Ask AI
Back Back
When the Sources of Trusted Information Change—Who Do We Believe?
Activity Information

Activity

Progress
1
Course Completed
Activity Information

Released: November 18, 2025

John Marshall
John Marshall, MD
Never Miss an Episode of Oncology Unscripted

Subscribe Now
Catch Up On All Episodes of Oncology Unscripted

Watch Now

When the Sources of Trusted Information Change—Who Do We Believe?

 

John Marshall, MD:
Happy whatever day it is today when you're watching this. John Marshall for Oncology Unscripted. A little bit of a rainy day here in Washington, DC. It's been a little bit of a weird time here in Washington, DC—even weirder than it normally has been.

 

Let's start with a little of the business of our world today—the business of oncology. You may have seen that we have a new National Cancer Institute director: Dr. Anthony. Professor of medicine, he's kind of a basic science guy, but he's also a medical oncologist from Dana-Farber. Would you take that job if it was offered to you? I knew some of the candidates who were in line for it—or the finalists—and you'd really have to want that job to take it right now, because of all the unsettledness at the NIH in general, et cetera. So, I'm grateful that this very smart person has said yes to the job. Now, what he does—one of his areas of expertise—is programmed cell death, which is sort of a subtle way of getting a cancer cell to kill itself, right? So maybe, just maybe, he'll use some of that expertise to help in the shifting of government. A little programmed cell death around here might go a long way. So, fingers crossed that he succeeds in maintaining and growing the research that we are doing in cancer, much of which is sponsored through the National Cancer Institute. So, fingers crossed.

 

But as soon as he gets the job, what happens? Well, we shut down the government.

 

We've done this before. It is weird in Washington when the government shuts down. Whether it's patients who now don't have a job for the moment and who risk not having health insurance to receive their ongoing cancer care—in my case—or care in general out there.  We're clearly seeing an impact on patients. We're clearly seeing an impact on government operations. I'm supposed to fly to Florida to get measles, maybe, this coming weekend, and I'm not sure we will do it because—who knows if there'll be air traffic controllers available? Would you go to work if you weren't getting paid?

 

I had a recent call with an NCI colleague who is going to work, who is seeing patients, and is trying to manage things—but is uncertain about whether they will be paid.

 

I also happened to come across recently somebody in the medical center who works up in McLean. If you know what offices are in McLean, I'll let you figure that out—sort of secret spy stuff. Normally, they're incredibly busy, but because there aren't any other government activities going on, they're kind of sitting there saying, "Well, we can't do what we normally do because we're dependent on the rest of the government to do what we do." So even those who are going to work are kind of stalled.

 

So, there's a whole lot going on. The one positive—and it's not really a positive to make up for the negatives—is that the traffic's a lot lighter here in Washington. But still, not enough to make up for it.

 

Now, I do want to talk a bit about another big topic that’s come forward. You know that RFK Jr. fired 17 members of the Advisory Committee on Immunization Practices. This is the group that gathers to make recommendations around vaccines and immunizations in general. He fired a lot of them. He put some replacements in—many of whom have been featured in other articles—I won’t drill down into the weeds on some of this, but many of them are more than just anti-vaxxers. They’re suggesting that we’ve mismanaged this as a medical community, and that we’ve not been telling the true scientific story.

 

The new people who’ve been put in place haven’t made any formal recommendations yet. But the most recent one that came out is that there’s even some debate about whether newborns should be given hepatitis vaccines. And that data is very, very tight about how many lives are saved because of vaccines—as they all have been shown. But we’ve forgotten data, and we’re going to have to relearn the lesson going forward.

 

Do you read the front page of the paper or don’t you? In my family, it’s split. My wife only reads the sports section. I read the front section—or at least read the headlines.

 

In the Washington Post editorial page was an article written by the last six Surgeon Generals—right and left—appointed by different presidents over time. And this was a very thoughtful piece that basically summarized that RFK Jr.—he’s perfectly entitled to have his own opinions about things—but he’s not entitled (this was their conclusion) to put other people’s health at risk.

 

And they collaboratively, collectively, emphatically said that that is what is going on with this new ACIP committee—with RFK Jr. at the helm. That we are putting a lot of people at risk, and it’s what’s making us all very, very anxious in the medical community today.

 

Now, I want to talk in closing on this about a book that I am reading. Don’t worry, it’s not too boring.

 

And the stuff I’ve been seeing during Jeopardy—I always measure the pulse of America by what ads run during Jeopardy every night.

 

Now, the book I’m reading is brilliant.

 

It’s called Empire of Pain. It’s written by a guy named Patrick Radden Keefe, and it’s the story of the Sacklers, Purdue Pharma, and OxyContin. I’m sure you may have seen the movie about this. It’s brilliantly written, and it starts with the first advertising that was ever done for drugs.

