I received a LOT of messages on my posts about certain companies in our industry that have a “don’t rock the boat” culture and only want to hire “yes people”. It’s obviously worse than I thought.

One person, who is an MD/MBA, was let go last year and still can’t find a position in medical affairs at a pharma company, even though he has 10 years of industry experience, including the launch of some blockbuster products. If you’re looking for a job in pharma right now, you’re probably hearing the same message over and over again: “We’re struggling to find talent.” Really? Because thousands of experienced pharma professionals are sending out resumes, networking, interviewing, and still struggling to land jobs and getting ghosted. Something doesn’t add up.

In 2025 alone, pharmaceutical and biotech companies announced tens of thousands of job cuts as organizations restructured operations and focused on profitability. Some firms implemented hiring freezes, while others reduced headcount in anticipation of future revenue pressures. 

Yet if you visit LinkedIn, you’ll see thousands of pharma jobs posted every day. That’s where another uncomfortable truth enters the conversation.

Not Every Job Posting Represents A Real Hiring Need

Many job seekers have discovered that some positions seem to remain open indefinitely. Others disappear without being filled. Some companies post positions while waiting for budget approval or simply to build a candidate pipeline for future needs. These so-called “ghost jobs” have become a growing problem across industries, including life sciences. Too many are posted only because it’s an HR requirement, even though they have already selected an internal candidate. The number of posted jobs may not accurately reflect the number of positions that organizations are actively trying to fill.

For job seekers, the distinction matters. Applying to 100 positions doesn’t help if more than half of them aren’t real opportunities.

The Competition Has Never Been Tougher

The pharma industry is experiencing a paradox. Companies claim they want top talent, yet experienced professionals with decades of success are struggling to get interviews. Why? Because every open position may attract hundreds of qualified applicants.

When major pharma companies conduct layoffs, those employees don’t disappear. They immediately enter the job market. Suddenly, hiring managers reviewing applications are choosing between candidates who all possess strong credentials and relevant experience.  As a result, employers can afford to be extraordinarily selective. Candidates who would have received offers in 2021 or 2022 may not even receive interviews today.

AI/Recruiters Aren’t Helping Job Seekers

Pharma companies love talking about innovation and artificial intelligence. Unfortunately, many applicants feel AI has made the hiring process less human. Resumes are filtered before a recruiter ever sees them. Qualified candidates receive automated rejections within hours. Interview processes drag on for months. Communication disappears without explanation.  Ironically, an industry built on science and human health often treats job applicants like data points.

The other issue that so many refuse to discuss is the lack of common business courtesy of company recruiters and hiring managers. When a candidate invests hours preparing for an interview and goes through several rounds, they deserve the common courtesy of an honest explanation for why they were not selected. However, it’s been my experience that doesn’t happen. Usually, a candidate finds out by reaching out of the silence, only to learn, “we went with someone else.”

Companies Want “Perfect” Candidates

Another reality few employers admit openly is that many hiring managers aren’t looking for great candidates. They’re looking for perfect candidates who, to them, are the right age and the right culture fit (they won’t challenge anything).

Instead of hiring someone who meets 80% of the requirements and training them on the remaining 20%, organizations continue searching for the mythical applicant who checks every box. Months pass. Positions remain vacant. Candidates remain unemployed. Everyone loses.

The Industry Needs To Be More Honest

If a position is on hold, say so. If funding hasn’t been approved, say so. If an internal candidate is likely to get the role, say so. If the company is building a talent pipeline for future openings, say so. Job seekers are investing hours customizing resumes, preparing for interviews, and following up with recruiters. They deserve transparency.

The pharma industry continues to produce life-changing medicines, but its hiring process needs great improvement. The reality is that hiring is slower, and many experienced professionals are finding it far harder to secure employment than company career pages would suggest. There are just too many hiring managers who fear hiring someone smarter than them.

The industry should stop pretending there’s a massive talent shortage everywhere. What many companies really have is a willingness-to-hire shortage. And until pharma becomes more transparent about how it hires, talented professionals will continue wondering why they can’t find jobs in an industry that claims it desperately needs them.

Unfortunately, this reaction demonstrates that many DTC marketers still don’t understand how patients make healthcare decisions. They are spending more money on the wrong solution.

The FDA Didn’t Tell Pharma to Buy More TV

The FDA’s actions were aimed at misleading claims and insufficient risk disclosures on digital platforms. The agency was not endorsing television as a preferred advertising channel. Yet many pharma companies appeared to interpret the crackdown as a signal that television was somehow safer.

