What is "value"?
It’s truly astonishing to see the scientific advances in cancer, especially in specific kinds of cancer. It’s even more astonishing that roughly 73% of persons diagnosed with cancer never get a second opinion and basically follow a care pathway dictated by the first oncologist they see and therefore don’t get the benefit of these advances. There are very clear ‘best practice’ or COE cancer protocols that include the use of genomic tests to recommend the most efficacious pathway (which often isn’t chemo) for the patient, yet patients continue to be subject to the protocols of the health system that they are driven into. While I entirely agree with your comments about our failures to assess drug efficacy up front (Pramod’s work is so important), I will tell you that many cancer COE centers are effectively using genomic diagnostic tools to assess tumors and also individualized drug efficacy and that many of these tools are quite advanced. I’ve had the benefit and opportunity to see the value of these personally.