Transcripted by AI
Ronit: Good afternoon, Professor Nechushtan. Could you please introduce yourself?
Prof. Nechushtan: It’s a pleasure to be here. My name is Hovav Nechushtan, and I’m originally from Jerusalem. I’ve been part of the Hadassah team for many years, primarily treating lung cancer patients and dealing with various genetic mutations.
Ronit: How has oncology changed in the past 20 years, based on your experience?
Prof. Nechushtan: Oncology is indeed changing, though the revolution hasn’t yet reached all areas of the field. We’ve seen significant advancements in oncogenetics, where we can identify specific mutations and target them with tailored drugs. This has been a game-changer for a subset of patients.
Additionally, the emergence of immunotherapy has been a significant development, ushering in a new era of cancer treatment. We’re also witnessing the introduction of innovative therapies, such as antibody-drug conjugates, that combine targeted antibodies with cytotoxic agents.
These advancements have led to more effective treatments. However, there’s a concerning trend – the skyrocketing prices of these new therapies.
Ronit: What is driving the high costs of these cancer drugs?
Prof. Nechushtan: The story behind drug pricing is complex. There are a few key factors at play:
1. The need for entrepreneurship and the associated risks: Developing a new drug involves significant investment and the risk of failure. Companies need to recoup their costs and justify their efforts.
2. The threat of competition: If a company introduces a groundbreaking drug, it may quickly be copied or replaced by a slightly modified version, posing a threat to their market share.
3. The expectation of high returns: Investors and analysts often value pharmaceutical companies based on their potential to generate massive profits, leading to inflated drug prices.
4. The challenge of combination therapies: Combining multiple expensive drugs, each from different companies, further compounds the financial burden on healthcare systems and patients.
Ronit: You mentioned that combining drugs is sometimes necessary for effective cancer treatment. How do you navigate this challenge?
Prof. Nechushtan: We strive to practice evidence-based medicine, meaning we make treatment decisions based on the available clinical evidence. When it comes to combining drugs, the process becomes more complex.
Conducting robust clinical trials to evaluate combination therapies is often difficult, as it requires coordinating between multiple pharmaceutical companies. Additionally, when dealing with patients in advanced stages of cancer, we sometimes have to resort to off-label use or compassionate use of drugs, without the benefit of strong scientific evidence.
It’s a constant struggle to obtain the necessary drugs and make these combinations work, often without the ideal level of clinical support. But when we succeed, it’s deeply gratifying, as it can make a significant difference in the lives of our patients.
Ronit: So from what I understand, if it’s possible to get private health insurance for those who can afford it, it can help cover drugs that are not included in the public health basket, right?
Prof. Nechushtan: That’s correct. It’s a slightly different topic, how the insurance works. What happens is, the medical coverage in the State of Israel is one of the best in the world, and in most situations the medical coverage covers what’s needed. But there are extreme cases where the medical coverage doesn’t cover some treatments, and in those cases private insurance can help. So those who have private insurance in addition to the public coverage can benefit from that. But in most cases, private insurance is less relevant. Of course, every case where it is relevant is a difficult one, and we really have to think hard about it. I remember the more challenging cases, but in most cases it’s less applicable. If there is the ability to obtain a drug, the prices are so high that even our excellent public health basket has to prioritize, and not every FDA-approved drug enters the basket today, unlike in the past.
Ronit: That makes sense in terms of the current situation, but do you have any real forecast for what the landscape will look like in the next decade?
Prof. Nechushtan: As they say, prophecy is given to fools. We don’t know what the future holds, but in general I think both positive and challenging trends will continue. We’ll have more and more good drugs, and more people who were once lost will now live much longer.
At the same time, more and more we’ll reach situations where the drugs will be too expensive. But maybe the drugs that are a bit older than the newer biologics will be released, and we’ll be able to help from that direction too. So it’s a combination of things. The paradox for cancer doctors is that it’s often not just that they can’t help, but that there’s a drug they think might have helped and they can’t obtain it – that happens too. But this is still a much better situation than simply not having any effective drugs at all.
