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Ray D. Ayshun said:
he is doing rural rad onc. i hear there's a need. wonder if anyone who doesn't do it knows what it's like. in any case, i'm sure there's no need to discuss as it's only the main justification for residency expansion.
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He's pretty anti expansion, and rural rad onc wasn't exactly his calling from the getgo 😉
 
medgator said:
He's pretty anti expansion, and rural rad onc wasn't exactly his calling from the getgo 😉
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Yes on the ant-expansion part, and yes on the other part. My point is, the maintenance of or expansion of resident numbers has been justified by "geographic maldistribution.". All the while, academic centers **** talk those in the community, in particular those in communities way out there. I'm only partly this, but am on the edge of the world in some respects. I'd love to hear from other rural docs regarding the system they're living in, but more importantly, I think it's a message worth getting out as there are unique challenges we face, which I'm certain the academic folk who have created the plans to solve the maldistribution problem are entirely ignorant of. As brilliant as scarb is wrt big picture stuff, he also likely has a perspective on this, which, with offense, is probably more worth hearing than just hearing from a female rockstar. Though Id happily listen to a rural female rockstar talk about her experience.
 
First of all, Todd is white?? What the hell?

Second of all, yeah, we aren’t doing rural radonc and jobs and all that all the time. I hope it’s clear I don’t subscribe to the Woke dogma that is going off. There are women with stories and ideas we can learn from. Sometimes we need to be intentional about it. No, it’s not about just window dressing.

Listen if you’d like, or not. But our intention is to have interesting voices tell interesting stories. Stuff you won’t get from RJ, or here or Twitter. And many won’t be interesting to you, but some will, we hope!
 
RealSimulD said:
First of all, Todd is white?? What the hell?

Second of all, yeah, we aren’t doing rural radonc and jobs and all that all the time. I hope it’s clear I don’t subscribe to the Woke dogma that is going off. There are women with stories and ideas we can learn from. Sometimes we need to be intentional about it. No, it’s not about just window dressing.

Listen if you’d like, or not. But our intention is to have interesting voices tell interesting stories. Stuff you won’t get from RJ, or here or Twitter. And many won’t be interesting to you, but some will, we hope!
Click to expand...

keep up the good work, I'm in it for the job stuff - this new ep with Todd/Nick/Matt was a good one
 
RealSimulD said:
First of all, Todd is white?? What the hell?

Second of all, yeah, we aren’t doing rural radonc and jobs and all that all the time. I hope it’s clear I don’t subscribe to the Woke dogma that is going off. There are women with stories and ideas we can learn from. Sometimes we need to be intentional about it. No, it’s not about just window dressing.

Listen if you’d like, or not. But our intention is to have interesting voices tell interesting stories. Stuff you won’t get from RJ, or here or Twitter. And many won’t be interesting to you, but some will, we hope!
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Can you start asking for the 23andme results of each speaker and post before the show so I can decide whether or not I want to tune in?
 
Palex80 said:
What is "Statin Island University Hospital"? Statines? Is it a cardiologic clinic? 😀
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“Statin Island is the penal colony where we send all the people who eat too much fat and mayonnaise and don’t monitor their HDL and cholesterol levels. You know, people not like me.”

- Dan Spratt
 
Palex80 said:
What is "Statin Island University Hospital"? Statines? Is it a cardiologic clinic? 😀
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I'm confused. This is still part of northwell system so is this like being a medical director of a site? We know that potters is the northwell chair.
 
TheWallnerus said:
“Statin Island is the penal colony where we send all the people who eat too much fat and mayonnaise and don’t monitor their HDL and cholesterol levels. You know, people not like me.”

- Dan Spratt
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Chair memo -

"In the interest of efficiency, all faculty and staff are to refer to geographic locations using no more than two syllables. Examples include 'Staten', 'Chicag', 'Miam', and 'Ohi'. I have calculated we can save 0.09 FTE per year if we all enact this practice immediately."
 
elementaryschooleconomics said:
Chair memo -

"In the interest of efficiency, all faculty and staff are to refer to geographic locations using no more than two syllables. Examples include 'Staten', 'Chicag', 'Miam', and 'Ohi'. I have calculated we can save 0.09 FTE per year if we all enact this practice immediately."
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He could've meant this too. Never put it past Dan to be playing some three dimensional chess.

