Speaker Connects Alfred Hitchcock with Clinical Trials

Alfred Hitchcock and randomized clinical trials seem like two entirely separate topics. The former is considered to be one of the greatest directors of all time, and the latter is necessary to make sure a certain medical treatment is safe and effective. It may seem preposterous to compare the two, but on Friday, Nov. 9, Dr. Richard Legro ’79 gave a lecture on how similar they actually are.

Legro has an illustrious academic and medical history: he went to medical school in Germany, got his clinical degree at Mt. Sinai, did a residency at the University of Pittsburgh and had a fellowship at the University of Southern California. However, during his time at the College, Legro was an English major and did not take any of the pre-med requirements.

Rather, he was fascinated by literature and film.

Legro opened the lecture by asking the audience if they knew who Alfred Hitchcock was. After the laughter died down, Legro explained that his talk would describe why randomized clinical trials are important and what Hitchcock can teach us about clinical trials.

Before diving into the meat of the lecture, Legro first touched upon the misconception that “great art and science are the work of individual geniuses working in solitude.” He noted that we tend to over-romanticize medicine, providing examples of “solo” scientists such as Alexander Fleming, who discovered penicillin. However, no one person achieved these breakthroughs alone — for instance, once penicillin’s use was discovered, there were hundreds of people mass-producing the penicillin mold to extract the antibiotic.

Randomized clinical trials (RCT) decrease biases from both investigators and subjects. The randomization aspect prevents such biases. Legro then explained another reason why RCTs are needed — to “eliminate common but ineffective, established treatments.”

He then delivered the gist of the lecture: RCTs are analogous to films such as Hitchcock’s because they are costly and time intensive, and require planning, expertise and complex interactions between stakeholders. In addition, both films and experimental results can be interpreted in many ways. Legro gave the example of silent movies, where the lines in the dialogue box could change the tone of the moving images from dramatic to satirical. The same can be done with experimental results — the “producers” can choose to show the “audience” what they feel the audience wants to see. He explained that this is not science, but rather, marketing.

Legro gave the example of a hormone treatment for menopause. It was widely advocated based on “perceived health benefits.” However, pharmaceutical companies were advertising this treatment before all of the clinical trials had been completed. Legro made a dark comment: “How could they know [the pros and cons] when the facts weren’t in yet?” Companies were advertising a product that had unknown side effects. Finally, a RCT was done, and found that there were many problems with the hormone treatment, including blood clots, heart disease, breast cancer and dementia. Expectedly, prescriptions decreased.

In addition to the “selling point” aspect, Hitchcock’s films can teach scientists about the importance of cooperation, planning and having a team of experts working in tandem to produce the best results. Legro noted that “scientists must lead trials from conception to completion by developing protocols, analyzing results, presenting and publishing data and publicizing it to colleagues and laypeople.” Also, Hitchcock chose important, captivating themes such as death, love and sex. Legro drew scientific comparisons to these themes: respectively, survival from cancer, infertility treatments and erectile dysfunction, all of which are important to either survival or quality of life. Legro also said that Hitchcock’s films were produced efficiently and swiftly because of all the meticulous planning that went into the storyboarding. By focusing on the planning stages and putting effort into a storyboard — or a scientific protocol — the filming (or experimenting) can go much smoother. Lastly, Hitchcock’s famous MacGuffins (the thing that everyone is chasing after in the movie) also make appearances in the scientific world. Researchers may think they are pursuing one goal, but could end up finding an entirely different result.

At the end of the lecture, Legro encouraged students to think independently and “turn off the internet.” He emphasized the importance of planning and preparation as the keys to realizing project goals. He also made clear that, as scientists or doctors, standing on the “shoulders of giants” is essential to scientific prowess.

Finally, Legro called attention to the success of scientists who build on other people’s work and work with others who are doing great work.

“There is no I in auteur,” he said.