It isn’t.

TV simply makes it easier to cram lengthy risk information into an advertisement. That doesn’t mean consumers pay attention to it. It doesn’t mean patients understand it. And it certainly doesn’t mean it influences treatment decisions. What marketers saw was compliance. What they should have seen was communication failure.

Patients Don’t Make Decisions As They Did Twenty Years Ago

Many pharma marketers continue to operate as if it’s 2005. Back then, a television commercial could generate awareness, drive patients to ask physicians about a drug, and ultimately influence prescribing decisions. Today’s patient journey looks completely different.

When consumers see a drug advertisement on television, most don’t immediately call their physician. They pull out their phone. They search Google. They watch videos. They visit patient forums. They join Facebook groups. They read Reddit discussions. They look for real-world experiences from people who have actually used the product. The television commercial is often nothing more than a trigger for additional research.

The actual decision-making process happens online.

This means pharma marketers are investing heavily in the awareness stage while underinvesting in the channels where patients are actually evaluating treatment options.

The Rise of the 60-Second Commercial Is Not a Victory

One of the more interesting developments following the FDA crackdown was the increase in 60-second commercials. Marketers seem to believe that longer ads solve the disclosure problem. They don’t.

Longer ads often create a different problem: viewer disengagement.

Consumers already skip, mute, ignore, or mentally tune out large portions of television advertising. Adding another 30 seconds of risk information does not suddenly make viewers more attentive. In fact, many viewers can probably recite the side effects of a dozen medications without remembering what condition the drug actually treats.

The industry has become remarkably good at satisfying legal requirements while failing to communicate effectively.

Compliance Is Not Marketing

One of the biggest mistakes in pharma marketing is confusing compliance with effectiveness. A commercial can be fully compliant and still be a terrible advertisement. A website can satisfy every regulatory requirement and still fail to answer the questions patients actually have. A campaign can pass legal review and still generate virtually no meaningful return on investment.

The goal of marketing is not simply to avoid an FDA warning letter.

The goal is to help the right patients find accurate information that supports informed treatment decisions. Those are not the same thing. Unfortunately, many organizations have become so focused on avoiding risk that they forget to measure whether their marketing is accomplishing anything meaningful.

The Money Would Be Better Spent Elsewhere

Imagine if a portion of the increased television spending had been directed toward:

• Building educational content that answers patient questions.
• Improving disease-state education.
• Monitoring patient conversations through social listening.
• Enhancing search visibility for accurate medical information.
• Creating better patient support resources.
• Improving the online experience after a patient searches for a drug.

These investments would align with how patients actually gather information today. Instead, many companies chose to buy more television inventory. That may make compliance teams comfortable. It doesn’t necessarily make marketing more effective.

DTC Marketers Need to Stop Looking for Safe Channels

The FDA crackdown should have sparked a deeper conversation about communication quality, patient understanding, and marketing effectiveness. Instead, much of the industry responded by shifting budget toward a channel that feels familiar and easier to manage from a regulatory perspective. That’s not strategy. That’s retreat.

The future of pharmaceutical marketing isn’t about finding the safest advertising channel. It’s about understanding how patients seek information, evaluate treatment options, and make healthcare decisions in a digital-first world. Until DTC marketers accept that reality, they’ll continue spending millions on television commercials that make lawyers happy while leaving patients searching elsewhere for the information they actually need. This version is intentionally provocative and aligned with your recurring theme that pharma marketers often misunderstand how modern patients research treatments before talking to physicians.

It’s not that the science isn’t impressive. It often is. Researchers continue to push the boundaries of what is possible in oncology. Some patients are living longer because of advances presented at ASCO. That should be celebrated. What troubles me is the growing disconnect between the excitement generated at ASCO and the reality facing most cancer patients.

Both my in-laws passed away from cancer, and in the process of treating them, they drained their bank accounts to almost nothing. My father had to go on Medicaid because he could not afford treatment. Even with medical insurance, most cancer patients can’t afford co-pays.

I’m glad that so much progress has been made with new oncology drugs, but at what price?

Breakthroughs Come With Astronomical Price Tags

Many of the drugs highlighted at ASCO are priced at levels that would have been unimaginable a decade ago. New cancer therapies routinely enter the market with annual costs exceeding $100,000, $200,000, or even more.

