Reviews
Tahla Burki in the Lancet Haematology. 2020
- Gavin Jones, MD, American Society of Radiation Oncology Book Club
A Philosophical Review by Ben Chin Yee
Summary
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
• 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.
““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, Queen’s University at Kingston Cancer Research Institute”
Ending Medical Reversal
Improving Outcomes, Saving Lives
Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD
Book Review from the New York Times
Jacket Summary
We expect medicine to progress in an orderly fashion, with good medical practices being replaced by better ones. But some tests and therapies are discontinued because they are found to be worse, or at least no better, than what they replaced. Medications like Vioxx and procedures such as vertebroplasty for back pain caused by compression fractures are among the medical "advances" that turned out to be dangerous or useless. What Dr. Vinayak K. Prasad and Dr. Adam S. Cifu call medical reversal happens when doctors start using a medication, procedure, or diagnostic tool without a robust evidence base—and then stop using it when it is found not to help, or even to harm, patients.
Drs. Prasad and Cifu narrate fascinating stories from every corner of medicine to explore why medical reversals occur, how they are harmful, and what can be done to avoid them. They explore the difference between medical innovations that improve care and those that only appear to be promising. They also outline a comprehensive plan to reform medical education, research funding and protocols, and the process for approving new drugs that will ensure that more of what gets done in doctors’ offices and hospitals is truly effective.
“An outstanding, genre-defining work, this book will be read by students, educators, policymakers, scientists, scholars, medical skeptics, and health-care pundits alike.”
“An important book that frames medical reversal in a compelling way. Readers will be drawn to this clearly written account.”