Dare you to reply!

[temujim]

Weak minds.

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[Mandelin Rain]

Weak minds.

Nah. I dig this. They believe something. Other person believes something else. They deserve to do what they gotta do.

 

[RadOncMegatron]

Not sure what to think. It's absolutely great to be passionate and be able to protest and walk out. It's also great to not walk out on during a white coat ceremony due to political differences. Life is going to suck if all speakers political views will be vetted and then 1/2 the people stay and 1/2 the people walk out. I suppose if we all lose than things will be equal... but if we can get out of boring admin meetings and internet modules b/c I don't agree with the admin politically than I shall let this pass lol

 

[RadOncDoc21]

Hence why we should leave politics and religion out of public events and not post those beliefs unless willing to deal with the backlash and consequences.

 

[Ray D. Ayshun]

Hence why we should leave politics and religion out of public events.

I don't disagree, which is why I checked to see what the speaker said at the event. She never got to the podium apparently. I'm all for standing up if she's espousing anti-abortion stuff at the white coat ceremony, but before saying anything, not so much.

 

[Lamount]

I don't know how I feel about this...

On the one hand, I would probably have wanted to stay if I were in their position. I am avidly pro-choice, but when I disagree with someone, I have always favored arguing over leaving. It's always easier to argue with someone when you understand their perspective Additionally, it isn't clear to me that the speaker was going to address the abortion debate... perhaps they have some wisdom to share on other topics. You can be respectful of people without being respectful of all of their views.

On the other hand, I can sympathize with the students' frustration. Perhaps this person wasn't the best choice for a keynote speaker, given how politically charged their views are and, ideally, this particular day is supposed to be apolitical. Their decision to walk out felt like it was more of a rebuke of their administration's poor choice than of the speaker

In general, I think we all need to get a little more comfortable being uncomfortable... and just hear eachother out. Worst case scenario, you walk out of the speech saying "yup, that speaker was wrong"

 

[RadOncDoc21]

I don't disagree, which is why I checked to see what the speaker said at the event. She never got to the podium apparently. I'm all for standing up if she's espousing anti-abortion stuff at the white coat ceremony, but before saying anything, not so much.

Looks like she already stated her beliefs:

“At issue was the keynote speaker: Dr. Kristin Collier, a Michigan faculty member and primary care physician who has spoken publicly about her Christian beliefs and anti-abortion views.”

Michigan medical students walk out on an anti-abortion keynote speaker

A petition had circulated before Sunday's white coat ceremony asking the university to remove the speaker, a physician who directs the school's Health, Spirituality and Religion program.

www.npr.org

 

[Ray D. Ayshun]

Looks like she already stated her beliefs:

“At issue was the keynote speaker: Dr. Kristin Collier, a Michigan faculty member and primary care physician who has spoken publicly about her Christian beliefs and anti-abortion views.”

Michigan medical students walk out on an anti-abortion keynote speaker

A petition had circulated before Sunday's white coat ceremony asking the university to remove the speaker, a physician who directs the school's Health, Spirituality and Religion program.

www.npr.org

Yeah, elsewhere. Does that mean no Christian can ever again speak at the white coat ceremony? (when it comes to being anti-choice and christian, I'm neither). If someone's an admitted christian, then they're anti-choice, and if they say they're not, or you believe they can be pro-choice, then there's a healthy bit of delusion going on.

 

[RadOncDoc21]

Yeah, elsewhere. Does that mean no Christian can ever again speak at the white coat ceremony? (when it comes to being anti-choice and christian, I'm neither). If someone's an admitted christian, then they're anti-choice, and if they say they're not, or you believe they can be pro-choice, then there's a healthy bit of delusion going on.

If I was to express a specific opinion or belief especially a controversial topic on a public platform, I would expect there to be backlash and consequences. She has every right to speak on her beliefs, just as the people have every right not to listen or walk out.

As far as religion is concerned, not all Christian’s believe in anti-abortion laws.

