Rad Onc Twitter

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But doesn't this do the opposite? SBRT to bring in all the immune cells. Then conventional fx RT to kill them all.

Whoops. Yes. You're correct. I like that less.
If only we could figure out the right sequence of fractions, along with fraction sizes, to reliably usher in this illusive immunogenicity upon command. If you think about it, there’s probably at least a few hundred feasible combos. Maybe more! Are we like Dr. Ehrlich blindly but one day serendipitously happening upon compound 606? Or are we just blind. Time will tell! I predict I’ll be dead before it does.
 
If only we could figure out the right sequence of fractions, along with fraction sizes, to reliably usher in this illusive immunogenicity upon command. If you think about it, there’s probably at least a few hundred feasible combos. Maybe more! Are we like Dr. Ehrlich blindly but one day serendipitously happening upon compound 606? Or are we just blind. Time will tell! I predict I’ll be dead before it does.
For this trial, the rationale is more than immunogenicity of course, although it would be nice if some magic happened. The more prosaic motivation is to see if one can safely improve local control and thus maybe pFS and OS by judiciously dose escalating with a highly conformal and upfront boost.

This is a lot different than escalating all disease from 60-74 Gy...not exciting, but different.

Agree about the sequencing question though, and all these arguments come out with every negative concurrent XRT/IO trial.

I'm convinced that radiation induced immunogenicity is a high variance problem in people. (Much less so in nude mice...why we have baller pre-clinical data.) In fact, I'm convinced that prior to the advent of targeted IO to conserved proteins like PD-L1, the high variance problem was why IO had been such a flop over 30 years of clinical research, despite clear evidence of periodic complete responses in patients.
 
For this trial, the rationale is more than immunogenicity of course, although it would be nice if some magic happened. The more prosaic motivation is to see if one can safely improve local control and thus maybe pFS and OS by judiciously dose escalating with a highly conformal and upfront boost.

This is a lot different than escalating all disease from 60-74 Gy...not exciting, but different.

Agree about the sequencing question though, and all these arguments come out with every negative concurrent XRT/IO trial.

I'm convinced that radiation induced immunogenicity is a high variance problem in people. (Much less so in nude mice...why we have baller pre-clinical data.) In fact, I'm convinced that prior to the advent of targeted IO to conserved proteins like PD-L1, the high variance problem was why IO had been such a flop over 30 years of clinical research, despite clear evidence of periodic complete responses in patients.
Agreed completely.
 
Inside joke?
IMG_1055.jpeg


Revenue Cycle wrote a letter to CMS asking for abolishment of direct virtual in which it called itself the leading billing and compliance rad onc company in America.

And this leading company’s CEO called an anon twitter account “limpy.”

Strange times.
 
[Edit] Wow if you read this physican's Twitter feed (she is a Med Onc), you can tell that she has some pent up issues. Maybe she ought to take up MMA or kickboxing to vent. Also, she REALLY likes N95 masks.

Yeah. I almost feel bad reposting that public tweet. There's clearly a lot going on.
Unfortunately I know another another MD way waaayyyy farther off in crazy town. It blows my mind what people think is appropriate to post on X under their own name as professionals.

Edit: Her rage tweets about patients trashing their liver with supplements are not wrong. I'll give her that. I am tired of seeing patients with ALI from taking veterinary fenbendazole because some guy online (who also happened to be on IO coincidentally) had a CR using it.
 
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Everyone else is crazy but me...


N95 masking in 2022, but not masking now as best as one can tell. "Do you not know that there comes a midnight hour when everyone has to throw off his mask," said Kierkegaard. Wonder when her midnight hour finally occurred. Would genuinely love to understand that logic.
 

When the Canadian naturopathic clinics are telling you it's quackery, you know you are in another level. Kind of like that time Kanye made Alex Jones look normal.

 
When the Canadian naturopathic clinics are telling you it's quackery, you know you are in another level. Kind of like that time Kanye made Alex Jones look normal.

Uh I take it this concept is going viral right now? Pun...somewhat intended...

I encountered this for the first time in my clinic two days ago.

"Is it OK to keep doing my holistic treatments during radiation?"

"What kind of holistic treatments?"

I think I confused the heck out of the patient when I told them using an actual, honest-to-God drug was NOT something you can call "holistic"...
 
Unless NEJM is putting pronouns, race/ethnicity, and age in the author byline these days - this is not a Tweet you can make without intentionally doing detective work on each author's pronouns, race/ethnicity, and age...

It's unfortunate she's so preoccupied with labels. It doesn't seem like a very equitable opinion, and her Tweets on the matter seem quite exclusionary.
 
Uh I take it this concept is going viral right now? Pun...somewhat intended...

I encountered this for the first time in my clinic two days ago.

