 Hi, I'm Dr. Bisal Gawali. I'm an MD, PhD, a specialist in medical oncology. I did my training from Nagoya University, Japan. And my field of interest is global oncology, cancer economics and cancer policy. So today I'm going to talk about an editorial I wrote for Onko Target. And the topic of the editorial is cancer drugs in low and middle-income countries cheap but unaffordable. Now this paper, this editorial focuses on a recent paper in Onko Target published by my colleague and friend Daniel Goldstein from Israel. So he published a very important paper showing that there were differences in cancer drug prices throughout the world, which we all knew before, but he gave us a quantification of that differences. And this was a very important history because he included countries from across the world, both high and low-income countries. And he showed that there were fluctuations in the prices of cancer drugs throughout the world. But he also showed that there were differences in affordability. Usually when we talk about drug prices, we only talk about the cost of the drugs. But affordability is a different attribute to cancer economics because you can have some very high-value drugs, very effective drugs, but still they can be unaffordable. Until now, the discussion has always revolved around the value of cancer drugs, how much benefit we receive for the price we pay. But even if you have a very high-value drug such as Herceptin for breast cancer, it can still be unaffordable for many patients living in low and middle-income countries. And that's exactly what this paper by Paulistin et al. showed. For example, they showed that cancer drug prices were cheapest in India, but they were the least affordable in India. So despite having cheaper drug prices, in people, patients living in low and middle-income countries cannot afford the cancer in the newer cancer drugs. So this is a landmark study in that sense. And this helps us in making further policies about how to make cancer drugs available to all patients globally. And my expertise or my interest in research is in cancer policy and global oncology. So previously, I have written about how can we make cancer drugs more affordable and available to patients living in low and middle-income countries. So one such step is the WHO EML list, which we call the Essential Medicine List. And the WHO EML is basically a document which contains the list of essential medications that every government should make available to its patients. And so recently, we had editions of drugs like Tastazumab and Retaximab in the WHO EML list and Imatinib. So this was a very important step. So the next step is to ensure that they remain affordable and accessible. Similarly, another important point is to be very careful about the highly effective cancer drugs versus moderately minimally free cancer drugs, because recently we have seen a slur of many cancer drugs that are of low value that provide very marginal benefit, but they cost a lot. So these cancer drugs are a particular challenge for every government, but especially low and middle-income countries should be very much careful not to spend a lot of resources on purchasing these low-value drugs, but they should focus more on what I call cancer ground shot, which means measures that we already know work and don't involve such highly expensive drugs. For example, many low and middle-income countries still don't have good surgeries or radiotherapy services for early stage cancers or preventive services against cancer. And these services, if available, will cure a lot of cancers, will prevent a lot of cancers, and it can be very, very cost-effective as well as effective for patients living in those countries. So in my editorial, I give an example of cervical cancer. So there are two aspects of looking at management of cervical cancer. One is about the affordability for advanced cervical cancer, but that would not be a reasonably strategic for low and middle-income countries, because low and middle-income countries should focus rather on HPV vaccination, tobacco cessation campaigns so that there are no longer cases of advanced cervical cancer. So this approach is what I refer to as cancer ground shot project, and I have written some papers about this, and I have talked about this in various conferences. So we need to be focusing on these type of strategies that are very helpful and easily affordable and available to every patient throughout the globe. And regarding cancer drugs, we need to differentiate between those cancer drugs which are very much effective, such as imatinib, trustism, which are really game-changing drugs, versus drugs such as Ramosirumab, let's say, which provide very marginal incremental gains. So low and middle-income countries should prioritize these highly effective cancer drugs, and they should limit the spending on these low or minimally effective cancer drugs. So it is basically a question of spending wisely the limited resources the cancer that the low and middle-income countries have. So in conclusion, in my editorial, I talk about this important Goldstein et al's paper, where they show that the cancer drug prices and affordability don't go hand in hand, because we have heard a lot of concerns throughout the world about, for example, many, many patients in high-income countries sometimes complain that cancer drug prices are very cheap in countries like India. So we also have some debate about whether to import drugs from these cheaper regions to expensive countries. But one thing to keep in mind is, although the cancer drug prices are cheaper, they are still beyond affordability for people living in those countries. So they are cheaper, but they are still unaffordable for patients living in low and middle-income countries. So how to address these? We need to change our policies. I talked about WHOEML list, that is an important step forward. And based on similar list, we need to prioritize highly effective drugs that should be available to everyone and how to reduce the cost of those drugs should be our first step. And we should not be spending our resources on minimally effective but expensive drugs. And we need to rather spend that funds for making, for example, surgery or pathology or radiative services that provide us very high value in terms of cancer care.