 

[Ray D. Ayshun]

If I was to express a specific opinion or belief especially a controversial topic on a public platform, I would expect there to be backlash and consequences. She has every right to speak on her beliefs, just as the people have every right not to listen or walk out.

As far as religion is concerned, not all Christian’s believe in anti-abortion laws.

I'm not arguing against their right to do this. You're conflating my thinking that it's just a group of sheep getting into a pissing contest to further polarize the issue with my suggesting they shouldn't have been allowed to do so. I actually support the students' side. OTOH, this is the quote I got from the speaker re her anti-abortion stance:

"holding on to a view of feminism where one fights for the rights of all women and girls, especially those who are most vulnerable. I can’t not lament the violence directed at my prenatal sisters in the act of abortion, done in the name of autonomy."

All I can say is, this seems reasonable, if you accept that Christianity is reasonable in the first lace (no comment). I would support answering reason with reason if the goal is actual change. I'm just not certain that's the goal.

 

[RadOncDoc21]

I'm not arguing against their right to do this. You're conflating my thinking that it's just a group of sheep getting into a pissing contest to further polarize the issue with my suggesting they shouldn't have been allowed to do so. I actually support the students' side. OTOH, this is the quote I got from the speaker re her anti-abortion stance:

"holding on to a view of feminism where one fights for the rights of all women and girls, especially those who are most vulnerable. I can’t not lament the violence directed at my prenatal sisters in the act of abortion, done in the name of autonomy."

All I can say is, this seems reasonable, if you accept that Christianity is reasonable in the first lace (no comment). I would support answering reason with reason if the goal is actual change. I'm just not certain that's the goal.

You’re welcome to stay and listen to the speaker. The students that left felt they rather do something else instead.

 

[TheWallnerus]

This thread is an instructive snapshot of the Revolution going on in lung cancer right now... and how rad onc is getting left behind. Its getting left behind is not in a Kevin McCallister-type sense but in the intellectual and cultural sense.

We have all felt this schism, yes? What is it that the medical oncologists and surgical oncologists see that the radiation oncologists don't. We are a bit "stuck." As you read through the thread, it is very much "The Structure of Scientific Revolutions," one of the greatest books about science ever:​

...Thomas Kuhn used the term ‘incommensurable’ to characterize the holistic nature of the changes that take place in a scientific revolution. His investigations into the history of science revealed a phenomena often now called ‘Kuhn loss’: Problems whose solution was vitally important to the older tradition may temporarily disappear, become obsolete or even unscientific. On the other hand, problems that had not even existed, or whose solution had been considered trivial, may gain extraordinary significance in the new tradition. Kuhn concluded that proponents of incommensurable theories have different conceptions of their discipline and different views about what counts as good science; and that these differences arise because of changes in the list of problems that a theory must resolve and a corresponding change in the standards for the admissibility of proposed solutions. So for example, Newton’s theory was initially widely rejected because it did not explain the attractive forces between matter, something required of any mechanics from the perspective of the proponents of Aristotle and Descartes’ theories. According to Kuhn, with the acceptance of Newton’s theory, this question was banished from science as illegitimate, only to re-emerge with the solution offered by general relativity. He concluded that scientific revolutions alter the very definition of science itself.​

Also, Drew M got pwned (this happens when you're operating outside the revolution vs within it, or affecting it):

 

[Ray D. Ayshun]

You’re welcome to stay and listen to the speaker. The students that left felt they rather do something else instead.

And I'm voicing my opinion that opting to walk outside and pat themselves on the back on twitter while further entrenching both sides in the absence of a provocation during the ceremony was the wrong choice.

 

[deleted1116990]

I love some good Drew M. vs. Stiles twitter drama. Especially when Drew is posting after 5 PM.

I'm not sure I've ever given neoadjuvant chemoRT since leaving residency and only saw it a handful of times in residency. Either upfront surgery or definitive chemoRT. Have people really been doing a lot of 45 Gy neoadj for stage 3 lung?

