MedBuzz Tariffs, Taxes, and Trade-Offs: Can Raising Taxes in the UK Get You Cheaper Drugs in the US? John Marshall, MD: John Marshall for Oncology Unscripted. There's been all sorts of stuff going on out there in healthcare—in the business of healthcare—and a recent article that was just published in The New York Times told us something about the relationship between the National Health Service, how patients get access to drugs there in Great Britain, and our relationship with them and the tariffs. You're like, how could the tariffs have anything to do with the National Health Service? Well, let me give you a very short little background, if you don't know already, on the National Health Service—Britain’s public health system. The Brits love it. It's tax-based. It's not fancy, it's not frilly. But if we're going to bring in some new medicine or some new expensive therapy—whatever it is—the budget has to be balanced.So, either they have to remove something from what the patients have access to, or they have to raise taxes. And there is a committee known as the NICE committee, the National Institute of Clinical Excellence—staffed by physicians that, in fact, governs that. You're thinking, where is Marshall going with this?Well, where he is going—and The New York Times presented this—is that because of the tariffs, right? Britain makes some drugs, and we import them here and use them. Well, if the tariffs are in place, those drugs will be more expensive to import. And the whole idea behind the tariffs is to make it so that more Americans are doing the manufacturing. Well, the Trump administration and the National Health Service just made a new deal where the Brits will get access to more drugs—so they'll raise their expenses, if you will. And it's going to hit the bottom line over there...because they're going to have access to medicines that they don’t currently have access to. In exchange, the U.S. is going to say, “Well, we'll waive those tariffs on drugs you import.” So, it is access over here for an economic change—an international economic change—around the tariffs. I have no idea how this is going to work out. I didn’t really understand all the math—were taxes going to go up in Great Britain? Were they going to call it a wash because the tariffs were not going to be in place? I don’t know. The good thing for patients in the UK is that they're going to have more access to more medicines. What I worry about is that it'll come on the backs of either going into debt—if the National Health Service goes into more debt, sort of like our healthcare system—or, in fact, they raise taxes, or somehow they magically make the budgets balance. So, we need to look ahead to 2026 and see just what happens with this UK National Health Service–Trump tariff deal that was just reported in The New York Times. Stay tuned here for more updates on Oncology Unscripted. [03:04] Editorial/Main Topic What I Tell Every New Patient With Cancer John Marshall, MD: John Marshall for Oncology Unscripted.I start almost every new patient appointment by talking with the patient and saying that I—I don't really know why people get cancer. We memorize lists of what we're supposed to do and what we're not supposed to do, but, bluntly, almost everybody sitting across the room from me didn't do anything on the bad list, and yet here they are, sitting there with cancer. It seems to me—and I think this is popular science thinking as well—that we probably all get cancer all the time. But our bodies actually have outstanding spell checkers and an outstanding functional immune system that can see early cancers and fix them before they cause any trouble. So, what that actually means, then, is that those cancers that make it—those cancers that survive through the spell checker or through the immune system—must have figured out a way to get around the spell checker, or have broken the spell checker, or maybe are hiding from the immune system. And so, almost all of our new research going on right now in cancer medicine is either trying to fix the spell checker—and by this, I mean targeted therapies, signaling pathways, et cetera—or it's trying to turn back on, wake back up, or uncover the tumor from the immune system so the immune system can go in and do its job. And so, I think what you see at almost any conference nowadays focuses on those two approaches. It's not some new chemotherapy, although chemo continues to be very important and has cured a whole lot of people, so don't get me wrong about that. But what we're seeing in terms of innovation has a lot to do with improving the immune system, measuring the immune system, having better immunotherapy or immunotherapy combinations, and, at the same time, uncovering the molecular abnormalities of our cancers and having targets to those—and, in some cases, combining those with novel therapies as well. So, be on the lookout for the next innovation: either