Vinay Prasad

Vinayak K. Prasad is an American hematologist-oncologist and health researcher. He is an associate professor at the University of California, San Francisco^[1] who, together with Adam Cifu, coined the term medical reversal. He is the author of two books and over 300 academic articles.^[2]

Early life and education[]

Prasad was raised in a suburb of Cleveland, Ohio, before moving outside of Chicago in northern Indiana. His parents immigrated from India.^[3]

Prasad was 2001 valedictorian of LaPorte High School.^[4] He attended Michigan State University, where he took courses in health care ethics and physiology. In 2005, Prasad graduated summa cum laude from MSU with a double major in philosophy and physiology.^[3] He gave the commencement speech to the College of Arts and Letters on behalf of the Philosophy Department.^[5] He completed his medical degree at University of Chicago in 2009 and completed a residency in internal medicine at Northwestern University in 2012. Prasad was certified in internal medicine by the American Board of Internal Medicine in 2012 and earned a Master's of Public Health from Johns Hopkins University in 2014. In 2015, Prasad completed a fellowship in oncology at the National Cancer Institute and hematology at the National Heart, Lung, and Blood Institute.

From 2015 to 2020, Prasad was assistant and then associate professor at the Oregon Health & Science University.^[6] He is the author of over 250 academic articles.^[7] He currently works at San Francisco General Hospital. Prasad's work has been cited over 6000 times.^[8]

Career[]

Prasad is a hematologist-oncologist and associate professor at the University of California, San Francisco.^[6] He is a cancer drug and health policy researcher. He also studies the financial conflicts in drug approvals.^[9]

Prasad hosts the podcast Plenary Session^[10][11][12] and blogs at MedPage Today.^[13] Prasad has won several teaching awards, including the 2017 Craig Okada Award for best teacher in the Hematology Oncology Fellowship program, the 2018 faculty mentorship award from the internal medicine residency, the 2019 J. David Bristow award from the graduating medical students, and the 2020 excellence in research and scholarship mentoring as awarded by the internal medicine residents.^[7]

Ending Medical Reversal[]

Prasad co-authored Ending Medical Reversal: Improving Outcomes, Saving Lives with Dr. Adam Cifu in 2015.^[14] Medical reversal occurs when "when a current clinical practice is found to be ineffective or inferior to a previous standard of care."^[15] According to reviews in The New York Times, the book is "subtly subversive."^[16] Writing for The NY Times, Abigail Zuger writes, "More surprising, though, is an odd paradox: Often it is the treatments that make the most theoretical sense that fail."^[16] Ending Medical Reversal is described as a "revolutionary" book by Dr. Kenny Lin, and it was named one of his top health care books of 2015.^[17] Sarah Wallan, a writer for MedPage Today, interviewed the co-authors about the book's origins as well as the potential improvements and comprehensive solutions they would like to see implemented in the landscape of healthcare and regulatory policy.^[18] In Wallan's review of the book, she addresses that Prasad and Cifu "carefully note that their intent in compiling this evidence was not to scold or criticize the members of their profession, but to remind clinicians to be humble in their approach to medicine, and to insist on proof before practice."^[18]

Editorials and News[]

In 2011, Prasad and colleagues published a research letter in the Archives of Internal Medicine.^[19] Charles Bankhead, a senior editor at MedPageToday, covered the topic, outlining the paper's primary point, which was the high prevalence of research articles demonstrating findings that deviated from the accepted standard of treatment at the time.^[20] Separately, "Retraction Watch" reported on Prasad's personal remarks about the paper, saying "For a long time, we were interested by what we believe to be a pervasive problem in modern medicine. Namely, the spread of new technologies and therapies without clear evidence that they work, which are later (and often after considerable delay) followed by contradictions, which, in turn, after yet another delay, is followed by changes in practice and reimbursement."^[21] Matthew Hoffman, writing in 2012 for MedPageToday's KevinMD covered a paper by Prasad and colleagues on "When to abandon ship" when it comes to failing medical practices and treatments.^[22][23] Hoffman builds on the authors' proposed barriers to market entrance, such as evidence of effectiveness in large randomized controlled studies prior to broad usage, and links them to the insidious aspects of healthcare, such as profit and status. In 2013, Prasad and colleagues addressed the necessity for randomized controlled trials for the inferior vena cava filter (VCF) despite the intervention's bio-plausibility.^[24] The authors suggest that since the intervention has known adverse effects but an uncertain benefit, well-designed studies are necessary to shed light on the intervention's efficacy. The JAMA Internal Medicine article received widespread media attention, with Reuter's Genevra Pittman interviewing Prasad about his further views on the intervention.^[25] According to the interview, Prasad advises against filter placement in all but the most extreme instances owing to a lack of proof and possibility for adverse events.^[25] Larry Husten, a writer for Forbes Magazine, focuses on how VCF's have been extensively adopted in the general population without strong follow-up clinical studies owing to the 510(k) approval process.^[26] Due to the fact that these devices are already authorized and gaining market share, companies have little motivation to conduct effectiveness studies that may yield challenging results. Also in 2013, one of Prasad's most notable papers was published in Mayo Clinic Proceedings, entitled A Decade of Reversal: An Analysis of 146 Contradicted Practices.^[27] The authors of this study evaluated 363 publications that evaluated the effectiveness of established medical practices. From these articles, 146 papers represented a medical reversal, which occurs when new, more rigorous research contradict the findings of the existing standard of care.^[27] The article was covered in a piece by The Huffington Post, which highlights a key lesson from the paper: patients should become more involved in their health care decisions rather than assuming a prescribed medication or device is beneficial.^[28] Patients may do this by asking their physician pertinent questions, such as what patient outcomes the intervention improved. Additionally, the article discusses the concept of healthcare cost. With growing anxiety about the expense of healthcare, utilizing limited resources on questionable medical practices with a weak evidence base threatens to jeopardize both the healthcare economy and patient health. Additionally, the authors of a Lancet Oncology editorial remark that "almost 10% of practice reversals occurred in oncology," suggesting that certain fields of medicine may be more susceptible to medical reversals than others.^[29] In a MedPageToday column written in October 2020, Prasad discussed the need to either reform or boycott additional fellowships.^[30] Due to the numerous disadvantages of extended healthcare training (e.g., deferred earnings, stringent parental leave policies, etc.), there may be a need to create alternatives or realign incentives. Prasad suggests in a similar column that even medical residencies may require reform. He does, however, point out that while the system has its limitations, medical residents should not ask for pity because being a doctor is a privilege.^[31] In a separate column published in November 2020, Prasad argued for a greater emphasis on precise medical definitions and randomized clinical trials to generate robust data on study treatments, rather than relying on biological speculation to examine the long-term effects of individuals with COVID-19.^[32] In 2019 Twitter posts and a 2020 blog article,^[33] Prasad criticized other medical skeptics for their choices of topics to tackle, including homeopathy, as being poor use of their time. Skeptics David Gorski and Steven Novella published criticisms of and counter-arguments to Prasad's stance.^[34][35] The article was followed up with a column the next week that focused on the themes of self-improvement, honest self-assessment, duty, and the value of reflection.^[36] In a separate article, Prasad hits a similar theme, stating, "No matter where you are in your career, you have to think more about finding your purpose. That comes when you are good at what you do, and take pleasure in it, while providing a benefit to society, which values your work."^[37]