When a study demonstrates that a new treatment extends life by a few months, the headlines focus on the clinical benefit. What receives far less attention is whether patients, employers, insurers, and taxpayers can actually afford it.The oncology community celebrates innovation. Unfortunately, affordability rarely receives equal billing.

Small Gains Are Often Marketed Like Miracles

Many ASCO presentations report statistically significant improvements in progression-free survival or overall survival. The numbers may be scientifically meaningful, but the public often receives a much different message.

A therapy that extends median survival by a few weeks or months may be portrayed as a major breakthrough. Investors hear opportunity. Pharmaceutical companies see revenue potential. Media outlets see compelling stories.

Patients hear hope. The problem is that hope can easily outpace reality.

Patients Are Becoming an Afterthought

ASCO is filled with discussions about biomarkers, trial endpoints, molecular pathways, and treatment algorithms. These topics matter.

But what patients often care about is much simpler:

• Can I afford this treatment?
• Will my insurance cover it?
• How much time will I spend receiving treatment?
• What will the side effects do to my quality of life?
• Will I be able to work, travel, or spend meaningful time with my family?

Those questions frequently get less attention than the scientific data.

The Financial Toxicity Conversation Isn’t Loud Enough

The oncology industry loves discussing toxicity related to adverse events. It spends far less time discussing financial toxicity. For many families, a cancer diagnosis can trigger financial devastation. Even insured patients face deductibles, coinsurance, travel costs, lost wages, and other expenses. When a new therapy is introduced at a record-breaking price, there should be as much discussion about its economic impact as its clinical benefit.

Too often, there isn’t.

ASCO Reflects a Larger Problem in Healthcare

My frustration with ASCO isn’t really about ASCO itself. It reflects a broader problem within healthcare. We have built a system that rewards innovation without adequately addressing affordability. We celebrate scientific progress while often ignoring whether patients can realistically access that progress.

The result is a growing gap between what medicine can do and what patients can obtain. I want to hear a pharma CEO say, “We will find a way to ensure that patients who need our drugs can get it without bankrupting them”.

The Question We Should Be Asking

Instead of asking only whether a new cancer drug works, we should also ask:

• Is the benefit meaningful to patients?
• Is the treatment accessible?
• Is the price justified?
• Will it improve quality of life?
• Who gets left behind because of the cost?

Those questions deserve a place on the main stage at ASCO, not in the margins. Cancer research has never been more exciting. But until affordability, access, and patient experience receive the same attention as clinical endpoints, I’ll continue to view the annual ASCO meeting with a healthy dose of skepticism. Scientific breakthroughs are important.

Making sure patients can actually benefit from them is even more important.

The uncomfortable reality is that many of the cancer drugs generating excitement at ASCO may ultimately be inaccessible to large numbers of patients because of their cost. New oncology drugs routinely launch with annual prices exceeding $100,000, and some advanced therapies, such as CAR-T treatments, can cost several hundred thousand dollars. (ASCOPubs)

Take the example of daraxonrasib, the experimental KRAS-targeted therapy that recently showed promising results in pancreatic cancer. If future studies confirm benefits in lung, colon, ovarian, and other cancers, demand could be enormous. The problem is that innovative targeted therapies often enter the market at premium prices because manufacturers seek to maximize returns on years of research and development. For patients, however, the issue isn’t the list price. It’s what they must pay out of pocket.

Researchers are increasingly using the term “financial toxicity” to describe the economic burden of cancer treatment. Even insured patients frequently face significant deductibles, coinsurance payments, travel expenses, lost income, and other treatment-related costs. Studies presented recently have shown that some Medicare beneficiaries with certain cancers face annual out-of-pocket expenses exceeding $10,000. (ASCOPubs)

This creates an unfortunate paradox in oncology.

A drug can demonstrate remarkable clinical benefit, receive standing ovations at ASCO, gain FDA approval, and still remain financially out of reach for many of the patients who need it most.

Insurers and pharmacy benefit managers will play a critical role in determining access. They will examine not only whether these drugs work but whether the clinical benefits justify the cost. Prior authorizations, step-therapy requirements, formulary restrictions, and reimbursement negotiations will increasingly influence who receives treatment and when.

The challenge is becoming more urgent. Cancer care costs in the United States are projected to exceed $245 billion annually by 2030, and oncology drugs remain one of the largest drivers of spending. (ASCOPubs) None of this diminishes the importance of innovation. Patients desperately need better treatments, particularly for cancers such as pancreatic cancer where survival rates remain poor. But the oncology community must begin asking a difficult question:

What is the value of a breakthrough if the patients who need it cannot afford it?