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins
Statin use and risk of prostate cancer recurrence in men treated with radiation therapy
 
RickyScott said:
Aren’t drug companies putting 10s of billions in research into the effort.
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Yes, even more reason to support research through other avenues that do not rely on pharma input or oversight
 
jondunn said:
Yes, even more reason to support research through other avenues that do not rely on pharma input or oversight
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Would guess most of the pharma bench research is at least “reproductible” since it’s their money in play. Most academic research is not.
 
radoncftw said:
I'm confused. This is still part of northwell system so is this like being a medical director of a site? We know that potters is the northwell chair.
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She’s not the chair of the system. She’s the chair of a single hospital in the northwell system. It looks like she’s the only one in the Dept. The guy she replaced looks like classic boomer RO. But that’s just based on doximity and searching the northwell website
 
Yeah there’s definitely more obesity in the US than down under. I wonder how they collected data for productivity per pound. Too lazy to read the paper.
 
communitydoc13 said:
curious what this is?
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I wasn't as articulate as I wanted to be. I don't think the current conversations about race (especially in our specialty) are nuanced.
The first time in recent memory people from our specialty were in NEJM, they are discussing representation of people in academic medicine.

I don't think this is a topic where one can speak with candor, nuance or humility. So, I won't.
 
1649689863073.png
 
RealSimulD said:
I wasn't as articulate as I wanted to be. I don't think the current conversations about race (especially in our specialty) are nuanced.
The first time in recent memory people from our specialty were in NEJM, they are discussing representation of people in academic medicine.

I don't think this is a topic where one can speak with candor, nuance or humility. So, I won't.
Click to expand...
Kind of like when carville spoke about people needing a “woke detox”
 
RealSimulD said:
The first time in recent memory people from our specialty were in NEJM, they are discussing representation of people in academic medicine.
Click to expand...
I think I get it. I agree it would nice if more science from radonc in NEJM. This is not due to a lack of talent. It is due to our subject matter.

Nothing wrong with the NEJM paper in my opinion. Also, nothing new in it IMO and it shows trends that are mostly representative of early vs late indicators in a rapidly changing society. This rapid change in racial demographics accompanied reasonable (as in non-racist) immigration policies that really only began about 50 years ago. These policies are probably responsible for many Asian American docs being here. The paper does show a hint that full professorship may more likely lead to a chair position for the most underrepresented men, although full professorship is very uncommon in this group.

"Wokeism" has been weaponized by the right and the negative connotation has even been adopted by the moderate left who are exacerbated with the most progressive left. It really should mean nothing more than awareness or alertness to discrimination. It has come to mean "An unreasonable adherence to a narrative that social justice is not being met. This adherence precludes critical analysis of individual events or crises." These are my words. I've never heard a conservative explain it this way. But it has become a bit of a dog whistle to condemn folks who are everything from trans rights advocates to BLM supporters.

I would contend that the "woke" folks are usually morally right. Just imagine what constituted woke, 200, 100, 50 or even 20 years ago. Right pretty much every damn time.

Here is a link to story about bad "wokeism". An example of an institution making a series of bad decisions in an effort to appear "woke".

www.newyorker.com

How an Ivy League School Turned Against a Student

Mackenzie Fierceton was championed as a former foster youth who had overcome an abusive childhood and won a prestigious Rhodes Scholarship. Then the University of Pennsylvania accused her of lying.
www.newyorker.com www.newyorker.com
 
communitydoc13 said:
I think I get it. I agree it would nice if more science from radonc in NEJM. This is not due to a lack of talent. It is due to our subject matter.

Nothing wrong with the NEJM paper in my opinion. Also, nothing new in it IMO and it shows trends that are mostly representative of early vs late indicators in a rapidly changing society. This rapid change in racial demographics accompanied reasonable (as in non-racist) immigration policies that really only began about 50 years ago. These policies are probably responsible for many Asian American docs being here. The paper does show a hint that full professorship may more likely lead to a chair position for the most underrepresented men, although full professorship is very uncommon in this group.

"Wokeism" has been weaponized by the right and the negative connotation has even been adopted by the moderate left who are exacerbated with the most progressive left. It really should mean nothing more than awareness or alertness to discrimination. It has come to mean "An unreasonable adherence to a narrative that social justice is not being met. This adherence precludes critical analysis of individual events or crises." These are my words. I've never heard a conservative explain it this way. But it has become a bit of a dog whistle to condemn folks who are everything from trans rights advocates to BLM supporters.

I would contend that the "woke" folks are usually morally right. Just imagine what constituted woke, 200, 100, 50 or even 20 years ago. Right pretty much every damn time.

