Malignant: How bad policy and bad evidence harm people with cancer Vinayak Prasad Baltimore, Maryland: John Hopkins University Press, 2020. $32.00. pp. 246. Hardcover. ISBN: 97814214376441421437643.

• Published date: 01 June 2023
• Author: Peter D. Park,Maya Ramy
• Date: 01 June 2023
• DOI: http://doi.org/10.1002/wmh3.520

DOI: 10.1002/wmh3.520

BOOK REVIEW

Malignant: How bad policy and bad evidence

harm people with cancer

Vinayak Prasad

Baltimore, Maryland: John Hopkins University Press, 2020. $32.00. pp. 246. Hardcover. ISBN: 97814214376441421437643.

Cancer plagues individuals of all ages and walks of life and has therefore quickly risen to be

one of the most heavily researched areas in medicine today. In Malignant, Dr. Vinayak

Prasad addresses how policy, science, and media impact cancer treatment. Prasad also

offers a cautionary tale of the harm this industry has caused and can further cause patients.

Intertwining evidence from multiple research trials, as well as his own data analyses,

Prasad's initial explanation of how a drug comes to market lays the foundation for his

perspective on pharmaceutical companies, oncologic drug regulation, and the policies

behind them. In one instance, he calls into question how 71 cancer drugs improved survival

outcomes by an average of 2.1 months in clinical trials with healthy controls, while the

benefits almost completely dissipated when administered to the treated patient population.

He emphasizes the process of how drugs with less impressive results are allowed to come

to market. His critiques are well‐founded, as he points to evidence and anticipates

counterarguments. Of particular note is that while Prasad acknowledges that cancer is

dense with technical terminology, he provides a thorough explanation of this jargon for the

lay reader, such as how he explains the differences between cytotoxic, targeted, and

immunotherapy drugs (pp. 50–51). Nonetheless, Prasad's book will be best understood by

trainees and practitioners in medicine, pharmacy, and policy, and those engaging

specifically with cancer research and treatment.

Prasad takes a critical dive into the hype surrounding cancer treatment and demystifies

what he sees as disingenuous terminology that amounts to a form of distortion. Superlatives

such as “unprecedented,”“game changer,”“miracle,”“breakthrough,”and “cure,”are utilized

by media, pharmaceutical companies, government officials, and physicians to sway public

perception of the success of drugs or treatment regimens. Prasad underscores the danger

this may pose for those who may be moved to choose one drug over another because of this

terminology. Additionally, he highlights the significance of financial conflicts of interest in

medicine and proposes six solutions to address this problem including encouraging the end

of financial associations between pharmaceutical companies and patient advocacy

organizations, professional organizations, physicians, and analysts. His solutions are

thorough and specific, with examples from his own personal experience within oncology and

academic medicine. Prasad's recognition of the difficult and convoluted nature of these

relationships, as well as his genuine desire to create an objective landscape for cancer

treatment that will benefit patients, are commendable.

Another section assesses cancer therapy study design options. Prasad dives into one

specific observational study suggesting the potential cancer mortality benefits of tree nuts.

Ultimately, Prasad's main point in this chapter makes readers ask: “how do we know how

accurate a given argument or research finding is regarding my cancer?”Prasad reiterates

World Medical & Health Policy. 2023;15:212–213.wileyonlinelibrary.com/journal/wmh3212

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