Criticizing the Young Oncology Critics

They don't know how important KOLs are

Today's guest post is from Victor K. Profiteer. Dr Profiteer is a middle age man and full professor. He has been the author of 600 papers, 500 of which were written by medical writers. He earns $200,000 a year in consulting payments. He is the Anil Potti Professor of hematology oncology at the top cancer center that doesn't care about the rankings. But it's #1 in that region. He discusses the young cancer critics emerging these days. It's my pleasure to host him on my substack.

Vinay Prasad

Criticizing the critics.

By Victor Profiteer

A new type of doctor has emerged: The professional critic. These parasites have nothing better to do than point out my negligent, unethical trials that harm people with cancer. Losers, the lot of them!

They could be writing uncontrolled phase 2 trials for pre-disease states and pocketing rolls of pharma money a.k.a. actually helping. Instead they act holier-than-thou, and patiently explain complicated biases that we have hidden for years. Let me humbly explain why these people are scum.

First, it's their tone. They have a bad attitude. Not like me, I am a gem. Just ask my ex wife. Not the first, the second. Anyway, they don't seem to know who I am. I am very important. Very very important. A big f***ing deal (BFD).

Want proof of that? I have tons of ribbons on my ASCO badge. Sometimes I can't see the end. It curves past my belly. Once, I dipped it in the urinal. I had to cut some off. Thankfully it was the less important ones: mentorship, equity, social justice, ethics and teaching, and not the key ones: oral speaker, plenary discussant, KOL of the year, top Pharma Cash earner and the Mr. PFS award for most PFS-only presentations.

These new oncologists don’t suck up to me enough. Where do they get the nerve? In this profession, you have to kiss my ass. Didn't you see the tweets about how I'm the best mentor, sponsor, boss and KOL? My mentees posted them, per my guidance.

What's my claim to fame? I took 2 drugs everyone was using and combined them. I am brilliant. Who could have thought of that? Before me no one ever said it! Pharma came to me and asked me to co-sign the trial. I did. Why? Because I am an innovator. You're welcome.

These new critics don't like that I use medical writers. What do you expect? Do you think I brush my own teeth, put on my own pants or love my own children? No, you get someone to do that for you! I am a busy man. You wouldn't know because you are unsuccessful.

I am famous. No, people don't recognize me on the street. But they do at ASCO. Maybe I am oncology famous, then. People take selfies with me outside Arie Crown Theater. That's where I talk. You won't find me standing next to a poster. Fellows talk about how they met an OncLive Giant when they ask me for a selfie. They probably brag to their partners when they get back home.

That's right, did I mention it? I am an OncLive Giant of Oncology. And a CancerToday 10 Heros a year. Someone gave me a glass trophy and I put it on my mantle next to the bullshit participation trophies they give my kids these days. Stupid kids. they don't know how to earn real awards like the Merck MidCareer Investigator of the Month or the Southern California GU Researcher of the Week. Ha, I hear some onco-critics earn institutional teaching awards. Losers! Teaching is for chumps. That's time that could be spent consulting.

The critics don't like my studies. Don't they know: I was the first person to treat healthy people with dara-rev-dex and measure time to MGUS. Hello, I saved lives!

The critics start by faulting me for not having control arms. Are you stupid? You don't understand how trials work. Control arms can ruin a drug launch with a negative result!

They say surrogate endpoints are overused. Overall survival takes too damn long. Like in pancreas cancer. If we used OS we would not have approved olaparib. We could even have rejected it months before approval. It occurs fast in that cancer. Thanks to PFS we didn't. These critics would have nothing to complain about if we used OS. Surrogates keep them employed.

Did I mention I invented MRD? That's right. I told you I was important. I once told an Amgen scientist there has to be myeloma in there, find it! I pointed at the patient. He did find it and that was MRD. So I invented it! Just like Robert Malone. Not just anyone would have known that if a disease always returns, there has to be disease left behind. It took a Giant KOL like me. What have you ever done, you whiny critic?

Some of these critics are on me about control arms. They keep saying: you would not give your mother chlorambucil. Of course not, my mother is rich. We go to low income countries to exploit them for US approval. Critics are stupid. They have never run a trial. They don't know that this is what you do to be successful. How else will you get your honoraria?

Did I mention the FDA made me do it? The company and I went into the meeting. We were like: we need this control arm to be the US standard of care. But Rick Pazdur said no, punish those people, kill them, if you have too. I know. I could barely believe it myself. But he said it. Or something like it. So I will tell you the same thing I told my first wife after she was mad about that conference in Vegas: the FDA made me do it!

It's easy to sit back and read the paper, the supplement and the protocol. Any fool can download the Kaplan Meyer curves and reconstruct survival. Any idiot can understand differential, informative censoring, and model it under alternative assumptions. Any moron can learn statistical analysis and probabilistic thinking. But, it takes a real goddamn hero to open your inbox one day and see a manuscript written by a medical writer and hit reply all, “looks good”.

Critics always say the system is broken because it's financially incentivized to promote profits over people. What do these policy experts know about a 150 billion dollar industry? Nothing, except a detailed understanding of how the system interacts.

Their reforms would significantly lower spending, and really cut into the lecture circuit market. How would we ever have conferences? The average person in America's wage will may go up. I don't disagree with that. But when I go to ASCO who will give me a latte with my face laser printed on the top in foam? Critics don't understand negative, unintended consequences.

Some of these critics are really smug. Once I was on a podcast discussing my New England journal paper. Someone asked me about early stage patients. I said there weren't any on the trial. They found some table that the medical writer put in there that said otherwise. They called it a ‘Gotcha’ moment. How am I supposed to know who's on the study? I'm a trialist. I don't have time to read the paper as closely as they do. I'm busy saving lives.

When I started in oncology, everyone was a generalist. Now everyone specializes in some cancers (GI. GU, myeloma, lymphoma, etc). This was a needed, and logical evolution. Now some critics want to focus on health policy, outcomes, disparities. What the hell? Don't they know professions are never supposed to change?

Of course, critics are a fly on the elephants back. I wouldn't care if these critics weren't multiplying. First there was one. Then a bunch of them said, the first one made good points, and now there are more. They are like a cancer. Spreading fast. All we can do is treat first and ask questions later. That's all we ever can do.

Let me end by telling you a story. When I was a junior oncologist I went to a conference in Vail. I asked a senior investigator a simple question. He snapped at me and said I had never done anything productive. He said I was a loser, and should shut up. He said he once worked with Devita and Frei, and I was a nothing and nobody, who would never succeed. He reminded me of my own father. That's when I vowed to…. pass it forward. I vowed to be as close minded and abusive to junior people as he was to me. That was the first day I started to be a KOL.

To the oncology critics. Things will never change. You will never win. Trials will never serve patients better. And if you see me at Asco and my ribbons are longer than yours, then shut the fuck up and don't ask me any questions at the mic; well, unless you want ask me for a selfie.

—Dr. Victor Kyprolis Profiteer

Dr. Profiteer is the Anil Potti Professor of Oncology at the #1 Cancer Center that Doesn't Care About Rankings, except to say we are #1.