Malignant
How Bad Policy and Bad Evidence Harm People with Cancer
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Narrated by:
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Vinayak K. Prasad
About this listen
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. PrasadListeners also enjoyed...
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"Correlation does not imply causation". This mantra has been invoked by scientists for decades and has led to a virtual prohibition on causal talk. But today, that taboo is dead. The causal revolution, sparked by Judea Pearl and his colleagues, has cut through a century of confusion and placed causality - the study of cause and effect - on a firm scientific basis.
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Great book! Not a great audiobook.
- By rrwright on 05-30-18
By: Judea Pearl, and others
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Denialism
- How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives
- By: Michael Specter
- Narrated by: Richard Poe
- Length: 8 hrs and 33 mins
- Unabridged
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New Yorker staff writer Michael Specter has twice won the Global Health Council’s Excellence in Media Award, as well as the Science Journalism Award from the American Association for the Advancement of Science. In Denialism, he fervently argues that people are turning away from new technologies and engaging in a kind of magical thinking that is hindering scientific progress.
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A compelling read
- By S on 05-17-11
By: Michael Specter
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The Future of Nutrition
- An Insider’s Look at the Science, Why We Keep Getting It Wrong, and How to Start Getting It Right
- By: T. Colin Campbell PhD
- Narrated by: Dan Woren
- Length: 11 hrs and 5 mins
- Unabridged
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Why, despite the many advances in science and technology over the past few decades, does our health only seem to be getting worse? Why, despite so much time and energy spent studying the foods we eat, are we more confused than ever about nutrition - what good nutrition looks like, and what it can do for our health? The Future of Nutrition offers a fascinating deep-dive behind the curtain of the field of nutrition - with implications both for our health and for the practice of science itself.
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His problem is the problem he has with others
- By abatista on 02-10-21
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Doing Harm
- By: Maya Dusenbery
- Narrated by: Dara Rosenberg
- Length: 13 hrs and 33 mins
- Unabridged
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Editor of the award-winning site Feministing.com, Maya Dusenbery brings together scientific and sociological research, interviews with experts within and outside the medical establishment, and personal stories from women across the country to provide the first comprehensive, accessible look at how sexism in medicine harms women today.
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One of the most important books ever written
- By Dresden on 03-18-18
By: Maya Dusenbery
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Panic Attack
- Playing Politics with Science in the Fight Against COVID-19
- By: Nicole Saphier
- Narrated by: Nicole Saphier
- Length: 10 hrs and 1 min
- Unabridged
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Medical doctor and national bestselling author of Make America Healthy Again Nicole Saphier reveals how politicization of the COVID-19 pandemic has baffled the public by creating distrust, fueling conspiracy theories, and making it harder for Americans to understand the necessary path forward. The pandemic has resulted in a failure of government, much of which is unavoidable in a unique disaster scenario. However, the rampant politicization of science has hopelessly muddied the water and knee-jerk anti-Trumpism made it all worse.
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Very disappointed
- By K. Green on 07-29-21
By: Nicole Saphier
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Sicker, Fatter, Poorer
- The Urgent Threat of Hormone-Disrupting Chemicals on Our Health and Future . . . and What We Can Do About It
- By: Leonardo Trasande MD MPP
- Narrated by: Leonardo Trasande MD MPP
- Length: 6 hrs and 44 mins
- Unabridged
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Lurking in our homes, hiding in our offices, and polluting the air we breathe is something sinister. Something we’ve turned a blind eye to for far too long. Dr. Leonardo Trasande, a pediatrician, professor, and world-renowned researcher, tells the story of how our everyday surroundings are making us sicker, fatter, and poorer. Through a blend of narrative, scientific detective work, and concrete information about the connections between chemicals and disease, he reveals what we can do to protect ourselves and our families in the short-term, and how we can help bring the change we deserve.
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The Must Read Book of 2019 is here early on Audio!
- By Ryan S on 12-21-18
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Counterclockwise
- Mindful Health and the Power of Possibility
- By: Ellen J. Langer
- Narrated by: Sandra Burr
- Length: 7 hrs and 10 mins
- Unabridged
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If we could turn back the clock psychologically, could we also turn it back physically? For more than 30 years, award-winning social psychologist Ellen Langer has studied this provocative question, and now has a conclusive answer: opening our minds to what's possible, instead of clinging to accepted notions about what's not, can lead to better health at any age.
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Surprisingly disappointing
- By Stephen on 06-23-09
By: Ellen J. Langer
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Epic Measures
- One Doctor. Seven Billion Patients.
