- Joined
- Dec 17, 2007
- Messages
- 3,674
- Reaction score
- 5,120
I bet we all use IMRT 100 percent of the time, what is the level one evidence that it is superior to non IMRT methods.

I bet we all use IMRT 100 percent of the time, what is the level one evidence that it is superior to non IMRT methods.
Fair but look at the financial delta between IMRT and 3d. Protons vs IMRT far greater with no evidence to support superiorityI love to poke fun as much as the next guy, especially to deflate hypocrisy or pomposity. But my dad used to start meetings sometimes with “one of these days we all need to get together and be honest.” Whenever we use IMRT (a “device” I’d argue, as would CPT 77338) for prostate cancer, and I bet we all use IMRT 100 percent of the time, what is the level one evidence that it is superior to non IMRT methods.
Dan is probably charging most insurances 5-10x cms rates and has satellites throughout the metro. He is playing the same game. Its ok to charge prices 10x that of a small community hospital for same services, but somehow problematic to hype a shiny new robot.
Still happening on his watch. Where does the buck stop? Not the chairman?‘dan’ as if he has anything to do with that let’s be real
Still happening on his watch. Where does the buck stop? Not the chairman?
He is a real go-getter. No doubt, he is growing his department by capturing patients from nearby community centers so to receive high priced care under the university umbrella.‘dan’ as if he has anything to do with that let’s be real
What a strange stretch of apples and oranges.Even if you didn't build the glass house in which you live, it is not a good idea to throw stones from it
No but chair knows how to keep the C-suite happy. Corporate medicine in action.chair got nothing to do with negotiated rates
Half of applicants are getting in. I thought it used to be 1/4th?Med school boom? I'm not sure what that was, or when. It looks like we graduate <30,000 MDs and DOs yearly in the US. I'm all for emphasizing that medicine is not what you think or hope it might be but having 2+ times as many applicants as spots only seems like those dreams that were unrealistic in the first place might be over. Maybe my math is wrong/I'm missing something.
I think it was around 1/3 15 or 20 years ago.Half of applicants are getting in. I thought it used to be 1/4th?
Should be 42,900 residency positions if our residency programs could get it together!According to a quick search there are about 30,000 UD MD/DO medical school positions offered per year and 43,000 residency positions in the match. Seems like we still need a lot more US Med school positions to open up.
Dan is probably charging most insurances 5-10x cms rates and has satellites throughout the metro. He is playing the same game. Its ok to charge prices 10x that of a small community hospital for same services, but somehow problematic to hype a shiny new robot.
‘dan’ as if he has anything to do with that let’s be real
Agree. Typical behavior from the condiments lobbyAgree with drowsy. Seriously, this is a moving of the goal posts from some of you guys. Why you so obsessed w/ Dan Spratt?
Yes academics and hospital systems get to charge more. This was happening before Spratt became chair and is completely unrelated to him existing.
It started with 'doesn't Spratt push protons'?
The answer was 'no, he's actually pretty conservative in regards to benefits and criticizes protons especially for prostate more than the average Rad Onc who is in a position of power. He criticizes them DESPITE having access to a proton machine at his facility, which is a significant rarity (generally those who are pro protons for prostate work for a proton center, generally those who are against protons for prostate work at a center that does NOT have protons)'
Then, there was a search about a portion of a UH website that is about proton cancer mentions the world prostate, and thus immediately the worst is assumed. Here is the FULL EXCERPT, bold my emphasis:
"Protons are most successful in treating solid tumors with well-defined borders that have not spread to other areas of the body. As such, proton therapy is most often used for tumors of the brain, head, neck, lungs and spine, although it can also treat eye melanoma, pituitary gland tumors, prostate cancer and a number of other contained cancers. Proton therapy can be combined with other forms of radiation and chemotherapy and can even be used as a follow-up treatment to surgery to help eradicate cancer from the surrounding tissues."