ASCO presentations often focus on progression-free survival, overall survival, and response rates. Those metrics matter enormously. Yet perhaps the most important question for many patients is much simpler:

“Can I actually get this treatment?”

Until affordability becomes part of the discussion alongside efficacy, many of the most promising advances in cancer care will remain breakthroughs on paper rather than breakthroughs for patients.

An FDA approval means a drug can be legally marketed and prescribed. It does not mean patients will actually be able to obtain it.

The Growing Power of Payers

Developing an oncology drug is an expensive and risky endeavor. Clinical trials can take years and cost hundreds of millions of dollars. Companies must demonstrate safety and efficacy to regulators before bringing a treatment to market. Historically, FDA approval was viewed as the critical hurdle. Once a drug was approved, access largely followed. Today, that is no longer the case.

Insurers increasingly conduct their own evaluations of newly approved therapies. They review comparative effectiveness data, budget impact analyses, quality-of-life outcomes, and projected costs before determining how broadly they will cover a treatment.

The result is that a drug can receive regulatory approval yet still face significant barriers to patient access through prior authorizations, step therapy requirements, restricted coverage policies, or high patient cost-sharing.

Clinical Benefit Isn’t Always Enough

Many oncologists assume that strong clinical data should naturally lead to broad coverage. Unfortunately, that assumption often collides with economic reality. Cancer therapies routinely launch with six-figure annual price tags. Some cell and gene therapies exceed hundreds of thousands of dollars per treatment.

Insurers face pressure from employers, government programs, and consumers to control healthcare spending. As a result, they increasingly ask a question that differs from the FDA’s mission: Is the clinical benefit worth the cost? That question introduces a layer of judgment that extends beyond safety and efficacy.

A drug that demonstrates a modest improvement in progression-free survival may satisfy regulators. Insurers, however, may view that same improvement as insufficient to justify a significantly higher price.

Patients Get Caught in the Middle

The greatest frustration often falls on patients and physicians. A physician may believe a newly approved therapy offers the best option for a particular patient. The patient may have exhausted existing treatments and desperately wants access to the newest innovation.

Yet FDA approval does not guarantee coverage by the patient’s insurer. Instead, patients may face delays, appeals, documentation requests, or outright denials. For someone battling cancer, these administrative hurdles are more than an inconvenience. They can create additional stress during one of the most difficult periods of a person’s life.

The Future May Bring More Restrictions

The pressure on insurers is unlikely to decrease. The oncology pipeline continues to expand, with increasingly specialized therapies targeting smaller patient populations. While these treatments may provide meaningful benefits, they often arrive with premium pricing.

At the same time, government programs and private insurers are facing mounting financial pressures. As healthcare costs rise, payers will continue searching for ways to manage spending. That means access decisions will likely become even more important in determining the commercial success of new oncology drugs. Pharma companies may need to generate not only clinical evidence but also economic evidence demonstrating value relative to existing therapies.

A Shift in Who Holds the Real Power

None of this diminishes the importance of FDA review. Regulatory oversight remains essential for ensuring that cancer treatments are safe and effective. But the healthcare landscape has evolved. The FDA determines whether a drug can enter the market. Insurers increasingly determine how many patients can actually receive it. That distinction matters.

For pharma companies, it means payer strategy must begin long before launch. For physicians, it means navigating an increasingly complex reimbursement environment. For patients, it means that a promising FDA approval may only be the beginning of the battle for access. As oncology innovation accelerates and healthcare budgets tighten, the ultimate question may no longer be whether a new cancer drug works.

The question may be whether insurers believe it is worth paying for. And in many cases, that decision will have a greater impact on patient access than the FDA approval itself.

Revlimid (lenalidomide) now faces generic competition, which has significantly altered the landscape of treatment options for patients. In this evolving market, payers have a powerful economic incentive to require patients to exhaust generic lenalidomide before approving a much more expensive branded successor. This trend is especially true in clinical scenarios where iberdomide or mezigdomide are used in settings where generic lenalidomide remains a clinically acceptable option.

As a result, healthcare providers must navigate this complex environment, balancing patient needs with cost considerations, and advocating for the most effective treatment while adhering to payer requirements. Furthermore, the introduction of generics not only affects costs but also raises questions about their efficacy and patient outcomes compared with their branded counterparts.

