I channel Dalton all the time.
the profound "pain don't hurt," remains my favorite, as it's comes around the same time he says that he's an NYU philosophy grad.
I can't really argue with Ralph on this one. Have it "out of my body?" That is an idiotic reason to undergo surgery in the absence of an outcome benefit.
It’s not a good medical reason but it’s one I’ve heard on more then one occasion. When I give the spiel some patients won’t even consider radiation because they “want it out” (“needs aht” where I grew up). Just like some won’t consider surgery because of fear of anesthesia or they can’t handle the idea of “being cut open”. Fortunately we are in a field with a reasonable degree of equipoise and can tailor our treatment to patient preference.
"Reasonable degree of equipoise" is the important bit - I absolutely do not understand the adversarial relationships of surgeons v. RadOnc on Twitter (or in other venues). We're all playing on the same team, and are here to help guide patients towards "reasonable" choices. The reasons I've heard for patients picking one modality over the other are...limitlessly interesting.
I hear that, too, and get it as a former cancer patient. As a cancer doctor, it's not a worthwhile point. I would hope dr servais wouldn't argue to have the pet avid axillary, cervical sand inguinal node resected if he were ever diagnosed with dlbcl. I also believe that surgery is the soc for stage I lung, and would be my preference.
1) Been there, had that discussion too.
Yeah, the masturbation thing was difficult to explain. I basically told him that there was some evidence that ejaculating might reduce the risk of cancer, but the evidence was in the same class as "wine makes you live longer".
Love how the average person interprets expectations and a fairly random universe. I was talking to a math teacher the other day about what a reasonable math curriculum would be for the 95% of people who don't go into STEM and don't need to work towards calculus. We agreed that basic intuitive stats is the most important, probably to even be a good voter.
Probably true
pubmed.ncbi.nlm.nih.gov
I spend a TREMENDOUS amount of time in consults, OTVs, and follow-ups trying to explain this to people. I don't know how successful I ever am. I think I say the phrase "population-level stats break down on an individual level" about 8,000 times a week.
Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up - PubMed
We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer.
As someone who experienced roughly 15 years of Catholic education, I love the idea of shaming someone for not masturbating enough.
For reference. “High frequency” in the study is considered >21x monthEjaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up - PubMed
We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer.
As someone who experienced roughly 15 years of Catholic education, I love the idea of shaming someone for not masturbating enough.
This the exact conversation I have with prostate patients.
It is entirely possible, and common even, to drown in a river that has an average depth of 1 foot.
Differential dx's:
I think there’s something seductive about this contrarian thought process where one thinks “I’m good at x. Y is just x-with-z, therefore I should be able to figure out the secrets of Y by treating it as X” and then they create an echo chamber.
Which is a very reasonable way to approach life.
lol. I think you are on to something.
Just like it was unseemly for politicians to wade into science and public health. Would be better if everyone stayed in their Lanes
Go back in time and delete medicare and medicaid? Listening....
Not sure i see how opining on vaccines or a pandemic is equivalent to creating Medicare/Medicaid?
I think a big part of the issue is what people think they understand.
Sounds like you are screening that this is political ?
If we are going to say that opining on public health and vaccines or creating CMS is political, is it unseenly then for nejm or jama to clap back?
Are drugs market up as much as RT is? Is this allowed? I thought the cost is the cost for the drugs, because they are always very specific about it (X costs $8k a month), while we rarely have those types of quotes about RT because it varies so much by payor and region.
Question is… is it necessary?
In small tumors, no. A Japanese randomized trial presented last year showed better results after segmentectomy.
I'm by no means an expert on drug reimbursement, but my understanding is that medicare has traditionally reimbursed drugs at average sales price of a drug + 6% in the physician office setting. I don't know how this changes at the private payor level, but I know hospitals are getting more through conversations I've had with others in the know. Maybe the + x% is higher for hospitals? That being said, I have a feeling you don't see anywhere close to the crazy multiple of Medicare we see on the XRT side, so I think you were absolutely correct in your post to point out the Medicare rate for SBRT does not reflect the true cost of that service at most hospitals/academic centers while the drug cost is probably closer to Medicare. So Medicare numbrs alone may not be a great estimate of the cost differential between XRT and drugs. I'm in no way debating med onc is significantly more expensive than rad onc, btw, but the discrepancy may not be as large as we think on the private side.
340b pricing allows for some additional margin on Medicare patients.