Here is a link to story about bad "wokeism". An example of an institution making a series of bad decisions in an effort to appear "woke".

www.newyorker.com

How an Ivy League School Turned Against a Student

Mackenzie Fierceton was championed as a former foster youth who had overcome an abusive childhood and won a prestigious Rhodes Scholarship. Then the University of Pennsylvania accused her of lying.
www.newyorker.com www.newyorker.com
Click to expand...
Plenty of nonwoke people see society in a woke way. They are nonwoke because they act in a way that would suggest they actually want change, not in a way that would suggest they are able to metabolize their indignation.
 
Ray D. Ayshun said:
Plenty of nonwoke people see society in a woke way. They are nonwoke because they act in a way that would suggest they actually want change, not in a way that would suggest they are able to metabolize their indignation.
Click to expand...
Yeah.

How did woke get so bad?

I'm thinking we are imagining a group of people here that rarely exist?

There are plenty of stories about woke villains and these villains are real but rare, whether it's Yale students yelling at faculty, or the Evergreen state fiasco or Oberlin's response to the bakery theft. Of course these stories get lots of press as do the Ammon Bundys of world. But, they are not common.

How many woke villains do you encounter in radonc? I'd say that there are plenty of villains but wokeism is not the source of their villainy, greed is. Lots of academic leaders with a "cloak of woke" who aren't true believers.
 
communitydoc13 said:
I think I get it. I agree it would nice if more science from radonc in NEJM. This is not due to a lack of talent. It is due to our subject matter.

Nothing wrong with the NEJM paper in my opinion. Also, nothing new in it IMO and it shows trends that are mostly representative of early vs late indicators in a rapidly changing society. This rapid change in racial demographics accompanied reasonable (as in non-racist) immigration policies that really only began about 50 years ago. These policies are probably responsible for many Asian American docs being here. The paper does show a hint that full professorship may more likely lead to a chair position for the most underrepresented men, although full professorship is very uncommon in this group.

"Wokeism" has been weaponized by the right and the negative connotation has even been adopted by the moderate left who are exacerbated with the most progressive left. It really should mean nothing more than awareness or alertness to discrimination. It has come to mean "An unreasonable adherence to a narrative that social justice is not being met. This adherence precludes critical analysis of individual events or crises." These are my words. I've never heard a conservative explain it this way. But it has become a bit of a dog whistle to condemn folks who are everything from trans rights advocates to BLM supporters.

I would contend that the "woke" folks are usually morally right. Just imagine what constituted woke, 200, 100, 50 or even 20 years ago. Right pretty much every damn time.

Here is a link to story about bad "wokeism". An example of an institution making a series of bad decisions in an effort to appear "woke".

www.newyorker.com

How an Ivy League School Turned Against a Student

Mackenzie Fierceton was championed as a former foster youth who had overcome an abusive childhood and won a prestigious Rhodes Scholarship. Then the University of Pennsylvania accused her of lying.
www.newyorker.com www.newyorker.com
Click to expand...

Do you really think most that are described as "woke" are solely making us aware or alerting us to discrimination?

Does shifting physicians from one setting (community practice) to another (academic leadership) benefit the provider, patients or society as a whole? If you remove someone from one setting and put them in another, is it possible this will have negative effect?

Think of "seminal" RO papers that have made it to NEJM and what they mean to us as a specialty or as a treating physician? The majority of papers in RO published in NEJM matter to my practice and people that actually practice medicine. When we are getting into the weeds of how many doctors of specific demographic should be in academic or clinical medicine, my simplistic opinion (and I am open to being corrected) is that this is leaving the area of cancer medicine and delving into social engineering. Where I think I may be wrong (or too old to "get it") is that maybe the mission of the NEJM has changed completely. My understanding was that if something is in the NEJM, it should be practice changing. Has any paper of this type "changed practice" ?

Do I believe that discrimination exists in medicine (or American society as a whole)? Absolutely. Does this seem like a report that will do anything? Unlikely - to me - but curious to see how you think this adds value to the literature or how it can be utilized to create positive change.
 
communitydoc13 said:
Yeah.

How did woke get so bad?

I'm thinking we are imagining a group of people here that rarely exist?

There are plenty of stories about woke villains and these villains are real but rare, whether it's Yale students yelling at faculty, or the Evergreen state fiasco or Oberlin's response to the bakery theft. Of course these stories get lots of press as do the Ammon Bundys of world. But, they are not common.

