Geographic Disparities in Radiation Oncology - Is There a Practical Solution?

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RSAOaky

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I hate to have to preface the topic this way, but this is not a troll post.

For years now we have heard that there is not a job availability problem, but rather a "geographic maldistribution" problem. I saw that there was an educational session on this (EDU 22). Is there a practical solution? It seems like the whole system is stacked against rural practices. The trend towards inclusion in medical school and residency training, which I am absolutely a proponent of, seems to be at odds with the concept of rural practice. I'd venture to guess that Jews, Asians, Indians, African Americans, Womens' Rights Activists, LGBTQ+, and most other graduating radiation oncologists who have spent the last 13+ years of their lives in the relatively liberal bubble of college, medical school, and residency, would have no interest in raising families in white, rural, Christian, conservative America. Worse yet, those that do are looked down upon if they apply for subsequent jobs in more urban areas. I saw that there were some Rural Task Force recommendations on the topic, is someone able to share their findings?
 
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The answer to your question is no, there isn't. Unless you recruit people from those communities into RO with return of service agreements.
 
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Neuronix

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Pay people more to go rural. It's pretty simple really. You will find a decent number of people willing to go rural for the right price.

If you're looking for hardworking people for rural locations, you either need to pay them a premium or be willing to accept a shortage because those will be the least desirable jobs. If you flood the market, as we're doing now, you'll fill the positions with unhappy people constantly looking for a new job.
 
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Without a command-and-control centralized-planning economy, good old supply and demand always wins the day. Fortunately for rural centers, the supply of radoncs isn't going to be a problem for a generation.

This isn't a problem unique to radonc at all. Physicians are highly-educated professionals, most of whom are not interested in rural living. Some are. Most are not. I would not be interested in practicing and living in a rural setting.

Let's look at the presenters for the session after all. They come from Atlanta, Chicago, Sedona (about as rural as Vail if you get my drift), and Winston-Salem in the research triangle. These sessions really should feature someone who actually practices/lives in a rural community, or else it can come across as a bit of "do what I say and not what I do" ism.
 
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RickyScott

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Geographic Maldistribution is a myth. Rural places under 100,000 cant support a linac (under apm/hypofract number is going to rise!). They are rural because they have few patients!. Least desirable jobs are last to full/have higher turnover. This is not an indication of maldistribution. Lastly, CMS solved the problem by not requiring supervision. Doc can come out one day a week,
Similar situation that elementary school economics described with jobs in totally saturated market: Even if there was significant UNEMPLOYMENT, jobs would still open up occasionally when someone retires, moves, and some malicious a--- will shout- look there are jobs in this field!
 
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KHE88

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Pay people more to go rural. It's pretty simple really. You will find a decent number of people willing to go rural for the right price.

If you're looking for hardworking people for rural locations, you either need to pay them a premium or be willing to accept a shortage because those will be the least desirable jobs. If you flood the market, as we're doing now, you'll fill the positions with unhappy people constantly looking for a new job.

Or you can actually try to meaningfully recruit med students with a high likelihood of going into rural practice instead of just paying lip service to the problem.

That said, 7 years ago when I applied to radiation oncology nobody wanted me because I had an average, non 270 step 1 despite going to a top medical school and having a strong interest in rad onc. I somehow squeaked in anyway (thanks rampant program expansion!). There otherwise was no interest despite expressing a desire to serve in a rural area. Presumably, it's not just about filling spots for bragging rights about which PD has the highest average step 1, and I would still struggle to get in today because I'm just going to rural PP and not going to be that guy pumping out groundbreaking retrospective reviews at large centers.

I took a job in a rural location that nobody else wanted for years.
I provide up-to-date standard of care treatment for my patients. I factor in burden to my rural patients in terms of cost and travel. I know my limitations. I will see anybody with any condition at any time. I refer out when appropriate, but if they are unable or unwilling, i find a way to get them treatment.

The message from our leaders is overwhelmingly clear: They do not care about addressing the gaps in care of rural Americans. Their focus is on addressing other things (see the Dare You to Reply Thread). All these rural patients should all find a way to get to Houston or NYC for treatment because I'll probably give them 1 Gy x 40 cobalt PCI for ES-SCLC.

I am an incompetent anti-masker with an average step 1 score from 8 years ago and they should probably take my license.


Admin (Neuronix) Edit: Knock it off with the anti-mask stuff or SDN is going to ban you. I deleted that part of your post.
 
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elementaryschooleconomics

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Or you can actually try to meaningfully recruit med students with a high likelihood of going into rural practice instead of just paying lip service to the problem.

