Podcast Summary
A Leading Voice in Medical Research and Policy: Vinay Prasad, a hematologist and oncologist, shares his journey into medicine and how his experiences led him to focus on healthcare's inconsistencies and structural failures. He discusses six hallmarks of cancer policy, offering insights into challenges and potential solutions.
Vinay Prasad, a practicing hematologist and oncologist and associate professor of medicine at UC San Francisco, is a leading voice in the field of medical research and policy. With over 250 academic articles and two books under his belt, Prasad is known for his work on the quality of medical evidence, particularly in oncology. In this podcast episode, Prasad shares his journey into medicine and how his experiences in clinical practice and research led him to focus on the inconsistencies and structural failures in healthcare. He also discusses his six hallmarks of cancer policy, providing valuable insights into the challenges and potential solutions in the field. Despite the two-hour-long conversation, Prasad's ability to articulate complex ideas in clear and accessible ways left Peter Atia constantly impressed. Whether you're a healthcare professional or simply interested in the latest developments in medical research and policy, this episode offers valuable insights from a unique perspective.
A complicated journey to medicine: Despite initial interest in philosophy, the speaker eventually found fulfillment in the decision-making aspects of medicine during clinical rotations, overcoming initial challenges and academic rigor of medical school.
The speaker's decision to pursue a career in medicine was not a straightforward one. He initially majored in science in college but was drawn to philosophy and ended up studying both. His interest in medicine developed later in life, and when he attended medical school at the University of Chicago, he found the environment to be intense and challenging. He felt frustrated during the first two years of medical school, which were primarily focused on memorization, and found the decision-making aspects of medicine and patient interaction more fulfilling during his clinical rotations in his third year. Despite the challenges, the speaker persevered and went on to have a successful career in medicine. The discussion also highlighted the existence of a perceived East Coast-West Coast divide in medical education during the speaker's time, with some institutions viewed as more academically rigorous and demanding than others.
Sparked by disconnect between clinical practices and research: Career in medical research born from desire to bridge gap between clinical practice and best available evidence, with example of overuse of stents leading to unnecessary procedures and costs.
The speaker's interest in medical research was sparked during his residency when he noticed a disconnect between clinical practices and the best available evidence. He began conducting studies to understand this phenomenon, which came to be known as "medical reversals." The speaker, who had initially planned on a career in private practice, found himself drawn to research and eventually built a career in health policy research. A key example of this disconnect is the use of stents, which are effective in critical situations but have been overused for less severe conditions, leading to unnecessary procedures and costs. The speaker's book tells the story of a woman who suffered complications after receiving a questionable stent placement. In summary, the speaker's career in medical research was born out of a desire to bridge the gap between clinical practice and the best available evidence.
Doctors' beliefs vs patients' expectations for angioplasty with stenting: The gap between doctors' knowledge and patients' beliefs about the effectiveness of angioplasty with stenting can lead to unnecessary risks and complications, driven by psychological and financial incentives for doctors.
There's a disconnect between patients' beliefs and doctors' knowledge regarding the effectiveness of certain medical procedures, specifically angioplasty with stenting for chronic stable angina. This disconnect can lead to unnecessary risks being taken without any clear benefit. The psychological and financial incentives for doctors to perform these procedures can create a powerful addiction, making it difficult to challenge the status quo despite evidence suggesting placebo effects. As a resident, witnessing complications and the potential conflict of interest further fueled my curiosity and commitment to understanding why we do what we do in medicine.
Placebo Effect in Medical Interventions: Studies reveal that placebo effects can produce similar results as actual medical interventions for subjective symptoms. Understanding this phenomenon is crucial for rigorous research and separating fact from fiction in medical practice.