When I entered medicine and oncology 25 years ago, the situation was very different. We had very limited chemotherapy options. Today we are, for a large part of patients, in a much better situation.
Ronit: You also seem quite up to date on start-ups working in areas related to oncology. Do you see any promising developments there?
Prof. Nechushtan: Well, I wouldn’t claim to be extremely up to date, but I do encounter developments here and there. I think there are ideas that are quite different from what’s being done today. One thing that’s going to happen, and maybe it will really change things for many people, is in the area of immunotherapy.
What’s happening today is that a large part of tumors don’t respond to immunotherapy treatments. There are many people working on ways to “turn on” the immune system to recognize and attack these “cold” tumors that it currently doesn’t see. I think within the next five years, this will provide an important addition for another significant group of patients.
So I think from the direction of start-ups, this is one area that will help a lot. Another area that will add a lot is our ability to better identify which patients will benefit from specific treatments, even for chemotherapies and certainly for biologics. I believe that within ten years this will improve significantly. This will help us choose the right treatments much better.
So these two directions – improving immunotherapy for currently unresponsive tumors, and better targeted treatment selection – I think will advance considerably in the next ten years. Of course, there may be other surprises for the better as well.
Ronit: Yes, I’m hopeful too. One more question – when a patient comes to you for the first time, what do you assume they already know? Do you have a standard approach?
Prof. Nechushtan: What I usually do is simply ask the patient. “What has been explained to you so far? What do you know?” Look, these are very, very difficult diseases – complex. Yes, but mainly, it’s something that none of the patients, or their family members, have encountered before.
I try to be gentle. There’s always room for improvement, but in general I’m very careful with both the bad news and the good news. I don’t want to make promises that I know I may not be able to keep in the short term, but I also don’t want to show despair, which I think can be dangerous in itself.
Ronit: You’re really good at not showing despair, from my experience. I remember when we first came to you, we had a letter from another doctor who had written that “the disease has no cure, or I explained to the patient that there’s nothing to be done.” Something like that. But you told me that it’s not right to be so definitive, because none of us knows what new developments tomorrow might bring, and we really need to be modest.
And I’ve heard from your colleagues that they say, “don’t worry, Hovav always has another idea in his head about the next step.” So I understood that you have another course of action and in general a positive approach, and you don’t despair quickly. I mean, sometimes patients do reach very difficult situations.
Who knows better than you, but you really always have a positive approach. I mean, you fight, okay? I don’t know if “positive approach” is the right word, but you just continue to fight. Is this always your approach?
Prof. Nechushtan: You need to be very careful with these things, and I actually listen a lot to both the patient and their family. I was told that in Egypt, unlike in Israel, there’s a law protecting the rights of the patient’s family. Interesting.
I think in many aspects they’re more right. Because the very fact that you’ll come, in the American style maybe, and tell all the truth to their face, which you’re also not sure will be the truth until the end, you also pay a price for this.
But at a certain stage, when you see that your chance to help is really small, and the chance to succeed is small, you need to be very careful before you offer another treatment, before you promise all kinds of promises that you can’t keep. You do try, you give the slightest chance, even with the smallest probability, especially for young people. You’re willing to try even for the smallest chance, so you need to really search the literature, try this and that, and if it succeeds for you, each such success is worth maybe ten attempts, if you didn’t harm the person in these attempts.
We had someone, a representative from hospice, and he gave us a reprimand that we don’t send patients to hospice early enough. Because in their opinion we’re just prolonging their suffering.
And I got very angry with him because I told him, you’re not an oncologist, you don’t know when we have something to do and when not. I remember the positive responses, I also remember people who were already on the verge of passing, and yes, succeeded, but there were many we couldn’t help. And then you gently, you need to explain that you have nothing more to do. Or… Depends on how you do it, yes.