The key question is whether the new drugs demonstrate benefits that are clearly beyond what generic lenalidomide can provide:

• Activity in patients who have become resistant to Revlimid.
• Meaningfully longer progression-free survival.
• Better responses in later-line disease.
• Utility in combinations where Revlimid is no longer effective.

If the drugs are primarily used after Revlimid failure, payer resistance should be less severe because there is no direct generic substitute. If Bristol tries to move them into earlier treatment lines where generic lenalidomide is entrenched, expect aggressive prior authorizations, step edits, and formulary restrictions. That’s the same challenge many oncology brands face when a highly effective generic already exists.

My view is that iberdomide and mezigdomide can become important myeloma drugs, but neither is likely to replicate Revlimid’s historic commercial dominance. Revlimid became a blockbuster because it was used broadly across multiple lines of therapy before generic competition existed. The new CELMoDs are entering a market that now has:

• Generic lenalidomide,
• CAR-T therapies,
• Bispecific antibodies,
• Numerous combination regimens.

So Bristol may replace part of the lost Revlimid revenue, but payer pressure and a much more crowded myeloma landscape make it unlikely that these drugs will enjoy the same market power Revlimid had at its peak. The pharmaceutical industry is witnessing a significant shift as numerous competitors emerge with similar therapies, which not only increases options for healthcare providers but also intensifies negotiations with payers. Additionally, as the market becomes saturated with these newer treatments, the potential for premium pricing diminishes, leading to greater scrutiny and cost-effectiveness evaluations by insurers.

Consequently, while Bristol may find some success in capturing market share, the broader landscape suggests that without strategic positioning and differentiation, it may face substantial challenges in achieving the same level of financial performance that once characterized Revlimid’s dominance.

Mezigdomide is part of a new generation of protein-degrading therapies and is one of two drugs Bristol Myers Squibb hopes will eventually succeed Revlimid, one of the most successful cancer drugs in pharmaceutical history. As Revlimid continues to face generic competition and declining revenues, the company desperately needs its next blockbuster.

On the surface, this appears to be exactly the kind of news investors, physicians, and patients want to hear. But is it all good news?

Not necessarily.

The multiple myeloma treatment landscape has become increasingly crowded and competitive. Innovative therapies, ranging from CAR-T treatments to bispecific antibodies, are reshaping treatment paradigms and giving physicians more choices than ever before. Any new entrant must demonstrate not only efficacy but also a compelling reason for physicians to use it over existing alternatives.

The encouraging aspect of mezigdomide is its apparent ability to help overcome resistance mechanisms that limit the effectiveness of existing treatments. If the drug continues to perform well in clinical practice, it could provide an important option for patients who have exhausted other therapies.

That is the scientific story. The business story may be more complicated.

Drug development success does not automatically translate into commercial success. Pharma history is littered with examples of companies that developed excellent products but failed to maximize their potential because of internal organizational issues.

When I posted my story last week on BMS, I received a lot of feedback on BMS: it was all negative. One person was let go because he dared to challenge his team’s assumption at a meeting. He told me via email that what he had challenged eventually came to pass. Another said she left BMS because it was “the most screwed up company I have been at”.

Working at Bristol Myers Squibb (BMS) can wear you down. . Many employees cite frequent layoffs, heavy workloads, and complex matrix structures as major pain points.

Common frustrations among staff include:

• Constant Restructuring: Frequent layoffs and reorganizations make job security feel unstable.
• Matrix Chaos: Cross-regional coordination and multiple layers of approval can make decision-making incredibly slow.
• Workload Pressure: Lean teams often lead to burnout and pressure to take on more than you were hired for.
• Career Progression: Promotions can be slow and heavily dependent on networking rather than on hard work alone.

If the environment has become toxic, updating your resume and exploring the job market might be your best move. You can start looking for fresh opportunities using the Indeed Job Search or LinkedIn Job Search platforms.

BMS risks becoming insular. Organizations that prioritize hiring people who “fit in” can inadvertently create environments where challenging assumptions becomes difficult. Diversity of thought often suffers when cultural conformity takes precedence over intellectual debate.

The danger is not that talented people are hired. The danger is when organizations place too much emphasis on finding people who think alike, work alike, and view the business through the same lens.

Successful commercialization requires marketers, sales leaders, medical affairs professionals, market access teams, and executives who are willing to challenge conventional wisdom. They must be able to identify emerging threats, understand changes in physician behavior, and recognize when established approaches are no longer effective.

