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

Oct 19, 2020

Vinay Prasad, a practicing hematologist-oncologist and associate professor at UC San Francisco, dives deep into the challenges of oncology. He discusses medical reversals, emphasizing the disconnect between clinical practice and robust research. Prasad highlights the high costs of cancer treatments versus their benefits, and the ethical dilemmas posed by financial interests in medical decisions. He concludes with his six hallmarks of successful cancer policy, offering a roadmap for meaningful progress in the fight against cancer.

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ANECDOTE

Insufficient Progress

Vinay Prasad recalls a drug that improved median survival for a cancer from six to eleven months.
His friend, without medical training, criticized this as insufficient progress, highlighting the need for higher aspirations in oncology.

INSIGHT

Marginal Benefits

New cancer drugs offer modest survival benefits, averaging 2.1 months based on 71 approved drugs.
These minimal improvements raise concerns given their high costs, often exceeding $100,000 annually.

ANECDOTE

Clinical Trial vs. Real World

Clinical trials select healthier patients, leading to inflated drug efficacy results.
A real-world study of the liver cancer drug sorafenib showed median survival of only four months, half that of the placebo group in the trial.

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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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