Ronit: I, by the way, in the context of hospice, I had some aversion to this concept. I think Israel was very sick , and I made a lot of efforts not to get to the point of talking about hospice. I remember that even just before he passed away I started thinking about it and then I said to him, “ah, but I talked to some company that provides hospice services, you’re not there at all because you have another future treatment, so there’s no need to talk about hospice at all.” And that actually gave hope, I think. So it’s always the question, because on the other hand, the hospices do very important work, also with home hospice.
Prof. Nechushtan: And I very much appreciate them, it shouldn’t be heard otherwise. And I think they help people in difficult times, and maybe sometimes you need to know when to use their help. Maybe not to determine this is hospice or that, but yes to know that they can help you. And they come home and I don’t come home, I’m in Hadassah all day.
Ronit: How do you really know? How should a family or patient assess when it’s really time for hospice?
Prof. Nechushtan: It’s difficult, you need to really talk with the doctor, go over all the patient’s history. See them, at least get an updated description of the patient’s condition, and examine what other medication options might still be possible.
This is not an easy problem, it’s a kind of balancing act, and it also depends on the family. Today there are some advanced medications, but if there’s a medication that costs a lot, like 300,000 shekels per month, it’s crazy. If it wasn’t covered by insurance, it’s hard to recommend such a medication that may or may not help.
Ronit: It reminds me that we had medications at home, from Israel’s health system. I did the calculation, it was around 25,000 shekels. I remember saying, if a thief breaks in, he’ll probably steal a 700-shekel necklace from me, and he doesn’t know that all the money is in the medications. But in light of these high prices, what do you really do in a case where a patient comes and you say, “Listen, there’s a medication, but it costs $70,000”?
Prof. Nechushtan: So first of all, there’s the English style of simply not saying anything. That’s not my style, because there’s a question of what’s right. Because maybe you say it, and you complicate things for the patient and create impossible situations.
On the other hand, I try to connect the patient to charity organizations, to all kinds of associations. Sometimes it works, sometimes it doesn’t. There are organizations that try to help. But it’s really a very difficult situation.
Ronit: I remember, I’m not sure if I’m right, correct me if I’m wrong, there was a story about a patient of yours who decided to stop the treatments altogether and opened some kind of café?
Prof. Nechushtan: No, no, that’s a different story, we can tell it. It was published in the newspaper. What happened was, it’s a young man who received treatments, and then the treatments, it’s a bit more complex.
In short, he received a combined immunological treatment that worked, and then he was left on one immunological treatment, and his condition worsened. There’s almost no literature on this, but we brought it back to him, and a lot of it was also his initiative, I must say, he went and collected money from friends, which is also a difficult thing, and bought medications for tens of thousands of shekels. To our surprise and joy, the treatment worked. It’s actually in kidney cancer, which is a tumor that usually responds to immunotherapy.
He has a certain message, he really responded well. He also opened a café, he’s very much into spirituality, and I think spirituality affects it, but it’s hard for us to measure it. I gave him a prescription that he must listen to music three times a week. In the café? No, in his treatment, and that’s what he asked for, I gave it. I think the mental aspect really does affect it, but it’s very hard to measure, because sometimes even the most optimistic people, it doesn’t work for them, these diseases are very, very difficult.
Ronit: A question that might be related – what does it mean when they say “first-line treatment”, “second-line treatment”?
Prof. Nechushtan: Well, it’s a term, because what happens is that treatments are often a combination of more than one medication. So you could say, “first combination of medications” is five words. “First line” refers to the first set of medications given in treatment, “second line” is the second combination given.
Ronit: But sometimes you reach many lines of treatment, right?
Prof. Nechushtan: Yes, because if you have more to do, you try to reach another line, another line. Even if you’re also doing combinations, or let’s say the medication worked, then today there are “lines and a half.” For example, we have a clinical trial now with a medication called Tagrisso, and then if it stops working, the trial examines giving chemotherapy – it’s like it was a second line, but half of the patients continue with Tagrisso. So you can already say “line one and a half.”