That said, 7 years ago when I applied to radiation oncology nobody wanted me because I had an average, non 270 step 1 despite going to a top medical school and having a strong interest in rad onc. I somehow squeaked in anyway (thanks rampant program expansion!). There otherwise was no interest despite expressing a desire to serve in a rural area. Presumably, it's not just about filling spots for bragging rights about which PD has the highest average step 1, and I would still struggle to get in today because I'm just going to rural PP and not going to be that guy pumping out groundbreaking retrospective reviews at large centers.

I took a job in a rural location that nobody else wanted for years.
I provide up-to-date standard of care treatment for my patients. I factor in burden to my rural patients in terms of cost and travel. I know my limitations. I will see anybody with any condition at any time. I refer out when appropriate, but if they are unable or unwilling, i find a way to get them treatment.

The message from our leaders is overwhelmingly clear: They do not care about addressing the gaps in care of rural Americans. Their focus is on addressing other things (see the Dare You to Reply Thread). All these rural patients should all find a way to get to Houston or NYC for treatment because I'll probably give them 1 Gy x 40 cobalt PCI for ES-SCLC.

I am an incompetent anti-masker with an average step 1 score from 8 years ago and they should probably take my license.

This was a roller coaster of a post.
 
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Rad onc's used to be paid $1M to work in rural or even smaller urban locations. If you paid me that out of training, I'd be willing to live somewhere rural. Unfortunately, if the pay isn't competitive, then rural areas will get perma-locums or crappy rad onc's. The health systems know this, and some admin or committee decided they'd rather go with the crappy rad onc and save a couple bucks.
 
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deleted605854

Rad onc's used to be paid $1M to work in rural or even smaller urban locations. If you paid me that out of training, I'd be willing to live somewhere rural. Unfortunately, if the pay isn't competitive, then rural areas will get perma-locums or crappy rad onc's. The health systems know this, and some admin or committee decided they'd rather go with the crappy rad onc and save a couple bucks.

1M, eh?

That's some good fodder for some student loan repayment followed by lots of burgers and fries
 
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KHE88

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Rad onc's used to be paid $1M to work in rural or even smaller urban locations. If you paid me that out of training, I'd be willing to live somewhere rural. Unfortunately, if the pay isn't competitive, then rural areas will get perma-locums or crappy rad onc's. The health systems know this, and some admin or committee decided they'd rather go with the crappy rad onc and save a couple bucks.

Good luck getting anywhere near 1M from a rural hospital.

They will scream that they would love to pay you this much but legally can't because of "fair market value."
You can say, meh I'll do my own billing. Good luck! You can say, that's fine, let me buy into 20% of the linac. You will get laughed out of the building. They protect their cash cow fiercely.

The hospitals would rather pay 3-4k/day to locums agencies in hopes of trying a few out to eventually snag a desparate marginally-competent permalocums and pay them 5% more than whatever Weatherby is paying them ($1500/day maybe?).

It's true that Wheeling, WV paid their rad oncs $1.2 million/year.
They also got busted for fair market value: Hospital Pays $50M to Settle Charges It Overpaid Docs for Referrals

It's funny that hospitals aren't losing money on this salary. Rad Oncs generate enormous amounts of revenue for the systems. It's not like the big academic centers that pay their satellite docs 300k are making any less (potentially much more).

But hey, good news! Wheeling is hiring!: Radiation Oncology position in WV (Oncology-Radiation) in Wheeling, West Virginia at Archway Physician Recruitment · DocCafe.com

Med students. This is your future. Maybe one day you can bounce around rural towns doing locums for $1500/day for half the year until one decides to sign you on with a one year renewable contract for $1700/day. This is a very likely scenario 10 years from now. Our leaders say that these fears are unfounded because the rad onc job cycle is cyclical and always goes through periods of "uncertanity." No. This time it's different. In past periods of uncertainty they did something about the "uncertainty." Not only are they not doing anything about it now, they are throwing fuel on the fire raging in the perfect storm they've created.
 
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deleted605854

Good luck getting anywhere near 1M from a rural hospital.

They will scream that they would love to pay you this much but legally can't because of "fair market value."
You can say, meh I'll do my own billing. Good luck! You can say, that's fine, let me buy into 20% of the linac. You will get laughed out of the building. They protect their cash cow fiercely.

The hospitals would rather pay 3-4k/day to locums agencies in hopes of trying a few out to eventually snag a desparate marginally-competent permalocums and pay them 5% more than whatever Weatherby is paying them ($1500/day maybe?).

It's true that Wheeling, WV paid their rad oncs $1.2 million/year.
They also got busted for fair market value: Hospital Pays $50M to Settle Charges It Overpaid Docs for Referrals

It's funny that hospitals aren't losing money on this salary. Rad Oncs generate enormous amounts of revenue for the systems. It's not like the big academic centers that pay their satellite docs 300k are making any less (potentially much more).