The privilege of observing various medical practices as a student exposes the presence of research pitfalls and evidence-based issues in different clinical settings. For instance, studies show that mechanical interventions for subjective symptoms like pain or discomfort often yield no better results than sham interventions, where the patient receives a placebo treatment or a simulated procedure without any actual benefit. This phenomenon, known as the placebo effect, highlights the importance of separating the psychological benefits of treatment from the physical intervention itself. In the Orbiter trial, for example, stenting for chronic stable angina did not yield statistically significant or clinically meaningful improvements in exercise capacity compared to a sham procedure, suggesting that the perceived benefit may be largely psychological. Understanding this theme can provide valuable insights into the complexities of medical practice and the importance of rigorous research to separate fact from fiction.
Personal experiences and mentors shape oncology career: Choosing oncology: Personal experiences & mentors played crucial roles. Transformative first year. National Cancer Institute's impact on cancer research and treatment.
Becoming an oncologist involves making important decisions influenced by personal experiences and mentors. The speaker chose oncology after having positive experiences with oncologists during his internal medicine training. His first year as an oncology fellow was transformative, marked by a steep learning curve and exposure to various diseases and treatments. The National Cancer Institute, where he spent a significant part of his training, is a unique and awe-inspiring place, known for its historical significance in advancing cancer research and treatment. The speaker's experiences highlight the impact of personal connections and experiences in shaping one's career path in medicine.
Navigating the Complexity of Oncology for Medical Trainees: Focus on patient care, learn systematically, improve bedside manner, and acknowledge the emotional demands of oncology to make a difference in patients' experiences.
While cancer may be a category term, it encompasses a vast array of complex and diverse diseases. For medical trainees, navigating this complexity can be challenging. However, focusing on patient care and learning as much as possible in a systematic way can help. Bedside manner, an essential aspect of patient care, is an area for constant improvement. Oncology is not solely about doom and gloom but also about managing a range of medical experiences, from curable conditions to end-of-life care. Doctors must acknowledge the tension between the demanding nature of the practice and the privilege of being intimately involved in patients' lives. By taking bedside manner seriously and striving for improvement, doctors can make a significant difference in their patients' experiences.
Delivering difficult news with grace and emotional support: Compassionate oncologists understand the importance of delivering difficult news with grace and emotional support, making a significant difference for dying patients.
Being a compassionate and caring doctor goes beyond just treating medical conditions. The story shared highlights the importance of delivering difficult news with grace and emotional support. Senior oncologists, who have been practicing for decades, understand the significance of these moments and continually strive to improve their approach. It's essential to remember that patients who are dying need our support more than ever, and the words we use and the way we deliver news can make a significant difference. In oncology, it's not just about prescribing the right treatment; it's about being there for the patient in their moment of need. This compassionate approach is what makes oncology, and healthcare in general, a rich and interesting field.
Limited benefits and high costs of new cancer drugs: The average benefit of a new cancer drug is only 2.1 months, and costs often exceed $100,000 per year, raising questions about their value and sustainability.
The current state of oncology research and drug development is not meeting the desired goals for improving patient outcomes and longevity. The speaker shares a personal experience of feeling unsatisfied with the limited benefits and high costs of newly approved cancer drugs. This led him to investigate the reasons behind the proliferation of "me too" drugs and the lack of transformative treatments. The average benefit of a new cancer drug is only 2.1 months, and the high costs, often exceeding $100,000 per year, raise questions about the value and sustainability of this approach. The speaker's journey to understand these issues and share his findings led him to write a book, "Malignant," which explores the structural problems in the cancer drug space and drug policy. The underlying theme is the need for a reversal in the current trend and a focus on developing fewer but better, more transformative drugs for cancer patients.
Reversing Medical Practices: Hormone Therapy and Premature Ventricular Contractions: Medical practices can be reversed when rigorous trials reveal they don't work or increase risks. Importance of testing assumptions, understanding relative vs absolute risks, and continued research in oncology.
