Taking a critical approach to precision oncology

  • June 27, 2022
Taking a critical approach to precision oncology

Ben Chin-Yee talks about his PhD on the ethics of precision oncology and how that is informed by his experience as a doctor.

I want to ask basic questions about what precision therapies are and how we communicate with patients about them and engage them in shared decision-making.

Ben Chin-Yee

Precision medicine offers huge possibilities for patients with cancer, but we risk in some cases falling for hype and spin if we do not take a critical approach and ask the right questions about what it is for, what its limits are and how we communicate that to patients, according to Ben Chin-Yee [2022]. 

His PhD, which he starts in the autumn, will study just that and comes after several years spent working as a doctor, including working through the Covid pandemic in internal medicine and haematology. 

In his work in haematology in Canada he saw up close the potential of new research in precision medicine based on technology and data.  He says: “I am excited by the developments and scope for targeted therapies, but I also recognise that without the sober critical thought about them we risk being persuaded by hype, misleading patients and doing harm.”  

Ben, who has first-hand experience of supporting a friend going through a new treatment, adds: “I hope my PhD will cut through these issues. I want to ask basic questions about what precision therapies are and how we communicate with patients about them and engage them in shared decision-making. It’s easy to be seduced by shiny new advances in cancer medicine and to hope they will translate into improvements in patient care, but there is a need for a critical dialogue about what is novel and what is impactful.” 

Childhood

Ben was born in London Ontario to a medical family. Both his parents are in medicine. His father is a haematologist and his mother a GP and psychotherapist. His older brother is a palliative care physician Growing up, Ben would visit the hospital and the laboratory regularly and acknowledges that that had a big influence on his career path and on his desire to help others. 

Nevertheless, he was always encouraged by his family to pursue diverse interests and was fascinated by the arts and humanities, particularly philosophy and history. He was very involved in musical theatre at school and played cello from a young age. He played in a string quartet in his home town and, along with his sister, was in a professional production of The King & I at the Stratford Festival of Canada when he was 12. 

Undergraduate studies

When Ben finished school he applied to do a biology degree at McGill University in Montreal. He was not sure at the time if he wanted to work in academia or to be a doctor. Biology was a broad enough umbrella to encompass his interests, with, for instance, philosophy and history forming part of his classes on evolutionary biology. Ben was particularly drawn to the philosophy of science and medicine. He was thinking about medical school, but, having attained enough credits, he applied to spend his fourth year – 2012/13 – as a visiting student at Fitzwilliam College in Cambridge. It was an opportunity to take more classes in the history and philosophy of science. “That was an a-ha moment for me,” he says. “This field was asking the kind of questions I had been interested in for a while, but had not articulated yet. It was about thinking critically about science, about what knowledge is and about what questions science can answer.” 

While he was in the UK, Ben applied to medical school at the University of Toronto and was also encouraged to apply for a master’s in the History and Philosophy of Science at the Institute for the History and Philosophy of Science and Technology in Toronto. He was accepted for both and decided to do the master’s part time over two years while he was studying medicine. “I think it was one of the best decisions I took and I am grateful to my mentors and supervisors in both areas for their support,” says Ben. 

When he finished the master’s he still had two years left of his medical training. These were mostly practical. He then completed a three-year residency in internal medicine from 2017 to 2020. Ben knew he wanted to do a PhD and had kept in touch with people in Cambridge, but he was also keen to finish his general and specialist medical training and get his practice licence in order to be able to contextualise the philosophical questions he had.  

Covid

Then Covid struck and everyone in the medical profession had to pull together. A lot of the health demands fell on trainees and residents.  “It was eerie. The streets were dead. There was a lot of fear and uncertainty and lots of cases in the hospital,” says Ben.  Medical staff had to go through a decontamination process on going home. Early on, there was a shortage of protective equipment, with doctors having only two masks for a 24-hours shift.

Over the past two years, Ben has been working mainly with cancer patients, many of whom have been especially impacted by the pandemic, with delays in treatment and being unable to see their families when in hospital 

The situation has eased in the last months, but immuno-compromised patients still face very real risks. Ben says burnout rates are very high despite his department being very supportive.  

His glimmer of hope after what he describes as two “hellish years” was his plan to do a PhD. “It was always at the back of my mind. We all sacrificed a lot in the pandemic. I didn’t want to put it on hold any longer. It was really important to me,” says Ben. “My years of clinical training reinforced for me the relevance of the philosophical questions I wanted to pursue and Covid made them very apparent – the importance of having a critical perspective at a time when medicine and healthcare are at the forefront of the public consciousness and when scientific developments are now a part of public debates. We need to ensure the approaches we are taking are doing good.” 

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