Vinay Prasad, M.D., M.P.H: Hallmarks of successful cancer policy

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
My guest this week is Vinay Prasad. Vinay is a practicing hematologist and oncologist and associate professor of medicine at UC San Francisco, where he focuses on not just the treatment of patients, but also health policy, clinical trials and decision making. He's what some might call a meta researcher. He studies the quality of medical evidence, and lately has focused most of his energy on oncology, of course. He's the author of over 250 academic articles, along with two books, Ending, Medical Reversal, which was published about five years ago, and published this year, the book Malignant, which we spend a lot of time discussing. He also hosts the oncology podcast, which is called Plenary Session. I recommend you check it out. And he runs a YouTube channel, along with his various activities on social media. He's primarily active on Twitter at Vprasad, that's P-R-A-S-A-D-M-D-M-P-H, where he writes some really great Tweetorials related to clinical trials, critical thinking, decision making, et cetera.
In this episode, we talk a little bit about his beginnings, how he got into medicine, and really how things that he saw during his medical training kind of woke him up to some of the issues in clinical medicine. Probably the first thing that he observed with some of the limitations in cardiology and how there was a disconnect between clinical practice and research. But really that kind of took off once he chose the profession of oncology, which is a field that is really rife with some of these inconsistencies. Now, this is a podcast that sort of builds on a lot of the stuff that we discussed in a previous podcast with Azra Raza, but we go a little bit deeper into some of the structural failures. This one goes by quick, and yet somehow at the end of it, I looked and realized we'd been talking for two hours. I could have spoken with Vinay for another two hours. We close this by doing kind of a deep dive on what he describes as his six hallmarks of cancer policy. And I think this is a really great discussion. I was just constantly impressed by the way that Vinay was able to kind of articulate things in ways that I even made the comment at one point, if you gave me two hours to explain what you just explained in five minutes, I wouldn't have been able to. So I hope you enjoy this. And without further delay, please enjoy my discussion with Vinay.
Hey Vinay, thank you so much for joining me. Where are you physically today?

**Vinay Prasad** (3:22)
I'm physically located in the Bay Area in one of the distant suburbs, just a temporary place I'm staying here, but hope to be settled in soon. I started at UC San Francisco pretty recently.

**Peter Attia** (3:33)
Yeah, I noticed that and I was gonna ask you about that. That's a soon to be your new permanent gig, huh?

**Vinay Prasad** (3:39)
Yeah, I mean, I started the job, but I do not yet have a permanent place to stay. So I'm just kind of hanging out for now, but I'm gonna work on that. And right now, we're in the midst of forest fires and COVID, and so it wasn't a terrific time to move in retrospect.

**Peter Attia** (3:53)
UCSF has a dear place in my heart. When I was in medical school, which was at Stanford, we still spent a lot of time at UCSF. We had the option to spend time electively, and Stanford was not a great place to get a lot of trauma experience for a budding wannabe surgeon, but of course San Francisco General was.
And then many years later when I returned, my wife was an ICU nurse at UCSF before later moving over to run the Coumadin Clinic, which was run by just a solo NP and one hematologist. So up on Parnassus there, it's some of the most beautiful views of the entire city. So one thing I remember her saying was, there was this gym up on the Parnassus campus where she would go and work out at like 5.3 before clinic starts. And you'd sort of get to kind of just watch the city as the sun was coming up.