NEJM

[canadianoutlaw]

NEJM gets skewered by the Boston Globe.

Maybe this press will force the bullies to move beyond their agenda-pushing sanctimonious biases, including a blatant bias against radiation. Get with the times.

https://www.bostonglobe.com/metro/2...ted-critics/9H3JFKzTNJpCsOQqIUNXJP/story.html

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[canadianoutlaw]

For example, see NEJM Deputy Editor Dan Longo's JCO editorial:
J Clin Oncol. 2015 Nov 10;33(32):3684-5. doi: 10.1200/JCO.2015.63.0285. Epub 2015 Aug 17.
Combined-Modality Therapy for Early-Stage Diffuse Large B-Cell Lymphoma: Knowing When to Quit.
Longo DL
Comment on
Treatment Selection and Survival Outcomes in Early-Stage Diffuse Large B-Cell Lymphoma: Do We Still Need Consolidative Radiotherapy? [J Clin Oncol. 2015]
PMID: 26282641

 

[Damn_Daniel]

Longo is a lug headed, ham handed, medical oncology baboon who has great difficulty understanding randomized controlled trials, let alone understanding that study. Yes, it's hypothesis generating. Just because it's a hypothesis you choose not to believe in doesn't mean the hypothesis shouldn't be tested. He doesn't have a clear understanding of basic oncology principles that even my ******* Caribbean medical school classmates have. Even some of the Oberlin religion majors I went to college with have a deeper understanding than he does. PMRT never showed a benefit in breast cancer until the shystemic therapy improved. The fact that anyone listens to this no talent ass clown makes me feel that medicine is going down the tubes. It was such a crummy analysis of the paper. There are gaps and criticisms to be made, but he didn't find any of them. He just made up stuff. And he wears a toupee.

 

[BobbyHeenan]

For example, see NEJM Deputy Editor Dan Longo's JCO editorial:
J Clin Oncol. 2015 Nov 10;33(32):3684-5. doi: 10.1200/JCO.2015.63.0285. Epub 2015 Aug 17.
Combined-Modality Therapy for Early-Stage Diffuse Large B-Cell Lymphoma: Knowing When to Quit.
Longo DL
Comment on
Treatment Selection and Survival Outcomes in Early-Stage Diffuse Large B-Cell Lymphoma: Do We Still Need Consolidative Radiotherapy? [J Clin Oncol. 2015]
PMID: 26282641

Ah yes, the great commentary where he juxtaposes a brainstem resection with 20 Gy of involved site radiation. Sounds like a really reasonable guy - toupee* not withstanding.

*disclaimer - I have no clue about the toupee, but Daniel always seems so truthful and without hyperbole that I'm sure it's true.

 

[thecarbonionangle]

There certainly is an anti radiation bias in internal medicine, but a lot of this comes from ignorance about the field, beginning with medical school. It is the perception that radiation is "bad" and chemotherapy is "good". The majority of my classmates have no idea what radiation oncology does. My internal medicine colleagues believe we do not see patients and use mostly imaging to guide our treatment with no need for a physical exam. I would like to know how many of you guys in your programs have reached out to your internal medicine colleagues to educate them? This should begin by having a faculty member go and lecture the medical students yearly as part of the curriculum, plus reach out to the internal medicine program to give a few lectures about radiation and the role we play in cancer care.

 

[Damn_Daniel]

Yup. Gave a yearly "radiation emergencies" lectures to the interns when I was a resident. This is when people treated SVC with RT and Counting Crows was cool. Little good that did.

There certainly is an anti radiation bias in internal medicine, but a lot of this comes from ignorance about the field, beginning with medical school. It is the perception that radiation is "bad" and chemotherapy is "good". The majority of my classmates have no idea what radiation oncology does. My internal medicine colleagues believe we do not see patients and use mostly imaging to guide our treatment with no need for a physical exam. I would like to know how many of you guys in your programs have reached out to your internal medicine colleagues to educate them? This should begin by having a faculty member go and lecture the medical students yearly as part of the curriculum, plus reach out to the internal medicine program to give a few lectures about radiation and the role we play in cancer care.

 

[Mr RADical]

There certainly is an anti radiation bias in internal medicine, but a lot of this comes from ignorance about the field, beginning with medical school. It is the perception that radiation is "bad" and chemotherapy is "good". The majority of my classmates have no idea what radiation oncology does. My internal medicine colleagues believe we do not see patients and use mostly imaging to guide our treatment with no need for a physical exam. I would like to know how many of you guys in your programs have reached out to your internal medicine colleagues to educate them? This should begin by having a faculty member go and lecture the medical students yearly as part of the curriculum, plus reach out to the internal medicine program to give a few lectures about radiation and the role we play in cancer care.

Similar sentiment in our medicine program but most of the other specialties come around after we have shared a case. One of our big problems is that after we work with them its usually a positive experience they then consult us for everything (including things like hempotysis and new lung mass on CXR) because we see patients quickly and know cancer staging/workup/management. There is certainly a lack of education in medical school and residency for non-oncology specialties about what we do even at places with very strong rad onc departments.

Of course a lot of people think that the first rule of radiation oncology is that you don't talk about radiation oncology.... So the education for medical students is usually low, especially for the percentage of cancer patients across the country treated with XRT.

 

[Krukenberg]

I think the ignorance of radiation oncology beyond the specialty and even oncology in general is evidenced by the fact that there is not a single radiation oncologist on the NCI's new blue ribbon panel for joe biden's moonshot program. This may seem unimportant but the panel will eventually be giving recommendations to the NCI about funding priorities.

http://www.ascopost.com/News/37458

Yes that's right, there is a nurse on the panel but no rad onc.


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[Damn_Daniel]

Do you think it's because we don't make much of an effort to be involved or is it because our voices are ignored?

Honest question - I have no idea.

I do know Astro's time has been spent lobbying against Urorads, as have many of the state chapters. In my limited understanding and knowledge, radiation oncologists don't spend a lot of time about "bigger picture" issues, rather they want to protect income. Very few radoncs head tumor board, or are chair of the department of oncology, or are the head of cancer services at private hospitals. There is a bias against us, but there certainly aren't too many of us clamoring for these roles. I'm not saying that I'm not guilty of this. But, the passivity of the field is nothing new and hasn't really changed. Why don't you smart people apply to these things? Why don't you all push cancer committee to let you be head of tumor board? I'm not saying I'm going to do it. I'm cool with being second banana, because I'm a steaming hot turd and not really easy to work with. But, complaining about it doesn't help unless you want to do something.

 

[Gfunk6]

My opinion is that the people who are entering our field are not (by and large) pioneers, leaders or visionaries. They do not (on the whole) want to take risks for the greater good. Though research is emphasized, it's all about the number of low impact, space wasting publications.

People want starting salary, lifestyle, and vacation. People are absolutely happy to cede autonomy to achieve this holy grail.

People like this are not willing to take positions with little/no compensation.


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