Mike spends more per year in advertising than many rad oncs make per year. He played “Don’t Cry For Me Argen-tweeta” on his $250K home sound system last night... he is proud of it because that’s about what he makes per month.
Sounds about right.... Could be understating it considering he owns the whole center?
Bullies are everywhere and the ones who have a sense of entitlement and power when challenged, can become monsters. These guys live off their pride and egos and are miserable in their own lives because they are wrong in truly understanding what is valuable and meaningful in life. This is why they lash out.. It’s truly sad to see.
Mike's in the top 20 highest paid rad oncs in the United States. He owns his own thing. This is what I wish we ALL could do.
Soon after, the cyberknife wars started... At one point it seemed like FL had like 20+ of them...3 in Tampa alone. Used to see billboards in many major cities touting it etc
I don’t think he hides it well.
Moving around multiple jobs is usually somewhat of an eyebrow raiser... The fact they are VA jobs, even more so
Twenty plus years ago when you retired from rad onc you knew you were going out with $10 million in the bank. Jim was one who did. They (the CyberKnifers) were doing prostate SBRT when "everyone" said it was dumb or unsafe. Like they say...
Actually a lot of them were money losers... Prostate ck was considered experimental and often didn't get paid esp if you weren't a hospital...
Some of these guys are truly bad actors/ and consummate hucksters, but that only makes them indistinguishable from many of the larger/proton centers. At the end of day, probably safer to go with Jim’s cyber knife or datolis 10 gy/5 fractions to “prime” the cells followed by an implant for low/intermediate risk prostate than protons with space oar.
That 10 Gy in 5 fx stuff was pretty uh ......
Big prostate brachy practice in Chicago back in the day as well, used to offer a fellowship?
Brian Moran maybe? He’s still active.
"when they didn't have insurance that would cover CK/protons"
"noninvasively burned out of my head." Lol. my new description of radiosurgery.
Probably the least useful case for them, i would think
Practice changing studies don't end up in the Red Urinal, that's for sure
That is debateable. One can also say that they are best used to achieve very high doses in areas where photon plans can only deliver 10-15% lower dose without an excessive risk of toxicity in serial organs. I am thinking here about the classic indication for proton treatment in skull base tumors (chordomas and sarcomas), where you can give 70-74Gy with protons but cannot do the same with photons due to toxicity to serial organs like the brainstem and the optic pathway.
Agree there is benefit in sparing serial structures in situations like chordoma… but this is where failing to account for the range uncertainties and biology can be most dangerous. We see this with brainstem necrosis in ependymoma. Additionally, conformality is better with photons in a lot of cases , depending on spot size and the need for robust optimization. Hubris and weak physics support are most dangerous trying to get cute with high gradients with protons… and these indications tend to be very specific and rare diseases. The low/intermediate dose sparing matters the same times it matters with photons (v20, heart dose, brain dose with large meningioma, retroperitoneal sarcoma abdominal dose, liver dose with B8 HCC etc…). These applications are more generalizable. While there are certainly cases where they are helpful with high dose near a serial organ, I don’t think this will be the most common application of this technology
What makes the optimization “robust” in terms of biological parameters- tissue culture models?
I wouldn’t expect biological differences to have a profound affect on RBE with protons, because it never gets that high to begin with ~1.7 in the LOW dose fall off, maybe 1.4 in the distal SOBP (where dose still exists). This is more an issue with heavy ions, alpha particles, or neutrons. If you want to robustly optimize RBE for, you can probably do so by assuming a distribution of LETs which will more profoundly impact RBE than an tissue specific factors. I’d argue considering LET at all is probably the most important first step with regard to biology.
I have some proton experience myself and have seen these issues too around the Bragg peak (and immediately beyond it).
Isn’t a 1.4 to 1.7 rbe same as 25 - 55 % hot spot?
Still not a peep from ASTRO about all of this while they were fraction shaming everyone else for years into "choosing wisely"
1.7 probably isn’t as clinically relevant… because it is in a region where does has already significantly died off. I don’t think 1.4 is as frequent with IMPT as opposed to passive scatter (no true SOBP with IMPR). Nonetheless, still the potential for very significant hot spot.
In just this data set.
I'll tell you, our group is not helping out. We have 20+ and have no intentions of hiring anyone over the next few years in absence of any catastrophic events (e.g. deaths or retirements). We have been asked to pick up more patients, instead of hiring new talent. This woman's, and everyone else's, outcomes will be on all of their heads.
Usually when it happens that quickly, there's a story, and usually not a good one.