"Is it OK to keep doing my holistic treatments during radiation?"

"What kind of holistic treatments?"

I think I confused the heck out of the patient when I told them using an actual, honest-to-God drug was NOT something you can call "holistic"...

Get a CMP on any patient coming in on any sort of dewormer.
The transaminase elevations will garner honorary membership at the local college fraternity.
 
Get a CMP on any patient coming in on any sort of dewormer.
The transaminase elevations will garner honorary membership at the local college fraternity.
NEW GRAY ZONE CASE

SOMEONE CALL RED JOURNAL

(these tips are infinitely more useful than yet another 5 fraction case report)
 
Unless NEJM is putting pronouns, race/ethnicity, and age in the author byline these days - this is not a Tweet you can make without intentionally doing detective work on each author's pronouns, race/ethnicity, and age...

As an aside, I find it so interesting that for a while it was basically a cardinal sin to assume gender or ethnicity in these kinds of DEI papers.

Yet, the ones most vocal about it seem to do it all the time when it is really the only way to complete the "study".

The fact that this medical oncologist pointed out THAT aspect of THAT study as what she is mad about... man, oncology is so far gone 🤣 😢
 
As an aside, I find it so interesting that for a while it was basically a cardinal sin to assume gender or ethnicity in these kinds of DEI papers.

Yet, the ones most vocal about it seem to do it all the time when it is really the only way to complete the "study".

The fact that this medical oncologist pointed out THAT aspect of THAT study as what she is mad about... man, oncology is so far gone 🤣 😢
Karen is upset!
 
As an aside, I find it so interesting that for a while it was basically a cardinal sin to assume gender or ethnicity in these kinds of DEI papers.

Yet, the ones most vocal about it seem to do it all the time when it is really the only way to complete the "study".

The fact that this medical oncologist pointed out THAT aspect of THAT study as what she is mad about... man, oncology is so far gone 🤣 😢

Some people make careers based on clinical trials.

Some make a career over being angry on social media. What they are angry about is variable, it's the being angry part that is what makes their career.
 
As an aside, I find it so interesting that for a while it was basically a cardinal sin to assume gender or ethnicity in these kinds of DEI papers.

Yet, the ones most vocal about it seem to do it all the time when it is really the only way to complete the "study".

The fact that this medical oncologist pointed out THAT aspect of THAT study as what she is mad about... man, oncology is so far gone 🤣 😢
i just don't get it.
i am all about equity, but DEI being applied to everything is just ridiculous.
Applying her logic - you can always find something to be upset about. If there were women on the paper, then the next logical step is...well are they diverse?

I mean should we start applying DEI to athletics? I guess there is some work in the NFL for head coaches.
 
i just don't get it.
i am all about equity, but DEI being applied to everything is just ridiculous.
Applying her logic - you can always find something to be upset about. If there were women on the paper, then the next logical step is...well are they diverse?

I mean should we start applying DEI to athletics? I guess there is some work in the NFL for head coaches.
The "DEI/Woke" pendulum swung too far.

We're back to another era of "let's get weird".

I wonder what's next?
 
Well, we do have an election coming up soon…
Yes, it's a choice between a white, male octogenarian with diminishing faculties and a white, male octogenarian with diminishing faculties. Outside of academics and academic medicine, as far as I can tell, this woke/dei agenda, as it were, is dying.
 
I do love that ‘swung too far’ means, checks notes, some white dudes are annoyed by tweets.

My take on this stuff is that it comes with the territory and you may not like everything that is said but that’s kind of the point.
 
I do love that ‘swung too far’ means, checks notes, some white dudes are annoyed by tweets.

My take on this stuff is that it comes with the territory and you may not like everything that is said but that’s kind of the point.
Incorrect - I would argue that has always been the case.

The difference between now and say, 5-8 years ago, is that there is open opposition to DEI and it's not a career death sentence.
 
I’m so glad that people can be against DEI, I agree that was a major societal problem that we needed to overcome. Progress has been made. /s
 
I’m so glad that people can be against DEI, I agree that was a major societal problem that we needed to overcome. Progress has been made. /s
I mean yea, there’s like one black head nfl coach now!
 
I’m so glad that people can be against DEI, I agree that was a major societal problem that we needed to overcome. Progress has been made. /s
Hahahaha

While others may say that, that's not my particular point.

There's always a "thing", a cause or an interest that gets picked up by the population and grows in popularity. On the upswing and the peak, you can't be skeptical of "the thing" without out-of-proportion backlash.

This is easily observable in RadOnc. With the workforce stuff. It's why I used the word "pendulum" - that was in the title of Chirag's 2013 paper we call "bloodbath".

11 years later, talking about the workforce goes...very differently.

Now, that's not to say there won't ALWAYS be consequences for having an opinion on issues, especially if it's the minority opinion.

