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He never meets a rad onc (dept manager) he can’t make money on god bless him
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He never meets a rad onc (dept manager) he can’t make money on god bless him
He had his therapy license revoked.
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Just out of curiosity, how does one become the chair of a department only 6 years after graduating from residency?
Lift and avoid condiments
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I hope I'm not reading this right. If I am, I would like it taken down.
I'm so curious to know what you mean.
I'll leave it to you to clarify.
I wanted a quick picture of the stands from the 1989 movie major league, a send up of baseball in general, but a bit of a dig at Cleveland. Most everyone had thrown in the towel at the beginning of the movie, even the most loyal fans, pictured there. Location, location, location is my answer to why so quickly made chair. That said, Spratt is clearly going to be a chair someday, makes sense to snag talent. Oh, and I do like Cleveland, just going along with the send-up...
All that said, that movie couldn't have been as good as it was were it the "Cleveland Guardians" .... thanks DEI!
I think it's a reference to Cleveland as a city, not the 'Indians' aspect.
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“At least we’re not Cleveland”
- Detroit
- Detroit
Can you imagine a rad onc giving this talk 20y ago
Unbelievable… we are witnessing modern day seppukku.
An honorable suicide, but suicide nonetheless…
I bet the title was meant to be confrontational or absurdist or self deprecating. But that’s kind of like Eric Clapton and his Cocaine song. He says it’s an anti drug song. My whole life I heard it as actually glorifying Cocaine… go figure.
Where is the "Where are we with eliminating endocrine therapy blindly prescribed by all medoncs for T1b breast cancers in women over 75 without any real conversation about benefits and side effects?"
Because that's what most of us see daily
Because that's what most of us see daily
new title coming soon: when the other shoe drops, prostate.
As an ASTRO exile and someone who tries to be academic at my own peril...
I never accept talks like this. I'm invited occasionally to talk about how to give less RT, how to manage RT toxicity (without a corresponding talk about benefits of RT), or why not to give RT in a certain scenario or talk about a situation where RT really isn't indicated (without a corresponding talk about when to use RT), and I'm mildly insulted.
What bothers me is that a lot of these senior people have the attitude that "I'm going to retire soon anyway, so what do I care." Thanks boomer.
I've had dinner with Julia White, and I wanted to ask her why she does this, but it wasn't the place. Does she really believe that we should just toss ourselves out of definitive intent therapy for breast cancer entirely? I'm open to believing that it's just a provocative title, though we can see how it is interpreted now in retrospect.
I feel the same working with rad oncs who want to do trials to eliminate RT for various indications. The steering committee at NCI for my disease site is now 50% med onc and their default is to block every trial that proposes a radiation question. Why do we do this to ourselves?
I never accept talks like this. I'm invited occasionally to talk about how to give less RT, how to manage RT toxicity (without a corresponding talk about benefits of RT), or why not to give RT in a certain scenario or talk about a situation where RT really isn't indicated (without a corresponding talk about when to use RT), and I'm mildly insulted.
What bothers me is that a lot of these senior people have the attitude that "I'm going to retire soon anyway, so what do I care." Thanks boomer.
I've had dinner with Julia White, and I wanted to ask her why she does this, but it wasn't the place. Does she really believe that we should just toss ourselves out of definitive intent therapy for breast cancer entirely? I'm open to believing that it's just a provocative title, though we can see how it is interpreted now in retrospect.
I feel the same working with rad oncs who want to do trials to eliminate RT for various indications. The steering committee at NCI for my disease site is now 50% med onc and their default is to block every trial that proposes a radiation question. Why do we do this to ourselves?
this is the kind of data the CMS Department of Decreased Reimbursement salivates over. I’m sure ASTRO will come up with a new simple or fast SBRT CPT code for less RVUs to make the RUC happy. And that’ll be fine for high volume centers; community, not so much.
That's what's wild and, in all honesty, scientifically blatantly wrong about what Dr. White is doing. The data is very clear that especially in the setting of partial breast radiation, APBI is tolerated much, much better than hormone therapy with equivalent efficacy. Why she would continue, relentlessly, to push for RT omission in the face of such data is completely beyond me. The only conclusion I can rationally come to is virtue signaling run amok.
Title says it all.
Please don't pretend this isn't some long term trend in this field, the move towards 0-5 fractions for many sites has been well documented (even when it blows up in people's faces, ergo OPRA for rectal)
Talk of eliminating RT instead of AI in early stage breast has been just absurd and ignorant of real world data/patient preferences and compliance
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julia was running an elimination trial that i dont think accrued well.
i have seen her promote the field to medical students. If this is the way she feels, fine, but you would expect her to be more vocal with astro and prudent management of departments and eductation.
Who is freaking out? This is some serious hyperbole in my opinion.
I will agree with you that it is same **** different day. The specialty is a bit like that. I was told on my first day of residency about 15 years ago by an attending that everyone is always trying to get rid of radiation. That does not seem to have changed.
Just don't talk out of one side of your mouth that we'll reduce or eliminate RT while working in an academic place that expands their residency programs. I don't know specifically if Ohio State's residency program has expanded, but I would be really surprised if it hasn't.