Medical practices, even those widely adopted and supported by observational studies, can be reversed when rigorous, randomized controlled trials reveal they don't work as intended or even increase risks. Examples include hormone therapy for women and suppressing premature ventricular contractions with certain drugs. These reversals occur frequently across various domains of medicine and highlight the importance of testing assumptions with well-designed studies. The distinction between relative and absolute risks is also crucial in understanding the implications of such studies. In the context of oncology, despite the propaganda suggesting success, we have had limited achievements against many diseases. This underscores the importance of continued research and a critical, evidence-based approach to medical care.
Progress in treating chronic diseases disappointing for average person: Despite advancements, progress in treating chronic diseases like metabolic disease, cancer, and neurodegenerative diseases is not enough for most people, and we need to focus on addressing root causes and finding effective treatments.
Despite significant investments in research and advancements in treating certain diseases like cardiovascular disease, the progress in combating chronic diseases such as metabolic disease, cancer, and neurodegenerative diseases has been disappointing for the average person. The benefits of expensive treatments, like cancer drugs, may not apply to everyone due to individual differences in health and tolerance to side effects. The societal cost versus individual cost of these treatments is a complex question, and it's important to remember that the progress we've made is not good enough for the majority of people facing these diseases. The foundation of metabolic disease, which includes conditions like hyperinsulinemia, insulin resistance, fatty liver disease, and type two diabetes, is crucial in understanding the development and worsening of other chronic diseases. While we've seen some success in treating cardiovascular disease, we need to focus on making substantial progress in addressing the root causes and finding effective treatments for metabolic disease and other chronic conditions.
The gap between clinical trial survival benefits and real-world patients: Clinical trials test drugs on healthiest individuals, leading to unrealistic survival expectations in real-world patients due to selective patient populations and industry incentives.
The survival benefits of drugs seen in clinical trials may not translate to the same extent in real-world patients. Researchers found that those taking seraphanib for a disease had a median survival of only four months, which was half the survival of those given a sugar pill in the trial. This gap, known as the "grand canyon of difference," is due to the selective patient population in clinical trials, where pharmaceutical companies aim to test their drugs on the healthiest individuals. The real-world patient is less resilient and may not tolerate the drug as well or experience the same survival benefit. The industry's incentive system, with potential profits of billions of dollars, can lead to trial designs that favor the drug, such as testing against older, weaker drugs or carefully curating patient populations. It's important to remember that these trials represent the best-case scenario, and the real-world outcomes may not meet desired expectations.
The Tension Between Individual and Societal Responsibility in Funding Expensive Cancer Treatments: The debate around funding for expensive cancer treatments, like Avastin, raises ethical and financial questions. Societies must balance individual freedom to spend on treatments with societal responsibility to allocate resources effectively.
The debate around access to expensive cancer treatments, such as Avastin, raises complex ethical and financial questions. Avastin, an anti-VEGF drug, was one of the first approved for cancer treatment around 2001, initially for colon cancer. Its cost, around $100,000 per year, led to varying responses from different countries. While the US allowed private insurance to cover the cost, the UK and others denied coverage due to cost-effectiveness concerns. This discussion highlights the tension between individual and societal responsibility in healthcare funding. Every dollar spent on Avastin is a dollar not spent on other interventions. Societies, as a whole, must make decisions that benefit the most people, while individuals have the freedom to spend their own money as they see fit. The debate continues on how best to ration limited healthcare resources, with some countries being more upfront about the discussion and others rationing through exclusion. Ultimately, this is a complex issue without a clear answer.
Balancing societal good and individual care in healthcare resource decisions: Utilitarian ethic prioritizes societal good, but deontology values individual care; finding a balance in healthcare cost issues, especially in oncology, is a complex ethical dilemma
When it comes to making decisions about healthcare resources, particularly expensive treatments with questionable benefits, a utilitarian ethic prioritizes the greatest good for the greatest number. However, other ethical perspectives, such as deontology, may value caring for individuals at the end of life regardless of societal implications. The speaker used the example of a friend in Saudi Arabia, who was capable of keeping his apartment cool all summer due to government subsidies, to illustrate how people make different cost decisions when they don't have a personal financial stake in the outcome. The challenge lies in finding a solution to healthcare cost issues, especially in oncology, where expensive treatments are a significant driver. Ultimately, the obligation to ensure that healthcare resources are used effectively and efficiently while still providing necessary care to individuals is a complex ethical dilemma.