How many woke villains do you encounter in radonc? I'd say that there are plenty of villains but wokeism is not the source of their villainy, greed is. Lots of academic leaders with a "cloak of woke" who aren't true believers.
Click to expand...
Imho cloak of woke worse than truly woke
 
RealSimulD said:
Does this seem like a report that will do anything? Unlikely - to me - but curious to see how you think this adds value to the literature or how it can be utilized to create positive change.
Click to expand...
I agree there is very little value here (maybe some formal analysis that hasn't been done before) and no conclusions that should surprise anyone who pays attention to the world around them.

The impact factor of the publication (very high) is not commensurate with the true impact of the work (very low).

But it is not evil. I do understand that it may be frustrating to academics that this type of work will get you farther than most of what other people are doing. But lets be honest, it is hard to do true high impact stuff in radonc today without the impact being less indication for XRT. Our best scientists do stuff that is generalizable to oncology and often only tangentially related to radonc.

I do not know the authors personally. Maybe they are awful. I don't know if they describe themselves as woke and I do not sit in on faculty meetings.
 
communitydoc13 said:
I agree there is very little value here (maybe some formal analysis that hasn't been done before) and no conclusions that should surprise anyone who pays attention to the world around them.

The impact factor of the publication (very high) is not commensurate with the true impact of the work (very low).

But it is not evil. I do understand that it may be frustrating to academics that this type of work will get you farther than most of what other people are doing. But lets be honest, it is hard to do true high impact stuff in radonc today without the impact being less indication for XRT. Our best scientists do stuff that is generalizable to oncology and often only tangentially related to radonc.

I do not know the authors personally. Maybe they are awful. I don't know if they describe themselves as woke and I do not sit in on faculty meetings.
Click to expand...
I don't think I said anyone was evil or awful, nor does it really matter if they were, because I'm trying to stick to the substance of the content.

You and I both are saying same thing - this report adds little value, conclusions are not-surprising, low clinical/patient/societal impact. Is this the type of publication that should showcase how brilliant people in RO are? Literally, have the brightest and best med students from around the country and world, and that chart that was up showed how little we are doing to get into NEJM (I presume our footprint is smaller in JCO these days, too).

The other tough part is that if you disagree or try to actually debate the value of these types of reports, you can get put in a box by those that support. Like, if you look at ESPAC and decide you don't think RT is useful for post-op pancreas, you typically aren't put into anti-RT box or called names. But, if you try to debate the value of these types of publications, it is quick road to being called an -ist of some sort.
 
Value is relative. NEJM values this kind of paper because it will likely generate citations. I don't really care for her, but Reshma Jagsi's highest cited paper is from NEJM and is along the similar vein of research
scholar.google.com

Reshma Jagsi

Professor, University of Michigan - Cited by 36,523 - breast cancer - ethics - policy - gender - women
scholar.google.com scholar.google.com

I think most people would agree clinical research obviously affects patient care the most. But some might also say a paper that generates 700+ citations must have also had some impact - whatever you assign that impact is up to you
 
communitydoc13 said:
I think I get it. I agree it would nice if more science from radonc in NEJM. This is not due to a lack of talent. It is due to our subject matter.

Nothing wrong with the NEJM paper in my opinion. Also, nothing new in it IMO and it shows trends that are mostly representative of early vs late indicators in a rapidly changing society. This rapid change in racial demographics accompanied reasonable (as in non-racist) immigration policies that really only began about 50 years ago. These policies are probably responsible for many Asian American docs being here. The paper does show a hint that full professorship may more likely lead to a chair position for the most underrepresented men, although full professorship is very uncommon in this group.

"Wokeism" has been weaponized by the right and the negative connotation has even been adopted by the moderate left who are exacerbated with the most progressive left. It really should mean nothing more than awareness or alertness to discrimination. It has come to mean "An unreasonable adherence to a narrative that social justice is not being met. This adherence precludes critical analysis of individual events or crises." These are my words. I've never heard a conservative explain it this way. But it has become a bit of a dog whistle to condemn folks who are everything from trans rights advocates to BLM supporters.

I would contend that the "woke" folks are usually morally right. Just imagine what constituted woke, 200, 100, 50 or even 20 years ago. Right pretty much every damn time.