The definitions are starting to get confused. But that’s the idea – you gave biological treatment, it didn’t work, so you gave chemotherapy. You went back to another biological treatment. Each time you progress. The problem is that usually, the chance of response, in oncology, tends to decrease as you progress in lines, because the tumor has already developed resistance to one type of treatment, and many times this resistance will allow it to escape from another type of treatment as well. But if you do a different action, you still sometimes get a response.
Ronit: I heard an interesting opinion, I think from doctors actually, who said: “Ah, in oncology, it’s fixed protocols, it’s easy work for the doctor.” Is there really not much importance to the treating doctor?
Prof. Nechushtan: Look, this is the oncology you knew, and the oncology that continues. And I’ve already said that most patients still, we’re in classical oncology with evidence-based medicine. But even when you’re in oncology with fixed protocols, you need there to be a person to listen to when to lower the dose, when to increase the dose, what happened with side effects – even the fixed protocols require some adaptability.
And the moment you reach more advanced lines, then you can change it and it depends on the disease. There are diseases where there’s more room for adaptation, and there are diseases where there’s less possibility to play with it. So I think that still, the doctor’s role is important.
Although soon they’ll replace us with these holograms from the computer. Meanwhile, there’s importance to doctors – you also need someone you can talk to a bit, that you feel is a bit… There are such doctors who think that maybe it’s less important, also patients sometimes think it’s less important, but I think that still the personal aspect is important also for the patient, not everyone thinks so, I don’t.
Ronit: What do you think about second opinions in this field of oncology specifically?
Prof. Nechushtan: They tell a story about a Christian, a Muslim and a Jew, whose doctor told them they have a month to live. The Christian went to Rome, the Muslim to Mecca, and the Jew to a second opinion – that’s a second opinion, right? So I think that second opinion is something that’s completely legitimate, no one knows everything. You don’t always need it, but if it gives you more peace and more…I can’t blame people who went to hear a second opinion after they were with me, because people also come to me for second opinions.
I think it’s also important that when people come to you for a second opinion, you give respect to the first doctor. Don’t say, as they said about some of my things, “He’s poisoning you with all kinds of nonsense,” because if a doctor in a second opinion tells you such a thing, then you need to treat him with some skepticism. He’s allowed to say a different opinion, and maybe it will also help your doctor, or you’ll make a different decision.
I think it’s a legitimate part of dealing with such a difficult disease. It’s definitely an important part.
Ronit: Besides it being legitimate, do you think it’s important? I mean, you as a doctor even. Is it important to get another input?
Prof. Nechushtan: Everyone has their ego. Right. So if I want more input, I present cases at our meetings in Hadassah and I consult, or do informal consultations. That’s with other oncologists. Yes, I consult with radiologists, with all kinds of oncologists. I have a certain amount of confidence that I’m offering something legitimate. But I don’t think it’s mandatory. Yes, I don’t think it’s mandatory.
But sometimes it contributes to me. And there are two sides – does the treating physician think it’s mandatory? And the other side, because the treating physician presents it to another group of doctors at the same center, on the other side it’s the side of the family, that the family wants to feel it’s not a closed process.
It creates some burden on the system, and therefore abroad maybe it’s less common, but I think it’s a legitimate need. I don’t feel I need a second opinion, I feel I’m competent enough to give the treatment alone. But I understand the patient’s perspective in wanting that additional input.
Ronit: What do you expect from the family doctors of your patients?
Prof. Nechushtan: Because they have a role, although emotionally they may be in the background… First of all, they have a role in helping us get medications, but also a role in the actual treatment, because many times patients come and they have more general health problems. Our cancer medications can cause them issues like high blood pressure or high cholesterol.