Focusing on cost-effective healthcare treatments: Prioritize no-regret moves in healthcare, like localized surgeries and radiotherapy, to ensure effective care and manage costs. Provide accurate info about benefits and costs to help patients make informed decisions.
The tension between who pays for healthcare and the choices people make can lead to decisions that may not be in their best interest. Using the analogy of a car, while someone may be willing to pay a small percentage for a car they don't actually get to use, the same is not true for healthcare. Many cancer drugs, for example, may have hidden costs and potential downsides that are not immediately apparent. These drugs may not improve survival or may require frequent visits to the doctor, taking away valuable time and resources from patients. To address this issue, it's important to focus on no-regret moves in healthcare, such as localized surgeries and radiotherapy, which have proven to be effective and cost-efficient. By prioritizing these treatments, we can ensure that patients receive the best possible care while also managing costs. Additionally, efforts should be made to provide accurate information about the benefits and costs of different treatments, allowing patients to make informed decisions.
Decision-making process for cancer treatments is complex: Not all cancer treatments provide equal benefits and come with varying risks and costs. Patients should carefully evaluate each option and consider their individual circumstances.
While there have been significant advancements in cancer treatment over the last 20 years, not all treatments are created equal. Some, like the inhibitors for the BCR-ABL fusion gene in Chronic Myeloid Leukemia, have shown tremendous benefits with low toxicity and have nearly normalized life expectancy. However, other treatments, such as cell-based therapies and checkpoint inhibitors, while promising, still have questionable benefits and come with significant costs and potential risks. The decision-making process for cancer patients is complex, and not all treatments are in their best interest. For instance, the use of PARP inhibitors in pancreas cancer patients with a BRCA gene mutation showed progression-free survival benefits but no overall survival benefits in a clinical trial. This highlights the importance of carefully evaluating the risks and benefits of each treatment option and considering individual patient circumstances.
Hype vs. Reality in Cancer Treatments: Old chemotherapy drugs may outperform new targeted treatments based on genomic signatures. Progression-free survival can be misleading and doesn't always reflect patient outcomes. The six hallmarks of cancer offer a framework for understanding cancer behavior and developing effective treatments.
The hype surrounding new targeted cancer treatments can sometimes outpace the actual benefits. Old cytotoxic chemotherapy drugs, while not as glamorous, may still be more effective than new targeted drugs based on genomic signatures. Progression-free survival, a common endpoint in cancer trials, can be misleading as it's based on arbitrary tumor growth measurements and doesn't always correlate with how patients feel or live longer. The speaker's experience with a particular drug serves as an example of this discrepancy. The six hallmarks of cancer, discussed in the speaker's book, provide a framework for understanding the disease's behavior and development. These hallmarks include self-sufficiency in growth signals, insensitivity to anti-growth signals, evasion of programmed cell death, limitless replicative potential, sustained angiogenesis, and tissue invasion and metastasis. Understanding these hallmarks can help in the development of more effective cancer treatments.
Independence in policy making: Minimize conflicts of interest and allow entities to advocate for their constituents without undue industry influence, especially in medicine.
Just as there are six biological hallmarks of cancer that have shaped our understanding of the disease, there are six essential hallmarks of policy that can make things better. The first of these is independence. This means minimizing conflicts of interest and allowing entities to advocate for their constituents without undue influence from industries. The speaker notes that this is a particular issue in the field of medicine, where financial ties between pharmaceutical companies and experts can influence views and prescribing patterns. The speaker recalls his own experiences of accepting meals and other gifts from drug reps during residency, and acknowledges that he was not fully aware of the implications at the time. While progress has been made in addressing these issues, the speaker argues that more needs to be done to address the high-level influences that continue to shape policy.
