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September 20, 2018

A 'professional troublemaker' or a revealer of truths? How one oncologist is stirring up controversy on Twitter and beyond.

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    At a time in medicine where physicians, hospitals, and reporters are routinely touting the lifesaving aspects of medical advances, such as precision medicine, one doctor stands out: taking to Twitter and physician conferences to bombastically counter what he calls "hype" in medicine, Richard Harris reports for NPR's "Shots."

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    Meet the tweeting oncologist

    Vinay Prasad is a hematologist-oncologist and assistant professor of medicine at Oregon Health and Science University in Portland. He attended medical school at the University of Chicago Pritzker School of Medicine and has master's degree in public health from Johns Hopkins University.

    After graduating from medical school, Prasad became a fellow at the National Institutes of Health. That's when he realized, in his own words, "even the most respected, charismatic and thoughtful experts often are incorrect." Prasad said, "And at some point, I made the conscious decision that if it troubles me enough, I want to look at it and study it."

    And Prasad has made a point of publicly calling out the areas where research comes up short. He has authored several scientific papers and written a book that address "uncomfortable facts about the science of cancer" as well as "the business and regulation of medical treatments," Harris reports.

    But Prasad may be best known for his bombastic tweets. Prasad's lively Twitter presence has garnered 25,000 followers, and launched roughly 32,000 tweets.

    A vocal critique of medical 'hype'

    One of the biggest points of contention for Prasad is the unfounded hype over precision cancer treatment. Prasad's primary critique about the hype surrounding precision medicine is that doctors often prescribe these treatments before the actual science concludes which conditions they're useful for and which ones they aren't.

    Drugmakers, Prasad said, are glad to not pay for research when doctors will prescribe the drugs regardless. "And that's the root of what bothers me about this," Prasad said.

    The words researchers and the media use to describe new treatments is another sticking point for Prasad. During a American Society of Clinical Oncology (ASCO) conference this summer, Prasad tweeted a bingo card and encouraged attenders to fill in the card with words such as "unprecedented," "breakthrough," "game changer," and "transformative,"  and mark spaces each time they heard those words during the conference.  According to Prasad, the card had been retweeted dozens of times as the meeting got underway.

    Prasad's loathing for superlatives is not unfounded: He published a scientific paper in 2016 on the topic. "What really got me," Prasad said, "was (that for) 14% of the drugs, the superlative was used based only on mouse or laboratory results, and they'd never given it to a human being."

    A 'professional troublemaker' or a revealer of truths?

    While Prasad is far from alone in feeling researchers and the media have overhyped the effects of precision medicine, he said he's developed the reputation of a "professional troublemaker"—a fact that he described as "unfortunate."

    According to Harris, Prasad's critiques and defenses can be delivered in a very direct manner and aggressive tone.

    For example, during the ASCO meeting, a young researcher thanked Prasad for some of the points he raised but criticized his tone, Harris reports. The researcher told Prasad, "I think both sides are too emotional," adding, "I think the truth is something in the middle."

    Prasad's response, according to Harris, was to vocally defend his stance, "often not letting [the researcher] finish her sentences." Prasad noted that most successful cancer treatment today still typically entails conventional chemotherapy, radiation, and surgery. He cited his own research showing genetic tests given to cancer patients identify clear treatments about 8% of the time, and that just 5% show a temporary response to treatment.

    But that's not to say, Prasad's colleagues don't agree with his arguments, Harris reports. ASCO CMO Richard Schilsky, who moderated a debate that Prasad took part in, said,"I enjoy his remarks very much." He added, "I mean, he's a bit of a gadfly. He's a bit of a provocateur. But frankly, he's taking a very hard and objective look at a very complex area and ... he's saying what's behind the curtain."

    For his part, Prasad does not relish his reputation as a professional troublemaker. He explained that his opinions are not meant to imply precision medications serve no purpose—but rather that their proven impact is overblown.

    "We really try to find those instances where the evidence and the narrative are divergent and try to ask what we can do to bring those two closer together." He added that he hopes others will join him in calling out shortcomings in the field. "I don't want to be the person to be doing all this work," he said (Harris, "Shots," NPR, 6/24).

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