- By: Jeremy N. Smith
- Narrated by: Patrick Lawlor
- Length: 10 hrs and 12 mins
- Unabridged
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Moneyball meets medicine in this remarkable chronicle of one of the greatest scientific quests of our time - the groundbreaking program to answer the most essential question for humanity: How do we live and die? - and the visionary mastermind behind it.
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Fabulously insightful read!
- By Dr. Jack E. Fincham on 10-08-15
By: Jeremy N. Smith
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The Secret History of the War on Cancer
- By: Devra Davis Ph.D.
- Narrated by: Pam Ward
- Length: 19 hrs and 11 mins
- Unabridged
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The War on Cancer was run by leaders of industries that made cancer-causing products and sometimes also profited from drugs and technologies for finding and treating the disease. Filled with compelling personalities and never-before-revealed information, The Secret History of the War on Cancer shows how we began fighting the wrong war, with the wrong weapons, against the wrong enemies, a legacy that persists to this day.
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Silly Book
- By Adam Smith on 12-24-14
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Noise
- A Flaw in Human Judgment
- By: Daniel Kahneman, Olivier Sibony, Cass R. Sunstein
- Narrated by: Jonathan Todd Ross
- Length: 13 hrs and 28 mins
- Unabridged
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From the best-selling author of Thinking, Fast and Slow, the co-author of Nudge, and the author of You Are About to Make a Terrible Mistake! comes Noise, a revolutionary exploration of why people make bad judgments, and how to control both noise and cognitive bias.
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Disappointing
- By Z28 on 05-31-21
By: Daniel Kahneman, and others
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Mindware
- Tools for Smart Thinking
- By: Richard E. Nisbett
- Narrated by: Joe Barrett
- Length: 10 hrs and 17 mins
- Unabridged
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Many scientific and philosophical ideas are so powerful that they can be applied to our lives at home, work, and school to help us think smarter and more effectively about our behavior and the world around us. Surprisingly, many of these ideas remain unknown to most of us. In Mindware, the world-renowned psychologist Richard Nisbett presents these ideas in clear and accessible detail, offering a tool kit for better thinking and wiser decisions.
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Sound scientific advice on how to live your life
- By Neuron on 08-26-15
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Ten Drugs
- How Plants, Powders, and Pills Have Shaped the History of Medicine
- By: Thomas Hager
- Narrated by: Angelo Di Loreto
- Length: 8 hrs and 39 mins
- Unabridged
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Beginning with opium, the “joy plant,” which has been used for 10,000 years, Thomas Hager tells a captivating story of medicine. His subjects include the largely forgotten female pioneer who introduced smallpox inoculation to Britain, the infamous knockout drops, the first antibiotic, which saved countless lives, the first antipsychotic, which helped empty public mental hospitals, Viagra, statins, and the new frontier of monoclonal antibodies. This is a deep, wide-ranging, and wildly entertaining book.
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Engrossing to physicians & lay persons alike
- By C. White on 03-08-19
By: Thomas Hager
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- What Broke American Health Care - and How to Fix It
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Great info, but I’m confused…
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In Blind Spots, Dr. Makary explores the latest research on critical topics ranging from the microbiome to childbirth to nutrition and longevity and more, revealing the biggest blind spots of modern medicine and tackling the most urgent yet unsung issues in our $4.5 trillion health care ecosystem. The path to medical mishaps can be absurd, entertaining, and jaw-dropping—but the truth is essential to our health.
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Outstanding and arguably daring
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Overdiagnosed
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Agreed, Too Many Medical Interventions
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Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's best-selling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he's also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting. Over the last 10 years, neither error rates nor costs have come down, despite scientific progress.
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Everyone should read this book.
- By Julie on 06-11-16
By: Marty Makary
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Bad Pharma
- How Drug Companies Mislead Doctors and Harm Patients
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Medicine is broken. We like to imagine that it's based on evidence and the results of fair tests. In reality, those tests are often profoundly flawed. We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry.
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A must read for health professionals
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One in five Americans now has medical debt in collections and rising health care costs today threaten every small business in America. Dr Makary, one of the nation's leading health care experts, travels across America and details why health care has become a bubble. Drawing from on-the-ground stories, his research and his own experience, The Price We Pay paints a vivid picture of price-gouging, middlemen and a series of elusive money games in need of a serious shake-up.
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Very important book!
- By Wayne on 05-17-21
By: Marty Makary MD
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Sickening
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The United States spends an excess $1.5 trillion annually on health care compared to other wealthy countries—yet the amount of time that Americans live in good health ranks a lowly 68th in the world. At the heart of the problem is Big Pharma, which funds most clinical trials and therefore controls the research agenda, withholds the real data from those trials as corporate secrets, and shapes most of the information relied upon by health care professionals.
