Malignant

How Bad Policy and Bad Evidence Harm People with Cancer

By: Vinayak K. Prasad

Narrated by: Vinayak K. Prasad

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 discusses about the many sobering examples of how patients are too often failed by cancer policy and by how oncology is practiced.

Throughout this audiobook, 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.

He 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.
• We need unbiased patient advocates and experts.

This well-designed, opinionated, and engaging audiobook 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.

PLEASE NOTE: When you purchase this title, the accompanying PDF will be available in your Audible Library along with the audio.

©2020 Vinayak K. Prasad (P)2020 Vinayak K. Prasad

fantastic

utterly changed the way I read medical literature.

am listening to it for a second time now.

Very thoughtful look at cancer policy

I am an oncologist, and Dr. Prasad outlines extremely important principles on how to interpret research studies, the conflicts and prejudices of pharmaceutical companies, the complicity of the FDA in approving marginal drugs and ways to make the system better. While aimed at a broad audience, very useful to cancer trainees as well as those practicing.

Love the book

Honest and insightful account of the current challenges and opportunities in drug development and policy from an active researcher and practitioner. I really enjoyed the book, learned a lot from it, and would recommend it highly.

Essential reading for clinicians, policymakers, and patients.

This is the best book I have read in the oncology space, ever! But its applicability is much more broad, and it should be read by involved parties in other medical specialties as well.

This is a manifesto for logical, scientific, rigorous thinking. This book appropriately rails against a dressed up, modern version of snake oil; filtered, blended, fragrances added — but still snake oil. It takes a brilliant mind to so skillfully weave together the themes covered in this book. Pay attention to this book and this author. I plan to digest, reminisce, and then come back to read again. -a physician, in training.

Must Read

For anyone and everyone. This book is interesting, therefore entertaining. Everyone will ultimately be faced with mortality. My takeaway is be cautious with headlines, do not trust FDA approval until you understand what that approval means. Many life saving drugs in the past. I don’t see it in the future. Too much money involved. Incentives galore. Good docs with no time….
Great job Prassad

Very insightful review of the trouble with science in the modern world

This book should be required reading or listening for any American that wants to have an opinion on healthcare spending.
The fact that academic research is so improperly motivated that we are trading way an incredible amount of life years for corporate profits is disgusting.

Great book but with multiple audio / reading error

Dr. Prasad has summarized many years of impactful research that he and others have done on the problem of ineffective, expensive cancer drugs being brought to market through a broken regulatory regime. The book is well written, well organized, and the arguments are compelling.

Unfortunately, near the end of the audiobook there are many (> 10) areas where Dr. Prasad repeats sentences verbatim (it seems like there were multiple takes of sentences that were not edited out). There are also several areas where he is being recorded drinking water, which is a little awkward to listen to.

A must read for Healthcare professionals!

This book is an eye opener for many aspects in cancer medicine. Topics like cancer research, conflict of interest, and the role of pharmaceutical industry in cancer management were presented in a very nice way. I recommend this book to anyone working on cancer or with cancer and to all Healthcare providers. It will give you a better understanding of cancer.

Excellent Analysis of a broken system

Everyone should read this analysis of cancer drugs. The advice to patients on how to talk to their doctors about cancer drugs is extremely helpful. I do not know if his conclusions could work, but it is nice to think that some people see a fix to a broken system.

Excellent

Best healthcare book that I’ve read in awhile (and I read a lot of them)