It is no longer necessary to recall the permeability of entire sections of academic research to theories themselves arising from the French Theory and deconstructivism at all costs. Initially confined to the human and social sciences, this groundswell is now affecting the hard sciences, since lofty articles such as "Queer identity and theory intersections in mathematics education: a theoretical literature review" or "A quantum physics explanation for polyamory, BDSM, and queer people" are now commonplace (1, 2). 

In the USA, this trend and in particular the emergence of the Critical Race Theory (or Critical Race Theory) is now affecting medical sciences and it is with a mixture of amusement and dismay that we see the blossoming, in the major international conferences usually held in North America, of lunar works now aiming to denounce the endemic and patriarchal WASP systemic racism in the care of patients with cancer. 

 Historically, two North American learned societies have dominated global cancer research: the all-powerful American Association for Cancer Research (AACR) rather dedicated to fundamental and translational research, and no less powerful American Society of Clinical Oncology (ASCO) dedicated to clinical research. These associations are also publishers of reference journals in the field with their flagships (Cancer Research for the AACR, and the Journal of Clinical Oncology for ASCO, both with high Impact Factors), plus half a dozen sister journals that are also authoritative. Having one's work selected for presentation at AACR or ASCO is a consecration for any researcher or oncologist and legitimacy of one's contribution to the fight against cancer, often prior to an international publication. When these two societies hold their annual meetings, it attracts tens of thousands of researchers and oncologists from around the world - these events are an opportunity to network, to obtain previews of clinical trial results or to identify new emerging therapeutic strategies, and generally to update one's knowledge in the always very fertile field of experimental or clinical research against cancer.  

Proof of the Woke wave that is now hitting all areas of academic research, we see at these congresses in the USA a flourishing of astonishing works, imbued with this new obsessive tendency to demonstrate that racial minorities are victims, including in the face of illness, of a deleterious stigmatization. The exponential multiplication of these works testifies to the provision of funds to finance this type of equally exponential research, and the opening of richly endowed calls for tenders to no longer develop new treatments or support patients, but now demonstrate the existence of systemic racism in the oncology community: there are clearly new priorities, new diagnostic or treatment tools will have to wait. On the AACR side, which focuses on cancer biology and pharmacology, we are struggling to get on the bandwagon: genes, chromosomes, signaling pathways, tumor cells, pharmacodynamic effectors and other mice nude are strangely impervious to intersectional struggles, and what's more, have difficulty being re-educated to think properly. And studies in pharmacogenetics, which explore the genetic dysregulations influencing the fate of certain drugs in the body, have not, for example, waited for the French Theory to demonstrate that inter-ethnic inequalities owe nothing to systemic racism but everything to genetics. Thus, since the 90's and 2000's it has been demonstrated that the polymorphisms of certain genes such as the gene DPYD involved in the metabolism of cancer chemotherapy drugs, for example, predispose African-American populations and women to experience chemotherapy-induced overtoxicity with certain treatments (3), while white and Asian populations are more affected by other genetic polymorphisms affecting the gene CYP2D6 compromising the effectiveness of certain hormone therapies in breast cancer (4). In pediatric oncology, tolerance to a chemotherapy widely used in childhood leukemia is governed by two genes, the gene TPMT not experiencing ethnic influence, while the other, NUDT15, is more frequently mutated in young Asians and Mexicans (5). Elsewhere, it has been shown that it is on the contrary Asian populations that are most advantaged in the management of lung cancer with certain targeted therapies, due to a pharmacogenetic profile that is this time more favorable to them (6). Nothing systemic or systematic here therefore: chromosomes have no use for the reading grids and intellectual blinkers of Critical Race Theory.    

On the ASCO side, however, it's an open bar: clinical research becomes a vast playground to demonstrate at all costs that oncology is essentially a racist medical specialty. Even if, as we will see, it means taking some liberties with methodological rigor and the most basic statistics - but in the end, since all modern experimental science and in particular evidence-based medicine (7) was forged by white scientists over the age of 50, not applying its precepts is ultimately consistent with the initial statement. If medicine is intrinsically racist since it is white, why then use a scientific methodology that has certainly proven itself and brought astonishing progress to humanity throughout the XNUMXth century?^eme century, but comes from this same endemic and criminal racism? 