So yes, proton therapy CAN be used to treat prostate cancer. Sure, it doesn't say whether it should or it shouldn't, but proton therapy can clearly be used to treat prostate cancer (even though IMO it shouldn't because there's no benefit to an individual patient and harm on a global scale).
I'm not saying Dan Spratt is amazing either, but, when it comes to prostate cancer, he is, IMO, at least consistent. He argues against non evidence based things and claims, regardless of who is making money off of it.
View attachment 402738
View attachment 402739
View attachment 402740
View attachment 402741
I would say, he likes protons.
But not for prostate.
See so much for RPHow about „treatment regret“ as an endpoint?
Ditto for XRT. All about your patient population.See so much for RP
Love rad onc and rad oncs, but there's a seductive blind spot for patients' radiation toxicities and regrets therefrom; takes a good decade or more in rad onc practice to start to understand this. In our defense, the chronologies of radiation toxicities are just so remarkably different than the chronologies of surgical or drug toxicities.Ditto for XRT. All about your patient population.
Ditto for XRT. All about your patient population.
Well well well folks. Looks like the failure rates on boards back up to six percent. Man is it any surprise why any of this is happening? PDs and APDs lowered standards to match any warm body with a pulse. I reckon the mayo PD essentially echoing Trump that the first class of the decreased standards was “the best ever” (the very best people!). is this only the beginning of what is to come. Is ABR going to “cook the books” to pass all the warm bodies? Discuss.
I blame AI.Well well well folks. Looks like the failure rates on boards back up to six percent. Man is it any surprise why any of this is happening? PDs and APDs lowered standards to match any warm body with a pulse. I reckon the mayo PD essentially echoing Trump that the first class of the decreased standards was “the best ever” (the very best people!). is this only the beginning of what is to come. Is ABR going to “cook the books” to pass all the warm bodies? Discuss.
Inb4 someone publishes a paper showing cetuximab inferior to cisplatinJust give concurrent cetuximab and beam on.
gotta start by comparing cetux to RT alone. there are 2 papers here.Inb4 someone publishes a paper showing cetuximab inferior to cisplatin
Three papers, gotta show cetuximab doesn't add benefit when combined with cisplatingotta start by comparing cetux to RT alone. there are 2 papers here.
In all seriousness, the proposed mechanism would be blocked by cetuximab as far as i can tell.Three papers, gotta show cetuximab doesn't add benefit when combined with cisplatin
RadOncs everywhere:
![]()
![]()
![]()
![]()
![]()
![]()
Is there a recent paper this is referencing?Just give concurrent cetuximab and beam on.
As i understand it the proposed mechanism is AREG is increased, which is an EGFR ligand. I'm partly joking about it being this simple, but whatever is causing this, if true, isn't magic.Is there a recent paper this is referencing?
this a real deal Nature pub, not Nature Clinical Radiation Oncology. Perhaps biases got it there, as it seems like a red journal article, but simply being a Nature pub makes it "strong" in some sense.The patient portion is so small you could probably have polled on mcdonalds dinery in the last 7 days before treatment and found a significant finding.
![]()
the ish is weak (but not deniable, yet)
Sure, strong is a strong word though, I mean the science and data is good, but low numbers is like a big shrug. Is it reproducible? Does it make any clinical significance? Why is this in nature, but actually practice changing pro RadOnc stuff is relegated to lesser journals? Because it's radiation? Lame.this a real deal Nature pub, not Nature Clinical Radiation Oncology. Perhaps biases got it there, as it seems like a red journal article, but simply being a Nature pub makes it "strong" in some sense.
because it's anti-radiation. ibram x kendi was a middle author.Sure, strong is a strong word though, I mean the science and data is good, but low numbers is like a big shrug. Is it reproducible? Does it make any clinical significance? Why is this in nature, but actually practice changing pro RadOnc stuff is relegated to lesser journals? Because it's radiation? Lame.
Call me crazy, but I am anti, anti-radiation titles promoting papers. I also definitely did not go back to check the author list after throwing up in my mouth a little bit.because it's anti-radiation. ibram x kendi was a middle author.