fixing your spell checker or fixing your immune system. But, in support of that, let's look at some of the coolest, latest data that's practice changing in our world today. John Marshall for Oncology Unscripted. [05:42] Interview New Hope in GI Cancer Care: A Candid Conversation with Dr Yelena Janjigian John Marshall, MD: Hey, everybody out there in videoland or maybe you’re in podcast land walking your neighborhood. Maybe you have a pit mix dog you're walking because she hasn’t been out in a while, but wherever you are, this is for Oncology Unscripted, and I am a lucky guy because I am joined today by not only a great friend, but also someone who is really setting the standard of care for us in so many ways in GI cancers, and that's Dr. Yelena Janjigian. Yelena, how is New York City today? How is it up there? Yelena Jangigian, MD: Thanks for having me, Donna. It's great. New York is the best place to be. It's beautiful and sunny, getting ready for holiday season. It's always good to catch up with you and talk research and talk gastric cancer and esophagus cancer outcomes. John Marshall, MD: Do the stores already have, like, decorations ready to go up there? Yelena Jangigian, MD: I have not been out, but I've noticed some things here and there in offices. John Marshall, MD: What do you mean you haven't been out? You live in the hospital, in the clinic, don't you go out? Yelena Jangigian, MD: Not out in shops, but I've noticed a few, like, you know, holidays, actually. Some of them are actually skipping Thanksgiving and going into holiday season decorations in random offices. So, but, you know, the spirit is, you know, cheerful in New York. John Marshall, MD: It is a good time of year. I know you very well, and I know lots of our listeners know you very well. Give us a quick little bio on what you're doing right now. Yelena Jangigian, MD: I'm a physician-scientist working at Memorial Sloan Kettering Cancer Center, focused on advancing care and helping patients with esophagus and stomach cancer live longer using both targeted and immunotherapies. Our lab is focused on trying to understand how we can overcome resistance to some of these medications using both tissue culture and other models. And, of course, I also lead a big group at Memorial Sloan Kettering Cancer Center. We have 45 oncologists all focused on one mission: to improve cancer care for worldwide options for gastric cancer, but also anywhere from esophagus down to the anal canal. So, it's a big group of very dedicated individuals. John Marshall, MD: So now I know why you haven't been outside. Because you haven't slept, you haven't left. Yelena Jangigian, MD: Annual review time. A lot of paperwork. John Marshall, MD: Well, let's get into the weeds a little bit on how you are, in fact, helping to lead the improvement in outcomes for patients. But before we jump in, as an old guy in this space, I do have frustration that we in the GI cancer world haven't made more progress compared to our friends in some other cancers. And I know in upper GI and stomach and adenos, etc., precision medicine hasn't been consistent. Things that work in the metastatic setting haven't necessarily worked in the adjuvant setting. It's taken us a long time to get precision medicine targets that are viable for therapies, etc. What are your thoughts about that and why that might be so? Yelena Jangigian, MD: So, yeah, I think it's important to start from basic knowledge that these diseases can be quite heterogeneous. And even in biomarkers such as HER2, cut-and-paste approaches from, for example, breast cancer into gastroesophageal cancer have not been the best way to do it. In fact, understanding the co-occurring alterations in our disease—the RAS pathway activation, the PD-L1 co-occurring with HER2—is what made the major milestone in the breakthrough in first-line setting beyond trastuzumab. So, I think understanding that this disease, in its nature, because of the nature of the GI epithelium, is more complex but also more heterogeneous than some of our other solid tumors is really critical. And also, because it's a rare disease in some countries, uniform and reflexive testing of biomarkers, where you get enough of a critical mass of data into the clinic so that you understand how each individual subset of a subset—for example, within HER2 tumors, p53-mutant tumors may do differently than p53 wild-type, RAS amplified vs RAS neutral—things like that. Until we do things in larger scale really going forward for all patients, we won't understand this nuance because in colon, breast, lung—the big three—there's more data, breadth and depth, these discoveries can be made. John Marshall, MD: I was thinking about the idea of mostly colon cancer, and we've been seeing with IO therapy, where we're going to go in a minute, that even in MSS colon cancers, if it's primary disease, we are seeing responses when we would never see them in metastat