So, at the last ASCO annual meeting in Chicago in June 2022, I was quite perplexed by these young researchers proudly presenting their doctoral work now entitled "Racial/ethnic Disparities in locoregional recurence of hormone-receptor positive node-negative breast cancer patients" (8) or even this cute "Real World outcomes of Black VS. Non-Hispanic White women with advanced triple-negative breast cancer treated with immune checkpoint inhibitors at an urban cancer center" (9). More recently at ASCO-GI, another ASCO Meeting specializing in digestive cancers (San Francisco, January 2023), similarly multiple presentations now revolved around themes such as "Disparities in Late stage Pancreatic Cancer: retrospective analysis of genomic testing and outcomes between Hispanics and Non-Hispanics" (10) while a bizarre "Women's Networking Reception" evening was organized on the congress site itself. This event was obviously forbidden to their male research colleagues or oncologists, probably to avoid a gender bias in the discussion or planning of new cancer research projects (as it is true that scientifically speaking, it is well known that mixing men and women could harm the healthy intellectual emulation necessary in research). However, proof of the great open-mindedness of the organizers: black and white women could still mix freely. Finally, a space delimited by barriers had been set up in the middle of the exhibition hall of the Moscone Center in San Francisco, in which a hundred women found themselves herded, while the rest of the congress participants went about their business, giving ASCO-GI 2023 a touch of a scientific meeting in Afghanistan – Wokism has its reasons that reason ignores.  

In the end, we will learn without surprise that indeed, most of the time being Black in the USA (only North American and more rarely Canadian teams engage in the exercise) is associated with either a higher incidence, or reduced survival, or an increased risk of toxicity of treatments, QED.  

QED? Actually, not quite: almost all of the work on the influence of ethnic origin in the management of cancer pathology is based on a statistical analysis in univariate mode, that is to say disconnected from all of the variables of interest that are also likely to impact the primary judgment criterion. From a methodological point of view, the analyses were in fact most often based on a simple monoparametric Student test or a one-way ANOVA with a multiple comparison test of the Tukey or Newman-Keuls type if several groups are to be compared on the same measure of interest – I define and measure my primary judgment criterion (overall survival, or response rate for example) in distinct populations (black VS. non-black for example), I set my alpha risk (5% most often) and I run an unpaired t-test. Bingo: as mentioned previously, ethnic origin is most often used in a pejorative way to the detriment of the black community – or sometimes Hispanic: clearly, the fate of Asians does not give rise to funding that justifies our interest in it.  

However, any first-year college student knows that correlation and statistically significant link do not mean causality – the presence of confounding factors or collinearity phenomena are elementary biases that must be rejected by ad-hoc tests – usually Cox models and multivariate analyses make it possible to easily and quickly remove these possible biases, as long as the sample size is sufficient. This is the so-called "ice-cream" effect, well known in statistics: it has been established that ice cream consumption in California predisposes to shark attacks. Not that eating ice cream makes surfers taste better (the shark is not, in any case, very much into pistachio-strawberry) – but ice cream consumption peaks on the hottest days of the year, which coincides with a greater probability of going swimming too and therefore of coming across a Great White – the confounding factor explaining the correlation devoid of causality between ice cream consumption and shark attacks here being seasonality – a multivariate analysis including, beyond ice cream, the time of year where simply the outside temperature would have allowed the p to rise well beyond the alpha risk of 5% and therefore exclude any direct link between ice cream consumption and shark attacks, which is what the univariate tests suggested, if one was not careful.  

In the area of ​​inter-ethnic differences supposedly demonstrated at ASCO, we are similarly struck by the absence of a multivariate approach including in particular income and generally the socio-educational level of the populations compared. In the USA, a country in which the quality of care and access to expensive care is not universally acquired as in France but depends on the level of private insurance that you can afford, it does not take a genius to imagine that sociologically the black minority being economically impoverished and disadvantaged, its access to care or clinical trials is affected - in fact the only two studies presented at ASCO in Chicago last June that risked doing multivariate analyses including in particular "Household income", the income of the household, no longer found ethnicity as a pejorative factor, crushed as it was by the statistical weight of the socio-economic level of the patients, indistinctly from the color of their skin. In short, it is the fact of being poor and uneducated, more than being black or Hispanic, which in the USA shortens the survival of patients, exposes them to more marked side effects because they are insufficiently taken into account, or increases the risk of cancers due to less effective access to screening, more anxiety-provoking living conditions, a job or housing exposing them to potential carcinogens, or a less balanced diet. In other words, yes, being black and having cancer in the USA constitutes a priori a risk of excess mortality, because statistically, being black is more likely to also come from a socio-economically disadvantaged background – but the white, poorly educated and poor patient will have a higher risk of excess mortality from cancer than a black, educated and wealthy patient. A multifactorial reality much more complex than what the Woke ready-to-think and Critical Race Theory currently suggest, and recently highlighted in a remarkable and courageous article by researchers at the John Hopkins Cancer Center in Baltimore, demonstrating that obesity, educational level and income explained the higher incidence of triple-negative breast cancer in the African-American population, plus genomic factors (see above) – without a trace of systemic racism or any white privilege at work in the field of clinical oncology (11). Oddly enough, the methodological weakness of the studies presented at major international conferences such as ASCO concerning ethnic disparities does not seem to shock anyone – the rare studies in multivariate analysis having taken careful care not to include the socio-economic criterion or the educational level in their final analyses, so as not to obliterate the ethnic parameter. Moreover, the doctoral students that I was able to approach and that I questioned about their work and the statistical weakness of their studies were on the defensive, and sometimes quite aggressive, in the face of any questioning of their conclusions – which reminded me of that old refrain of totalitarian trials: “Present me a culprit, and I will make up the crime for you”. Here, the designated culprit being white oncological medicine, suggesting that the inequalities observed remain above all social and/or economic, and not racial, unfortunately did not fit into their initial postulate of a systemic white racism inherited from Critical Race Theory. 

