The New “Political” Science: Avastin Breast Cancer Debate Exposes Paradox and Contradictions

The FDA’s recommendation to rescind Avastin’s metastatic breast cancer indication provoked a mix of commentary, commendations, and outcry from across the spectrum of stakeholders with an interest in the decision – and in what the decision might mean for the future: the future of cancer therapy approvals, evidence-based medicine, coverage for off-label use, drug pricing, and healthcare rationing … among other things.

This debate lies at the center of a tangled web of science, psychology, politics, economics, and ethics. Science and psychology, in particular, collide here in a way that reminds us of the challenge of selling the public on evidence-based medicine.

We are built by evolution to see cause-and-effect. The subset of women with metastatic breast cancer who have done well on Avastin almost cannot help but believe that they have done well because of Avastin. And it is no easy thing to overcome this built-in visceral conviction with the dry logic of rationality or the weight of evidence from patients treated in groups rather than as individuals.