April 21, 2020
9.00 Inches (US)
6.00 Inches (US)
0.97 Inches (US)
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$32.95 USD, £24.50 GBP
v2.1 Reference
Electronic book text
April 21, 2020
9.00 Inches (US)
6.00 Inches (US)
$32.95 USD, £24.50 GBP
v2.1 Reference


How Bad Policy and Bad Evidence Harm People with Cancer

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 writes about the many sobering examples of how patients are too often failed by cancer policy and by how oncology is practiced. Throughout this work, Prasad illuminates deceptive practices which

• promote novel cancer therapies long before credible data are available to support such treatment; and
• 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. Prasad 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; and
• we need unbiased patient advocates and experts.

This well-written, opinionated, and engaging book 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.

About the Author

Vinayak K. Prasad, MD, MPH is a practicing hematologist-oncologist and internal medicine physician. An associate professor of medicine and public health at Oregon Health & Science University, he is the coauthor of Ending Medical Reversal: Improving Outcomes, Saving Lives.


"Prasad does a commendable job demonstrating how lax standards of evidence and regulations, coupled with the profit-driven pharmaceutical industry, result in a lot of poorly effective or ineffective (but very expensive) drugs being used on cancer patients in the United States and worldwide. There isn't anything quite like this book out there."

- Kenneth W. Lin, MD, MPH, Georgetown University

"This important book tackles a very topical and controversial subject in a scholarly, original, and skeptical (but not too cynical) way. Prasad's iconoclastic position will hopefully contribute to reflections on how to change some paradigms in cancer medicine. An essential read for oncologists in training, people in the drug industry, and health care policymakers."

- John A. Hickman, health care consultant

"Prasad outlines a plan that will educate consumers about how we ended up in our current predicament and explain what we can do to extricate ourselves from it. I highly recommend this book to patients, patient advocates, and all physicians—not just oncologists."

- Ameet Sarpatwari, Harvard Medical School / Brigham and Women's Hospital

"An insightful, well-written, and important book. Prasad has a masterful understanding of the issues he presents, weaving them into a compelling story."

- Christopher Booth, MD, Queen's University at Kingston Cancer Research Institute

"Oncology drug development is full of hype and spin, which raises false hopes, confuses patients, and wastes money. Prasad incisively dissects crummy evidence and systematic abuses, including the pernicious effects of financial conflicts and academic self-promotion, and proposes sensible steps to improve development of new therapies for cancer."

- David P. Steensma, MD, Dana-Farber Cancer Institute / Harvard Medical School

"Malignant confirms Vinayak Prasad's status as one of the most cogent critical voices in oncology today. This is a book that needs to be read by everyone involved or interested in the care of people with cancer as a comprehensive overview of a dire situation and a call to action."

- Richard Lehman, University of Birmingham

"A must-read! Prasad masterfully dissects problems in policy and evidence that have led to a surfeit of high-cost/low-value cancer drugs. With powerful examples he shows why this cannot continue if the best interests of patients are to be served and offers solutions ready for implementation."

- Elizabeth Eisenhauer, OC, MD, FRCPC, Queen's University


"Malignant is punchy and persuasive, and the author is clearly in command of his subject matter. Prasad offers valuable advice on how to keep up with research as well as the appropriate way to analyse clinical trial reports."

- Talha K Burki - The Lancet Hematology

"Aimed at general readers (including patients), oncology trainees and experts in health-care policy, it informs and disturbs throughout."

- Andrew Robinson - Nature
Johns Hopkins University Press
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9781421437637 : malignant-prasad
304 Pages
$32.95 USD
9781421437644 : malignant-prasad
Electronic book text
304 Pages
$32.95 USD

Other Titles by Vinayak K. Prasad

Ending Medical Reversal

Vinayak K. Prasad, MD, MPH, and Adam S. Cifu, MD
May 2019 - Johns Hopkins University Press
$24.95 USD - Electronic book text
$24.95 USD - Paperback / softback

Other Titles in MEDICAL / Hematology

Living with HHT

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Dec 2017 - Johns Hopkins University Press
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The Bleeding Disease

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May 2011 - Johns Hopkins University Press
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Supportive Care of Children with Cancer, third edition

edited by Arnold J. Altman, M.D. - with a foreword by Gregory H. Reaman, M.D.
Mar 2004 - Johns Hopkins University Press
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Other Titles in Oncology

Living with Cancer

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May 2017 - Johns Hopkins University Press
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A Physician's Guide to Pain and Symptom Management in Cancer Patients, third edition

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Pancreatic Cancer

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Jun 2011 - Johns Hopkins University Press
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