We're on the downswing of DEI/woke at the moment. There are many other candidate issues. There doesn't seem to be a clear winner...yet.

It sort of depends on if WW3 or Civil War II happens first, I guess.
 
Nobody bats 1000. Reasonable enough question to investigate if using devices that pump enough RF energy out to put a hi def movie in front of you wirelessly in a few seconds could potentially be harmful. The guy is not motivated by any external interests and that says a lot when comparing to the other two choices of pus$y grabber and senile corrupt grandpa.

The biggest issue I had with him, is in his book when he suggested that HPV vaccines actually cause cervical cancer, and he provided a reference, which was invalid and I could find no actual evidence at all for this claim on a independent search. On the other hand we have a generation of doctors that actually believe that HPV vaccines provide durable complete immunity against HPV, which they do not: They lower your risk of acquiring HPV, however you still very much can get it despite being vaccinated against it. They just reduce the risk of acquiring the harmful strains during the critical period of adolescence. It’s amazing to me how few people understand this. (Yes, I’ve been vaccinated myself).

Medical science gets a lot of things wrong and is constantly updating recommendations that were sure things before. It is simply cult like behavior to not be able to admit “we might be wrong about this” and mock and shame anyone who asks questions out of a genuine desire to prevent harm.
But you'd sign someone that had one hit in 500 at-bats?
 
Yes, it's a choice between a white, male octogenarian with diminishing faculties and a white, male octogenarian with diminishing faculties. Outside of academics and academic medicine, as far as I can tell, this woke/dei agenda, as it were, is dying.
 
Economy?
Climate?
Inflation?
America's role in the world/NATO?
Trade wars?
Culture wars?
Border wars?
Drug wars?
Taxes?
Protecting democratic institutions?
Jobs?
Corporate greed?
Political extremism/violence?
Bodily autonomy?
Voters' rights?
Cost of/access to healthcare?
Supreme Court?
Entitlements, Social Security/Medicare?
Housing crunch/cost?
Education?
Middle class dream disappearing?
Disaffected youth?
Declining reproduction rates?

Screw all that. THEE only issue worth caring about in 2024 is COVID-19 vaccinations.
 
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Economy?
Climate?
Inflation?
America's role in the world/NATO?
Trade wars?
Culture wars?
Border wars?
Drug wars?
Taxes?
Protecting democratic institutions?
Jobs?
Corporate greed?
Political extremism/violence?
Bodily autonomy?
Voters' rights?
Cost of/access to healthcare?
Supreme Court?
Entitlements, Social Security/Medicare?
Housing crunch/cost?
Education?
Middle class dream disappearing?
Disaffected youth?
Declining reproduction rates?

Screw all that. THEE only issue worth caring about in 2024 is COVID-19 vaccinations.
Our current "elite" rests on the assumption that their credentials (thought to be synonymous with intelligence or good judgement or whatever) assures good decision making and technocratic skill. But what happens when this managerial elite, whose right to rule rests on making better decisions than the great unwashed can on their own -- no longer are "right"? When this managerial elite are publicly, embarrassingly wrong? When peoples lives and livelihoods suffered so greatly? With never an apology, never accountability, only MoveOn. Btw, this isn't a partisan statement; you can pick your great issue of the past, and many of those technocrats or politicians are still around, still held in "esteem", zombies of the current process, held in place because they're "our guy". Why should anyone trust the same folks who were so wrong to address correctly or competently anything on that list?
 
They are going to find, at their own peril, that there a lot more out there who are waking up to what happened now that questioning the narrative doesn’t immediately make you a pariah. The current administration literally tried to use OSHA to force 90 million Americans to take an experimental therapeutic funded by taxpayers to enrich big pharma with liability shields, at the threat of losing their livelihoods. There is no way I could ever support these people again just based on that.

But he should be thrilled with the incessant tangents he posts back to Trump. Given that I will never vote for anyone who supported the above, Bobby Kennedy has peeled away a Trump vote. There are a lot like me.
Galaxy brain level take right here
 
i just don't get it.
i am all about equity, but DEI being applied to everything is just ridiculous.
Applying her logic - you can always find something to be upset about. If there were women on the paper, then the next logical step is...well are they diverse?

I mean should we start applying DEI to athletics? I guess there is some work in the NFL for head coaches.

I mean she's a white woman.... so it wouldn't be her career that would be facilitated by being made that there was no diversity on the paper.

But wait, looking at the FULL author list (if you click 'et. al' on NEJM):
1711389504479.png


I am not going to bother googling all of these names, but surely some or most of those circled in red are probably women?

So we (the proverbial 'we') are outraged because the female names are all 'below the fold' as one would say if talking about newspapers? But co-authors on a NEJM paper?
 
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