But hey, good news! Wheeling is hiring!: Radiation Oncology position in WV (Oncology-Radiation) in Wheeling, West Virginia at Archway Physician Recruitment · DocCafe.com

Med students. This is your future. Maybe one day you can bounce around rural towns doing locums for $1500/day for half the year until one decides to sign you on with a one year renewable contract for $1700/day. This is a very likely scenario 10 years from now. Our leaders say that these fears are unfounded because the rad onc job cycle is cyclical and always goes through periods of "uncertanity." No. This time it's different. In past periods of uncertainty they did something about the "uncertainty." Not only are they not doing anything about it now, they are throwing fuel on the fire raging in the perfect storm they've created.

You're too optimistic

The future is jobs being posted from other countries. Take a look at what Canadian ASTRO (CARO) has posted
1603825975130.png

Now...what is NSIA-LUTH?

Well, behold!

1603826036229.png

Bet you wish you had a chance at getting those burger and fries on a whim now, right ?

Enjoy!

P.S.: Abbotsford is in British Columbia. That link does not work. They likely have an internal candidate. Probably someone in a rural place in the States wanting to come back to Canada. So, they're not going to fix that link
 
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Reaganite

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I hate to have to preface the topic this way, but this is not a troll post.

For years now we have heard that there is not a job availability problem, but rather a "geographic maldistribution" problem. I saw that there was an educational session on this (EDU 22). Is there a practical solution? It seems like the whole system is stacked against rural practices. The trend towards inclusion in medical school and residency training, which I am absolutely a proponent of, seems to be at odds with the concept of rural practice. I'd venture to guess that Jews, Asians, Indians, African Americans, Womens' Rights Activists, LGBTQ+, and most other graduating radiation oncologists who have spent the last 13+ years of their lives in the relatively liberal bubble of college, medical school, and residency, would have no interest in raising families in white, rural, Christian, conservative America. Worse yet, those that do are looked down upon if they apply for subsequent jobs in more urban areas. I saw that there were some Rural Task Force recommendations on the topic, is someone able to share their findings?

The irony is that the PP owners of all races in these big cities are some of the most conservative dudes you'll ever run into. Never met so many Jewish republicans in my life as I do in PP medicine.
 
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KHE88

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Admin (Neuronix) Edit: Knock it off with the anti-mask stuff or SDN is going to ban you. I deleted that part of your post.

I know this is above your head.

I am very aware that COVID policy discussion is forbidden on SDN among other places. I hadn't intended on posting further, but felt compelled to chime in on the rural situation. Sorry for the snark. People should know there's an accrued randomized phase 3 trial (in addition to other ongoing trials) investigating a certain intervention, which this time I won't link to. If that can't be known, especially on a medical forum, that's sad. I hope that if/when the results are ever published, it will be permitted to critique the study and discuss the implications.
 
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I know this is above your head.

I am very aware that COVID policy discussion is forbidden on SDN among other places. I hadn't intended on posting further, but felt compelled to chime in on the rural situation. Sorry for the snark. People should know there's an accrued randomized phase 3 trial (in addition to other ongoing trials) investigating a certain intervention, which this time I won't link to. If that can't be known, especially on a medical forum, that's sad. I hope that if/when the results are ever published, it will be permitted to critique the study and discuss the implications.

This is not a question about masks, but trial design. Let's say you wanted to evaluate whether condoms reduce the likelihood of intercourse leading to a pregnancy. How would you do that if you only enrolled dudes?

images (1).jpeg
 
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KHE88

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This is not a question about masks, but trial design. Let's say you wanted to evaluate whether condoms reduce the likelihood of intercourse leading to a pregnancy. How would you do that if you only enrolled dudes?

View attachment 321607

Since you asked about trial design, I'll respond.
While I appreciate Office-space humor as much as the next guy, your hypothetical is a bit confusing to me.
If you wanted examine whether a certain intervention worked to prevent infection among asymptomatic people in the community, it seems like randomizing 6000 random healthy people in a certain European country, oh lets say Denmark, to either use the intervention or not and go about their lives and tract infection rates would be a good way to determine the effectiveness of that intervention.
In the case of a hypothetical respiratory virus, it might also be worthwhile to look at evidence from certain Asian countries, oh lets say Singapore, providing a rather strong case for aerosolized spread with detection of small viral particles in air filters of isolation rooms, measurement of viral particle size, and then look at the porosity of layers of cloth, and generate hypotheses to test.

It is interesting when numerous studies originate all around the world except in a certain specific country where the experts have already figured it out. Can you imagine what rad onc would be like if we ignored studies from Canada, the UK, Germany, France, Japan, and China?

I like the scientific method. You know. Generating a hypothesis and then trying to disprove that hypothesis (and all the fun stuff along the way such as trying to control for confounders, elimiate bias, etc). I'm not so much a fan of the other way around, which is deciding what you want the science to prove, compiling evidence that supports your desired outcome, not conducting tests that may disprove that outcome, prohibiting debate/criticism about the methods used to generate the outcome, telling everyone that the science has been settled and to trust the experts, then either making fun of them or threatening to ban/fire/censor them for asking honest questions.

