We aren’t the only ones doing low impact research

[Chartreuse Wombat]

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CT screening for lung cancer for homeless people: the new JAMA IM paper

Common sense is dead, and careers are made from useless research.

open.substack.com

 

[Palex80]

Empty stomachs / muscle mass were likely a secondary endpoint?

 

[deleted1180461]

There are rad oncs and med oncs out there who believe that lung cancer screening has a near 100% positive predictive value and use that justify SBRT to basically every nodule that is discovered on their in house screening programs using machines they own forgoing biopsy because it could cause a "collapsed lung"

I gave up arguing against this nonsense. They don't know the data and they don't care. What's the negative predictive value on screening studies? Crickets. Actually, F you for asking that question. Cognitive dissonance to the max. They are treating stuff that isn't cancer because it "grew" on serial scans. Guess what? Benign lung nodules don't just pop up overnight to their largest size.

100% of this crap care gets paid for and I can't get an SBRT boost for very high risk prostate cancer covered?

I love me some Vinay Prasad

Especially his article on the ridiculousness of the covid mask-psuedoscience: Mask studies reach a new scientific low point

 

[medgator]

I love me some Vinay Prasad

Especially his article on the ridiculousness of the covid mask-psuedoscience: Mask studies reach a new scientific low point

Ok khe/turaco

 

[communitydoc13]

CT screening for lung cancer for homeless people: the new JAMA IM paper

Common sense is dead, and careers are made from useless research.

open.substack.com

I don't read Prasad often and have disagreed with him on specific issues in the past. He is pretty opposed to lung CA screening, and usually I am not.

He is well aware that controversial positions carry more purchase regarding building a personal brand than conventional ones. It's a pretty seductive position to many "Kennedy anyone" to position yourself in opposition to the medical establishment.

On this particular paper, I agree with him. However, I don't agree with the narrative that this type of research is why "we" are collectively lamenting low impact research in our field. I suspect there are anecdotal cases that are very bothersome to us. Academics building careers and getting promotions based on non-actionable disparity research, when doing real science is just very, very tough and other docs are seemingly getting passed by.

But, nearly all research is low impact. I would argue that most basic science research is so esoteric that only a sliver of it becomes incorporated into applied work. This doesn't mean that basic science research is not valuable or critical. You need lots of low impact work to support the rare high impact work. Often basic science work will demonstrate impact decades after publication, if only in directing the work of others.

What we are lamenting is the lack of clinically "high impact" therapies or narratives emerging from all of our research effort. This is not because of docs doing DEI stuff. This is because our field is unlikely to be the source of such a therapy or story...period. Cancer is overwhelmingly a nuanced, high variance, biologically driven phenomenon, and we are in the business of refining a physical tool. It's just not that fruitful anymore. We collectively jumped on XRT as an immune modulator based on case reports and low variance animal studies. We have invested enormous amounts in pursuing a very high cost intervention that deposits energy slightly differently (and much less predictably) than photons. Neither of these have given us anything resembling the types of KM curves we routinely see with new targeted systemic therapy nowadays.

Lets not create a false bogeyman.

Risk stratification, reduced fractionation, reduced volumes, personalized avoidance of XRT altogether and DEI is what we've got.

How many iterations of systemic therapy have our medonc colleagues seen in the past 8 years regarding triple negative breast cancer? Oh yeah,...and it matters.

 

[deleted1180461]

Ok khe/turaco

What?

Is treating random lung abnormalities without a tissue diagnosis really that controversial?

Edit: oh you mean the masks. Yeah there are, uh, lots of people who have realized that was all complete bs. Censoring anyone who wants to discuss mask and vaccine data is so 2021.