In 2020, the majority of Prasad's popular writing centered on health policy choices related to the global pandemic triggered by COVID-19.^[38] For instance, in April 2020, Prasad and Jeffrey Flier published an opinion piece in STAT on the value of listening to contestable, independent thinkers in the area of scientific research. The authors acknowledge that while scientific agreement is important for policymaking, hastily rejecting ideas without evaluating their feasibility may result in group think rather than productive policy change.^[39] Even if these divergent views are incorrect, Prasad stresses the critical nature of scientific debate in order to advance the discipline. This message is emphasized in an essay published in MedPageToday in which he discusses the aforementioned theme, but also the dangers of the social media censorship of these ideas. Even without censorship, there are concerns about the widepsread use of superlatives throughout the news media, particularly in the oncology space. In a wider context, Dr. Miriam Knoll, a contributor for the healthcare section of Forbes Magazine expands on how false information can lead to hype through via use of superlatives, covering one of Prasad's research articles covering the topic.^[40] In the article, Dr. Knoll states that Prasad "found that the use of superlatives such as “breakthrough,” “game changer,” “miracle,” “transformative,” “life saver,” “groundbreaking,” and “marvel,” were used to describe many drugs that weren’t even approved to treat cancer."^[41][40]

Malignant[]

In the spring of 2020, Prasad published his 2nd book, Malignant: How Bad Policy and Bad Evidence Harm People with Cancer.^[42] The book delves into cancer policy, oncologic drug regulation, and clinical trial design, examining how many marginal and unproven cancer therapies are pushed to market on the basis of hype and bias.^{[citation needed]} According to Benjamin Chin Yee, who wrote an in-depth review of Malignant, states "Prasad does not shy away from controversy, and lays out his argument in lucid, readable prose."^[43] Tahla Burki writes in the Lancet Haematology, "Prasad outlines how the US Food and Drug Administration (FDA) approves cancer therapies on the basis of arbitrarily assigned surrogate endpoints that typically have no bearing on overall survival or quality of life. He examines how a complex web of conflicts-of-interests pollutes policy debates and expert recommendations, and how studies ask irrelevant questions in unrepresentative patient populations."^[29] Prasad has appeared on many podcasts to discuss Malignant, such as EconTalk with Russ Roberts^[44] and Oncology Overdrive with Shikha Jain.^[44] These discussions examine the current state of cancer policy and the ways in which physicians and patients can benefit from appropriate solutions.

Selected works[]

Articles[]

• Prasad, Vinay; Cifu, Adam; Ioannidis, John P. A. (January 4, 2012). "Reversals of Established Medical Practices: Evidence to Abandon Ship". JAMA. 307 (1): 37–38. doi:10.1001/jama.2011.1960. PMID 22215160.
• Prasad, Vinay; Vandross, Andrae; Toomey, Caitlin; Cheung, Michael; Rho, Jason; Quinn, Steven; Chacko, Satish Jacob; Borkar, Durga; Gall, Victor; Selvaraj, Senthil; Ho, Nancy; Cifu, Adam (August 2013). "A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices". Mayo Clinic Proceedings. 88 (8): 790–798. doi:10.1016/j.mayocp.2013.05.012. PMID 23871230.
• Prasad, Vinay (September 2016). "Perspective: The precision-oncology illusion". Nature. 537 (7619): S63. Bibcode:2016Natur.537S..63P. doi:10.1038/537S63a. PMID 27602743. S2CID 205090720.
• Chokshi, Dave A (March 2016). "A course in reversal". The Lancet. 387 (10025): 1266. doi:10.1016/s0140-6736(16)30025-3. S2CID 54233440.

Books[]

• Prasad, Vinayak K. (2020). Malignant: How Bad Policy and Bad Evidence Harm People with Cancer. Johns Hopkins University Press. ISBN 9781421437637.
• Prasad, Vinayak K.; Cifu, Adam S. (2015). Ending Medical Reversal: Improving Outcomes, Saving Lives. Johns Hopkins University Press. ISBN 9781421417721.

References[]