Aug 17, 2010
280
0
Status
Hey everyone,

As we go through this interview process, I am hoping to find a program that is strong in CNS. Would anyone be able to name a few programs with good CNS exposure/research? Thanks, and good luck to everyone!

Seldon
 
OP
S
Aug 17, 2010
280
0
Status
For Radiation Oncology only:

UCSF, Pitt, Harvard, MDACC, Wisconsin are strong in the field both scientifically and politically.
Thanks so much! Any advice on these programs as well for CNS and CNS research:

Stanford, Duke, NYU, Jefferson, UVA

Thank you!
 

Charles_Carmichael

Moderator Emeritus
10+ Year Member
7+ Year Member
May 11, 2008
4,078
41
Status
Non-Student
I always thought that Mehta's responses in the Red Journal regarding Tomotherapy seemed sort of like the pot calling the kettle black type of thing. Any others felt similarly or am I just an idiot who misreads/misunderstands things?
 
Last edited:

SimulD

Senior Member
15+ Year Member
Apr 22, 2001
1,622
3
Alexandria, VA
Visit site
Status
I don't understand the question you are asking, K.

I think not disclosing is poor form on his part, but at the same time, the type of people that would read that journal (well, at least from the US) would know that he had an association with Tomo, like if the Stanford or UPMC guys wrote an article supporting CyberKnife - we know they have a little more than the standard academic interest in it.

I don't mean to say he was right, but if he had disclosed, it wouldn't have changed anything for me. I know a UW guy is going to be pro Tomo, just like someone from Loma Linda is going to be pro proton.

I'm not saying that science is inevitably corrupted by corporate interests, but anyone that has attended ASTRO in the last 5 years knows that there is more vendor space then there is space for posters. We can't assume that our specialists are not corporate shills. In fact, my assumption is that they all are and they have to tell/show me something to prove that assumption otherwise.

This message was brought to you by Vac-Lock....

-S
 

medgator

Senior Member
10+ Year Member
Sep 20, 2004
4,224
1,085
Status
Attending Physician
I always thought that Mehta's responses in the Red Journal regarding Tomotherapy seemed sort of like the pot calling the kettle black type of thing. Any others felt similarly or am I just an idiot who misreads/misunderstands things?
I actually liked the CNS didactic talks I heard from him at the national meetings. He'd throw a plug in for tomo here and there, but overall I thought they were good lectures.
 

Cancerdancer

10+ Year Member
Jul 20, 2007
212
21
Status
Resident [Any Field]
So, in the spirit of disclosures, Dr. Mehta wrote me a letter of rec for residency, and has been very good to me.

That said, a lot of this was ridiculous...
1. The article he got in trouble for not disclosing on was a physics article on which he was 4th author, looking at daily setup variation (PMID 19251098). I doubt he contributed to the manuscript in any real sense, and it certainly wasn't touting superiority of Tomo vs any other modality. I would question whether the disclosure form even made it to his desk...

2. Glatstein lambasted Mehta for not writing about his affiliation with Tomo. However, the article in question by Mehta clearly says he's a UW professor and Tomo consultant in the byline of the article. How much clearer could that have been? I guess you have to write it into every paragraph...

3. The article that Mehta criticized made claims about the superiority of another technology vs Tomo, without every treating a patient on Tomo. That was the thrust of Mehta's critique...that unscientific claims should not be given scientific validity by acceptance into a peer-reviewed journal. Seemed to be a pretty reasonable critique, which is why I would imagine the Red Journal published it...
 

Charles_Carmichael

Moderator Emeritus
10+ Year Member
7+ Year Member
May 11, 2008
4,078
41
Status
Non-Student
I don't understand the question you are asking, K.

I think not disclosing is poor form on his part, but at the same time, the type of people that would read that journal (well, at least from the US) would know that he had an association with Tomo, like if the Stanford or UPMC guys wrote an article supporting CyberKnife - we know they have a little more than the standard academic interest in it.
Sorry for not being clear. What I had in mind was his back-and-forth thing with one of the authors of a VMAT study (IIRC) who suggested that VMAT > Tomo. And I think one of the editors of the Red Journal also posted a response. I'm not completely sure since I'm at home and, with a slow internet, it would take me too long to log on to the VPN to verify. I honestly can't remember too much of this discussion since I read it around 1.5-2 monts ago (or something like that). Hopefully, you guys know what discussion I'm referring to. I just thought it was funny that it was essentially a clash between two groups that had conflicts of interest: Tomo vs. VMAT. That was what prompted my question.

