美国国家公共电台 NPR Tweeting Oncologist Draws Ire And Admiration For Calling Out Hype

 

SUSAN DAVIS, HOST:

And we finish the hour with this weekend's Long Listen. Precision treatments for cancer are hot right now. But one young cancer doctor is pushing back against some of the hype through scientific articles and on social media. NPR science correspondent Richard Harris met up with him recently at a big cancer conference in Chicago, where the doctors squared off in a debate about precision medicine.

RICHARD HARRIS, BYLINE¹: Soon after I meet Vinay Prasad, we stroll past one of the many glitzy displays that the pharmaceutical² companies erect³ to generate buzz about their products.

VINAY PRASAD: The carpet is so plush in many of these exhibits, you could twist your ankle in it. But this is actually a really gorgeous display. You would win any science fair with a booth like this. You would just crush it. It's bathed in purple light - incredible. Oh, hey. How are you? Good to see you. Good to see you.

HARRIS: A colleague comes up and, after asking me not to quote her on this touchy⁴ subject, both thanks Prasad for raising important issues in the field but also implores⁵ him not to get so overheated. It's not as bad as you seem to make it, she argues. And she reels off a list of precision-targeted drugs that help people with melanoma, lung cancer and other diseases.

PRASAD: I use those drugs. There are some good drugs. No one said there's no good drugs. The question is, let's be honest. The truth is 8 percent of people benefit from these drugs. Of the 8 percent that get these drugs, 50 percent have tumor⁶ shrinkage. 50 percent don't.

HARRIS: And tumor shrinkage doesn't mean cure. The problem, in his eyes, is that the field has gotten so enthusiastic about these drugs that they aren't waiting for actual science to distinguish between the times when they are useful and where they are a very expensive, wasted effort.

PRASAD: A lot of people want to push it to the treatment side. They want to get Medicare to pay for it. They want to get the drugs paid for off label because they don't want to shoulder the cost on the industry side. And that's the root of what bothers me about this.

HARRIS: People who buy health insurance and taxpayers⁷ are funding a massive, uncontrolled experiment with these drugs. Nobody's even collecting the data most of the time to find out what might be useful. Prasad, a 35-year-old oncologist who treats patients at the Oregon Health and Science University, says when he was in medical school, he assumed he would spend his career as a community doctor, treating people with cancer. But then he discovered how much of medical practice was based on traditions, rather than actual science.

PRASAD: Even the most respected, charismatic and thoughtful experts often are incorrect.

HARRIS: The more he learned about what's called evidence-based medicine, the more captivated he became.

PRASAD: I found it harder to just observe things that troubled me and not study them. And at some point, I made the decision - the conscious decision - that if it troubles me enough, I want to look at it kind of and study it and try to say something about it. And maybe somebody else will carry the torch and actually fix that problem someday.

HARRIS: He started out publishing analyses in the scientific literature about bad assumptions and bad practices he encountered. His notoriety really took off when he started opining on Twitter. Today, he has more than 20,000 followers⁸. And he has punched out nearly 30,000 tweets. His pointed⁹ commentary sometimes gets him tagged as a troublemaker¹⁰.

UNIDENTIFIED PERSON: Good afternoon. I'd like to welcome you to the 2018 session.

HARRIS: And the sessions and meetings like this are ripe targets. We settle back into seats in the cavernous meeting room where thousands of doctors have gathered to hear the big talks at the American Society of Clinical Oncology conference. The screen during the warm-up presentation flashes random¹¹ tweets about the meeting, including one of Prasad's. It's a bingo card that features buzzwords surrounding advances in cancer treatment.

PRASAD: The words that are displayed are unprecedented¹², personalized, microbiome, precision, inflection point, breakthrough, silo, big data...

HARRIS: ...Among others.

PRASAD: I guess it has almost 100 retweets now.

HARRIS: He actually wrote a scientific paper about the overuse of superlatives in scientific presentations and news coverage¹³. He found plenty of uses of the terms game-changer, breakthrough, miracle, cure or home run.

PRASAD: But what really got me was 14 percent of the drugs - the superlative was used based only on mouse or laboratory results. And they'd never given it to a human being.

HARRIS: We lower our voices when the talks begin. Prasad joins the Twitter conversation about the session while keeping an ear tuned¹⁴ to the presentation.

