QUALITY: Pawelski’s out of line in accusing the NCI by Oren Grad

Oren Grad, a physicians and an independent consultant whose work focuses on policy and strategy in the health sciences, didn’t think much of what Greg Pawelski said yesterday on THCB about cancer research being aimed at the wrong things. Nor did he much appreciate the way that he said it. Again, I’m no expert in these issues and, although I have some sympathy with the position that we do too much at the margin in oncology that promotes the profit of the oncologists rather than of the patients, I understand that this is a very, very delicate area. Greg has good reasons for holding his positions, but here’s Oren’s explanation of why he’s wrong.

I have to say that Greg Pawelski’s post today on cancer research was annoying. I think he’s out of line in both tone and substance, and his "expose" is in fact pretty stale by now.

It’s not as if the leadership of NCI aren’t very well aware of the issues Greg raises, as well as many more that he doesn’t. The CTWG initiative described in these links is but one of several being pushed vigorously by NCI director Andrew von Eschenbach. A lot of very smart, very busy people both within and outside NCI are currently chewing up substantial time figuring out how to adjust NCI’s approach to meet today’s challenges rather than yesterday’s.

From a scientific perspective as well, the implication that Greg’s found magic answers that are being scandalously overlooked is way off base. Both metastasis and ways of individualizing treatment are very much on people’s minds, and will, appropriately, see increased research effort in coming years. Only time will tell whether the insights brought by these efforts will in fact pan out in improved patient outcomes. Cancer is fundamentally a very hard problem.

It’s certainly difficult to redirect a large public agency like NCI quickly. But as a long-time observer of cancer research policy and bureaucratic politics, I do think that as the current initiatives play out we can expect to see changes that will help NCI respond more effectively to new scientific findings and opportunities.

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Gregory D. Pawelski
Gregory D. Pawelski

I revisit this posting by Oren Grad that still shows up on Google, to express not only wasn’t I out of line then, but I’m still not out of line now, three years later. The headlong rush to develop pre-tests (companion diagnostics) to identify molecular predisposing mechanisms still does not guarantee that a cancer drug will be effective for an “individual” patient. Nor can they, for any patient or even large group of patients, discriminate the potential for clinical activity among different cancer agents of the same class. The drug discovery model over the last three years or so has… Read more »

Gregory D. Pawelski
Gregory D. Pawelski

Dr. Andrew C. von Eschenbach was tapped as the new acting chief of the FDA. It is Dr. von Eschenbach’s belief that now, doctors treat illnesses based on how well other people have responded to a given treatment. However, soon they will develop a tailored response built around specific understandings of the patient, the treatment and the disease. “We are discovering so much about diseases like cancer at the molecular level,” he says, “which will lead us to a new kind of health care.” He feels much of what has been done, has been based on a model of “empiricism.”… Read more »

Gregory Pawelski
Gregory Pawelski

In an era of ever increasing numbers of partially effective cancer treatments, there is an obvious need for technologies to better match treatment to a patient. In the field of chemosensitivity testing, there is substantial literature that has not been recently reviewed and which the vast majority of clinical oncologists are not familiar. Clearly, more effective therapies are desperately needed; we should look for other avenues of study. It is time to set aside empiric one-size-all treatment in favor of recognizing that various forms of cancer represent heterogenous diseases, where the tumors of different patients have different responses to chemotherapy.… Read more »