United Against Cancer: Dr. Ahmed Elzawawy on Cost – Effective Treatments v1 | Dr. Zainab Shinkafi-Bagudu

And the president of ICE DOC, and also experts in cancer without borders. He has been instrumental in leading cancer research in Africa and globally, and is a current professor of clinical oncology at the Suez Canal University in Ismaila, and the chairman of Al-Soliman Radiation and Clinical Oncology Center in Port Said in Egypt.

We’re delighted to have you, Prof, with your extensive leadership and look forward to a very interesting session. I know I would have missed a lot of things in your bio, but it is okay, we have to just do a summarized version. So if we jump straight in, today, aside from the work that you have led in research globally and your positions, I think one of the things that aspects of clinical oncology or oncology that you are best known for is the Win-Win Initiative.

So I want you to tell me a little bit about the Win-Win Initiative. It’s very difficult, but just tell me in a summary what the goals are, and what made you, finally, what made you start this Win-Win Initiative? The name is so nice, it’s Win-Win for all of us.

So tell us a little bit about it and your motivation.

It’s not like what we exaggerate and what we propagate in many occasions. The reality is that despite of all efforts, international and national, and publication and numbers and reports, the gap between what is required and what is available and accessible for millions of cancer patients in the world is widened in the last two decades. This is published.

Despite of this, some actions, yes, respectable action, respectable movement, respectable goals, respectable festivals, all this. But the gap is widened. It was widened in the last two decades.

This is what’s published. And there is no indication that this gap will be shortened or become less in the upcoming 10 years, despite of all what we are saying. So we would like to be more realistic, more scientific, not with the slogan like we have cancer, not like before.

We change the image of cancer that we know. Zero cancer in Africa tomorrow. These slogans are not scientific, but we can do a lot.

First, I put some questions and apply quickly. Is lowering the total cost of cancer care, better value cancer care, is possible via scientific approaches? Yes, there are tens or even hundreds of examples, but nobody listens.

That is what our message in the Win-Win. Second, is it possible of what is available now in Africa, in the world, with radiotherapy facilities, to treat double or triple number of patients in scientific way and without compromising the outcome? Yes, yes, yes.

And it is published and we have a book about all this. We have 100 contributors from the world contributed in this, but nobody listens. We just repeat the previous speech that we need some million dollars of aid from United States or from here and there to give pegging here and there.

No. Third question. There are no resources in Africa or in developing countries.

No. Africa is rich. I gave example in the last lecture that college tourism or what is paid for treating cancer from East Africa every year is two billion dollars yearly.

So imagine these two billion dollars used to in five years, this is 10 billion dollars. 10 billion dollars can make East Africa with facilities more than United States. But what is the problem?

Because the problem is that we are not dealing with the real win-win incentives. We have to satisfy the needs of the people who transfer this patient, include all who are benefit from this business. So, in 800 million dollars from this power or this European Union or United States or something to facilitate, this do nothing.

But we have a lot of resources. Other thing about is it is a waste in resources. Even in the United States, yes, I gave one many examples in the last lecture, and it is all published in the leftover of one drug only in the United States.

So, is there ways to reduce this waste? Yes, it is published, but nobody listens. So, there are many things to do.

Other thing I would like to explain that also when we explain, when we discussed oncology education and cancer education, most of the oncology now is just introduction with some clinical trial from pharmaceutical companies. This is not the oncology. So, we would like to say global oncology that fits our patient in scientific way, in tailored to our patient in the same way that all will win.

Even people and our cancer patient in affluent country in United States. I would like to say also that is this problem that we see some pity for our patients in Africa or Asia or Latin America, or it is a problem is global. I would like to add, please stop giving lessons from abroad because 40% of cancer patients in this year, by the statistic of ASCO, who sent their guidelines, which is not applicable in our countries, it is not applicable also for 40%, it’s difficult to be applicable for 40% of cancer patients in the United States.

According to ASCO, American Society of Clinical Oncologists statistics, 40% of cancer patients, the first fear of cancer is economic burden. Surprisingly, this is more fear than cancer deaths and cancer pain. And if I repeat some examples, and there are many, many examples.

One example, I repeated just to people to catch the number, but there are many numbers. The average price of certain new drugs, cancer drugs in the United States, this last year was $2,500,000. So it is three times the average of income of a family, not a person in California.

So you can imagine what’s happening in the other states and what is happening in Gabon, in Egypt, in Nigeria, in India. So we should be realistic and scientific in the same way. Are there ways to do this?

Yes, there are many scientific ways and we publish this and we have now, the key, our tools for doing this is global oncology implementing science courses, which is focused on how people in Nigeria, Egypt, in Asia, in Latin America, develop their scientific work with the help of big institutes in the States, in Oxford, in Cambridge, in Germany, in everywhere, to develop protocols that fits their patients and at the same time to lower the total cost, which is beneficial also for patients.

Many of these can be inspired by some changes to patients in the United States, in Canada, in everywhere, because the problem is global, it’s not the problem of Africa or sub-Saharan Africa or some poor countries. This is a problem and it’s worsened by time. I would like to say that also, to be scientific and to return to the real statistics that say that there is an expected tidal wave of increase of cancer incidence in the upcoming seven years, not like what the pink ribbon and festivals and world days and ASCO and NCI, this is, tomorrow everything will be finished.

