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Malignant: How Bad Policy and Bad Evidence Harm People with Cancer
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About Malignant: How Bad Policy And Bad Evidence Harm
Product Description How hype, money, and bias can mislead the public into thinking that many worthless or unproven treatments are effective. Each week, people read about new and exciting cancer drugs. Some of these drugs are truly transformative, offering major improvements in how long patients live or how they feel―but what is often missing from the popular narrative is that, far too often, these new drugs have marginal or minimal benefits. Some are even harmful. In Malignant, hematologist-oncologist Dr. Vinayak K. Prasad writes about the many sobering examples of how patients are too often failed by cancer policy and by how oncology is practiced. Throughout this work, Prasad illuminates deceptive practices which • promote novel cancer therapies long before credible data are available to support such treatment; and• exaggerate the potential benefits of new therapies, many of which cost thousands and in some cases hundreds of thousands of dollars. Prasad then critiques the financial conflicts of interest that pervade the oncology field, the pharmaceutical industry, and the US Food and Drug administration. This is a book about how the actions of human beings―our policies, our standards of evidence, and our drug regulation―incentivize the pursuit of marginal or unproven therapies at lofty and unsustainable prices. Prasad takes us through how cancer trials are conducted, how drugs come to market, and how pricing decisions are made, asking how we can ensure that more cancer drugs deliver both greater benefit and a lower price. Ultimately, Prasad says, • more cancer clinical trials should measure outcomes that actually matter to people with cancer;• patients on those trials should look more like actual global citizens;• we need drug regulators to raise, not perpetually lower, the bar for approval; and• we need unbiased patient advocates and experts. This well-written, opinionated, and engaging book explains what we can do differently to make serious and sustained progress against cancer―and how we can avoid repeating the policy and practice mistakes of the past. Review Malignant is punchy and persuasive, and the author is clearly in command of his subject matter. Prasad offers valuable advice on how to keep up with research as well as the appropriate way to analyse clinical trial reports. -- Talha K Burki ― The Lancet Hematology Aimed at general readers (including patients), oncology trainees and experts in health-care policy, it informs and disturbs throughout. -- Andrew Robinson ― Nature Patients should ask their oncologist how good the cure is: do I really live longer and better than doing "nothing"? Let them start by asking whether their doctor has read Prasad's book. ― Zurich Weekly News Review Prasad does a commendable job demonstrating how lax standards of evidence and regulations, coupled with the profit-driven pharmaceutical industry, result in a lot of poorly effective or ineffective (but very expensive) drugs being used on cancer patients in the United States and worldwide. There isn't anything quite like this book out there. -- Kenneth W. Lin, MD, MPH This important book tackles a very topical and controversial subject in a scholarly, original, and skeptical (but not too cynical) way. Prasad's iconoclastic position will hopefully contribute to reflections on how to change some paradigms in cancer medicine. An essential read for oncologists in training, people in the drug industry, and health care policymakers. -- John A. Hickman Prasad outlines a plan that will educate consumers about how we ended up in our current predicament and explain what we can do to extricate ourselves from it. I highly recommend this book to patients, patient advocates, and all physicians―not just oncologists. -- Ameet Sarpatwari An insightful, well-written, and important book. Prasad has a masterful understanding of the issues he presents, weaving them into a compelling story. -- Christopher Booth, MD Oncology drug develop