As the oncology marketplace becomes more competitive, companies need more diverse perspectives, not fewer.

Bristol Myers Squibb has clearly demonstrated that its scientists remain capable of developing important new medicines. The mezigdomide data reinforces that point. The question is whether the organization can be equally effective at fostering the kind of culture that allows innovative thinking to thrive throughout the company.

Patients benefit when great science reaches its full potential. The Phase 3 results suggest mezigdomide could become an important weapon against multiple myeloma. Whether it becomes the successor to Revlimid that Bristol Myers Squibb hopes for will depend on more than clinical trial data.

I’m sure that this treatment option, once approved by the FDA, will cost a LOT of money. BMS needs the money after the Celgene mistakes. But whether BMS has the smart people to make this product a success is a huge question mark. I’ve learned that even drugs with excellent data can fail to meet sales projections if your army is comprised of “yes people”.

Can BMS avoid the organizational complacency that often accompanies success and ensure that it values diverse thinking as much as scientific innovation? Hiring solely based on “culture fit” risks creating an echo chamber and introducing unconscious bias into the workplace. Instead, leading organizations now prioritize culture add and skills-based hiring to build diverse, high-performing teams.

The Shift to “Culture Add”

Instead of asking “does this person jfit in?”, smart companies look for culture add—hiring individuals who bring fresh perspectives, new skills, and complementary personalities to the team:

• Shared Core Values: Candidates should align with the company’s core values (e.g., integrity, customer obsession).
• Diversity of Thought: Seek out candidates who challenge the status quo and introduce new ways of solving problems.
• Competency First: A candidate’s technical skills and capacity to learn should always dictate the baseline decision.

At this point, I’m not sure BMS has the right people in place because they want “people who do,” not “people who think.”

According to Jody Dushay, an assistant professor of medicine at Harvard Medical School, one of the most common questions she receives is whether people should microdose GLP-1 drugs for cosmetic weight loss. Her answer is straightforward: microdosing GLP-1s is not a medically recognized treatment strategy, and there is no legitimate long-term data supporting the practice.

That reality has not stopped the trend from spreading across social media, wellness clinics, and online communities where anecdotal success stories often receive more attention than scientific evidence.

What Is Microdosing GLP-1s?

The term “microdosing” generally refers to taking a fraction of the approved therapeutic dose of a medication. Advocates claim that lower doses can help suppress appetite, reduce food cravings, and promote modest weight loss while minimizing side effects.

The problem is that GLP-1 drugs were not developed, tested, or approved using these unconventional dosing approaches. The clinical trials that demonstrated the safety and effectiveness of these medications followed carefully designed dosing schedules that gradually increased patients to therapeutic levels.

When individuals experiment with doses that fall outside those protocols, they are essentially participating in an uncontrolled experiment.

The Evidence Gap

The most important issue surrounding microdosing is the lack of evidence.

While there is substantial research supporting the use of GLP-1 medications for obesity and type 2 diabetes when prescribed according to approved guidelines, there is little reliable data evaluating long-term outcomes for individuals taking very low doses solely for cosmetic weight loss.

Questions remain unanswered:

• How effective are microdoses compared to standard doses?
• Can weight loss achieved through microdosing be maintained?
• What happens when patients stop treatment?
• Are there long-term safety concerns associated with prolonged low-dose use?
• Does microdosing create unrealistic expectations about weight management?

Without rigorous clinical trials, neither physicians nor patients have clear answers.

Social Media Is Driving the Conversation

Much of the enthusiasm surrounding microdosing comes from social media rather than medical research. Influencers and wellness advocates frequently share personal experiences that portray GLP-1 medications as a simple solution for achieving an ideal body shape. Unfortunately, anecdotal reports are not the same as scientific evidence.

What works for one individual may not work for another. More importantly, positive stories rarely capture the full picture, including side effects, costs, discontinuation rates, or weight regain after stopping treatment.

Healthcare decisions should be guided by data, not trends.

The Cosmetic Weight Loss Question

The growing interest in microdosing also raises broader questions about the role of GLP-1 medications in society. These drugs were developed to address serious medical conditions such as obesity and diabetes, both of which are associated with significant health risks. As demand expands among individuals seeking minor cosmetic weight loss, healthcare professionals must consider whether limited healthcare resources are being directed toward the patients who need them most.