That is, there’s the overall management of a patient with an oncological problem, and there the family doctor has a very important role. Yes. And there are also problems that I should be in contact with them about – things I deal with less, like diabetes. All kinds of general topics that are more in their domain.
And also, of course, to help with all the bureaucracy, because one of the main problems of patients with this disease is endless bureaucracy, and if they don’t have a caregiver, the caregiver himself can already collapse from it. But if there’s no caregiver and they do it themselves…it becomes very, very difficult. Yes. And if the doctor manages to help with this as well, it’s a very, very important contribution. I try, but I’m always behind.
Ronit: In full disclosure, I also interviewed a family doctor, and one of the things I noticed during the disease is that the systems don’t fully support the integration between oncology and family medicine.
Prof. Nechushtan: Okay, it often depends on both the doctor and the oncologist. We’re all in some kind of race. And there’s a lack of time. And one patient can actually demand, and rightfully so, almost infinite time. So there’s some kind of disconnect, and the systems are not fully connected to each other, and maybe that’s good sometimes.
I can’t, for example, read the results from the health fund if the patient isn’t registered with us on the same day. That’s something that’s missing. The doctor there can’t read our results, which sometimes sounds good. Why? There’s another problem we didn’t talk about regarding medication prices and insurance companies, where basically the decision on the patient’s treatment has already left the hands of the treating physician to the insurance companies in many cases.
And then you stand, let’s say there’s a medication… The question is, of course, how they tested the medication, how they got approval for it, and for what and so on. As long as the medications didn’t go up in price much, then it wasn’t a problem, chemotherapies are usually not a problem. But there are biological treatments, where the trial was done in a certain way, and the insurance funds are very rigid, very interfering, don’t give me the decision to say for whom the medication continues to help and for whom- not. The fund decides according to these rigid criteria.
Despite the professional medical opinion… despite me being the professional authority, they think they know better, and what interests them is what’s written in the health basket. So you can shout about it and say, it’s not fair, but even when they budgeted it, they did it maybe according to the trial.
The matter is a bit complicated, because in clinical trials they usually used only CT for imaging. When I send a patient to do a PET scan, it’s much more sensitive. So basically I discover things that in the clinical trial they might not have discovered. There’s some duality here.
So one of my tasks is to know how to get the insurance to approve in a way that’s legitimate in my eyes, not wild, and not to do things for example that weren’t in the clinical trial, not to be holier than the Pope and stop the patient’s treatment, Before the time, in my opinion. So there’s some kind of hidden struggle here between the insurer and the treating physician.
And could the family doctor help you at this stage? He can’t help with this, but the health fund can interfere. The fund sometimes interfered with me. I’m not here to judge it, they do it because of budgetary considerations. They received a certain budget and we can, thank God, sometimes live much longer than their budget.
But I can’t do the fund’s calculations, my only calculation, as I see it, is not systemic, maybe I’m not suitable to be at the stage where I’m a doctor, I’m not talking about the stage where I’m managing the Ministry of Health. I, as a doctor, I only see the patient in front of me, I don’t have some kind of general view on the benefit of the system, maybe there are other doctors who are better, who have that, I look at the patient in front of me.
Ronit: But how can you actually fight the health funds, in your experience? How to preserve the patients?
Prof. Nechushtan: First of all, the health funds, they do have an exceptions committee, and there are, overall there are doctors there, and it’s not that they never want to help. What always worries them is the precedent, that suddenly we’ll start doing wild things, and if you write a letter, another letter, it of course takes your time in an extraordinary way, this is one of our problems, as oncologists. A lot of bureaucracy. We also need to fight…And sometimes it works, sometimes not.
They’re not evil, right? I don’t want, God forbid, it to come out like that, I’m saying again, in Israel they give and help much more than what happens in the world, but in any case, sometimes when I follow, let’s say, an article with ten patients or five patients, then from their perspective, it’s not evidence. From my perspective, when I see the patient in front of me walking and responding, then it is important.
