism and active engineering of choice architecture.
‘One of the main justifications for Thaler’s and Sunstein’s endorsement of libertarian paternalism in Nudge draws on facts of human nature and psychology. The book is critical of the homo economicus view of human beings “that each of us thinks and chooses unfailingly well, and thus fits within the textbook picture of human beings offered by economists.”
They cite many examples of research which raise “serious questions about the rationality of many judgments and decisions that people make”. They state that, unlike members of homo economicus, members of the species homo sapiens make predictable mistakes because of their use of heuristics, fallacies, and the way they are influenced by their social interactions.’
As an example of nuance in expressions of human intention, I refer to The Royal Society article ‘The limitations of polling data in understanding public support for Covid-19 lockdown policies.‘ That is the sort of debate that we might have at the proposed conference, exploring nuances in the expressed attitudes of funding and health care management agencies, clinicians, patients and their associates.
My own experience of harm by the health care system led to involvement in research. Over the last six years I have joined research agencies as a lay patient adviser, currently at the global Cancer Grand Challenge, Imperial College, Oxford University, Cancer Research UK, Myeloma UK and the National Institute for Health Research, where I am an expert assessor, using my experience of published research, managed by Madeline Drake at the London Centre for Environmental Studies, data analytics and digital pattern recognition at Google DeepMind.