Here is a link to story about bad "wokeism". An example of an institution making a series of bad decisions in an effort to appear "woke".

www.newyorker.com

How an Ivy League School Turned Against a Student

Mackenzie Fierceton was championed as a former foster youth who had overcome an abusive childhood and won a prestigious Rhodes Scholarship. Then the University of Pennsylvania accused her of lying.
www.newyorker.com www.newyorker.com
Click to expand...
That New Yorker story is horrifying, but I see it more as a story of an elite institution crushing an individual to protect its reputation rather than anything about wokeness. The way that one “anonymous” tipster’s accusations are taken up as gospel are frightening.
 
grenz said:
That New Yorker story is horrifying, but I see it more as a story of an elite institution crushing an individual to protect its reputation rather than anything about wokeness. The way that one “anonymous” tipster’s accusations are taken up as gospel are frightening.
Click to expand...
This is the world we live in. The monster will eat us all no matter your ideology.
 
grenz said:
That New Yorker story is horrifying, but I see it more as a story of an elite institution crushing an individual to protect its reputation rather than anything about wokeness. The way that one “anonymous” tipster’s accusations are taken up as gospel are frightening.
Click to expand...
Also, thank goodness that long-form investigative journalism is a last shot at justice for powerless people who are wronged by the powerful. Obviously for every 1 Mackenzie there are 100s more who just get squashed, but at least justice could be done in this one case. I have no doubt Penn will have to pay her millions in restitution for the character smear.
 
The term woke has obviously lost all meaning and is now solely used to pejoratively describe anybody who lives two steps to the left of yourself. For instance, If you're a republican, you use it to describe any democrat (RINO being the term you call anyone who is one step to the left of yourself).

Once again, this is the world we live in.
 
Mandelin Rain said:
The term woke has obviously lost all meaning and is now solely used to pejoratively describe anybody who lives two steps to the left of yourself. For instance, If you're a republican, you use it to describe any democrat (RINO being the term you call anyone who is one step to the left of yourself).

Once again, this is the world we live in.
Click to expand...
To some, I would claim half a step. Being “canceled” is another hot topic word that has lost its intended meaning.
 
RealSimulD said:
I don't think I said anyone was evil or awful, nor does it really matter if they were, because I'm trying to stick to the substance of the content.

You and I both are saying same thing - this report adds little value, conclusions are not-surprising, low clinical/patient/societal impact. Is this the type of publication that should showcase how brilliant people in RO are? Literally, have the brightest and best med students from around the country and world, and that chart that was up showed how little we are doing to get into NEJM (I presume our footprint is smaller in JCO these days, too).

The other tough part is that if you disagree or try to actually debate the value of these types of reports, you can get put in a box by those that support. Like, if you look at ESPAC and decide you don't think RT is useful for post-op pancreas, you typically aren't put into anti-RT box or called names. But, if you try to debate the value of these types of publications, it is quick road to being called an -ist of some sort.
Click to expand...


you're doing too much. it doesn't need to be that deep or too complicated.

it suffices to say 'surprised that got into NEJM, wow' and move on, IMO.
 
grenz said:
a story of an elite institution crushing an individual to protect its reputation rather than anything about wokeness
Click to expand...
Wokeness is never mentioned directly in the story if I recall. I brought it up because I think PENN was chasing what they perceived others would perceive as justice and this may fit with what some people think wokeness means. In truth, there was no justice to be had and the moral thing to do was to look out for their student. If they were not consumed with selling her story as a poor student in the first place and not worried about how an on-paper, well-to-do white girl with privilege looked ultimately, they would have backed away and acknowledged that supporting the future of all their students was the most important thing.
 
RealSimulD said:
O

Your opinion is most desired

SDN - feel free to ask Dr Dunn what is optimal post length
Click to expand...


I mean what exactly is your issue?

IMO, UNLESS you are annoyed that something you submitted to NEJM got rejected and this got accepted (Academic jealousy), I will never have an issue with research getting published. Some people get lucky, right place right time. this is what I chalk it up to.

There was an MDACC 30 patient trial that got into Lancet a few months ago for SBRT for RCC, I was also surprised a 30 patient single arm trial got into LANCET. but good for them!

for any residents or academic attendings there - let this be a lesson. if you don't submit and go for a 'reach' you will never get that reach. worth a shot I guess!
 
Just to maybe shine some ray of hope.. NCI is making occasional efforts to promote radiation related research. E.g., this recent request for applications is looking for ideas for radiation related cancer reprogramming to improve targeted therapy. Decent number of awards will be funded.

"The basic premise of PAIRS is that the conditional effects of radiation therapy responses can be leveraged to either create or enhance actionable vulnerabilities that work in tandem with synthetic combination targeting agents. In this manner, conditional PAIRS strategies have potential to optimally target specific essentiality in tumors relative to normal tissues, thereby greatly enhancing the therapeutic index."
 
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