Rad Onc Twitter

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medgator said:
So prescient
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That was literally my first thought as well. The original writer of that statement didn't give a timeline on their prediction. I'm think we're naturally inclined to interpret that statement as "dying soon", but it remains relevant if you broaden your vision.

Protons and flash and oligomets and cardiac ablation are cute patches in the holes of the RadOnc boat, but the government continues to fire torpedoes at us. Thank God they figured out a way to pry reimbursements away from us so CMS can afford some more Keytruda!
 
elementaryschooleconomics said:
That was literally my first thought as well. The original writer of that statement didn't give a timeline on their prediction. I'm think we're naturally inclined to interpret that statement as "dying soon", but it remains relevant if you broaden your vision.

Protons and flash and oligomets and cardiac ablation are cute patches in the holes of the RadOnc boat, but the government continues to fire torpedoes at us. Thank God they figured out a way to pry reimbursements away from us so CMS can afford some more Keytruda!
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Clearly it was meant to be sarcastic, but i doubt the writer could have forseen where we would be today (with the help of rad onc leadership and academia, gotta give credit where it is due!)
 
Quite unfortunate that there are many against prescription drug reform bill on the docket right now!
 
medgator said:
Clearly it was meant to be sarcastic, but i doubt the writer could have forseen where we would be today (with the help of rad onc leadership and academia, gotta give credit where it is due!)
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I don’t think it was meant to be sarcastic necessarily. It’s what I heard when I was coming up too, it’s only now that the ‘rad onc is dying’ has some truth

Other than the job-related issues and hypofrac issues that we discuss often here, it is the fact that the last 5 years of massive improvements in systemic therapy and what that looks like moving forward as well as the potential impact of blood based predictors for who needs adjuvant therapy that has called into question the actual role of radiation in multiple disease sites
 
jondunn said:
I don’t think it was meant to be sarcastic necessarily. It’s what I heard when I was coming up too, it’s only now that the ‘rad onc is dying’ has some truth

Other than the job-related issues and hypofrac issues that we discuss often here, it is the fact that the last 5 years of massive improvements in systemic therapy and what that looks like moving forward as well as the potential impact of blood based predictors for who needs adjuvant therapy that has called into question the actual role of radiation in multiple disease sites
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All the proton hype has amounted to nothing meanwhile while the number of centers keep growing. Going to see a lot of bankruptcies is decade esp if apm goes mainstream
 
jondunn said:
I don’t think it was meant to be sarcastic necessarily. It’s what I heard when I was coming up too, it’s only now that the ‘rad onc is dying’ has some truth

Other than the job-related issues and hypofrac issues that we discuss often here, it is the fact that the last 5 years of massive improvements in systemic therapy and what that looks like moving forward as well as the potential impact of blood based predictors for who needs adjuvant therapy that has called into question the actual role of radiation in multiple disease sites
Click to expand...
medgator said:
All the proton hype has amounted to nothing meanwhile while the number of centers keep growing. Going to see a lot of bankruptcies is decade esp if apm goes mainstream
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The current environment is so paradoxical. On the one hand, I am absolutely blown away by what we can do in Oncology today, between new systemic therapies and SBRT/SRS. I have patients cruising along who would have been dead by now if we were stuck with treatment options from even 10 years ago.

On the other hand, healthcare in America is a business, and we have departments fighting to maintain a huge resident workforce while the government and insurance companies fight to fund drugs at the expense of radiation, all in the name of profits.

The individual Radiation Oncologist - who is a person with hopes, dreams, a family, etc - is left in the lurch, told that they make too much money, that they should be happy with just securing A job, that everything is fine.

It reminds me of what happened with recycling in America. People are concerned about the levels of waste we produce and its effect on the environment. By far the biggest culprit of waste and pollution are large corporations, and regulation on those corporations would be the most effective way improve the problem.

But what did we do? Put the onus on the individual. Told people they needed to sort their garbage into trash vs recycling, go out of their way to make sure it is disposed of properly, create a culture where people who don't recycle are looked at sideways like they don't care and want to melt the ice caps. Meanwhile, corporations continue on with toothless "regulations", creating vastly more pollution than an individual citizen can even imagine, protected by their lobbyists.

That's what we did in RadOnc, too. This focus on fraction shaming to spare patients "financial toxicity" puts the onus on the individual Radiation Oncologist. If you use conventional fractionation, you don't care about your patient and want to bankrupt them. Meanwhile, PPS-exempt centers collect massive reimbursements for short courses of radiation and Keytruda, by itself, costs CMS more per year than all of Radiation Oncology combined. Merck makes this happen with their army of lobbyists and PAC funds.

As far as I can tell, using 7920 in 44 on a prostate is the same as throwing a Coke can into the regular trash. How dare you, you monster.
 
jondunn said:
View attachment 344071




lol if you google 'rad onc' this is what comes up hahaha. from 2008.
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bdVRuY2.png


No. But we're trying.