The discussion becomes particularly important when drug shortages occur or insurers restrict coverage due to escalating costs.

Patients Deserve Facts, Not Hype

GLP-1 medications represent a significant medical advancement for many patients struggling with obesity or diabetes. However, the excitement surrounding these drugs should not replace evidence-based medicine. Microdosing may sound appealing because it promises weight loss with fewer side effects and lower costs. But until robust clinical studies are conducted, patients and healthcare providers are operating without the data necessary to understand the true risks and benefits.

As Dr. Dushay points out, microdosing GLP-1s is not an established medical practice. The long-term evidence simply does not exist.

For now, individuals considering GLP-1 medications should have candid discussions with qualified healthcare professionals and rely on proven treatment approaches rather than social media trends. In medicine, enthusiasm is never a substitute for evidence.

People in pharma don’t get a cup of coffee without first researching it. However, there comes a time when you need to question your research based on “what you should know”. I’ve found that in qualitative research, people often struggle to put emotions into words, especially in front of others.

People Don’t Really Know Why They Do What They Do

One of the biggest flaws in qualitative research is the assumption that people understand their own behavior. Patients often cannot fully explain why they delayed treatment, stopped taking medication, ignored symptoms, or chose one therapy over another. Physicians may struggle to articulate why they prescribe one drug over another when multiple options appear clinically similar. The reality is that much of human decision-making occurs below the level of conscious awareness.

When researchers ask people why they made a decision, respondents often offer a reasonable answer rather than one that accurately reflects what happened. They’re not lying. They’re simply constructing a narrative that makes sense after the fact. Unfortunately, healthcare marketers and executives frequently mistake these explanations for objective truth.

A great example is the research that I was part of on GLP-1 drugs. We heard a lot about why patients discontinued their use (side effects), but we really had to dig deeper to understand that it was “quality of life issues” and how using GLP-1s made them miss out on some social gatherings around meals. The Product Director also said that his market research people mentioned that a lot of people went on GLP-1s because of “fat-shaming”.

Emotions Are Difficult to Express

Healthcare decisions are often driven by emotions such as fear, anxiety, hope, uncertainty, trust, frustration, and event triggers. The problem is that emotions are notoriously difficult to describe. Ask a patient how they felt when they received a diagnosis, and you’ll get words. What you won’t get is the full emotional experience. Language is an imperfect tool for expressing complex feelings.

Patients may say they were “worried,” but what does that mean? Were they worried about dying? Losing their job? Becoming dependent on others? Financial ruin? Family responsibilities?

A single word rarely captures the depth of emotion driving healthcare decisions. As a result, qualitative researchers often end up interpreting what respondents mean rather than measuring what they actually feel.

The Researcher’s Bias Never Disappears

Another challenge is that qualitative research is highly dependent on interpretation. Researchers decide which questions to ask. Moderators decide when to probe deeper. Analysts decide which comments are important. Report writers decide which themes to emphasize. At every stage, human judgment influences the outcome.

Two researchers can review the same interview transcripts and arrive at different conclusions. Both may be intelligent and experienced. Both may be convinced they are right. That should concern anyone making multimillion-dollar business decisions.

Small Samples Create Big Risks

Healthcare companies routinely make strategic decisions based on interviews with a handful of physicians or patients. Sometimes those samples are astonishingly small. Ten physicians. Twenty patients. A few focus groups.

Yet the findings are often presented as if they represent an entire market.

The problem is that healthcare markets are incredibly diverse. Patient experiences vary by geography, age, socioeconomic status, disease severity, insurance coverage, and countless other factors. What sounds like a powerful insight in a focus group may be completely irrelevant to the broader population.

What People Say and What People Do Are Often Different

Perhaps the biggest reason I distrust qualitative research is that stated behavior and actual behavior are frequently disconnected. Patients say they want one thing and do another. Physicians say they rely on clinical evidence yet may be influenced by habit, peer recommendations, formulary restrictions, or patient requests. Consumers routinely claim they dislike advertising while simultaneously purchasing products promoted through advertising.

If healthcare organizations want to understand behavior, they should spend more time studying actual behavior and less time studying explanations of behavior. Digital analytics, prescription data, claims data, website behavior, search behavior, and observational studies often reveal patterns that interviews miss entirely.

Use Qualitative Research Carefully

I’m not arguing that qualitative research has no value. It can help uncover issues worth exploring. It can identify language patients use. It can generate hypotheses. It can help researchers understand context.