 

This was Librium and Valium—done by Pfizer at the time. And the Sacklers kind of invented this strategy where they were figuring out how to tell a story of a new medicine—in this case, anti-anxiety, kind of anti-depression medicines, Librium and Valium.

 

These were for patients who weren’t psychotic—so they didn’t need to be admitted for their psychiatric anxiety and problems—but there were a lot of people out there who could use a little something to help take the edge off. So, they created a market. They had drugs that would solve this problem for people. And Librium and Valium became the biggest-selling drugs at their time. This was through peer-to-peer teaching. So, start thinking about your own role in this as you listen. Physicians who were trained to teach other physicians about the new medicine. Direct-to-consumer, certainly. The Sacklers owned a medical journal where they advertised in it and could write editorials about their medicine. They also had consultants that worked for it.

 

Now, as I’ve been reading this, I’ve been thinking: I play all of these roles. I’m a consultant of pharmaceutical companies. I do peer-to-peer education. I do clinical trials. I write papers for journals. I do video podcasts, for God’s sake.

 

And so, I’m out communicating my bias, my opinions to others—to influence their practice on some level. Not my goal, but it’s certainly a downstream product of influencing their practice.

 

So, this family had figured out a way to take advantage—and coach and train us all—how to use medicines. And this was in the very, very early part of my career. But then what they figured out was how to take pain medicine, believe that the pain medicine would help, make it longer-acting, get a good price for it, sell it, convince us all that we needed to be on it, and increase the utilization of long-acting pain medicines. So, when I was just a fellow and a new faculty member, we were all coached that there is no high enough dose. That all patients need to be on it. That it’s normal to be on these drugs. And in point of fact, it is the right thing for people to be doing. Only now do we recognize that this was really an over-push for these people.

 

I’m just reading the section of the book now where people were abusing it. That they became addicted to it. And it was not really for cancer pain or other things—they were just hooked to the drug. And it took a long time for that to get broken.

 

So early in my career, I was pushing huge doses of this medicine. You were, too.

 

And now there’s nobody I’m giving much more than about 10, 20, 30 BID of long-acting pain medicine. So, we learned our lesson about how we were kind of lied to in this setting.

 

More recently, we have a new point-counterpoint with the government. I’m seeing it from Pfizer. I’m seeing ads today during Jeopardy and other shows like that, where Pfizer is basically reminding us all—as an audience—that vaccines can help.

 

The government is telling us, RFK Jr. is telling us, that vaccines are bad. That we shouldn’t be taking them. That they cause all sorts of trouble in patients, and we shouldn’t be messing with it.

 

But then I’ve got Pfizer doing a very clean ad over here that says, “Don’t forget vaccines.”

 

Let’s look a little bit at the science that’s being referred to. The science back when we were giving long-acting pain medicines, and now when we are making new recommendations by our government.

 

So, back then, they actually didn’t even get formal FDA approval for MS Contin, because morphine was already approved. They just got it. They just started shipping it out. They just started making it and shipping it out.

 

They then got approval for OxyContin—but the guy who approved it at the FDA, believe it or not, a couple of years later, starts to go and work for them outside the FDA. So, there’s a lot of question about whether that was legitimately covered.

 

But the idea was that OxyContin would be less addictive—but they never really showed that, even though they marketed that.

 

So, the cleaner processes that we’re used to for drug approval were not put in place. And then the claims that could be made about how well these pain medicines worked—anybody could say anything. There wasn’t a lot of supervision around that until it kind of came back to bite them and haunt them.

 

We are, in today’s world, hearing the government, RFK Jr.’s gang, and other people talking about immunotherapy, vaccines, et cetera—saying things that have no real foundation in science. They are based on just speculation, or something somebody put on Twitter one day. And it becomes our job, in the medical community, to judge what is the correct thing to be doing.

 

And I think right now, you’re seeing insurance companies and pharmaceutical companies and the medical teams really sticking with the more clean science, and applying therapies based on what they know—and sort of ignoring what they’re hearing in the public media, et cetera, based on what the government is saying.

 

So, this has put us in a new and awkward position, where we are on the side of business in this case, and not on the side of government.

 

If you haven’t read this book, Empire of Pain, I would recommend that you do—particularly if you are an older person who’s lived through some of this. But I also want you to recognize that there’s a lot of pressure—mixed pressure—out there on just providing today’s standard of care.

 

And so, the next time you see that Pfizer ad, remember that you’re probably now on that side of the coin—advocating for ongoing immunotherapy for our patients in the form of vaccines to prevent, but also in managing and preventing other cancers from occurring through the use of immunotherapy.

 

Complex times. Lots going on in the news today. Lots that’s affecting our world and the treatments that we are offering. Lots to incorporate in your recommendations.

 

I hope this has been helpful in summarizing that, and it’s useful for you tomorrow in your practice.

 

John Marshall for Oncology Unscripted.