I actually liked the CNS didactic talks I heard from him at the national meetings. He'd throw a plug in for tomo here and there, but overall I thought they were good lectures.
Don't get me wrong. I really enjoy reading Mehta's studies and his responses to studies done by others. Based on just what I've read, it seems like he would be a great lecturer. Hopefully, I'll have the opportunity in the near-future to meet him in person and listen to one of his didactics. What I mentioned above was pretty much what I had in mind when I wrote my OP.

In defense of Mehta...
I apologize if I came off as someone attacking Mehta. Like I mentioned above, it was really the back-and-forth between authors with conflicting interests that I was thinking about when I made my OP. I just thought it was kind of a funny discussion, is all.
 

G'ville Nole

Member
10+ Year Member
15+ Year Member
Jun 2, 2002
291
0
Ocala, FL
Visit site
Status
Attending Physician
I can promise you that Minesh's reasons for departure had little if anything to do with disclosures and COIs.

My disclosure in this situation is that Minesh is a friend, and foremost among all of my mentors. If he has a fault in this situation, it is that he's so genuinely excited by the science of what he's doing that he fails to consider how his relationship with TomoTherapy may color the way others view his opinions, and he probably should have remained silent rather than air his (legitimate) critique of a different platform, thus subjecting himself to these accusations. It's easy and understandable in this day and age how those who don't know the man will default to the more cynical view, that he is just a shill for Tomo. If you know him, or have read any of his manuscripts dealing with Tomo (I think I've read most of them), his work is no more advertisement for Tomo than Adler's is for CyberKnife, Kondziolka's for Gamma Knife, or Slater's for proton therapy.

A question for the "pure" academicians who are now falling over themselves in anti-industry self-flagellation (and probably don't read this board, so nobody take this personally): are these guys NOT supposed to publish manuscripts that provide a validation for the continued adoption of these technologies? In all the cases I noted above, the investigators' focus is on the technology, not the tool. The problem is that platforms such as Tomo and CyberKnife are unique in their delivery, thus making the technique and the tool inseparable.

Incidentally, Eli was pretty vocal about jhis problems with wider adoption of proton therapy during Eric Hall's talk at ASTRO 2006. He's been curiously silent on the subject since Penn's proton center opened. OMG, is that Ivory Tower really off-white? The VMAT/Tomo dispute would probably have been more deftly handled by John Stewart.

Whatever faults you may perceive in him, you will not find a nicer or smarter guy in the field than Minesh Mehta. That is saying a lot, but I stand by it. Northwestern is lucky to have him, and it is certainly Wisconsin's loss. And Kaushik, this isn't directed at you or GFunk or anyone else. I just happened to have a more personal perspective, and a bit of a rant, and wanted to share both.
 

SimulD

Senior Member
15+ Year Member
Apr 22, 2001
1,622
3
Alexandria, VA
Visit site
Status
Man. Northwestern has got a pretty great situation - tons of clinical volume, some big names, technology, amazing location, big medical center. Wonder why it isn't considered a top program.

I didn't mean to say he's a shill - I'm just saying the guys that write about one technology over and over (b/c that's what they use) ... well ... let's just say if Dr. Kondziolka or Dr. Mehta or Dr. Waggoner found a negative aspect to their platform, I have a hard time believing they would rapidly submit something like "GammaKnife / TomoTherapy / X-Platform outcomes found to be worse than other framless linac based radiosurgery for the treatment of X disease"

That's all I'm getting at - the way the branding/marketing is in our field, it just makes things challenging to tease out what is science and what isn't.

-S
 

Gfunk6

And to think . . . I hesitated
Moderator Emeritus
Lifetime Donor
15+ Year Member
Apr 16, 2004
3,620
652
SF Bay Area
Status
Attending Physician
And Kaushik, this isn't directed at you or GFunk or anyone else. I just happened to have a more personal perspective, and a bit of a rant, and wanted to share both.
No offense taken, it's valuable to have input from somenone who knows the man well.