UNIDENTIFIED PERSON: ...Was to develop a paradigm¹⁵ of biomarker-directed chemotherapy.

PRASAD: They're winning my bingo. Did you hear all those words?

HARRIS: Prasad retweeted some sharp critiques of the talks but also tweeted praise for one panelist who added some important caveats¹⁶ to a study that had just been presented. The next day, we meet again at Prasad's main event, the debate over the value of precision medicine.

RICHARD SCHILSKY: OK. Good morning, everyone.

HARRIS: Dr. Richard Schilsky, the oncology society's chief medical officer, steps up to referee¹⁷ the face-off between Prasad and Vanderbilt University oncologist Jeremy Warner.

JEREMY WARNER: So the first thing I have to say is that I'm the underdog.

HARRIS: Warner flashes a cartoon with two dogs, his face plastered onto one on the ground and Prasad's face spliced¹⁸ onto the animal looming¹⁹ above. A cloud of Twitter birds represents Prasad's army of followers. The so-called debate about this multibillion dollar enterprise was civil. Afterwards, Warner reflects on their considerable points of agreement. Warner disagreed, though, about how to accommodate patients' desires for these new medicines before the careful studies show whether they will actually work for their particular type of disease.

WARNER: Yeah. Saying that someone should just be on a clinical trial - I mean, it sounds easy. But it's actually not easy at all.

HARRIS: And Schilsky, the moderator, found he was in considerable agreement with Prasad as well.

SCHILSKY: I enjoyed his remarks very much. I mean, you know, he's a bit of a gadfly. He's a bit of a provocateur. But, frankly²⁰, he's taking a very hard and objective look at a very complex area. And, you know, he's calling it out. He's saying, you know, it's, you know - it's what's behind the curtain. And, you know, let's celebrate what really works. And let's look hard at what doesn't. And let's try to develop the evidence that we need to make important decisions for patients.

HARRIS: Plenty of people aren't so accommodating, particularly on Twitter, Prasad notes.

PRASAD: I think it's unfortunate that I'm thought of as a professional troublemaker because the work we do - we really try to find those instances where the evidence and the narrative²¹ are divergent and try to ask ourselves, what can we do to bring those two closer together?

HARRIS: Is this good for your career, or is this bad for your career?

PRASAD: (Laughter) To be honest with you, I don't know the answer. I guess I would say I wish I didn't - as a young person, I don't want to have to be the person to be doing all this work. I wish there were senior people who would do this work. Senior people are not doing this work.

HARRIS: The point in the end is not to be cynical²² about science, he says, but to help this critical field do science better. Richard Harris, NPR News.

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1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 pharmaceutical   

adj.药学的，药物的；药用的，药剂师的

参考例句：

• She has donated money to establish a pharmaceutical laboratory.她捐款成立了一个药剂实验室。
• We are engaged in a legal tussle with a large pharmaceutical company.我们正同一家大制药公司闹法律纠纷。

3 erect   

n./v.树立，建立，使竖立；adj.直立的，垂直的

参考例句：

• She held her head erect and her back straight.她昂着头，把背挺得笔直。
• Soldiers are trained to stand erect.士兵们训练站得笔直。

4 touchy   

adj.易怒的；棘手的

参考例句：

• Be careful what you say because he's touchy.你说话小心，因为他容易生气。
• He's a little touchy about his weight.他对自己的体重感到有点儿苦恼。

5 implores   

恳求或乞求（某人）( implore的第三人称单数 )

参考例句：

• Every movie we see, every story we are told implores us to wait for it. 我们看的每一部电影，听的每一个故事都恳求着我们驻足等待。
• Every movie we see, every story we're told implores is to wait for it. 我们看的每场电影，听过的每个故事都告诉我们要耐心等待。

6 tumor   

n.（肿）瘤，肿块(英)tumour

参考例句：

• He was died of a malignant tumor.他死于恶性肿瘤。
• The surgeons irradiated the tumor.外科医生用X射线照射那个肿瘤。

7 taxpayers   

纳税人，纳税的机构( taxpayer的名词复数 )

参考例句：

• Finance for education comes from taxpayers. 教育经费来自纳税人。
• She was declaiming against the waste of the taxpayers' money. 她慷慨陈词猛烈抨击对纳税人金钱的浪费。