- Your Rad Onc Leaders
 
RealSimulD said:
these are just random community docs with free time on their hands, not the Illuminati.
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Describes me perfectly at least
elementaryschooleconomics said:
As far as I can tell, using 7920 in 44 on a prostate is the same as throwing a Coke can into the regular trash. How dare you, you monster.
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If compensated the same as a shorter course, 7920 in a healthy retiree with some baseline LUTS has no moral downside IMO. I hardly ever do it nowadays, because of some vague, virtual peer pressure.

Chartreuse Wombat said:
The point is that the "elites" no longer control the narrative.
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I can never figure out the sweet spot. SDN radonc thread a long way away from know-nothing populism. (like the upswell of strange sentiment that lets 96% (KHE clearly a smart 4%er) of docs get vaccinated vs 65% of nurses (numbers may be off)). I'm guessing almost all of us are MDs (or DOs), are radiation oncologists and can read papers at roughly the level of the elites. I'd like to think that while most of us are not in charge and certainly would not be designated "thought leaders", we are those doing the work.

As a consequence of the radonc "gilded age", many regular radoncs (not me) have early life CVs that would make the most elite of elite radonc leadership blush.
 
elementaryschooleconomics said:
The current environment is so paradoxical. On the one hand, I am absolutely blown away by what we can do in Oncology today, between new systemic therapies and SBRT/SRS. I have patients cruising along who would have been dead by now if we were stuck with treatment options from even 10 years ago.

On the other hand, healthcare in America is a business, and we have departments fighting to maintain a huge resident workforce while the government and insurance companies fight to fund drugs at the expense of radiation, all in the name of profits.

The individual Radiation Oncologist - who is a person with hopes, dreams, a family, etc - is left in the lurch, told that they make too much money, that they should be happy with just securing A job, that everything is fine.

It reminds me of what happened with recycling in America. People are concerned about the levels of waste we produce and its effect on the environment. By far the biggest culprit of waste and pollution are large corporations, and regulation on those corporations would be the most effective way improve the problem.

But what did we do? Put the onus on the individual. Told people they needed to sort their garbage into trash vs recycling, go out of their way to make sure it is disposed of properly, create a culture where people who don't recycle are looked at sideways like they don't care and want to melt the ice caps. Meanwhile, corporations continue on with toothless "regulations", creating vastly more pollution than an individual citizen can even imagine, protected by their lobbyists.

That's what we did in RadOnc, too. This focus on fraction shaming to spare patients "financial toxicity" puts the onus on the individual Radiation Oncologist. If you use conventional fractionation, you don't care about your patient and want to bankrupt them. Meanwhile, PPS-exempt centers collect massive reimbursements for short courses of radiation and Keytruda, by itself, costs CMS more per year than all of Radiation Oncology combined. Merck makes this happen with their army of lobbyists and PAC funds.

As far as I can tell, using 7920 in 44 on a prostate is the same as throwing a Coke can into the regular trash. How dare you, you monster.
Click to expand...
 
TheWallnerus said:
Click to expand...

This is absolutely perfect. This is what it feels like treating prostate cancer with radiation in 2021. Folks with clipboards who claim to have authority ask you to sort patients into the appropriate bin for the greater good. If you put them into the wrong bin, you're hurting the environment and it's a moral failing on your part.
 
communitydoc13 said:
If compensated the same as a shorter course, 7920 in a healthy retiree with some baseline LUTS has no moral downside IMO. I hardly ever do it nowadays, because of some vague, virtual peer pressure.
Click to expand...

We've had this discussion in some other thread, hell maybe even this one.

I feel anecdotally, damn the evidence, that 79.2/44 is easier for me to manage during OTV process. That's really what matters to me and my patients over the course of our relationship isn't it - if long term results are similar. Yet I feel extreme pressure from my chart rounds and group to be fraction shamed about doing it. In over 2 years, I've only done conventional fractionation 4 times. That's it - although I don't see a huge volume of prostate. I kind of want to go back there in my practice for patients I know have larger prostates, worse bladder filling, logistical ability to make the treatments, etc. It's only my personal experience from residency and the few I've done but I lean toward that it's better acute toxicity profile. However I'm being told it's wrong from every other angle so I've essentially given up.
 
I present: the rare Ralph apology! (context: Ralph did his typical "anything new that I'm not a co-author on is bad")

1633391263748.png


Other things Ralph forgets: his current home address, all phone numbers he's had after 1997, and any sense of decorum, ever.
 
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JASAozu.png


Another headline, and he lets it slip just ever so often, is that one of rad onc's leaders, one of its big names, says rad onc has third world status in oncology. And why should med students go into rad onc again? The doublespeak is pretty confusing with Ralph: 1) send us your best and brightest and let's keep expanding, but 2) rad onc sucks.

"Decades of ineffective leadership." LOL. Ralph is the leadership!

Ralph's trying to tell you med students.

Listen.
 
nah ralph isnt the leadership. hes a science guy. hes clearly an outsider to insider rad onc. hes in his own world.

leadership means looking at policy makers, those who decide what is focused on clinically in the field, leaders of national cooperative groups, ASTRO presidents for last 20 years (both private and academic people) etc
 
jondunn said:
nah ralph isnt the leadership. hes a science guy. hes clearly an outsider to insider rad onc. hes in his own world.

leadership means looking at policy makers, those who decide what is focused on clinically in the field, leaders of national cooperative groups, ASTRO presidents for last 20 years (both private and academic people) etc
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He's a chair of a very well known program in the field. Try again
 
medgator said:
He's a chair of a very well known program in the field. Try again
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I think it would behoove you on this board and in real life to think about things on more than a superficial level.
 