 

[TheWallnerus]

Have people really been doing a lot of 45 Gy neoadj for stage 3 lung?

of course not

 

[RickyScott]

This thread is an instructive snapshot of the Revolution going on in lung cancer right now... and how rad onc is getting left behind. Its getting left behind is not in a Kevin McCallister-type sense but in the intellectual and cultural sense.

We have all felt this schism, yes? What is it that the medical oncologists and surgical oncologists see that the radiation oncologists don't. We are a bit "stuck." As you read through the thread, it is very much "The Structure of Scientific Revolutions," one of the greatest books about science ever:​

​

...Thomas Kuhn used the term ‘incommensurable’ to characterize the holistic nature of the changes that take place in a scientific revolution. His investigations into the history of science revealed a phenomena often now called ‘Kuhn loss’: Problems whose solution was vitally important to the older tradition may temporarily disappear, become obsolete or even unscientific. On the other hand, problems that had not even existed, or whose solution had been considered trivial, may gain extraordinary significance in the new tradition. Kuhn concluded that proponents of incommensurable theories have different conceptions of their discipline and different views about what counts as good science; and that these differences arise because of changes in the list of problems that a theory must resolve and a corresponding change in the standards for the admissibility of proposed solutions. So for example, Newton’s theory was initially widely rejected because it did not explain the attractive forces between matter, something required of any mechanics from the perspective of the proponents of Aristotle and Descartes’ theories. According to Kuhn, with the acceptance of Newton’s theory, this question was banished from science as illegitimate, only to re-emerge with the solution offered by general relativity. He concluded that scientific revolutions alter the very definition of science itself.​

Also, Drew M got pwned (this happens when you're operating outside the revolution vs within it, or affecting it):

Drew’s argument is actually quite spurious. Path cr from chemo/xrt is occurring in the chest, mostly because of the addition of xrt.

Path cr from systemic therapy/io alone is indicative of systemic “path cr”.

 

[BobbyHeenan]

I've already seen this trial be mis-interpreted at our tumor board.

The neoadj chemo-IO is for UP FRONT ELIGIBLE FOR SURGERY. It is not to convert someone from unresectable to resectable. As noted above, your chances of a path CR aren't terribly high on trial (?like 30ish % ).

We had med onc and CT surg arguing for pre op chemo-IO in a patient with a resectable lung mass, but an unresectable node. They were talking about how that node may "clear" with chemo-IO.

We've "re-educated" ourselves with this trial at our place. I'm perfectly fine with (especially) single station, resectable (BOTH node and tumor) patients getting this treatment.

You just KNOW though the itch to have med onc start this treatment even before multi-D look is going to be very easy to scratch. I anticipate treating more post op lungs than I have in a long time when we get + margins and unresected nodes on down the line. Can't wait for the pneumonitis!

 

[RickyScott]

I've already seen this trial be mis-interpreted at our tumor board.

The neoadj chemo-IO is for UP FRONT ELIGIBLE FOR SURGERY. It is not to convert someone from unresectable to resectable. As noted above, your chances of a path CR aren't terribly high on trial (?like 30ish % ).

We had med onc and CT surg arguing for pre op chemo-XRT in a patient with a resectable lung mass, but an unresectable node. They were talking about how that node may "clear" with chemo-IO.

We've "re-educated" ourselves with this trial at our place. I'm perfectly fine with (especially) single station, resectable (BOTH node and tumor) patients getting this treatment.

You just KNOW though the itch to have med onc start this treatment even before multi-D look is going to be very easy to scratch. I anticipate treating more post op lungs than I have in a long time when we get + margins and unresected nodes on down the line. Can't wait for the pneumonitis!

playing devils advocate.often, surgery is technically possible, but given extent of nodal station involvement , we historically felt pt would benefit more from chemo/xrt. These type of pts were eligible for io neoadjuvant trials which included stage IIIb. I have seen multiple thought leaders argue for this approach in stage IIIb pdl1+ pts already. Some are also suggesting 2cyles of neoadjuvant io followed by assessment of mediastinum, and if good response, proceeding to full surgery.

