在本次访谈中，执业血液肿瘤学家兼“元研究者”Vinay Prasad深入探讨了临床治疗与现有医学证据的差异，这些差异常常导致患者无效甚至有害的结果。他聚焦于肿瘤学领域的结构性问题，包括进步与资金脱节、药品成本和财务利益冲突，并提出了“癌症政策六大成功标志”作为持续对抗癌症的路线图，以避免重复过去的政策和实践错误。

🩺Vinay Prasad的双重身份：作为执业血液肿瘤学家和“元研究者”，Vinay专注于医学证据质量、卫生政策和临床试验的研究，他的独特视角为肿瘤学领域带来了深刻的见解。

🔄医学逆转：Vinay指出医学研究与实践之间的脱节，许多医疗实践基于低水平的证据被采纳，导致无效甚至有害的治疗方法。

💰肿瘤学结构性问题：Vinay列举了肿瘤学领域的几个主要问题，包括高昂的成本换来的微小改善、缓慢的研究进展、治疗决策者与支付负担不匹配等。

🌟癌症政策六大成功标志：Vinay总结出成功癌症政策的六大标志，包括独立性、证据、相关性、可负担性、可能性和议程，为未来癌症政策的制定提供了方向。

🧬肿瘤基因组测序和液体活检：Vinay还讨论了肿瘤基因组测序和液体活检等新技术在癌症治疗中的应用和前景。

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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