Disclaimer: This post is not about COVID. But to be clear, I think COVID is probably very deadly and has a high chance of killing people it infects, and no matter what the collateral consequences may be that we should all stay alone in our houses as much as possible and wear any type of available face covering when leaving home until the virus is eradicated from the planet. Above all as lowly MDs with subspecialized medical training, we should do what the experts say and not question them. As a radiation oncologist, I am not qualified to speak on public health matters and certainly it would be madness for me to serve in the government in any capacity that doesn't involve shooting moonbeams at people. FDA commissioner? Meh. Gray/Grey/Gy/gray area.
 

Ray D. Ayshun

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Since you asked about trial design, I'll respond.
While I appreciate Office-space humor as much as the next guy, your hypothetical is a bit confusing to me.
If you wanted examine whether a certain intervention worked to prevent infection among asymptomatic people in the community, it seems like randomizing 6000 random healthy people in a certain European country, oh lets say Denmark, to either use the intervention or not and go about their lives and tract infection rates would be a good way to determine the effectiveness of that intervention.
In the case of a hypothetical respiratory virus, it might also be worthwhile to look at evidence from certain Asian countries, oh lets say Singapore, providing a rather strong case for aerosolized spread with detection of small viral particles in air filters of isolation rooms, measurement of viral particle size, and then look at the porosity of layers of cloth, and generate hypotheses to test.

It is interesting when numerous studies originate all around the world except in a certain specific country where the experts have already figured it out. Can you imagine what rad onc would be like if we ignored studies from Canada, the UK, Germany, France, Japan, and China?

I like the scientific method. You know. Generating a hypothesis and then trying to disprove that hypothesis (and all the fun stuff along the way such as trying to control for confounders, elimiate bias, etc). I'm not so much a fan of the other way around, which is deciding what you want the science to prove, compiling evidence that supports your desired outcome, not conducting tests that may disprove that outcome, prohibiting debate/criticism about the methods used to generate the outcome, telling everyone that the science has been settled and to trust the experts, then either making fun of them or threatening to ban/fire/censor them for asking honest questions.

Disclaimer: This post is not about COVID. But to be clear, I think COVID is probably very deadly and has a high chance of killing people it infects, and no matter what the collateral consequences may be that we should all stay alone in our houses as much as possible and wear any type of available face covering when leaving home until the virus is eradicated from the planet. Above all as lowly MDs with subspecialized medical training, we should do what the experts say and not question them. As a radiation oncologist, I am not qualified to speak on public health matters and certainly it would be madness for me to serve in the government in any capacity that doesn't involve shooting moonbeams at people. FDA commissioner? Meh. Gray/Grey/Gy/gray area.

I am talking about an infectious disease. Pregnancy. If you wanted to test the efficacy of a condom in this manner, the mechanism you're concerned with is not something getting in from the outside, but rather, the sperm getting out, making it's way to the egg, and eating it to grow stronger. You could enroll a bunch of dudes, but there's really no way to evaluate the outcome if pregnancy is the end point without the fairer sex. On the other hand, you could do a test that evaluates the ability of the condom to keep things in.
 

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I grant that masks may not be proven to be effective, but until they are conclusively proven to be ineffective, why not mandate them?

It very well may be that people with masks are more likely to go out in public and those that don’t are more careful -in a randomized study, so not sure it can answer the question. (If I were randomized to no mask, there is no way I would go out to a restaurant)
 

KHE88

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I am talking about an infectious disease. Pregnancy. If you wanted to test the efficacy of a condom in this manner, the mechanism you're concerned with is not something getting in from the outside, but rather, the sperm getting out, making it's way to the egg, and eating it to grow stronger. You could enroll a bunch of dudes, but there's really no way to evaluate the outcome if pregnancy is the end point without the fairer sex. On the other hand, you could do a test that evaluates the ability of the condom to keep things in.

That's one specific STI that always has 100% one-way transmission (male to female) even without a barrier (odd way to phrase pregnancy, but ok). There are many other STIs that condoms protect both from getting in and getting out.

Two issues:
1. If your hypothesis is that the purpose of a barrier is to prevent outbound transmission only and that the same barrier cannot prevent inbound transmission (which is kind of a bizzare hypothesis, but ok), then the randomized groups could be further analyzed by looking at infection rates of close contacts and rates of mask wearing around contacts. If there is a trend, other studies could certainly be done to test this more robustly.
2. The question of whether a virus is mainly spread as a droplet or aerosol is important.