 

[Ray D. Ayshun]

Treating patients pre-op gets me an extra 77427

 

[BobbyHeenan]

playing devils advocate.often, surgery is technically possible, but given extent of nodal station involvement , we historically felt pt would benefit more from chemo/xrt. These type of pts were eligible for io neoadjuvant trials which included stage IIIb. I have seen multiple thought leaders argue for this approach in stage IIIb pdl1+ pts already. Some are also suggesting 2cyles of neoadjuvant io followed by assessment of mediastinum, and if good response, proceeding to full surgery.

Right or wrong, my take thus far is if the the surgeon thinks that right now as of initial diagnostic imaging that he/she can remove everything, then sure, have at it. Even multi station disease.

I am just apprehensive about them saying - "well maybe if we get some shrinkage THEN we'll be able to surgically remove." These patients weren't on the trial.

 

[RickyScott]

Right or wrong, my take thus far is if the the surgeon thinks that right now as of initial diagnostic imaging that he/she can remove everything, then sure, have at it. Even multi station disease.

I am just apprehensive about them saying - "well maybe if we get some shrinkage THEN we'll be able to surgically remove." These patients weren't on the trial.

I agree with you, but I also sense a paradigm shift developing here, with the surgeons and medonc giving IO without much deference to what radiation oncology thinks.

 

[BobbyHeenan]

I agree with you, but I also sense a paradigm shift developing here, with the surgeons and medonc giving IO without much deference to what radiation oncology thinks.

I absolutely agree with this.


Eventually I suspect we'll have a trial neoadjv chemo/IO first....with no progression then randomize to chemo XRT or surgery.

Or alternatively chemo/IO surgery versus chemo/XRT then IO.

 

[medgator]

Treating patients pre-op gets me an extra 77427

45-50 vs 60-66?

 

[Ray D. Ayshun]

45-50 vs 60-66?

Instead of treating to 60/30 (definitive) I treat to 61.2/34 when they inevitably remain inoperable.

 

[TheWallnerus]

playing devils advocate.often, surgery is technically possible, but given extent of nodal station involvement , we historically felt pt would benefit more from chemo/xrt. These type of pts were eligible for io neoadjuvant trials which included stage IIIb. I have seen multiple thought leaders argue for this approach in stage IIIb pdl1+ pts already. Some are also suggesting 2cyles of neoadjuvant io followed by assessment of mediastinum, and if good response, proceeding to full surgery.

Unresectability is not a sharp line. With IO, that line is moving!

 

[TheWallnerus]

I agree with you, but I also sense a paradigm shift developing here, with the surgeons and medonc giving IO without much deference to what radiation oncology thinks.

it’s because the rad oncs are now speaking in terms with which med onc and thoracic surg no longer understand

Rad onc didn’t change

Other things did

 

[Lamount]

Unresectability is not a sharp line. With IO, that line is moving!

The phrase that comes up in my circles is... "if the patient isn't resectable today, then they aren't going to be resectable after neoadjuvant IO".

...also many surgeons aren't particularly excited about operating after IO... it's evidently a fibrotic mess

 

[Ray D. Ayshun]

The phrase that comes up in my circles is... "if the patient isn't resectable today, then they aren't going to be resectable after neoadjuvant IO".

...also many surgeons aren't particularly excited about operating after IO... it's evidently a fibrotic mess

Have heard the same thing when io is used neoadjuvantly in esophagus.

 

[TheWallnerus]

The phrase that comes up in my circles is... "if the patient isn't resectable today, then they aren't going to be resectable after neoadjuvant IO".

...also many surgeons aren't particularly excited about operating after IO... it's evidently a fibrotic mess

“It’s a fibrotic mess”

This was a common phrase I heard from surgeons in the transition to preop chemoRT for rectal cancer ~25y ago

Fibrosis is also what often occurs when a tumor disappears

 

[evilbooyaa]

I absolutely agree with this.


Eventually I suspect we'll have a trial neoadjv chemo/IO first....with no progression then randomize to chemo XRT or surgery.

Or alternatively chemo/IO surgery versus chemo/XRT then IO.