But that’s very different from using qualitative findings as the primary basis for major business decisions. Too often, healthcare organizations treat qualitative research as if it reveals objective truth. It doesn’t.

At best, qualitative research offers a collection of stories, opinions, perceptions, and interpretations. Those stories may be valuable, but they should be validated using larger, more objective data sources before millions of dollars are invested in strategy changes, product launches, messaging campaigns, or patient programs.

The healthcare industry places enormous faith in qualitative research because it feels human. It feels insightful. It feels like we’re hearing the authentic voice of patients and physicians. But feelings are not facts. People struggle to explain their emotions, often misunderstand their own motivations, and frequently behave differently than they claim they will.

That doesn’t make qualitative research useless. It becomes dangerous when treated as evidence rather than as a starting point for further investigation.

When important business decisions are on the line, healthcare organizations should trust what people do more than what they say.

Having relatives that died rom cancer demonstrated just how bad the cost of most cancer drugs are. One of my relatives drained his bank account and had to sell his car to pay for treatments. Another liquidated her 401K to pay for cancer treatment and another declined treatment because it would have been over $15,000 a month.

Cancer Innovation Is Advancing—But So Are Costs

There is no question that oncology has made remarkable progress. Immunotherapies, targeted treatments, CAR-T therapies, and precision medicine have extended survival and improved outcomes for many patients. But the cost trajectory has become unsustainable.

Research published in oncology journals has noted that many cancer drugs now exceed $100,000 per year, with some therapies costing substantially more. Even insured patients are struggling.

Another study found that nearly half of cancer patients enrolled in early-phase clinical trials reported monthly out-of-pocket costs exceeding $1,000.

The National Cancer Institute acknowledges that cancer remains one of the most expensive medical conditions to treat in the United States and that financial toxicity has become a major issue affecting patients and survivors. Yet despite all of this, discussions around cost still feel secondary at major oncology meetings.

The Industry Celebrates Innovation While Patients Fear Bankruptcy

Financial toxicity is no longer a fringe issue in oncology. Researchers have linked rising treatment costs to treatment nonadherence, emotional distress, poorer quality of life, and even worse outcomes. Some studies have shown cancer patients are significantly more likely to experience bankruptcy than individuals without cancer.

That should alarm everyone involved in cancer care. Because what exactly are we celebrating if patients cannot realistically afford the treatments being discussed?

At ASCO, there will be endless conversations about biomarkers, sequencing strategies, response rates, and combinations. But many patients are asking far simpler questions: “How do I pay for this?”

“Will my insurance cover it?”

“Will this treatment financially destroy my family?”

Those questions rarely make headlines from ASCO.

Oncology Has Become Increasingly Disconnected From Economic Reality

One of the biggest problems in oncology today is that success is often measured clinically while affordability is treated as someone else’s problem. Drug makers focus on innovation. Physicians focus on efficacy. Investors focus on revenue growth. Health systems focus on reimbursement.

But patients experience all of it simultaneously.

ASCO itself recognized this issue years ago when it developed a value framework intended to evaluate clinical benefit alongside cost. Yet in practice, the oncology ecosystem still largely rewards innovation regardless of affordability.

The result is a system in which therapies that generate modest survival improvements can launch at staggering prices, while discussions about value remain uncomfortable and politically sensitive.

Financial Toxicity Is Now a Side Effect of Cancer Care

The phrase “financial toxicity” has become common in oncology for a reason. Researchers increasingly view the economic burden of cancer similarly to physical side effects from treatment itself. And unlike nausea or fatigue, financial toxicity affects entire families.

Patients delay retirement.

Drain savings.

Accumulate debt.

Skip doses.

Delay care.

Or avoid treatment altogether.

This issue is especially severe among lower-income patients, minorities, younger patients, and those who must travel long distances for care. Yet oncology conferences still tend to frame affordability as a policy discussion rather than a patient outcome issue. That mindset needs to change.

ASCO Should Spend More Time Talking About Affordability

The oncology community should absolutely celebrate scientific advances. But it should also acknowledge that a cancer treatment people cannot realistically afford is not fully solving the problem. If ASCO truly wants to champion patient-centered care, affordability must become part of every major conversation—not just a breakout session tucked away in the schedule.

The future of oncology cannot simply be about developing more expensive therapies faster. It also has to be about creating a system where patients can access those therapies without financial devastation.

Because survival statistics mean little if surviving cancer leaves patients financially broken.