And there’s another mechanism, which is to start bargaining with the health fund, after you’ve succeeded in treatment for a certain period, to try to get the medication from them anyway. This can also consume your time. Letters, issues, more letters and more letters. But still, the situation here, there’s no comparison, I think. A patient who came to us from abroad, where the doctor simply told her she had metastases, and the tumor with translocation, and here in Israel we managed to treat her, and she’s been living well for a year now. And it’s possible that in her country, she would have been fully insured.
Ronit: Another question – I think this is a discipline that I only discovered during the illness – you once referred to an “onco-cardiologist.” Are there such onco-disciplines developing for other medical fields as well? I mean, is there a sub-specialty of medicine that is specifically focused on the oncological aspects?
Prof. Nechushtan: It’s starting to develop, starting with doctors. They’re doing a kind of specialization, and this might become more established disciplines in the future. Because we have a guy who’s interested, he’s a nephrologist, he’s interested in the nephrological problems of the kidney in our cancer patients. So maybe it’s not a fully fledged discipline yet, and there are rheumatologists as well, and we give a lot of immunotherapy drugs that can cause rheumatological problems.
So gradually there will be doctors who specialize more and more in these oncological subspecialties. For cardio-oncology, they’ve already held conferences and such things. So slowly these things are emerging, where for example a doctor specializes in the cardiac effects of our oncological treatments. So maybe it’s not yet a full sub-sub-specialty, maybe it’s not yet an official unit for that, but it’s a trend that will continue where there will be doctors who are experts in these oncological subspecialties across different fields of medicine.
Ronit: Well, everyone needs work, right. But essentially what you’re saying is that these doctors, it’s not really their personal interest? Like, how does one actually find a doctor who is really an expert in these oncological subspecialties?
Prof. Nechushtan: So you need to ask, I think in every major medical center, there’s a doctor who deals with this. There are 4-5 major centers in the country, and so, in each center there’s a passionate doctor who has developed expertise in an oncological subspecialty, and patients can be referred to them. More and more doctors are becoming interested in these areas, so they’ll become more and more specialized. For example, in onco-cardiology, there are several people in the country who deal with this.
Ronit: But do you as the oncologist refer your patients to these subspecialists?
Prof. Nechushtan: Usually, yes, the oncologists are the ones making the connections. They’re the ones who know which doctors have developed expertise in these oncological subspecialties. There’s also in the country a phenomenon of medical activists, like Rabbi Phirer and others, who also sometimes know about these specialized doctors.
Ronit: Now, another question – I happened to come across the subject of steroids, and I think you’re also sometimes cautious about using steroids.
Prof. Nechushtan: Steroids, yes, but you need to look at it from two angles. On the one hand, steroids, these glucocorticoid drugs, have many side effects – they lower the immune system, cause weight gain, and can interfere with the effectiveness of some biological drugs, depending on the dosage and duration of use.
The immunotherapy drugs in particular work much less, if at all, when steroids are used. That’s the less desirable side of steroids.
The other side is that steroids have important aspects – they can reduce swelling in the brain, for example. But we need to remember that we have another tool, which is treatment with Avastin, a kind of antibody that can also reduce brain swelling without the side effects of steroids. You need to see what’s suitable for each patient.
The main downside of Avastin is the financial toxicity – it’s very expensive. So it’s a balancing act. Steroids probably reduce a lot of the tumor-promoting cytokines, so they are important, especially for patients who don’t have much appetite.
But you need to think carefully before using steroids, and try to reduce their use, especially if the patient is on immunotherapies where steroids can really undermine the treatment. We need to be thoughtful about the role of steroids versus alternatives like Avastin.
The default or tendency to rush to steroids is something we need to check carefully, especially in cases where there is only mild swelling. Avastin, for example, can help support immunotherapy, while steroids can paralyze the immunotherapy response. But Avastin is not widely used in Israel, as it’s not in the health basket, so that’s another challenge.