If a virus escapes a barrier and is suspended in the ether, a number of things matter. How long is it is suspended matters. How far it travels matters. The size of the particle matters, and the transmission specifics (such as porosity and fit) of barriers (if any) worn by the transmitter and any potential receivers matter. Presumably, if a virus can escape through a barrier, either in a droplet or aerosol form, then it can potentially pass through the same barrier of a close contact. Infectious viral load also matters.

I'm glad that we have answers to all these questions, namely:
1. It's all droplet.
2. The droplets are big enough that any old type of barrier will do.
3. The barriers contain all the droplets. So everyone has to use them, not just the symptomatic and the vulnerable (as has always been done).

It's worth noting the extreme precautions we take for something like TB in a patient considering the size of the mycobacterium droplet, and compare it to something like an RNA virus. I really, really don't want TB.

Disclaimer: This post is not about COVID or specific infection control barrier devices. But to be clear, I think COVID is probably very deadly and has a high chance of killing people it infects, and no matter what the collateral consequences may be that we should all stay alone in our houses as much as possible and wear any type of available face covering when leaving home until the virus is eradicated from the planet.
 
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RadOncDoc21

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Why do we need a randomized trial to prove if masks are helpful or not to prevent the spread of a virus? Do I need a trial to tell me if getting shot in the face is helpful or not also?
 
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KHE88

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I grant that masks may not be proven to be effective, but until they are conclusively proven to be ineffective, why not mandate them?

It very well may be that people with masks are more likely to go out in public and those that don’t are more careful -in a randomized study, so not sure it can answer the question. (If I were randomized to no mask, there is no way I would go out to a restaurant)

I don't think it's permitted to ask questions about m*** policy.

But, in regards to your second point, it also may well be that people may be lulled into a false sense of security if their prevention devices are not actually effective. I don't know why you would avoid going to a restaurant (where you presumably have to have your face uncovered to eat along with everyone else) whether or not your face is covered on the 10 second journey to your table. There is one surefire way to never get infected with anything: NEVER LEAVE YOUR ROOM.
 

KHE88

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Why do we need a randomized trial to prove if masks are helpful or not to prevent the spread of a virus? Do I need a trial to tell me if getting shot in the face is helpful or not also?

Going back to the condom example, it's helpful to know what the risk reduction is, and this is a complicated problem of biophysics. For instance, non-latex (sheepskin) condoms are very ineffective at preventing HIV transmission due to issues with porosity. Comparing this issue to getting shot in the face with a gun is a false equivalence. The bullet has a near 99.999% chance of hitting you in the face.

It is frustrating to watch highly educated individuals oversimplify complicated problems, criticize further investigation, and ignore confounders and biases.
Anyway, that's enough from me on this hypothetical discussion about trial design and non-specific virus transmission.
 

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[decides to die on mask hill]

"‘Cause you have to die somewhere."

Might as well be railing against non-invasive, common sense measures to prevent the spread of deadly disease.
 
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[decides to die on mask hill] "‘Cause you have to die somewhere." Might as well be railing against non-invasive, common sense measures to prevent the spread of deadly disease.

Oops, you're right my bad. I forgot to mention that it is also frustrating to watch highly educated individuals use phrases like "common sense" and "trust the experts" instead of demanding robust data and well-elucidated mechanisms. If you do that, then you're anti-science or anti-something. Never want to be anti-something!

I will be sure to explain to Evicore in my next phone consult that 45 fraction IMRT for low risk prostate is just common sense. Non-invasive even!

Malaria kills millions. A tiny little mosquito. We've been trying to control it forever. We can't even control a little mosquito. Restricting everyone in tropical areas to remain indoors or in outdoor areas with mosquito netting seems like common sense until we can eradicate the malaria reservoir permanently.
 
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or instance, non-latex (sheepskin) condoms are very ineffective at preventing HIV transmission due to issues with porosity.

Damnit, does anyone know amazon's return policy?? Asking for a friend
 
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RadOncDoc21

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Going back to the condom example, it's helpful to know what the risk reduction is, and this is a complicated problem of biophysics. For instance, non-latex (sheepskin) condoms are very ineffective at preventing HIV transmission due to issues with porosity. Comparing this issue to getting shot in the face with a gun is a false equivalence. The bullet has a near 99.999% chance of hitting you in the face.

It is frustrating to watch highly educated individuals oversimplify complicated problems, criticize further investigation, and ignore confounders and biases.
Anyway, that's enough from me on this hypothetical discussion about trial design and non-specific virus transmission.

Its frustrating seeing people who practice medicine use politics to omit anything they ever learned from day one in biology.
 
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Mandelin Rain

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Gene-pool preserving, common-sense intuition has nothing to do education level.

Thank God, in some case.
 
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KHE88

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Its frustrating seeing people who practice medicine use politics to omit anything they ever learned from day one in biology.

I agree 100%. It's shameful how this has been politicized. It's not surprising. The politics of fear has been used extensively in history. I'd recommend everyone check out Michael Crichton's "State of Fear" for some light, but thoughtful reading.