I know several other places with chairs who talk privately about how the specialty is doomed, and then continue to expand their satellites and residency programs, with the philosophy that when it all comes crashing down they'll be dead or retired. It's really perverse, and where else do we get to talk about it? Just here. Please post this perspective on ASTRO's forums once you pay for your ASTRO membership and time how fast you get banned. I could use a good laugh.
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When looking back on my relatively short career, I can remember some pretty cool stuff happening with hn patients, esophagus, rectal/anal, lung... If all I had to remember were breast cases id be sad. In turn, id like to give talks that were warmly received.
Imagine Letitia James going to Cornell and giving a talk "Where Are We With Supporting the Patriarchy." Like you know she would be trying to be clever, maybe too clever by half, but pretty much every female undergrad on campus would be apoplectic regardless the (completely predictable) content of the talk; maybe I’d be mad too. Of course Letitia James would never do that because she's not trying to satisfy two groups at once.
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It must be a strange feeling to be a first year rad onc resident on a gyn rotation struggling to learn about point A and point B etc and then read the below. I suppose once there is no more cervical cancer to treat in the states ASTRO will establish an away training center in Africa or something. Because it will still be vital (and very rad onc) to teach the technique even though no rad onc will ever actually do it.
At some point I am going to be seriously questioning the iq of 1st year radonc residents. Probably need to give wonderlich tests during future job interviews
I have no problem studying RT omission. I have a problem with five years of endocrine therapy getting a free pass while five fractions of APBI are treated as the burden to eliminate. De-escalation should reduce the patient’s total treatment burden—not simply remove our modality.
And if departments genuinely believe demand is contracting, perhaps they could apply some of that enthusiasm for de-escalation to residency slots.
And if departments genuinely believe demand is contracting, perhaps they could apply some of that enthusiasm for de-escalation to residency slots.
YES!
I posted this in the other thread at the same time:
"I do not understand how you can have a breast practice and see your follow ups (beyond their first post treatment check) and not come away convinced that we need to get rid of the AI when applicable. No one cares about 5 APBI treatments. My whole clinic (and family members that are survivors) full of miserable, formerly very active (sexual and otherwise) ladies in their 60's and 70's that are hating life because of their AI. This whole issue with Julia White angers me so much."
It's like the investigators don't actually see patients in a real clinic
Why it's important to have a dual referral to med onc AND rad onc from a surgeon for every breast pt
I had an old school mdacc trained med onc that often wouldn't even send early stage pts over the age of 70 for a referral to discuss RT when I first got to town, he just made the RT omission decision himself and would initiate endocrine therapy.
The dual referral became even MORE important when these pts literally refused to see that med onc to discuss adjuvant AI therapy at all (because of what they heard or read on the web) and would only see me, esp when they saw him and he kept pushing endocrine therapy
It's honestly like the ROs running these trials are low energy lackeys doing the bidding of old school med oncs (newer MOs hate the idea of 5 years of AI over 1-3 weeks of RT as much as we do a lot of times, only takes one hip fracture or psychosis to really mess things up)
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an “academic” “breast” radonc entirre research career is predicated on the elimination of xrt. I am actually embarrassed at the purported existence of “experts” in beast. It would be like a surgeon considering themselves an expert in putting in a central line.
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It's the same thing in general surgery.... Why breast is only a one year fellowship.
Have heard anecdotally from some more experienced general surgeons who do breast that the younger fellowship trained breast surgeons are excited about the elimination of axillary and SLN dissections because they don't feel as comfortable doing them, I know one who had to get called into the OR to assist in an ALND being done by a less experienced fellowship trained breast surgeon
Funny you should mention this. The new young med oncs in town have absolutely no interest in giving AI to these older women with early stage tumors. I can't tell you the number of patients who come to me now where the med onc told them to forget endocrine and do XRT instead. I actually called one and he told me it is not worth their time dealing with the side effect management. They'd rather get patients onto clinical trials and on meds that pay well that they can dispense in house. Apparently kisqali is big money for them, and endocrine pays close to 0.
Yep. Generics don't pay **** if you are dispensing from your own pharmacy, a big chunk of where their bread and butter comes from with infusional revenue drying up if you're in PP. Even IO is switching to SQ shots.
Again shows how out of step these trials really are vs the real world
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Not at my center. RVU based med oncs making >$100/wRVU can crank out 20 endocrine therapy level 4 f/u’s in a couple hours. It’s a dumb payment model that doesn’t incentivize new patients enough!
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Speaking of side effects. I saw a photo on Twitter recently iirc where a lady academic breast rad onc was speaking on LDRT for women with sore joints on endocrine therapy
The in house dispensing is a big money source for med onc nowadays. Although it’s few and far between some drugs can cost them 50 dollars per script and they can make like 2 or 3 thousand profit per script. Only in America.
Yep. Interesting to see whether hospital based rvu MOs are practicing different than PP MOs who own an in house pharmacy and dispense....
Do you remember the post/have a link? Not a lot of data I can find on efficacy for ldrt in that circumstance
So true. I have noticed this for years.
This has to be the most perplexing of all this. 5 years of a drug that has poor tolerance versus 5 days or 3-4 weeks of RT with some minor acute effects. Then a study showing that, if you had to choose, RT was preferred and still the medoncs give the drug automatically and question whether RT is needed, like they never thought of it any other way.
