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Science, Policy, and the Future of Cancer Care
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Released: May 21, 2026

John Marshall
John Marshall, MD
Catch Up On All Episodes of Oncology Unscripted

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Ep 30 MedBuzz: Science, Policy, and the Future of Cancer Care

John Marshall, MD: John Marshall, Oncology Unscripted, believe it or not, episode 30. Here we go, and there’s a whole lot to talk about.

I am a real doctor. I just want to show you that. I’m actually on service this week.

This is a Harvey three-head stethoscope. I actually do know how to use it. This is a mask for when you go into the rooms where you need one of those. Actually, I’ve got one patient right now who has some bedbugs and lice, so we have to be particularly careful there. We even have those here in Washington, DC.

So, real doctor, been on rounds today, but a whole lot to talk about. And where I wanted to start is actually with an article that came from a paper. You remember, I really like paper journal articles. I don’t know if you do, too. This is from the Journal of Clinical Oncology, and there are 2 articles on rectal cancer.

One’s a new data set, and the whole point of this strategy is: can we get rid of radiation in these people with rectal cancers? Because remember, radiation’s in there for bad surgery.

And now that surgery has gotten so much better and our preoperative chemo has gotten better, can we do away with it? And as you’ll see from this article, there is really pretty solid evidence that we need to reduce how much radiation we are giving, giving it less frequently. And what I really like about what JCO did with this is that they then brought forward a review article by Barbara Noiret et al, who kind of looked at all the data that’s been coming forward over the last 10 years and really kind of sliced and diced where the tumor is—very low down by the sphincter, up higher by the sigmoid colon, in the middle—and really gave us some nice overview about how best to proceed in patients with newly diagnosed rectal cancer.

We’re going to review this article in our fellows’ journal club this Friday, so I think it’s pretty important. I think any of you out there who take care of rectal cancer—surgeons, radiation oncologists, or oncologists—ought to make sure and review this new data. I think it’s important, and I think practice-changing even immediately as we go.

But let’s shift gears a little bit and talk about sort of the business side of oncology, and I know that you see lots of mergers and acquisitions, but one that I’m particularly interested in is that Abbott has recently acquired Exact Sciences. And you know Exact Sciences because of Cologuard and Oncotype DX.

They’ve made all of these genomic tests available, whether it’s for screening or risk analysis out there, and we’re all using them more and more. There are ads running on TV for that box, you know, for screening for colon cancer. That’s Exact Sciences. But this merger really does put together 2 companies that I think will serve each other well as they go forward in trying to help revolutionize the management of cancer in general and the incorporation of genetic information into our decision-making day in and day out. So keep an eye on that.

Second, you probably saw just within the last day or 2 that the National Science Board, the National Science Foundation that was founded by Congress back in 1950, actually the entire board of this was fired. Donald Trump sent them all an email. He’s so nice about how he fires people.

Sent them an email and basically said, “You’re fired,” and doesn’t really explain why. There is some spokesperson who kind of dances around the issue. They say, “Well, if they’re not really in line with what the current policies are, we can do whatever we want.” But as I thought about this, what’s the job of the National Science Foundation and the National Board here?

Well, it was brought on by Congress to be an advisor to the president, executive branch, as well as to Congress about what we need to know from a science and engineering perspective so that we can incorporate that into our own policies. And so, by firing all of that board, the suspicion is he’s going to put in people who think like he does. And so what that board will then make are formal, government-funded recommendations that basically agree with the current administration. And, you know, I keep shaking my head about this. His policy is, “If I don’t want to hear what you have to say, well, I’ll just fire you, and I’ll bring in people who do say what I want to be said.”

And so, I’m very anxious about this. I do think it represents one more level of unstableness in our world here in the United States as we think about knowledge and intelligence, those things that we pride ourselves on, getting more and more eroded so that one day we will no longer have the capability to lead in the space of science and technology.

And this also sort of rang true with my next point. And as I started to review the ASCO abstracts, they were just released, and we’re all getting ready for the big meeting in Chicago. And I scanned down what many of the presenters, where they came from, and some of the science that they were coming with.

One, there’s a lot of genetic precision medicine stuff coming. We’ll get back to that later on. But a strikingly high percentage are coming from nontraditional sources, such as China and other parts of Asia. And so, if we’re really trying to make America great again with having the best science and intelligence, at the same time we’re taking away those people who are going to be the best advisors and policy setters that are here today, I don’t see how we’re going to really justify the actions that are going forward.

So, we’re already seeing the shift in science and innovation to ex-US sites and investigators, and we continue to sort of degrade the brain trust that exists here in the United States that we’re paying our taxes to help fund and support. So yes, if you’re unsettled, you are hearing me correctly.

But then my last point on this is around our FDA commissioner, Marty Makary. I think I’m saying that right. Now, Marty is a GI cancer surgeon from Hopkins, originally I think from England, and very, very bright, has written books on many, many subjects, and took on the role about a year ago now as FDA commissioner. Obviously, not an easy role to play in the current administration. To be a real scientist and to live in this ecosystem is not an easy thing to do, but so far, I think he’s doing okay. He too is disruptive. He too wants to be disruptive, and I’m not against disruption fundamentally. And so where I’m kind of torn, and also a bit bipartisan, by the way, just want to point out to everybody that these are elephants on this tie, so this is my bipartisan moment, wearing the elephant tie and Marty’s—On one breath, he is saying we should do with psychedelics. We can talk about that later. It was a great night or 2 I had in Durham, North Carolina, with psychedelics, but that was many, many years ago, actually in the last century, so we won’t talk about that. But what he’s really talking about in terms of disruption is improving clinical trial efficiency, and I am so into this concept. We’re working on this with some colorectal stuff that we are doing on a national level. Can we actually alter traditional drug development so that we can find the right patient, right drug, high bar, don’t need control arms, reduce cost, speed, accelerate the clinical benefit for that individual patient, reduce drug costs, get more therapies out there for our patients more quickly, and not just here in the United States, but everywhere else?

So, this idea of faster readout and different design strategy, disrupting traditional design strategy, I’m very much into. But one thing that he pointed out in a recent video that I saw of his is that he was arguing in favor of direct reporting to the FDA. So, we know that the CROs do take a lot of our finances and time as they process the data for clinical research and then hand it off, prepare it, and hand it off for the FDA and other regulatory agencies.

But what he was proposing is: why don’t we just have some sort of direct line from, say, my electronic medical record that I entered into today as an attending on call, and if it’s a patient on trial, have that feed directly over to the FDA? And I say, on one level, I kind of get that, but that’s when I used to trust our government with our data. And I realize that’s a big thing to say, but I’m uneasy right now of having that go directly to them without some sort of independent review in there.

That’s what the FDA is supposed to be, but I’m not sure they’re still maintaining that or can continue to maintain that at the level we’ve come to expect. So, other than that direct data feed, I like what he’s saying. So, in my bipartisan, elephant-tie-wearing spirit, I do think we ought to listen to what the FDA is saying around clinical trial disruption and evolution, maybe revolution, so that we can drop the price, improve the speed with which we identify the right therapies for the right patient, incorporate precision medicine more readily, and cure more people more of the time. That should be in the Constitution.

 John Marshall for Oncology Unscripted.

This transcript has been developed using AI and edited for clarity.