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Great info, but I’m confused…
- By Iread on 04-04-22
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Outstanding and arguably daring
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Going against the conventional wisdom reinforced by the medical establishment and Big Pharma that more screening is the best preventative medicine, Dr. Gilbert Welch builds a compelling counterargument that what we need are fewer, not more, diagnoses. Documenting the excesses of American medical practice that labels far too many of us as sick, Welch examines the social, ethical, and economic ramifications of a health-care system that unnecessarily diagnoses and treats patients.
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Agreed, Too Many Medical Interventions
- By Pamela Harvey on 09-12-12
By: Dr. H. Gilbert Welch, and others
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Unaccountable
- What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care
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Dr. Marty Makary is co-developer of the life-saving checklist outlined in Atul Gawande's best-selling The Checklist Manifesto. As a busy surgeon who has worked in many of the best hospitals in the nation, he can testify to the amazing power of modern medicine to cure. But he's also been a witness to a medical culture that routinely leaves surgical sponges inside patients, amputates the wrong limbs, and overdoses children because of sloppy handwriting. Over the last 10 years, neither error rates nor costs have come down, despite scientific progress.
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Everyone should read this book.
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What listeners say about Malignant
Average customer ratingsReviews - Please select the tabs below to change the source of reviews.
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- Mark
- 12-11-21
fantastic
utterly changed the way I read medical literature.
am listening to it for a second time now.
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- Merry Rogers
- 05-11-22
Must Read
For anyone and everyone. This book is interesting, therefore entertaining. Everyone will ultimately be faced with mortality. My takeaway is be cautious with headlines, do not trust FDA approval until you understand what that approval means. Many life saving drugs in the past. I don’t see it in the future. Too much money involved. Incentives galore. Good docs with no time….
Great job Prassad
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- J. Muscato
- 10-10-22
Very thoughtful look at cancer policy
I am an oncologist, and Dr. Prasad outlines extremely important principles on how to interpret research studies, the conflicts and prejudices of pharmaceutical companies, the complicity of the FDA in approving marginal drugs and ways to make the system better. While aimed at a broad audience, very useful to cancer trainees as well as those practicing.
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1 person found this helpful
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- Eric Novik
- 07-08-20
Love the book
Honest and insightful account of the current challenges and opportunities in drug development and policy from an active researcher and practitioner. I really enjoyed the book, learned a lot from it, and would recommend it highly.
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- John Cooper
- 01-30-21
Essential reading for clinicians, policymakers, and patients.
This is the best book I have read in the oncology space, ever! But its applicability is much more broad, and it should be read by involved parties in other medical specialties as well.
This is a manifesto for logical, scientific, rigorous thinking. This book appropriately rails against a dressed up, modern version of snake oil; filtered, blended, fragrances added — but still snake oil. It takes a brilliant mind to so skillfully weave together the themes covered in this book. Pay attention to this book and this author. I plan to digest, reminisce, and then come back to read again. -a physician, in training.
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- Scott D.
- 08-06-22
Very insightful review of the trouble with science in the modern world
This book should be required reading or listening for any American that wants to have an opinion on healthcare spending.
The fact that academic research is so improperly motivated that we are trading way an incredible amount of life years for corporate profits is disgusting.
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1 person found this helpful
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- Amazon Customer
- 05-20-20
Great book but with multiple audio / reading error
Dr. Prasad has summarized many years of impactful research that he and others have done on the problem of ineffective, expensive cancer drugs being brought to market through a broken regulatory regime. The book is well written, well organized, and the arguments are compelling.
Unfortunately, near the end of the audiobook there are many (> 10) areas where Dr. Prasad repeats sentences verbatim (it seems like there were multiple takes of sentences that were not edited out). There are also several areas where he is being recorded drinking water, which is a little awkward to listen to.
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- Amazon Customer
- 08-02-21
A must read for Healthcare professionals!
This book is an eye opener for many aspects in cancer medicine. Topics like cancer research, conflict of interest, and the role of pharmaceutical industry in cancer management were presented in a very nice way. I recommend this book to anyone working on cancer or with cancer and to all Healthcare providers. It will give you a better understanding of cancer.
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- Mary LaMoreaux
- 03-30-22
Excellent Analysis of a broken system
Everyone should read this analysis of cancer drugs. The advice to patients on how to talk to their doctors about cancer drugs is extremely helpful. I do not know if his conclusions could work, but it is nice to think that some people see a fix to a broken system.
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1 person found this helpful
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- Robert
- 08-02-23
Excellent
Best healthcare book that I’ve read in awhile (and I read a lot of them)
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1 person found this helpful