TheWallnerus said:
JASAozu.png
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Is he serious with this?

Ralph, I've never said this before but: I agree with you. However, I think you're forgetting that you've been a major part of the leadership of this field for decades. You have been - for years now - using your platform to cast aspersions on literally any attempt at innovation that isn't your own, with a healthy smattering of ad hominem attacks which your supporters label as "radical candor".

I'm glad you co-authored that 1995 editorial with Hellman. What's that saying? Either die a hero, or live long enough to see yourself become the villain? I hope your colleagues are planning a fantastic retirement party!
 
jondunn said:
nah ralph isnt the leadership. hes a science guy. hes clearly an outsider to insider rad onc. hes in his own world.

leadership means looking at policy makers, those who decide what is focused on clinically in the field, leaders of national cooperative groups, ASTRO presidents for last 20 years (both private and academic people) etc
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If I ever publish hundreds of papers and create a whole new oncologic “paradigm” hailed as a potential savior of my specialty, and someone says I’m not a leader… I’m gonna be hurt

pubmed.ncbi.nlm.nih.gov

Weichselbaum RR - Search Results - PubMed

Weichselbaum RR - Search Results - PubMed
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
thecarbonionangle said:
Who cares if the Canadians want to eat their own with shaved truffles and poutine. I say c’est la vie!

Focus on USA breadlines. There ain’t any truffles or gravy there folks!
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canadians are storming our borders and taking our jobs.

 
jondunn said:
Is it?

this just seems more like low level humble bragging, or bragging.

virtue signalling is like gas lighting now, an over used term that is starting to mean less.
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Agree that it is hackneyed, but in this case, the author is using the pretense of complimenting supporting group to broadcast that he has 300 pubs.
 
forums.studentdoctor.net

Chirag/Royce Editorial, Goodman Article, Potters Response on Job Market 031121

Here's another article from today from Paul Harari and crew: https://www.redjournal.org/article/S0360-3016(21)00216-9/abstract Someone should ask the first author of this study about the rumor that his group was looking to replace a retiring partner this year and then decided not to hire...
forums.studentdoctor.net forums.studentdoctor.net
Brag post...or virtue signaling
 
Bequerel said:
Is this for real? Is his name really Dick Simcock? Why would he specialize in breast? What a missed opportunity.
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I'm not gonna apologize. I'm a cocksman.

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1633568213278.png


This is the paper:

"After the Match: The Anesthesiology Match May be a Harbinger for EM"

I really respect how aggressive some of the EM folks are about openly discussing their specialty issues, it speaks to the culture/personality difference between EM and RadOnc. The linked editorial is interesting as well, I had forgotten about the anesthesiology issues from the 90s. Anesthesia, Radiology, Pathology, EM, NucMed, RadOnc...no one is immune to market forces and key players acting in their own best interest to the detriment of their specialty. Tragedy of the commons and all that.

The RadOnc leadership, once everyone gets past their bruised egos at our fall from grace, would do well to realize that what's happening to us is not unique, nor is it irrevocable. I'm glad we seem to have moved beyond ASTRO's silly "anti-trust" claim and some of the people in power (Emma Fields, Brian Kavanagh, Thomas Eichler, etc) have been willing to talk about our problems in traditional platforms.

As we enter another interview season where there are fewer applicants than spots, we again have the chance to witness if departments will allow the decreased demand to help alleviate our supply issues, or if greedy academicians will artificially prop up the economy of residents to the detriment of us all.
 
elementaryschooleconomics said:
View attachment 344341

This is the paper:

"After the Match: The Anesthesiology Match May be a Harbinger for EM"

I really respect how aggressive some of the EM folks are about openly discussing their specialty issues, it speaks to the culture/personality difference between EM and RadOnc. The linked editorial is interesting as well, I had forgotten about the anesthesiology issues from the 90s. Anesthesia, Radiology, Pathology, EM, NucMed, RadOnc...no one is immune to market forces and key players acting in their own best interest to the detriment of their specialty. Tragedy of the commons and all that.

The RadOnc leadership, once everyone gets past their bruised egos at our fall from grace, would do well to realize that what's happening to us is not unique, nor is it irrevocable. I'm glad we seem to have moved beyond ASTRO's silly "anti-trust" claim and some of the people in power (Emma Fields, Brian Kavanagh, Thomas Eichler, etc) have been willing to talk about our problems in traditional platforms.

As we enter another interview season where there are fewer applicants than spots, we again have the chance to witness if departments will allow the decreased demand to help alleviate our supply issues, or if greedy academicians will artificially prop up the economy of residents to the detriment of us all.
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Starting to notice that drop off again in gas also... Have heard it's pretty ridic out there now with a lot of the big groups selling out to PE and new hires getting employed with crappier and exploitative contracts under new group ownership
 
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