No, be prepared, please, there are tidal waves of increase of cancer incidence. This is published, I don’t mean, I didn’t invent anything by the way, all is published, all is by reference, just return to our lecture and our books, you’ll find many references. I don’t claim anything, they’re all reference.

Why we don’t listen to this reference? Why? Written by many experts in the United States and Canada and everywhere.

There is also another increase of, it will be another increase in the cancer among younger patients. So in the upcoming 10 years, we’ll see more cancers among colorectal and prostate particulate and this type of cancer among younger age, among 50 years, not 70 years, 40 years, maybe 30 years and 20 years even in some cases. So this is, there is biological background for this and this is published, this is just many details if anyone would like to know more about this.

So this is the real picture, not zero cancer tomorrow. This is nonsense. Also, cancer is not, the cancer is the disease of the modern civilization and something and no, cancer, Hatshepsut is a queen in ancient Egypt, died with breast cancer.

By the way, this is maybe, I don’t remember, maybe 30,000 years before or something like that. And there is in the mummy of ancient Egyptians, there are operated for tumors and for cancer. And even the papyrus of Smith, it is described the inflammatory T4, inflammatory advanced breast cancer.

It is explained. So it is, the cancer is not the disease of the human being only, but it is present in the mammalian cells before even many thousands of years before the human beings. So it is not a new disease, but because as you know better than me, all of you, that because there is now, there is not much infectious disease like before, less of fetal, of infant deaths and maternal deaths and many aging and all these aspects and increasing population.

So it becomes a big factor. But besides the new things in the new civilization, this is a factor, but this is not only the acute thing about presence of cancer in our view. So in TV and on many TV talks, this is a disease of the new civilization.

This is not true, but it’s increased that it’s picture in relation to other problems in the new eras. And it is what is attributed to the new things in civilization. Yes, smoking and all these things, yes, it’s attributed, surely.

Another thing that I would like to stress on that, is that what I am saying that how to lower the total cost of cancer care without compromising the outcome, is that possible? There are tens of tens or even hundreds of examples. And this is just what we noted, what we published, what we presented in our courses is just, it is not all.

This is stimulating examples for researchers everywhere in Africa and Asia, United States and everywhere to be focused on that in the same time with realistic ways. Is that against this pharmaceutical company? When I say, for example, a drug, you can reduce the dose by 70% or 60% without compromising the outcome.

And even you can less the side effect. It is published since 10 years, not me, but it’s published more than 10 years. There are many examples like this.

And I imagine, I don’t, I can’t, I can’t, I can’t understand why it is not in, we don’t hear this in big conferences of ASCO, ESMO and all these things. We see, you always say, we give you some millions to help you and some researchers do a PT for you, but we can reduce a lot the cost of drugs with compromising the outcome. You imagine that all, that many of the doses prescribed by the FDA themselves since 2008 was exaggerating in prescribing the dose for phase one of immunotherapy.

So we can reduce a lot. Who publishes this? The FDA.

This is, I took this from the FDA information and from many professors in the United States and their references. So we can reduce a lot. And there are many professors now are experts, are encouraging this and supporting this and say, this is true.

Like Professor David Care, who is the chair of the ASCO international committee and he’s a professor, a distinguished professor in Oxford, a cancer sociologist and he was past president of ASCO, Professor Eduardo Gazzab. Many professors are really, really supporting this. Carol Sikora in Buckingham, Faculty of Medicine and many, surely inspired this from many also professors like Professor Ian Tannock.

I learned a lot from what he wrote and I took his reference. Professor Ratan in Leicester and many, many, many, many, but nobody listened. Why?

We can lower the total cost of cancer care via scientific approaches, not via slogans, not via festivals, by scientific approach. This is our role as doctors. I speak here as a doctor and scientist, not like public TV talks.

This is our role, not to speak about cancer tomorrow, cancer yesterday. We are doing zero cancer tomorrow. We are giving hope, giving hope by your work, by scientific work, how this family can obtain this drug with treatment, this radiotherapy, this surgery with dignity, without ruining the economy, the family.

This is the message. Is it possible? Yes, but we can say that, but this is, if you will use the total cost of cancer care and then together, then it will be against pharmaceutical companies and industry.

No, it is win-win. We should remember that 85% of cancer patients in the world didn’t take their appropriate treatment and even more than 70% didn’t take anything at all. So there is a dead market.

This is a very big dead market. When we improve these opportunities to use the win, it needs smart ways, it is smartly, not hardly. It needs also pioneers in economics, in business and smart deals.

It needs to unite together within scientific approach and win-win model. From a scientific point of view, it is possible, but how we can apply these needs? People like you, who advocate this patiently in the world, without tireless, because nobody listens.

This is upload for the first time and this is forget after. This is need persistent. We would like to change and I would like to stress here that I am not criticizing, we are not criticizing any excellent key players in the world.

All organizations are excellent, all the intentions are excellent, but the problem is in the game, not in the players. So what we are trying to do is to change the game so all the players will make more goals where we may win this game and not repeat the same slogans again. This is simply.

And so our tools is Global Oncology Implementing Science. We have this program, please lead it and contribute in it and advocate for it. This is not me or 100 people with me who can lead this, but should be many in the world, particularly with our younger colleagues who changed their focus to increase to their patient, to be patient-centered and how the patient gets the treatment with dignity.

This is a summary.