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  • Malignant

  • How Bad Policy and Bad Evidence Harm People with Cancer
  • By: Vinayak K. Prasad
  • Narrated by: Vinayak K. Prasad
  • Length: 7 hrs and 23 mins
  • 4.9 out of 5 stars (22 ratings)
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Malignant cover art

Malignant

By: Vinayak K. Prasad
Narrated by: Vinayak K. Prasad
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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 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

What listeners say about Malignant

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Coherent and great

I have read quite a few of Prasad’s papers and listened a lot to his podcast Plenary Session. It was still very nice to get a thorough summary of his work and thinking in longform. I am a doctor, but not in oncology. I think this book is mostly for health care professionals and for the odd very interested lay person

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Fascinating dissection of how and why the cancer treatment system is broken

Prasad delivers an incisive insider analysis of why the system of treatment of cancer is failing patients so badly and what could be done to improve it. This is focused on health policy, especially in the US, rather than biomedical science and aims to be understandable to a wide audience. The scale of the problem of vested interests and perverse incentives is astonishing. Prasad strives to be constructive in his critique, and certainly could have been harsher on pharma- he always gives the benefit of the doubt in terms of motivation and steers clear of the more egregious wrongdoing by drug companies. Overall an excellent and timely book. Thought provoking and sobering.

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