Since I am undoubtedly about to get sent to permanent re-education camp, let me leave you all with a final parting story:

I was recently back home and called up my former best friend who I'd known since about age 10 up until the time I left for residency. I asked if he wanted to meet up and catch up. He told me that he was busy, and also since that he knew I was "anti-mask" that he had a family he had to be mindful of. He basically accused me of recklessly endangering his family (nevermind the fact that he frequents crowded restaurants and bars and hangs out with his local friends maskless). I would have gladly worn a mask or done whatever silly thing my friend wanted because he was my friend. He basically told me to F-off and have a nice life.

His family, all healthy and under the age of 35, who have a very conservatively 1 in 5000 chance of dying if they get infected. He accused me of potentially murdering them.

This is what we have done to each other.

Take care.
 
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RickyScott

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Gene-pool preserving, common-sense intuition has nothing to do education level.

Thank God, in some case.
I don't think it's permitted to ask questions about m*** policy.

But, in regards to your second point, it also may well be that people may be lulled into a false sense of security if their prevention devices are not actually effective. I don't know why you would avoid going to a restaurant (where you presumably have to have your face uncovered to eat along with everyone else) whether or not your face is covered on the 10 second journey to your table. There is one surefire way to never get infected with anything: NEVER LEAVE YOUR ROOM.
I don’t look at as on/off but time and quantity of exposure. Mask question very unlikely to be settled, given behavioral changes.
 

RadOncDoc21

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I agree 100%. It's shameful how this has been politicized. It's not surprising. The politics of fear has been used extensively in history. I'd recommend everyone check out Michael Crichton's "State of Fear" for some light, but thoughtful reading.

Since I am undoubtedly about to get sent to permanent re-education camp, let me leave you all with a final parting story:

I was recently back home and called up my former best friend who I'd known since about age 10 up until the time I left for residency. I asked if he wanted to meet up and catch up. He told me that he was busy, and also since that he knew I was "anti-mask" that he had a family he had to be mindful of. He basically accused me of recklessly endangering his family (nevermind the fact that he frequents crowded restaurants and bars and hangs out with his local friends maskless). I would have gladly worn a mask or done whatever silly thing my friend wanted because he was my friend. He basically told me to F-off and have a nice life.

His family, all healthy and under the age of 35, who have a very conservatively 1 in 5000 chance of dying if they get infected. He accused me of potentially murdering them.

This is what we have done to each other.

Take care.

I think your friend was probably thinking to himself “Why would I be willing to risk my life and my family’s life on you?”

Let’s say that this virus is deadly and contagious and there is no cure or vaccine, why not try to mitigate the risk if there is a small chance it could help?
 
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KHE88

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I think your friend was probably thinking to himself “Why would I be willing to risk my life and my family’s life on you?”

Let’s say that this virus is deadly and contagious and there is no cure or vaccine, why not try to mitigate the risk if there is a small chance it could help?

Seriously? You can't see the logical flaws in this? The sheer ridiculousness of it?

"Let's say it's deadly?" How about lets find out how deadly it is and to whom?
With all the uncertainty in the world, I think it's prudent to deal is specifics, not hypotheticals.

Influenza is a deadlier threat to healthy young people than COVID. This is a fact. This is not misinformation. The virus is mainly deadly to those near the end of their lives or older people who are morbidly obese (both groups that could crump at any minute from a whole host of various physical insults, not just COVID).

We take risks every day. Driving a car. Eating at golden corral. Being in public in flu season not in a HAZMAT suit. The risk of my friend's family catching COVID from me and dying from it was minuscule. If anything, I probably had a higher risk getting it from him. I am mainly socially isolated in the middle of nowhere, keep my clinic visits brief, and am paranoid about hand hygiene.

Here is the data for anyone who cares to look at data (no one's interested): Demographics of COVID-19 Deaths - United States of America

Last time I ran the numbers, the risk of dying for someone under the age of 44 if they get COVID was 1 in 719. This includes those with pre-existing conditions (morbid obesity) and does not include the likely very large number of people with COVID who recovered who never got tested. A conservative estimate of risk of death if you get it as a healthy or even average person in this group would be 1:5000 to 1:10000. A large number of the early deaths were due to people being inappropriately ventilated by people who had no idea what they were doing (iatrogenic deaths). Yet we have been gaslit to believe case trends = death trends, which is not true at all.

Sometimes I wonder if I'm being trolled. There are lots and lots of doctors and other highly educated individuals who think exactly like me. We have been told by the mothership that our jobs will be at risk if we speak our minds on this. Fun stuff.

I really hope that some of you can take a step back and look at how absurd all this is, but you won't because you're dug in too deep. I'm sorry. I really am.
 
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Chartreuse Wombat

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Cases don't equal deaths. Media likes to count cases.

