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deleted1180461
You can't be serious.
You can't be serious.
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Here is the article he cited.
9 weeks of protons vs 5 days of SBRT. The only advantage of protons was that you get paid more.
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Dear proton prostate believers,
This is selling snake oil. I mean, why not go all the way and sell gold energy rings and colloidal silver CBD compounds in the lobby wig shop to help the cancer? Maybe have a Reiki guy come once a week?
Sincerely,
Your shameless 45 fraction IMRT prostate bad guy.
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What the gist for those of us not on Elon's toy?x.com
x.com
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deleted1180461
I don't use X either, but you can see most of his posts, seems to be a guy who wears the bright red woke-style eyeglasses but surprisingly has a bone to pick about anti-hospital/ACA, regulatory capture of healthcare, cartel like practice consolidation, pro-physician ownership, price transparency, etc.
I have immediate respect for anyone (especially non-physicians) who rejects the label "provider" regardless of how stupid their eyeglasses are.
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I was questioning my most recent choice in eyewear...bright red, curvy (dare say voluptuous) plastic frames...a tad feminine. I thought they might work well for me, but I wasn't sure. Imagine a middle aged bear with Chino's fashion sense...good or no?
But if they can convey wokeness! Damn... I'm all in.
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Only Sally Jessy Raphael should ever wear thick red glasses. They should die with her.
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deleted1180461
Don't forget the rhinestone cloth mask and pink hair highlights!
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Just so you know who you are dealing with....I'm considering an unironic "Stay Woke" neck tattoo once I retire.
Rhinestones...yes...unfortunately, I'm way too bald for any sort of highlights.
I've decided that gleeful, inclusive, non-conformity is the way to go!
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I love hearing arguments about bio-research ethics when sham RT is proposed as a trial arm.
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I want to see Vinay enroll a patient to his proposed trial. “Miss, I know you’re in pain but… hear me out… what if we randomize you to nothing?”
Also, I interpreted the study as CP radiosurgery IS a palliative option. Haha they showed efficacy.
What are Lancet the way they are?
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I need to clarify that I am a huge fan of VP for his calling out of the pseudo-scientific Covid-mitigation insanity wrt to masks and distancing mandates. But this is stupid. He’s smarter than this and knows better. Walk it back dude.
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What he is missing is that there are close to o downside from this approach. Did a case today.
He would absolutely destroy that argument lol. It’s high dose radiation that we don’t know that’s helping, of course has risks, and importantly if patients are choosing this they may not choose something else that has more chance of helping
To be clear I offer this treatment too, just saying it’s something that is fairly easy to criticize if you’re a purist for evidence as VP is.
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I suspect that sham RT is highly effective. For subjective measures (pain, depression) the placebo effect is real and strong and level of ritual and belief seem to matter as well.
How should we bill for it?
The trial has shown that at the very least the process of going through RT is effective.
Should negative SHAM controlled trials be kept away from the public? So as to preserve the efficacy of the sham intervention.
How should we bill for it?
The trial has shown that at the very least the process of going through RT is effective.
Should negative SHAM controlled trials be kept away from the public? So as to preserve the efficacy of the sham intervention.
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For extreme pain, the type requireing massive doses of duragesic, I am not sure the placebo effect is real. It is reasonable to compare xrt to celiac block, but not placebo.
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It’s a stupid comment because it is intentionally single arm with a goal of finding how well the treatment works. We know radiation to the pancreas tumor and involved nerves helps pain- we give RT for tumor caused pain all the time (in this disease, pancreatic cancer is involving the nerves). Sham RT here is unethical. You could argue they should have included a dose escalation run in since 25Gy may be unnecessary.
You have to find out the treatment effect to inform design of the randomized trial. what he is proposing is the phase 3 which the authors also propose, although his version of that is not the right arms. I wouldnt take him seriously. This is far from his first idiotic comment regarding trials.
You have to find out the treatment effect to inform design of the randomized trial. what he is proposing is the phase 3 which the authors also propose, although his version of that is not the right arms. I wouldnt take him seriously. This is far from his first idiotic comment regarding trials.
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Placebo effect in the management of chronic pain
www.ncbi.nlm.nih.gov
Excellent summary of placebo effect in management of chronic pain. First key point..."It is unethical to knowingly deceive a patient into believing they are receiving an active treatment whilst offering them an inactive one".
