#133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy

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Episode: #133 - Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy
Pub date: 2020-10-21


Podcast Notes Medicine is an art: sometimes you have to make decisions with less than perfect informationThere is often a disconnect between what patients perceive as the benefit of a procedure versus what doctors know as the likely outcome Despite a lot of propaganda, we really haven’t had a lot of success in cancerOncology drug studies are conducted on patients who don’t resemble what is happening in realityNew drugs are often tested against the oldest, weakest drug in the space to prove efficacy and game the systemConflicts of interest and financial influence distort the true outcomes and benefit to the end-user We need practitioners with no financial relationship with companies that make the productDrug research needs to focus on improved quality of life, not just arbitrary cut-points (e.g, measuring tumor size)

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Vinay Prasad is a practicing hematologist-oncologist who doubles as a “meta-researcher,” studying the quality of medical evidence, health policy, and clinical trials. In this episode, Vinay discusses the differences in clinical treatment from the existing medical evidence, often leading to useless, or even harmful, outcomes for patients. With a focus in oncology, he takes a deep dive into the field’s structural problems, which include the disconnect between progress and funding, drug costs, and financial conflicts of interest. He concludes with his “six hallmarks of successful cancer policy” as a potential roadmap to sustained progress against cancer and a way to avoid repeating the policy and practice mistakes of the past.

 

We discuss:

Vinay’s background and unique perspective [3:15]; Medical reversal—the disconnect between research findings and clinical applications in medicine [10:15]; The uniquely challenging field of oncology [22:45]; The importance of bedside manner with cancer patients [30:00]; Structural problems in oncology—Problem #1: Huge costs for small improvements [37:00]; Structural problems in oncology—Problem #2: Medical reversal—when medical practices are adopted based on low levels of evidence [40:15]; Structural problems in oncology—Problem #3: Slow progress in cancer research (despite all the hype and propaganda) [45:00]; Structural problems in oncology—Problem #4: The burden of payment is not matched with those making treatment decisions [54:45]; “No-brainer” moves in oncology [1:06:45]; “Fool’s gold” treatments in oncology [1:09:30]; The six hallmarks of successful cancer policy [1:16:00]; Cancer policy hallmark #1: Independence [1:18:00]; Cancer policy hallmark #2: Evidence [1:28:15]; Cancer policy hallmark #3: Relevance [1:31:30]; Cancer policy hallmark #4: Affordability [1:32:00]; Cancer policy hallmark #5: Possibility [1:47:00]; Cancer policy hallmark #6: Agenda [1:52:00]; Tumor genome sequencing and liquid biopsies [1:54:30]; Vinay’s clinical philosophy, being skeptical without being too contrarian, and practicing medicine without perfect information [2:03:30]; and More.

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