Conflicts of interest in medical research go beyond small gifts: Senior oncologists with industry ties create a positive feedback loop, leading to incomplete and inaccurate disclosure. Incentives for academics to not take industry money and stricter rules could help reduce conflicts.
The issue of conflict of interest in the medical field goes beyond small transgressions like accepting meals or pens from pharmaceutical companies. Senior oncologists, who write guidelines that determine Medicare coverage and pricing for drugs, often receive significant payments and research funding from the industry. These relationships create a positive feedback loop, as industry connections help advance their careers, allowing them to continue working with the industry. To address this issue, creating incentives for academics to not take money from the industry, such as favoring faculty members who don't take industry money for guideline committees, could help reduce conflicts of interest. However, disclosure, a current method for addressing conflicts, has been shown to be incomplete and often inaccurate. Divestment and different rules and incentives may be more effective ways to separate these relationships.
Conflicts of interest in cancer medicine: The current cancer treatment system prioritizes tumor size measurement over patient outcomes, driven by a 1976 study. To create a fairer and more effective system, we need a transparent, evidence-driven approach, focusing on patient outcomes and reducing industry influence.
The conflicts of interest in cancer medicine, particularly regarding the high cost of drugs and the influence of industry payments on decision-making, can lead to an imbalanced system. The people with the power to change the situation, such as oncologists, professional society leaders, and university senior leadership, often benefit financially from the current system. Therefore, an external entity needs to intervene to ensure evidence-based decision-making and focus on what truly matters to patients: increasing survival or improving health-related quality of life. Additionally, the current system focuses on measuring tumor size on CAT scans for two-thirds of cancer drugs, while only one-third measures what actually matters to patients. This prioritization stems from a 1976 study where oncologists determined a reliable tumor size measurement cutoff using marbles and calipers. However, it's important to note that measuring tumor size is not an accurate indicator of patient outcomes. To address these issues, we need a more transparent and evidence-driven approach to cancer drug development and approval. This includes focusing on patient outcomes, ensuring financial disclosures, and reducing industry influence on decision-making. By doing so, we can create a fairer and more effective cancer treatment system.
Shifting focus to more effective and accessible drugs: Policymakers should require stronger evidence of survival or quality life benefits for drug approval, focus on last-line settings and drugs that truly improve outcomes, conduct studies on diverse populations, and address affordability through Medicare negotiations and state-level experimentation.
The current approach to evaluating the efficacy of drugs in clinical trials may be misleading, as many drugs that show only minor improvements or even no significant impact on patients' survival or quality of life are still approved. These drugs, which make up about two-thirds of the treatments, may be considered for waste if policies require stronger evidence of survival or quality life benefits. This shift would lead to more selective drug development, focusing on last-line settings and drugs that truly improve survival or quality of life. Another important issue is the relevance of clinical trials to the average population. Studies should be conducted on more diverse populations to ensure the drugs work effectively for a wider range of people. Lastly, affordability remains a significant challenge, with many drugs being out of reach for a large portion of the population in the US and globally. Solutions include giving Medicare the ability to negotiate drug prices and encouraging state-level experimentation to bring down drug costs. Overall, these changes would result in fewer drugs coming to market but the ones that do would be more effective and accessible to those who need them.
Disparity in Access to Life-Saving Drugs: Despite having only 4% of the world's population, the US accounts for about half of global pharmaceutical spending. The high drug prices in the US result from a deal where the US provides most R&D funding and first access to new drugs, but this system raises concerns about fairness and affordability.
