Prasad doubts government cost control will be value-driven, predicting indiscriminate cuts that discourage both transformative and marginal products.
I have little confidence it will be value driven. In other words, I doubt that government will reduce spending on marginal goods and service and incentivize innovation and valuable services. Instead, very likely it will be done haphazardly and indiscriminately resulting in disincentives to make transformative products and marginal products alike.
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Prasad argues AI tools and private markets, not government, will best solve access to medical advice, with information quality exceeding most doctors.
The solution here is likely to be private markets and AI driven. These tools dramatically lower the barrier to ask medical questions, and the quality of the information surpasses most doctors. Technology and not government is best poised to address this.
Prasad says many new drugs and devices don't work or do more harm than good, and the ACA worsened this by letting lobbyists add unproven products to public spending.
Many novel drugs, devices and procedures debuted don’t work/ have harms exceeding benefits. The ACA has only exacerbated this problem by allowing lobbyists to add more and more unproven remedies, tactics, strategies and products to the public tab.
Prasad warns that cost control will rely on tiers and arbitrary delays, frustrating American consumers' access to new therapies.
Again, because we are unable to differentiate good vs marginal products, cost control will rely on tiered structures, arbitrary delays, etc. This will likely result in further frustration from the American consumer.
Prasad argues overall survival is the only meaningful endpoint in smoldering myeloma trials because early treatment adds toxicity and cost without proven benefit.
With smoldering myeloma, the only endpoint that matters is overall survival. After all, if you treat a pre-cancer with a temporizing regimen, you add toxicity and cost, by definition. Your tumor will still eventually grow, and it will still eventually kill you.
Prasad says trials like Aquila can manufacture an OS benefit by comparing against substandard control-arm care in global trials rather than true US standard of care.
So the only appropriate study would be to randomize to early treatment vs current standard of care, and measure survival. But that would be difficult, and make it hard to increase uptake for your product, so the easy cheat code is to randomize to early treatment vs poor care— if you run your trial globally the control arm will tank— then you can easily show a OS benefit.