NY Times today

1603923767147.png

We are learning how to treat the disease when it becomes symptomatic and severe. If cases are used as the benchmark we will be in shutdowns for a very long time. I am skeptical that the vaccine will work very well. In meantime protect the vulnerable; the curve has been flattened.
 
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RadOncDoc21

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I don’t know about you guys but I don’t like getting sick, much less getting really sick or dying. I could go and have unprotected sex with a prostitute and yes I might not get HIV, but why risk it?
 
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medgator

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Cases don't equal deaths. Media likes to count cases.

NY Times today

View attachment 321660

We are learning how to treat the disease when it becomes symptomatic and severe. If cases are used as the benchmark we will be in shutdowns for a very long time. I am skeptical that the vaccine will work very well. In meantime protect the vulnerable; the curve has been flattened.
Guess el paso must be lying about their icus being full
 
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Going back to the condom example, it's helpful to know what the risk reduction is, and this is a complicated problem of biophysics. For instance, non-latex (sheepskin) condoms are very ineffective at preventing HIV transmission due to issues with porosity. Comparing this issue to getting shot in the face with a gun is a false equivalence. The bullet has a near 99.999% chance of hitting you in the face.

It is frustrating to watch highly educated individuals oversimplify complicated problems, criticize further investigation, and ignore confounders and biases.
Anyway, that's enough from me on this hypothetical discussion about trial design and non-specific virus transmission.
My point was, this is a question that can't be answered by a trial due to myriad confounders. Seems more reasonable to do mechanistic and retrospective studies, which support the use of mas...er condoms.
 

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I don’t know about you guys but I don’t like getting sick, much less getting really sick or dying. I could go and have unprotected sex with a prostitute and yes I might not get HIV, but why risk it?

I think you're getting it.

Everyone has different risk tolerances. In a free society, people should have the liberty to decide what's right for them.

But it's important to know what that risk of getting HIV from the prostitute is (you might be surprised to learn it's near zero from a single sex act even if she is HIV positive, which she likely isn't as most prostitutes always use condoms and get tested regularly -- also female to male transmission from a single act is rare even without a condom). Facts and data matter when making individual risk assessments.

If you are 70, obese, with a double lung transplant, it is probably not a good idea to go to a crowded bar. But you should be free to do so. The solution is not to shut the bar down for something that is not very harmful to everybody else or make everyone wear PPE.

If there is a market for a restaurant to require everyone wear masks even when chewing, limit occupancy to 10%, and raise prices 500% so they are still profitable, then fine. The government shouldn't have the right to shut everything down whenever it wants without extremely good rationale. 14 days to flatten the curve was reasonable when we were still learning. Rolling lockdowns, masks forever even alone on an iceberg, and economically unsustainable business operating mandates cause more harm than good and take away the responsibility of personal decision masking and risk assessment. Which is what many want. The government knows what's best for you and will tell you what to do and protect you. Listen and obey, we got this, just watch your Netflix until we tell you it's safe. Here's some free money in the meantime.

Remember when people would shame you for using plastic drinking straws and grocery bags and ultra woke towns banned them? I had to waste 4 different plastic containers to put my protected lunch together today in the cafeteria. Funny stuff.
 
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Ray D. Ayshun

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I think you're getting it.

Everyone has different risk tolerances. In a free society, people should have the liberty to decide what's right for them.

But it's important to know what that risk of getting HIV from the prostitute is (you might be surprised to learn it's near zero from a single sex act even if she is HIV positive, which she likely isn't as most prostitutes always use condoms and get tested regularly -- also female to male transmission from a single act is rare even without a condom). Facts and data matter when making individual risk assessments.

If you are 70, obese, with a double lung transplant, it is probably not a good idea to go to a crowded bar. But you should be free to do so. The solution is not to shut the bar down for something that is not very harmful to everybody else or make everyone wear PPE.

If there is a market for a restaurant to require everyone wear masks even when chewing, limit occupancy to 10%, and raise prices 500% so they are still profitable, then fine. The government shouldn't have the right to shut everything down whenever it wants without extremely good rationale. 14 days to flatten the curve was reasonable when we were still learning. Rolling lockdowns, masks forever even alone on an iceberg, and economically unsustainable business operating mandates cause more harm than good and take away the responsibility of personal decision masking and risk assessment. Which is what many want. The government knows what's best for you and will tell you what to do and protect you. Listen and obey, we got this, just watch your Netflix until we tell you it's safe. Here's some free money in the meantime.

Remember when people would shame you for using plastic drinking straws and grocery bags and ultra woke towns banned them? I had to waste 4 different plastic containers to put my protected lunch together today in the cafeteria. Funny stuff.
Let's say you do get hiv from that one experience. Before you get diagnosed, what are the odds you're gonna **** everyone else in your zip code?
 