There's a significant disparity in access to life-saving drugs, particularly in developing countries, where only a small percentage of the population can afford these treatments. In the United States, about half of pharmaceutical spending comes from the US, despite having only 4% of the world's population. The high drug prices in the US are a result of a tacit agreement between the US and pharmaceutical companies, where the US provides the majority of R&D funding and first access to new drugs in exchange for subsidizing the cost for the rest of the world. However, this system raises questions about the fairness of subsidizing marginal drugs with the same intensity as transformative drugs. The US pays roughly double what countries like Norway pay for cancer drugs, and the cost of these drugs, particularly those with limited benefits, is a concern for many. The drug discovery process has become more efficient with the outsourcing of research to biotech and venture capital, but the negotiation of drug prices by CMS raises concerns about the potential impact on pharma's incentive to innovate. Ultimately, there is a need for a policy solution that incentivizes the development and access to drugs with substantial benefits while minimizing the cost of those with limited benefits.
Drug pricing in the US: Incentivizing high prices: The current drug pricing system in the US incentivizes high prices, lowering the bar for FDA approval, and calls for a value-based pricing model to incentivize drugs with greater health benefits, but policy changes are complex and require testing and refinement through state-level experiments.
The current system for drug pricing in the United States, as exemplified by the Centers for Medicare and Medicaid Services (CMS), creates a powerful incentive for drug companies to charge high prices for approved drugs without much regard for the actual cost of production or the drug's benefit. The FDA approval process also plays a role in this issue as the bar for approval seems to be lowering, leading to questionable approvals. One proposed solution is a value-based pricing model, which would incentivize drugs that provide greater health benefits. However, policy changes are complex and come with unintended consequences. State-level experiments and initiatives could provide opportunities for testing and refining effective policies. Ultimately, the problem of high drug prices remains unsolved, and further discussion and innovation are needed to find a balanced solution.
Fear of negative publicity and smaller budgetary impact for insurers: Insurers lack negotiation power against CMS due to fear of public backlash, smaller budgetary impact, and medical loss ratio provisions incentivizing cost predictability over reduction.
The lack of negotiation power among private payers in the healthcare industry against Centers for Medicare and Medicaid Services (CMS) can be attributed to various reasons. One reason is the fear of negative publicity and potential damage to their brand and reputation if they don't cover certain treatments or drugs that CMS does. Another reason is the smaller budgetary impact for the insurers since the population of patients using these expensive drugs is relatively small. Lastly, the Affordable Care Act's medical loss ratio provision, which caps the profit that insurers can earn, incentivizes them to maintain predictable costs and avoid large, unpredictable expenses from new and expensive treatments. The insurers' primary focus on ensuring year-to-year cost predictability and profitability, rather than reducing overall healthcare costs, means they don't have enough "skin in the game" to drive meaningful change. Employers, who have the most potential sway due to their large numbers, are disaggregated and cannot speak or act in a unified way, further hindering the ability to negotiate effectively. Additionally, there is a risk for insurers in funding studies for new treatments, as the information generated would be accessible to their competitors.
Funding fundamental inquiries for scientific advancements: Increase funding for science steadily, distribute grants effectively, and support fundamental inquiries to foster scientific discoveries
Expanding funding for basic science research, or "blue sky science," is crucial for scientific advancements. The NIH plays a significant role in funding such research, but the current funding system is lopsided, with some researchers receiving large grants while others struggle. To address this issue, the speaker suggests increasing funding for science steadily and studying more effective ways to distribute grants. The goal should be to support fundamental inquiries and allow researchers to pursue scientific questions out of curiosity, as some of the greatest scientific discoveries have resulted from such pursuits. However, a balanced approach is necessary, with both incremental and transformative funding available.
The Importance of Both Basic Inquiry and Clinical Trials in Cancer Research: Basic inquiry leads to groundbreaking discoveries while clinical trials test new treatments, but it's crucial to avoid redundant trials and consider the cost and potential harm to patients in tumor genome sequencing.
