These 250 pages on the many ways that cancer care in America is broken should be read by everyone with even a passing interest in oncology, and must be read by every heme/onc fellow or fellow-to-be. Malignant reminded me of the best days of my own fellowship, when the then-program director Tito Fojo would eviscerate an article — these tended to be poorly thought out phase 3 trials of one TKI or another that somehow made it to the New England Journal — with a few slides made at the last minute.1 But this is not just a rehash of those lectures, nor is it the best of Prasad’s prolific Twitter feed, nor an overview of his billion meta-science articles and editorials. It is instead a series of lectures — enough to fill a semester — that takes bits and pieces of the above and adds quite a bit of new to make something better.
It is not the easiest of narratives to follow. This is understandable: cancer research, policy, and outcomes are as intertwined as the molecular pathways Prasad valiantly tried to avoid, and mapping their connections will inevitably result in a crazy wall. There are nominally four parts to the book with four chapters each, because you had to put it together somehow, and the parts make sense. Even so, more than once I was wondering what exactly a particular vignette had to do with where it was in the book, and wanted to put it somewhere else. But the feeling goes away quickly — Prasad’s style is entertaining, the puns are clever2, and there isn’t a superfluous paragraph in site.
To that last point — if anything, the book is too short. My pet cancer peeve, the disconnect between bioplausability and reality, and the many misuses of animal models to inform clinical trials, was barely mentioned when it could’ve easily made a whole chapter. Same for grant mechanisms, which did get a page and a half — that one half is a figure — but left too many things unexplained and uncovered, particularly for the lay audience. And as to Prasad’s big advice that the federal government should take over running clinical trials from private companies, well, it’s nice to put some pie-in-the-sky proposals out there, but something that is so against the grain should be more fleshed out.3 Or maybe mention some more feasible proposals, in the line of Vincent Rajkumar’s plea to cut down the number of people with veto power over a randomized controlled trial. I could go on, but I’d rather not spend too much time on what can be refuted by a single sentence: “Write your own damn book”.
Written by Vinay Prasad, 2020
And I mean this quite literally: you could see him cropping screenshots two minutes before journal club. ↩︎
My favorite involves a marinating chicken and curry. ↩︎
There is, of course, the argument that someone who’s never run a clinical trial has no right to comment on the quality of those that are out there, nor to propose how they should be done. Rather than resorting to modern arguments against gatekeeping, I will echo my grandmother: I don’t have to lay eggs to know when there’s a rotten. ↩︎
The decade in which one’s three children are born will have to rank among the best ones ever, no matter what else happened. But then add marriage, a move to America, completing 25 years of training, Thats 8 years of elementary school, 4 years of high school, 6 years of medical school, 4 years of residency — Chief year included — and 3 years of fellowship. getting a dream job, becoming an uncle — twice — and not to forget, starting this blog, and, well, it is hard to imagine things getting any better.
So yes, it has been a good ten years. Certainly better than any other ten-year span I’ve had. A good test would be imagining the ten-year-ago me learning the outcome of the single decision he’s made back in 2008 to go for residency training in the US of A instead of a PhD in Germany, and I’m not one to pee their pants from excitement but I do imagine myself coming close, even without knowing the counterfactual.
Is America the greatest country in the world? It was for me, at the time, even as a visitor Or rather a nonimmigrant alien of extraordinary ability, for now.. And it may continue being so for decades to come; I don’t see any competitors coming close. And I’m looking.
Directed by Various, 2019
EconTalk with Russ Roberts is the best interview podcast I’ve listened to, period. Unlike Tyler Cowen Roberts focuses on an issue or two, not the personality being interviewed. He gives fewer if any passes. The effect is that I feel like I’m actually learning about the thing in question, not just getting acquainted with Cowen’s personality du jour. Whether any learning actually takes place at my advanced age is another matter.
My top 5 episodes:
Honorable mentions: Cowen, Holiday, Hossenfelder, Bertaud
Conversations with Tyler are as good as ever. This year’s favorites:
(Note that the majority are episodes with women - Cowen has Roberts easily beaten here)
Breaking Smart with Venkatesh Rao I would recommend to anyone who’s enjoyed the above-linked interview Russ Roberts did with Rao on one of the better Breaking Smart essays. It’s 15-20 minutes of Rao performing mental stretching excercises, solo.
Plenary Session with Vinay Prasad is another podcast that shines with the solo performances, but the interviews aren’t half-bad either. That isn’t a surprise, since this year Prasad has talked to David Steensma, Frank Harrell, Adam Cifu, H. Gilbert Welch, and Clifford Hudis, among others. Sadly, the podcast still doesn’t have a proper website, so I can’t link to any of these episodes directly.
Written by Branko Milanović, 2019
Written by George Packer, 2019
I started the decade childless and am ending it with three, so I have missed most of the 2010s’ pop culture. This includes the entire Transformers franchise and most of the Marvel Cinematic Universe (so, not much missed then?)
Movies and music were better in the 2000s, but oh what time to watch TV and follow tennis. It’s too early to judge the books (though it’s telling that my favorite was originally written in 2008).
Written by Malcolm Gladwell, 2019
Things I found to be scarier than this movie:
That this was co-written and produced by Guillermo del Toro and directed by the same person who did The Autopsy of Jane Doe is not exactly mind-boggling, but certainly disappointing. I wonder what went wrong.
Directed by André Øvredal, 2019
A collection of essays from the man who wrote Infinite Jest, also known as the 20th century’s best 21st century book. Each one is near-to-completely brilliant and worthy of more thought than a one-line in an inconsequential blog post, but that won’t stop me:
Written by David Foster Wallace, 2007