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KHE88

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Let's say you do get hiv from that one experience. Before you get diagnosed, what are the odds you're gonna **** everyone else in your zip code?

You're comparing apples and oranges and doing some serious mental gymanstics here to try and support your position with this and questioning the utility of randomized data. (By the way, it would be simple to design a study like this in a nation willing to do it. Mandate masks in one city and do not mandate them in another - whether they are having a bigger effect on preventing outbound or inbound transmission is not important in this case, and the data should come in quickly to determine what the risk reduction is).

But to answer your question regarding HIV. If you are newly infected, your viral load is high. You have a higher chance of infecting somebody with it, but this depends on whether you are a male or a female, you are using a condom, how you use the condom, what type of condom you use, and what type of sex you are having.

But more important, presumably the person you are having sex with has made a conscious choice to assume this risk, instead of you know, staying home and having sex with nobody. Which is cool. People should be allowed to make choices and stuff.
 

thecarbonionangle

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I agree 100%. It's shameful how this has been politicized. It's not surprising. The politics of fear has been used extensively in history. I'd recommend everyone check out Michael Crichton's "State of Fear" for some light, but thoughtful reading.

Since I am undoubtedly about to get sent to permanent re-education camp, let me leave you all with a final parting story:

I was recently back home and called up my former best friend who I'd known since about age 10 up until the time I left for residency. I asked if he wanted to meet up and catch up. He told me that he was busy, and also since that he knew I was "anti-mask" that he had a family he had to be mindful of. He basically accused me of recklessly endangering his family (nevermind the fact that he frequents crowded restaurants and bars and hangs out with his local friends maskless). I would have gladly worn a mask or done whatever silly thing my friend wanted because he was my friend. He basically told me to F-off and have a nice life.

His family, all healthy and under the age of 35, who have a very conservatively 1 in 5000 chance of dying if they get infected. He accused me of potentially murdering them.

This is what we have done to each other.

Take care.

Just wear the mask. Your friend did not want to have a discussion about it. He just saw you as “anti” and decided to unfriend you. Was it really worth it? Unlikely. likewise you seem hell bent on getting banned from sdn. You cannot help yourself! Step away from the keyboard mayne
 
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KHE88

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Just wear the mask. Your friend did not want to have a discussion about it. He just saw you as “anti” and decided to unfriend you. Was it really worth it? Unlikely. likewise you seem hell bent on getting banned from sdn. You cannot help yourself! Step away from the keyboard mayne

Dude/ette, I said I would have worn a mask for him since he is my friend and I don't want to lose friends over politics or things I think are stupid. I'll do anything for my friends. It's truly sad that we're banned from even having a reasonable conversation about it and it immediately devolves to personal attacks and each side calling the other one hitler trying to kill grandma or something.

My point was that he basically accused me trying to kill his family and is a hypocrite because he (like most) preach and condemn others while they behave the opposite in their private lives. Doctors here vocal about this issue and admin who aggressively push this mask-at-all-time and stay home stuff have had large, close gatherings with 30+ people at their houses not wearing masks. Seriously. Hell, the mayor just got busted doing the same thing.
 
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RadOncDoc21

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I think you're getting it.

Everyone has different risk tolerances. In a free society, people should have the liberty to decide what's right for them.

But it's important to know what that risk of getting HIV from the prostitute is (you might be surprised to learn it's near zero from a single sex act even if she is HIV positive, which she likely isn't as most prostitutes always use condoms and get tested regularly -- also female to male transmission from a single act is rare even without a condom). Facts and data matter when making individual risk assessments.

If you are 70, obese, with a double lung transplant, it is probably not a good idea to go to a crowded bar. But you should be free to do so. The solution is not to shut the bar down for something that is not very harmful to everybody else or make everyone wear PPE.

If there is a market for a restaurant to require everyone wear masks even when chewing, limit occupancy to 10%, and raise prices 500% so they are still profitable, then fine. The government shouldn't have the right to shut everything down whenever it wants without extremely good rationale. 14 days to flatten the curve was reasonable when we were still learning. Rolling lockdowns, masks forever even alone on an iceberg, and economically unsustainable business operating mandates cause more harm than good and take away the responsibility of personal decision masking and risk assessment. Which is what many want. The government knows what's best for you and will tell you what to do and protect you. Listen and obey, we got this, just watch your Netflix until we tell you it's safe. Here's some free money in the meantime.

Remember when people would shame you for using plastic drinking straws and grocery bags and ultra woke towns banned them? I had to waste 4 different plastic containers to put my protected lunch together today in the cafeteria. Funny stuff.

Do you think I like wearing mask, not being able to go out? It’s more about doing the right thing and keeping people safe. Stop being selfish, nobody is after your freedoms, guns, etc! Wear a damn mask and use condoms! Make America Safe Again!
 
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