There are two important aspects to scientific research in the field of cancer: basic inquiry and clinical trials. Basic inquiry, which involves pure research without a specific goal in mind, has led to some of the most groundbreaking discoveries in modern science. On the other hand, clinical trials are essential for testing new treatments and determining their effectiveness. However, it's important to avoid redundant and duplicative trials, which can deplete the scarce resource of patients and potentially lead to false positives. Therefore, someone needs to take a holistic view of the field and consider the bigger picture when it comes to the clinical trials agenda. In oncology, tumor genome sequencing can play a role, but it's crucial to approach it with caution and consider the cost and potential harm to patients.
NGS testing for cancer patients: Benefits and limitations: NGS testing can identify mutations for approved therapies and pair patients with clinical trials, but it's essential to consider the significance of each mutation and standard treatment outcomes before opting for targeted therapies.
Next generation sequencing (NGS) tumor genomic testing can be beneficial for certain patients, particularly those with lung cancer, melanoma, colon cancer, and Lynch syndrome. These patients may have mutations for which there are approved therapies. NGS can also be used to pair patients with clinical trials. However, it's important to note that not all mutations are created equal. Some mutations may be driving the tumor growth, while others may be a result of the tumor's instability. In such cases, it's crucial to consider the track record and outcomes of standard treatments before opting for targeted therapies based on NGS results. The humility to acknowledge the limitations of our knowledge and the importance of individualized care are also essential in making informed decisions. Ultimately, as long as alternative or complementary approaches don't interfere with standard care and are not excessively costly, they should be allowed.
Liquid biopsies: Not a one-size-fits-all solution for cancer detection and treatment: Liquid biopsies have potential but their sensitivity varies for specific mutations and results can differ between testing companies. Approved drugs for common mutations and tumor tissue for subtyping remain important. Serial monitoring of cancer progression is their key strength.
While liquid biopsies, which analyze DNA or other markers in the blood to identify cancer mutations, have shown promise, they are not a one-size-fits-all solution. The results can vary between different testing companies and even within the same tumor. Approved drugs for common mutations will continue to be important, and the decision to use liquid biopsies should be based on their sensitivity for specific mutations and the potential need for tumor tissue for subtyping. The real value of liquid biopsies may lie in their ability to provide serial information on the progression of cancer over time. The speaker, known for his skepticism and critical thinking, acknowledges the role of liquid biopsies in the clinic but emphasizes the importance of good clinical trials to determine their full potential.
Balancing Skepticism and Action During a Pandemic: During a pandemic, it's important to have a balanced approach, using available information to make informed decisions while being cautious not to delay potentially beneficial treatments based on incomplete data.
While skepticism is important in medicine, waiting for the complete paper before making decisions during a pandemic can lead to delays in potentially beneficial treatments. The speaker emphasizes the importance of having a balanced approach, using the example of the recent dexamethasone recovery trial for COVID-19. They also stress the importance of clinical conversations between doctors and patients to help them make informed decisions based on available information. The speaker acknowledges that medicine is an art as well as a science, and that decisions often need to be made with less than perfect information. They also highlight the value of having a team of colleagues to debate and discuss treatment options. Ultimately, the goal is to empower patients with information and help them make decisions that are right for them.
Collaborating with colleagues and attending multidisciplinary meetings keep skepticism in check: Engaging with colleagues and attending multidisciplinary meetings provides valuable insights, maintains balance, and offers opportunities for further discussion on various topics. Joining a membership program can offer in-depth content, exclusive benefits, and transparency through full disclosure of conflicts of interest.
Seeking the perspectives of colleagues and attending multidisciplinary meetings can help keep skepticism in check and maintain a balance in medical decision-making. These interactions can provide valuable insights and remind us that there may be different approaches to treating patients. Additionally, engaging with a community of learners through a membership program can offer in-depth content, exclusive benefits, and opportunities for further discussion on various topics. Remember, it's essential to consult with healthcare professionals for medical advice and not rely solely on podcasts or other sources for diagnosis or treatment. Finally, full disclosure of conflicts of interest is crucial for maintaining transparency.