I think it is reasonable to actively take advantage of placebo in practice , while administering a presumably active treatment that has not been subject to a sham controlled trial.
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You have to know it’s an inactive treatment. Or that the alternative is active.Placebo effect in the management of chronic pain
Excellent summary of placebo effect in management of chronic pain. First key point..."It is unethical to knowingly deceive a patient into believing they are receiving an active treatment whilst offering them an inactive one".
I think it is reasonable to actively take advantage of placebo in practice , while administering a presumably active treatment that has not been subject to a sham controlled trial.
Nobody is arguing that radiation is a placebo. We believe it works in this circumstance.
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Agree...my interpretation of the key point is that SHAM controlled trials are often morally dubious.
edit: It is likely IMO that the intervention works both because it is active and because there is a component of the placebo effect. I personally emphasize that the treatment is likely to work when administering most palliative pain XRT, because I am confident that this provides a benefit to the patient.
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x.com
A not so gentle reminder that the people running things at ASTRO are not only out of touch with the vast majority of radiation oncology, they're completely out of touch with a generation of people that understand online humor/memes.
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I have to give kudos to Todd - doing the Lord's work.
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I cant understand why anyone would be a member. Even if you set aside the hostility, they spend a TON of money on consultants and lawyers for really dumb stuff.
I think your dollars are almost certainly better spent on literally any other society.
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...and here's how it goes with *many* situations where weak kneed admins lean heavily on "consultants" *not unique to ASTRO or health care*....
Admin - we should hire a consultant
Admin to Consultant - we have this idea and we *wink wink* think your recs should be this or that. Oh BTW we will pay you a lot to do a consult on this. We may even use you in the future on some other projects that are in the works.
Consultant - results are just as you expected
Admin to everyone when they face any consequences of their decisions - yeah but the consultant said this was the way to go.
===
What exactly are we paying admins for if they turn to consultants ***without skin in the game*** for every hard decision?
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That consultant move is the biggest bunch of horse****. Seen it 1000 times.
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I have it under good authority that Ralph Weichselbaum was the one who produced that letter
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Joe Biden helped? I KID.
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deleted1180461
Considering it says “Federal Express” instead of FedEx and contains numerous typos, unmmm yes. What a loser.
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I bet if you’re on the receiving end of ASTRO’s shenanigans it’s a lot much
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Telefax omg. Literally lol’ed.
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Barbara Streisand effect. Before Ralph’s time so you can’t really fault him.
Post is still here as of 1 minute ago
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Has a sound ever captured the vibe of an organization more perfectly than this one captures the vibe of ASTRO?
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Honestly? No.
They are beyond petty and egotistical. It's sad that Todd had to get a lawyer involved - I'm sure the time, stress, and money were significant.
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A little lost in all this is… the reality of the situation (apart from social media, which is never real).
And that reality is ASTRO wrote a letter to CMS that said in no uncertain terms general supervision should never be allowed in radiation clinics, and that clinics using general now should be forced with the power of federal government to change their behavior to direct supervision. And then, ASTRO made an essentially complete reversal/180 on the matter a few months later—“under the gun” of widespread outrage. But did not write another letter to CMS (as far as one knows) stating they had “changed their mind” on the whole matter.
It’s things like this that are damaging, not jokey tweets.
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This whole astro legal threat and rebuttal need to go into a hall of fame of examples of what is wrong with that organization and its "leadership".
It is just such a embarrassment, these are deeply unserious people.
So strange i couldn’t find it… maybe a me problem then
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That's why you guys have got to SCREENSHOT all Twitter posts. Anything that is posted on this thread is liable to be deleted shortly.
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Wait guys, have to disagree with Gfunk
Don’t screenshot the fake ASTRO letter
ASTRO will attack you with trademark attorneys and have Congress subpoena you. You and Steve Bannon may then become roommates.
This is exceedingly dangerous information and digital data
You can’t be trusted with it and you can’t even trust yourself having it
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If people are changing their thought processes based off of a post on this site, I'd call BS. No one is going to change their mind and "harm" ASTRO based off of a singular post on this site or on Twitter
