39. Vinay Prasad Wants to Flip Your Vote | Chemotherapy delusions, overstating benefit, trade offs, and medical reversal

Vinay Prasad pulls no punches in this wide ranging conversation about the realities (and delusions) about chemotherapy research, principle centered social media engagement, flipping votes, the FDA drug approval process, the importance of early palliative care, the dangers of embellishing therapeutic benefit, medical reversals, effective vs efficacious, and trade offs in decision making. 

Guest Bio: Dr Vinay Prasad is a practicing hematologist-oncologist and Associate Professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco.  He studies cancer drugs, health policy, clinical trials and better decision making. He is author of over 250 academic articles, and the books Ending Medical Reversal (2015), and Malignant (2020).  He hosts the oncology podcast Plenary Session. Follow Vinay on Twitter.

Episode Sponsor: 

This podcast is also brought to you by Panacea Financial, a financial services company created for doctors, by doctors -- aiming to improve the lives of physicians and physicians in training with products and services tailored to the medical community.  Spotlighted in this episode is the Panacea Financial Foundation which provides grants to underrepresented minorities in medicine. Panacea Financial is a Division of Sonabank, Member FDIC.

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For full show notes of this episode and all sorts of other goodies, visit our podcast website

We discuss:

• The realities of the dissemination of scientific information on Twitter [05:12];
• Vinay’s intent when he posts a controversial tweet [09:00];
• Why he’s an outlier in the cancer drug policy circle [16:15];
• A recent JAMA article which raises the question:  Do we have a collective delusion about the potential benefits of chemotherapy? [18:20];
• The FDA drug approval process [20:25];
• The discrepancy between what's measured in cancer clinical trials and what actually would matter to cancer patients [22:38];
• Questions to ask when being offered treatment options for cancer [24:30];
• The importance of having rich discussion with patients about treatment side effects and potential toxicities [28:30];
• The value of early palliative care and a common cognitive pitfall in oncology [31:25];
• The dangers of empathy and the better alternative:  compassion [35:00];
• Why embellishing the benefit of a treatment is the wrong thing to do [39:20];
• Prasad’s book Ending Medical Reversal and the potential harms of sudden flip-flopping of standards of care in medicine [44:00];
• The difference between ‘effective’ and ‘efficacious’ as it relates to public health and policy [47:46];
• Prasad’s thoughts on the language surrounding masks vs. the data surrounding masks [54:40];
• How not wearing a mask might be the product of a lot of long-standing failures in American economic policy and upward mobility [01:02:00];
• A deficiency of the pandemic which is to not thoroughly consider the trade-offs of the decisions we make [01:06:24];
• What the data tells us about the risk of COVID transmission in schools [01:08:34];
• And more.