In the end, we remain perplexed and worried by this growing wave of studies – on the one hand because it now captures a substantial share of NIH-type funding that could be allocated to more useful work in the fight against cancer – and on the other hand because it demonstrates that when the facts are stubborn, it is now enough, even in this temple of knowledge that is a major international scientific conference, to hide them in order to avoid having to invalidate an initial hypothesis. However, a hypothesis that cannot be invalidated is transformed into a postulate, then into an axiom, and finally quickly into a dogma – while science has nothing to do with dogmatism and everything to do with doubt and objective and agnostic experimentation. When politics gets involved in science, the latter loses its primary purpose, access to objective knowledge – to become a simple agent in the service of fashionable intellectual propaganda. All great totalitarianisms proceed in the same way – infiltrate culture, rewrite history, reinvent language and finally, manipulate science to control minds and transform hypotheses into dogmas. We are getting very close to this in the field of clinical cancerology. 

References

1. Moore AS. Queer identity and theoretical intersections in mathematics education: a theoretical literature review. Mathematics Education Research Journal, Volume 33, Issue 4, p.651-687
2. https://thenextweb.com/news/a-quantum-physics-explanation-for-polyamory-bdsm-and-queer-people
3. Mattison LK, Fourie J, Desmond RA, Modak A, Saif MW, Diasio RB. Increased prevalence of dihydropyrimidine dehydrogenase deficiency in African-Americans compared with Caucasians. Clin Cancer Res. 2006 Sep 15;12(18):5491-5.
4. Katoh T, Higashi K. Ethnic differences of the primary gene defect at the cytochrome P-450 2D6. J UOEH. 1992 Sep 1;14(3):205-9.
5. Yang JJ, Landier W, Yang W, Liu C, Hageman L, Cheng C, Pei D, Chen Y, Crews KR, Kornegay N, Wong FL, Evans WE, Pui CH, Bhatia S, Relling MV. Inherited NUDT15 variant is a genetic determinant of mercaptopurine intolerance in children with acute lymphoblastic leukemia. J Clin Oncol. 2015 Apr 10;33(11):1235-42.
6. Sekine I, Yamamoto N, Nishio K, Saijo N. Emerging ethnic differences in lung cancer therapy. Br J Cancer. 2008 Dec 2;99(11):1757-62.
7. Bet WF. Finding truth from the medical literature: how to critically evaluate an article. Prim Care. 2006 Dec;33(4):839-62. 
8. ASCO Meeting Chicago IL USA Abstract 515, DOI: 10.1200/JCO.2022.40.16_suppl.515 Journal of Clinical Oncology 40, no. 16_suppl (June 01, 2022) 515-515.
9. ASCO Meeting Chicago IL USA Abstract 1074, DOI: 10.1200/JCO.2022.40.16_suppl.1074 Journal of Clinical Oncology 40, no. 16_suppl (June 01, 2022) 1074-1074.
10. ASCO-GI Meeting San Francisco CA USA Abstract 663 DOI: 10.1200/JCO.2023.41.4_suppl.663 Journal of Clinical Oncology 41, no. 4_suppl (February 01, 2023) 663-663.
11. Siddharth S, Sharma D. Racial Disparity and Triple-Negative Breast Cancer in African-American Women: A Multifaceted Affair between Obesity, Biology, and Socioeconomic Determinants. Cancers 2018, 10, 514.