Am I the only one that thinks all these classifications are stupid? Especially when things can change by the time a pre-med is applying for residency?

Even if you knew every configuration down to the atom of every gene and protein in every cell/bacteria/cancer you still need to alter it. As anyone who has picked up a pharm textbook knows, all drugs have side effects and most research drugs often fail to make it out of clinical trials for adverse effects in other areas of the body.

Yes, technology is getting much more powerful, yes, we have more funding for research and more researchers, BUT the process/speed of clinical trials is still the same. Its going to take upwards of 15+ years to create a single generation of a drug. Even then that will only be 1st generation (radiation still might be more effective). Not to mention radiation oncology itself is a research powerhouse, in 15 years radiation will also have evolved to be better with less side effects.

Consider this...compare technology/silicon valley of 1990 to 2012 (ridiculous different). Now compare 1990 to 2012 in the world of medicine (nowhere close to what has happened in the world of computers/internet). The point is medicine and medicines research protocols are built such that it can not and will not grow at an exponential speed.

Let me put it in these terms...SDN is ~10 years old, what has medicine accomplish in this time (this is 1/3 the length of our careers).

Dude, you're grossly underestimating how long it will take for cancer therapeutics to reach that stage. I work for biopharma and I can tell you that getting a new drug approved by the FDA is a long, long process, and there are always side effects. Don't expect a new class of cancer drugs to make radiation therapy obsolete during your medical career.

Oncology has a lot more research dollars. While it's under the general umbrella of IM, the numbers are pretty striking, things like pharma and biochem also contribute to med onc.

From the BLUE RIDGE INSTITUTE for MEDICAL RESEARCH BRIMR.ORG
Rank Department Awards
1 INTERNAL MEDICINE/MEDICINE $3,154,119,314
2 PSYCHIATRY $774,148,590
3 PEDIATRICS $719,343,524
4 MICROBIOLOGY/IMMUN/VIROLOGY $621,420,800
5 PATHOLOGY $612,776,786
6 BIOCHEMISTRY $605,254,818
7 PHARMACOLOGY $502,417,187
8 GENETICS $446,731,045
9 PHYSIOLOGY $443,807,426
10 NEUROLOGY $421,793,982
11 ANATOMY/CELL BIOLOGY $403,247,317
12 RADIATION-DIAGNOSTIC/ONCOLOGY $326,790,053
13 PUBLIC HEALTH & PREV MEDICINE $275,794,320
14 NEUROSCIENCES $270,862,043
15 SURGERY $269,563,461
16 NONE $223,275,487
17 OPHTHALMOLOGY $194,883,787
18 BLANK $193,905,832
19 OTHER BASIC SCIENCES $168,981,160
20 OBSTETRICS & GYNECOLOGY $156,424,229
21 BIOLOGY $134,178,606
22 ANESTHESIOLOGY $103,067,885
23 OTOLARYNGOLOGY $80,219,714
24 NEUROSURGERY $74,205,199
25 UROLOGY $64,232,585
26 DERMATOLOGY $60,718,724
27 MISCELLANEOUS $60,690,690
28 FAMILY MEDICINE $55,011,698
29 VETERINARY SCIENCES $49,108,983
30 ORTHOPEDICS $47,215,307
31 BIOSTATISTICS & OTHER MATH SCI $42,769,638
32 OTHER HEALTH PROFESSIONS $38,133,455
33 OTHER CLINICAL SCIENCES $36,102,758
34 EMERGENCY MEDICINE $35,044,094
35 BIOMEDICAL ENGINEERING $27,074,212
36 ADMINISTRATION $20,089,241
37 PHYSICAL MEDICINE & REHAB $15,237,383
38 BIOPHYSICS $13,910,761
39 ENGINEERING (ALL TYPES) $10,056,857
40 PSYCHOLOGY $7,533,825
41 SOCIAL SCIENCES $5,090,351
42 NUTRITION $3,664,297
43 PHYSICS $3,104,661
44 CHEMISTRY $2,229,380
45 DENTISTRY $836,506
46 PLASTIC SURGERY $439,071

why the hell is vet medicine not the last one on the list?



edit: I just noticed flatearth became a martyr!

There are no duty hour regulations once you get out of residency and into the real world. Which is funny, because that is when it really counts, there is no upperlevel or attending watching over you anymore. Perhaps certain practices or groups an individual works for my set such limits, but if you need to work 100hrs/week you do.

The current regime can't really work for personalized medicine. Radioimmunotherapy has a lot of potential, and it doesn't fully fall under the realm of radonc. You can also use various targeting molecules to deliver other payloads, toxins, etc. Those types of drugs are already under development.

There are other potential therapies that rely more heavily on bioinformatics, and while we don't have the knowledgebase yet, it will be there soon (ideally with the computational power to analyze it).

There will eventually need to be a change to the FDA approval process for things the exploit pharmacogenomics, and while it's in the future, it's not that far away.

60 years ago we didn't know the structure of DNA. 10 years ago we didn't have the sequence of even a single genome. We now have thousands, as well as the genomes of many cancers.

You're underestimating the rate of progress.

People love their pets?

rofl vet's don't just treat pets >.> where do you think that steak and fried eggs for breakfast comes from? ;p And who treats all those farm animals ;o

I realize science has come a long way in the last century, but I wasn't debating the rate of scientific progress. My point was that it's a long road between R & D and release of a new cancer drug, and for good reason. There is no "magic bullet" as a previous poster remarked. These drugs tend to have serious side effects. If the FDA's approval process wasn't as rigorous as it is, biopharmaceutical companies would be pushing through a host of new drugs whose impact we don't fully understand. I don't see the FDA significantly compromising on its drug approval process, and for that reason I don't see how rad onc will become "irrelevant" during my lifetime.

Johnnydrama, you are sounding like the people who say that computers are bound to take over radiology in our lifetimes. Radiation may be dirty, but so is chemotherapy and surgery.

Surgery and targeted chemotherapy (eg imatinib, herceptin) can be cleaner than radiation.

And yeah, I'm one of those guys too. :laugh:

sure, but those are 2 miracle drugs with very specific indications. You wanna talk about "real" chemo you are talking about cisplatin and 5-FU, which are dirty, dirty drugs. Even newer agents like avastin are having their indications pulled left and right because of all the toxicity.

And, yes, breast cancer surgery is clean, but tell me that an esophagectomy with a gastric pull through isn't a dirty procedure...

Cancer is a dirty disease, and requires dirty treatment.

Grocery store duh! Jk.

I would think that kind of research would be more funded through agriculture than vet medicine, but I'm sure there's prob some overlap.

Oh, of course I'm not talking about general chemo. That's also a dirty treatment.

There will be more "miracle drugs" like that in the pipeline. The trick will be figuring out where they are effective (and where they are dangerous).

The pharma industry (and the FDA) will also have to adapt to targeting drugs at much smaller populations with favorable genotypes, which admittedly is a more difficult business model than selling SSRIs and statins to everybody.

what field are you in (jw)?