SimulD said:
let's just say if Dr. Kondziolka or Dr. Mehta or Dr. Waggoner found a negative aspect to their platform, I have a hard time believing they would rapidly submit something like "GammaKnife / TomoTherapy / X-Platform outcomes found to be worse than other framless linac based radiosurgery for the treatment of X disease"

That's all I'm getting at - the way the branding/marketing is in our field, it just makes things challenging to tease out what is science and what isn't.
I also agree with this statement. Studies with pharmaceutical freebies show that physicians (like all people) are influenced by financial considerations. This is not bad or unethical but simply human nature which is why disclosures are important.
 

G'ville Nole

Member
10+ Year Member
15+ Year Member
Jun 2, 2002
291
0
Ocala, FL
Visit site
Status
Attending Physician
let's just say if Dr. Kondziolka or Dr. Mehta or Dr. Waggoner found a negative aspect to their platform, I have a hard time believing they would rapidly submit something like "GammaKnife / TomoTherapy / X-Platform outcomes found to be worse than other framless linac based radiosurgery for the treatment of X disease"
Totally agree with this, and to push the concept further, not only does "publication bias" affect the body of literature, fear of a negative result for one's pet modality affects the design of clinical trials. Proton therapy is a great example. Skeptics of the therapeutic benefit of protons largely reside in practices without protons, and thus can't conduct a randomized comparison. Conversely, the proton centers have little incentive to conduct a superiority trial, as they effectively "kill the goose" with a negative result.

And Simul, it's all good. I felt compelled to provide a defense of Minesh, but outside of the linked material, nothing I saw in this thread constituted an attack per se. Just playing Harry Potter to his Dumbledore. OK, maybe Neville Longbottom, but still.

Back on topic, I'd add UCSF to the list of good CNS institutions.
 
Aug 4, 2010
20
0
Status
So I seem to have steered this conversation in the wrong direction with my simple question of where Mehta went after Wisconsin. For what it's worth, regardless of his reasons for departing, many of these journals do not require anyone except the first author to sign a conflict of interest statement. If I remeber correctly, the red journal only requires a first author, but JCO required everyone listed to sign. The volume of publications that some major authors produce, I can easily see how it would be overlooked in error. It seems such a minor issue in our field, but in other fields where there is a much more intimate relationship with the drug industry, this is much more common. As much as people would like to think it ruins careers, many switch institutions and move through unscathed. Nemeroff's move from Emory to Miami easily comes to mind.
I've asked this around, and if anyone has thoughts, please pipe up- but I don't think ghost writing is an issue with rad onc the way it is in psych or cards. Mehta may be promoting tomo, but at least you know he wrote it himself.

And since when should we rely on common media outlets to accurately and truly report about what happened in his situation? The coverage seemed to be sensationalized for the sake of a quick hit of a mouse button or two. I don't know Mehta, or why he left, but I am not sure how much credence I would give to what is in the mainstream media links in this thread.
 

Gfunk6

And to think . . . I hesitated
Moderator Emeritus
Lifetime Donor
15+ Year Member
Apr 16, 2004
3,620
652
SF Bay Area
Status
Attending Physician
To get back on the topic of this thread, CNS strength is a bit of a dicey issue because it is a multi-disciplinary field. Ideally you would like strength not only in Rad Onc, but also in Neurosurgery and Neuro Onc. The latter is quite rare to see as a separate department even in large, academic medical centers. Finally, if you have a strong concentration of clinicians then this will almost always mean strong clincal/basic CNS research, which is also quite important.

In my mind a strong CNS program has strength in all three clinical fields + strength in research -- this is relatively rare. More often than not, an institution will have very strong Neurosurgery but relatively weak Rad Onc/Neuro Onc. This may be a good or bad thing for you depending on the institution or people involved. Good in that there is a degree of CNS strength already that you can build on, that you have potentially strong collaborators, and that you have the opportunity to build a program and make it your own. Bad in that surgeons may take a dim view towards Rad Onc and this can be reflected in institutional biases.