Ronit: What about cannabis – do you deal with that as well?
Prof. Nechushtan: Half the cannabis in Jerusalem, I sign the forms for. But no, we have one doctor who is in charge of that subject, and I just fill out the forms. I’m not an expert on the pros and cons of cannabis.
What I do know is that cannabis can improve appetite and reduce pain quite effectively for some patients. But there are also some concerns. First of all, there have been cases of psychosis, especially in younger patients. My patients tend to be older, so I’m a bit less worried about that.
My main concern with cannabis is the evidence that it may reduce the effectiveness of immunotherapies. There are claims that some cannabis compounds can interfere with the immune response against the tumor. There’s debate on this, as it’s hard to study definitively, but retrospective analyses suggest there may be an interaction.
So although some doctors are more open to cannabis, I tend to be more cautious, especially for patients receiving immunotherapy. Our association head, Prof. Gil Bar-Sela, has published important work on this, and I align with his more cautious approach. In Israel, I’m one of the few who is quite careful about cannabis use, especially for immunotherapy patients.
There’s also the issue that cannabis can be hard to stop once started. So I really think through it carefully before agreeing to its use. It’s a complex topic, but I prefer the side of caution when it comes to cannabis, especially for my immunotherapy patients.
Ronit: But can you control it? I mean, what if a patient has already started using cannabis, or is using it and then needs immunotherapy – what will you do?
Prof. Nechushtan: So we try to tell the patient, let’s try to reduce the cannabis use. It’s a reversible thing, you can decrease or stop it, but it’s not trivial for some patients to wean off. There are patients who find it very difficult to stop.
There are those for whom cannabis helps them a lot, in terms of reducing pain and such. They tell me, and I tend to believe them. But I still try to convince them to reduce or stop it, especially if they are going to be starting immunotherapy, where the potential interference is a major concern for me.
Ronit: One last question, I think. Yes, I know you’re pressed for time. What do you love about your profession?
Prof. Nechushtan: What do I love about my profession? Ah, a tough question. I love a tough question.
First of all, I have a sense of duty. I started this profession to make a living. So that’s one aspect. But it’s also a profession where you get to help people, and that’s certainly something I’ve always loved – helping others.
So you have this feeling that although you may not be the professor who discovers the drug that will save the world, you’re still making a difference, helping people get a few more months, which is important.
But I’m very careful with grand descriptions. I don’t describe myself as someone on a mission or using bombastic words. I’m simply trying to do my duty, to the best of my abilities.
I also think this profession combines two sides that I’m interested in – the biology and science that I love, from my doctoral work, as well as the social work aspect that I get from my family background.
I feel well-suited for this type of work, with the long-term connections with patients. I wouldn’t be as suited for something more intense like surgery or critical care. This more gradual, relationship-oriented approach fits me better.
Ronit: I had a recent meeting, and someone who’s not a doctor and has no connection to cancer was very surprised. They said, “I saw some research on a drug that only extends life by 3 months, 2 months, 5 months. What’s the point of that?”
Prof. Nechushtan: I want to explain about this. Sometimes there’s a drug like erlotinib (Tarceva) that was used for lung cancer. The evidence showed it extended life by an average of 13 days.
Now, one may think that’s not much. But you have to understand the desperate situation we’re in. For some patients, even 3 months can make a huge difference – it’s not just about prolonging suffering, but about being able to do more, to live more.
There are also cases where a drug may only extend life by a few months on average, but for certain patients it works remarkably well, causing the tumor to disappear for several months. The averages can be misleading.
So while 3 months may not sound like much, for those patients suffering terribly from the disease, those 3 months can be incredibly valuable. We shouldn’t dismiss or belittle that. Those who haven’t experienced it firsthand don’t understand the difference it can make.
Ronit: Thank you very much. I really appreciate you taking the time, which I know is so precious.