8 followers   

追随者( follower的名词复数 )； 用户； 契据的附面； 从动件

参考例句：

• the followers of Mahatma Gandhi 圣雄甘地的拥护者
• The reformer soon gathered a band of followers round him. 改革者很快就获得一群追随者支持他。

9 pointed   

adj.尖的，直截了当的

参考例句：

• He gave me a very sharp pointed pencil.他给我一支削得非常尖的铅笔。
• She wished to show Mrs.John Dashwood by this pointed invitation to her brother.她想通过对达茨伍德夫人提出直截了当的邀请向她的哥哥表示出来。

10 troublemaker   

n.惹是生非者，闹事者，捣乱者

参考例句：

• I would hate you to think me a troublemaker.我不愿你认为我是个搬弄是非的人。
• Li Yang has always been a troublemaker.李阳总是制造麻烦。

11 random   

adj.随机的；任意的；n.偶然的(或随便的)行动

参考例句：

• The list is arranged in a random order.名单排列不分先后。
• On random inspection the meat was found to be bad.经抽查，发现肉变质了。

12 unprecedented   

adj.无前例的，新奇的

参考例句：

• The air crash caused an unprecedented number of deaths.这次空难的死亡人数是空前的。
• A flood of this sort is really unprecedented.这样大的洪水真是十年九不遇。

13 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

14 tuned   

adj.调谐的，已调谐的v.调音( tune的过去式和过去分词 )；调整；（给收音机、电视等）调谐；使协调

参考例句：

• The resort is tuned in to the tastes of young and old alike. 这个度假胜地适合各种口味，老少皆宜。
• The instruments should be tuned up before each performance. 每次演出开始前都应将乐器调好音。 来自《简明英汉词典》

15 paradigm   

n.例子，模范，词形变化表

参考例句：

• He had become the paradigm of the successful man. 他已经成为成功人士的典范。
• Moreover,the results of this research can be the new learning paradigm for digital design studios.除此之外，本研究的研究成果也可以为数位设计课程建立一个新的学习范例。

16 caveats   

警告

参考例句：

• I would offer a caveat for those who want to join me in the dual calling. 为防止发生误解，我想对那些想要步我后尘的人提出警告。 来自辞典例句
• As I have written before, that's quite a caveat. 正如我以前所写，那确实是个警告。 来自互联网

17 referee   

n.裁判员．仲裁人，代表人，鉴定人

参考例句：

• The team was left raging at the referee's decision.队员们对裁判员的裁决感到非常气愤。
• The referee blew a whistle at the end of the game.裁判在比赛结束时吹响了哨子。

18 spliced   

adj.（针织品）加固的n.叠接v.绞接( splice的过去式和过去分词 )；捻接（两段绳子）；胶接；粘接（胶片、磁带等）

参考例句：

• He spliced the two lengths of film together. 他把两段胶卷粘接起来。 来自《简明英汉词典》
• Have you heard?John's just got spliced. 听说了吗？约翰刚结了婚。 来自辞典例句

19 looming   

n.上现蜃景（光通过低层大气发生异常折射形成的一种海市蜃楼）v.隐约出现，阴森地逼近( loom的现在分词 )；隐约出现，阴森地逼近

参考例句：

• The foothills were looming ahead through the haze. 丘陵地带透过薄雾朦胧地出现在眼前。 来自《简明英汉词典》
• Then they looked up. Looming above them was Mount Proteome. 接着他们往上看，在其上隐约看到的是蛋白质组山。 来自英汉非文学 - 生命科学 - 回顾与展望

20 frankly   

adv.坦白地，直率地；坦率地说

参考例句：

• To speak frankly, I don't like the idea at all.老实说，我一点也不赞成这个主意。
• Frankly speaking, I'm not opposed to reform.坦率地说，我不反对改革。

21 narrative   

n.叙述，故事；adj.叙事的，故事体的

参考例句：

• He was a writer of great narrative power.他是一位颇有记述能力的作家。
• Neither author was very strong on narrative.两个作者都不是很善于讲故事。

22 cynical   

adj.(对人性或动机)怀疑的，不信世道向善的

参考例句：

• The enormous difficulty makes him cynical about the feasibility of the idea.由于困难很大，他对这个主意是否可行持怀疑态度。
• He was cynical that any good could come of democracy.他不相信民主会带来什么好处。