This is the trial that actually would benefit patients, seeing if there's any benfit of whacking out their lung when they have N2 disease compared to PACIFIC. Maybe PACIFIC-2/3 are out by then.

 

[RickyScott]

This is the trial that actually would benefit patients, seeing if there's any benfit of whacking out their lung when they have N2 disease compared to PACIFIC. Maybe PACIFIC-2/3 are out by then.

Problem is that neoadjuvant io studies can be run in 2 years using path response as endpt while pacific like trial would take at least 3x as long. May be into 3rd/ 4th iteration when pacific based trial out.

 

[Lamount]

Problem is that neoadjuvant io studies can be run in 2 years using path response as endpt while pacific like trial would take at least 3x as long. May be into 3rd/ 4th iteration when pacific based trial out.

That said... a pCR says nothing about surgery

 

[evilbooyaa]

Problem is that neoadjuvant io studies can be run in 2 years using path response as endpt while pacific like trial would take at least 3x as long. May be into 3rd/ 4th iteration when pacific based trial out.

pCR endpoints are fine when you're comparing two separate neoadjuvant regimens and everyone is getting surgery, but it says nothing about the benefits of surgery compared to another local therapy.

 

[RickyScott]

pCR endpoints are fine when you're comparing two separate neoadjuvant regimens and everyone is getting surgery, but it says nothing about the benefits of surgery compared to another local therapy.

Agreed, but by the time a chem/io rads vs chemo/io followed by surgery has dfs/os results, the neoadjuvant io/chemo in the surgical arm could be out of date.

 

[evilbooyaa]

Agreed, but by the time a chem/io rads vs chemo/io followed by surgery has dfs/os results, the neoadjuvant io/chemo in the surgical arm could be out of date.

In 2 or 5 years for lung cancer? Do we expect big changes beyond 'add immunotherapy' to neoadjuvant chemo? Where do they go for neoadjuvant therapy from there?

 

[Lamount]

In 2 or 5 years for lung cancer? Do we expect big changes beyond 'add immunotherapy' to neoadjuvant chemo? Where do they go for neoadjuvant therapy from there?

There are second generation IO

 

[RickyScott]

There are second generation IO

Total checkpoint blockade, optimizing chemo io combo, small molecule io enhancers etc

 

[jondunn]

 

[RadOncMegatron]

I always trust my diversity officer...

 

[jondunn]

 

[Palex80]

In 2 or 5 years for lung cancer? Do we expect big changes beyond 'add immunotherapy' to neoadjuvant chemo? Where do they go for neoadjuvant therapy from there?

More immunotherapy combinations? De-escalation of chemotherapy? Clarification how much IO is needed (and for how long) depending on response?

 

[jondunn]

 

[deleted1111261]

What are you saying, JD? Why post this?

I’m very curious about the relevance - is it about race? Is it about ancillary staff? It certainly is not about oncology or radiation oncology.

 

[Mandelin Rain]

What are you saying, JD? Why post this?

I’m very curious about the relevance - is it about race? Is it about ancillary staff? It certainly is not about oncology or radiation oncology.

He's trying to get a certain reaction.

 

[jondunn]

What are you saying, JD? Why post this?

I’m very curious about the relevance - is it about race? Is it about ancillary staff? It certainly is not about oncology or radiation oncology.

You do know what thread you’re in?

Half of the posts in this thread have been about importance or lack there of of representation in medicine.

These posts support the view of people in my camp on the matter

Dare you to reply

 

[Ray D. Ayshun]

/thread

 

[jondunn]

So, how does this support that with no commentary?

I….. I don’t know how either post 1642 or 1644 don’t speak for themselves. Post 1644 even says worth a thousand words.

 

[TheWallnerus]

So, how does this support that with no commentary?

JonDunn is doing the equivalent of Molotov cocktailing with these things. And pardon me for speaking for JD lol.

 

[jondunn]

lol. imagine reading this thread - seriously read it some time - and then saying that these posts are Molotov Cocktails.

wow.

 

[deleted1116990]

JD trolling.

Daring you to reply in the dare to reply thread. Clever.