False Hope is about the story of high-dose chemotherapy and bone marrow transplant for breast cancer. It reviews the initial Phase II studies for the treatment, the subsequent political and economic forces encouraging its use, and the eventual Phase III trials that led to its abandonment. Besides the treatment itself, the book documents Insurance denials, ensuing litigation by Patients, the discussion within the leadership of Oncology about the procedure, and some recommendations for the future.
Similar to the NEJM review, I think the book had a little bit of a "I told you so attitude". As a budding oncologist though, it is an absolutely fascinating story and important to learn about. There is definitely a lot of name dropping -- even names a young physician can recognize. The story is easily applicable to other new, expensive, unproven technologies ready to be unleashed.
On content, I think the book would have benefited if it addressed the technical questions more thoroughly and perhaps been a little less gossipy. A more thorough chapter devoted to the differences between Phase II and Phase III randomized trials -- something more technical, and co-written with an epidemiologist would have been beneficial (chapter could have also included a discussion on biomarkers and end points). Also, there was a lot of inside-baseball on the procedure from the oncology community -- but we don't hear anything at all regarding financial analysis run by insurance companies on the procedure. We only hear details regarding the technology assessments. I also though that it was hard to understand the problem they are trying to address --- access vs. evaluation -- without a result from the other side (i.e. a contested treatment that was denied while being evaluated, but wound up being helpful -- e.g. AIDS drugs in trials?). This was tangentially mentioned, but not really adequately compared to.
The last chapter on their solution to the problem was poorly done and I think would have tremendously benefited from feedback from people who are a little more critical. First -- their explanation for the failure of medical journalists sounds reasonable -- just like HDC to cure breast cancer sounds reasonable -- but if you think about the stellar job journalists did on WMDs and the financial crisis --- it seems more like a deeper institutional problem with journalism itself, then minor technical problems with medical journalism in particular that resulted in shoddy reporting. Second, there are some rather inflamatory comments in this part, that are contradicted by other parts of the book (e.g. Duke having a financial incentive to put people on HDC/ABMT -- even though they mention Peters insisted everyone went on a Trial (as the authors suggest should be the case)). Also suggesting ASCO do more in terms of patient advocacy while ignoring other institutions that already issue guidelines and seem more prone to that kind of work, such as the NCCN -- seems like a blunder. There is no clear explanantion why ASCO is in a better position than the NCCN.
Only other stylistic point would be it gets a bit redundant at times.
Overall a good read, if a little tedious, -- especially for future oncologists or anyone in medicine.
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