Thank you. This is one of your best substacks. I don’t know if I will have the opportunity to ask, ‘What is he allowed to die of?’ Or even, ‘What am I allowed to die of?’ I wish you had more influence on medicine, it would be for the better.
I often feel that it might be better if we put little less value on medicine. There are often more important things in life.
What often also makes the difference in clinical practise is not the medicine but just being human to another and being able to share some of weight another human being is going through.
Meanwhile functional oncology diagnostics that measure drug response using the patients live cells are burdened with a NCD 190.7!!!! 93% PPV is not good enough to get anyone’s attention-UGH what is water.
I don't sit in the rooms where standing ovations are given to drugs that cure 0 people, add 6 months to life, and cost 477,000 per year — but I counsel the patients who inherit the bill and the toxicity. From the pharmacy counter, 'median six months' stops being a statistic and becomes a person asking me what the hand-foot syndrome is really for, and whether the co-pay math is survivable. The asymmetry that stayed with me from your piece: the drug's value gets tallied in endpoints moved and revenue booked, while the patient pays in dollars and side effects. Pharmacy trains us to quantify value in NNTs and QALYs — then the system prices the marginal month like a cure. Your eulogy-versus-resume distinction holds for medicines, too: a drug's legacy ought to be counted in lives genuinely extended, not in progression-free survival gains that never became time anyone actually got to live.
Amen
Thank you. This is one of your best substacks. I don’t know if I will have the opportunity to ask, ‘What is he allowed to die of?’ Or even, ‘What am I allowed to die of?’ I wish you had more influence on medicine, it would be for the better.
Thank you for writing this. Eulogy values over resume values, how a person made the people closest to them feel. I hope that's what we all remember.
Very good!!
I often feel that it might be better if we put little less value on medicine. There are often more important things in life.
What often also makes the difference in clinical practise is not the medicine but just being human to another and being able to share some of weight another human being is going through.
Thank you for reinforcing my desire for quality over quantity in ALL things. I will keep that fish at the forefront of my mind.
Meanwhile functional oncology diagnostics that measure drug response using the patients live cells are burdened with a NCD 190.7!!!! 93% PPV is not good enough to get anyone’s attention-UGH what is water.
Thought provoking! It's why I'm a paid subscriber. No one better than Dr. Prasad to point out the obvious.
I didn’t see this one coming
Posts like this are why I stay on this app
We’re tasked with impossible situations to deal with day in and out
Humanism is never the wrong choice
Thanks for the reminder
(I hope I spaced this properly lol)
I don't sit in the rooms where standing ovations are given to drugs that cure 0 people, add 6 months to life, and cost 477,000 per year — but I counsel the patients who inherit the bill and the toxicity. From the pharmacy counter, 'median six months' stops being a statistic and becomes a person asking me what the hand-foot syndrome is really for, and whether the co-pay math is survivable. The asymmetry that stayed with me from your piece: the drug's value gets tallied in endpoints moved and revenue booked, while the patient pays in dollars and side effects. Pharmacy trains us to quantify value in NNTs and QALYs — then the system prices the marginal month like a cure. Your eulogy-versus-resume distinction holds for medicines, too: a drug's legacy ought to be counted in lives genuinely extended, not in progression-free survival gains that never became time anyone actually got to live.
Indeed: WHAT are we doing?
"We give standing ovations for drugs that cure 0 people, add 6 months to life, and cost 477,000 per year"
Thank you. This post will stay with me.
This is a resonant and thought-provoking piece. We need to be more ambitious as an industry for cures, and restoring health.