Policymakers should create incentives and rules to minimize financial conflicts of interest for medical experts involved in guideline creation and policy. This ensures that recommendations are unbiased and prioritize patient interests over financial gains.
Regulators should require new cancer drugs to demonstrate actual survival or quality of life benefits for approval, rather than relying solely on surrogate endpoints like tumor shrinkage. This policy shift would lead to fewer, but more effective, drugs reaching the market.
Researchers and regulators should design clinical trials to include patient populations that accurately represent average Americans, not just highly selected, healthier individuals. This ensures that reported drug benefits are truly applicable to real-world patients.
Policymakers should empower major payers, such as Medicare, to negotiate drug prices and encourage state-level experimentation with pricing models. This approach aims to connect drug cost to its actual value and improve access to transformative treatments.
Policymakers and funding bodies should increase stable, long-term funding for basic, ‘blue sky’ scientific inquiry, separating it from political cycles. This fosters fundamental discoveries that often lead to serendipitous, transformative medical advances.
Regulators and research consortia should oversee the overall clinical trial landscape to prevent redundant studies and ensure efficient use of scarce patient resources. This optimizes research efforts and improves the interpretability of findings across the field.
Doctors should empower patients by transparently explaining drug benefits, uncertainties, known toxicities, and risks, then guide them in deciding if those risks align with their personal values. This approach respects patient autonomy and facilitates informed, individualized treatment decisions.
Patients and doctors should critically evaluate the actual survival or quality of life benefit versus the high cost of new cancer drugs. Understand that reported clinical trial benefits may not fully translate to average patients in real-world settings.
Medical professionals should continuously strive to improve their bedside manner, recognizing it as a crucial art in medicine. This enhances patient trust and provides essential emotional support, especially during difficult times.
Medical professionals should recognize that dying patients often need their care and presence more than living patients, requiring heightened compassion and support. This ensures dignified and supportive end-of-life care.
Medical professionals should use precise and empathetic language, such as stating ’the therapy failed the patient’ instead of ’the patient failed the therapy.’ This shifts blame away from the patient and fosters a more supportive and understanding environment.
Medical professionals must balance healthy skepticism about treatments with the need for action in patient care, recognizing the potential cost of inaction. This involves making informed decisions with imperfect information, often in consultation with colleagues.
Medical professionals should regularly participate in tumor boards or multidisciplinary meetings to gain diverse perspectives and inform complex patient care decisions. This practice enhances decision quality and broadens understanding of challenging cases.
When considering alternative or complementary therapies, patients and doctors should assess if they are low-cost, non-harmful, and do not interfere with established medical treatments. This allows for patient choice without compromising primary care.
Medical professionals should maintain humility about the limits of current medical knowledge and be transparent about what is known and unknown. This fosters realistic expectations and builds trust with patients.
For localized cancers, surgery is often a highly effective ’no-regret’ treatment. For specific cancers like Hodgkin’s lymphoma, testicular cancer, and CML, established and often curative drug combinations exist and should be prioritized.
For subjective symptoms like angina or pain, patients and doctors should critically evaluate mechanical interventions, as studies suggest they may be no better than sham procedures due to a strong placebo effect. Consider the true benefit beyond psychological stimulus.
Routinely perform tumor genome sequencing (NGS) for specific cancers (e.g., lung, melanoma, colon for MSI-high) where FDA-approved targeted therapies exist. Also, use NGS to match patients with appropriate clinical trials, especially for rarer tumor types or younger patients.
Avoid automatically gravitating towards targeted drugs based on NGS findings if there’s no strong clinical trial evidence, especially if it means foregoing established therapies with better track records. Some mutations may not be primary drivers or may vary across tumor sites.
Employ liquid biopsies for non-invasive mutational information and for serial monitoring of cancer over time, particularly where tissue biopsies are difficult or repeated sampling is needed. Be mindful of test sensitivity and the potential need for tissue confirmation if liquid biopsy is negative.
Administer dexamethasone to hospitalized COVID-19 patients requiring supplemental oxygen or mechanical ventilation, as studies show an all-cause mortality benefit. Avoid its use in hospitalized patients not requiring supplemental oxygen, as it may cause harm.
Listeners interested in clinical trials, critical thinking, and decision-making should check out Vinay Prasad’s ‘A Plenary Session’ podcast, his YouTube channel, and his Twitter account (@VPrasadMDMPH) for tutorials and insights.
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