"Science"

[deleted1111261]

"Mentorship seems to work, maybe kinda" - no hypothesis tested. No cancer related outcomes. Very low numbers in certain domains. One very odd statement - saying one of the hypotheses was that certain groups were more likely to not complete survey and this is in line with "attrition" in medical school. WTF? Quitting medical school is in line with not doing a survey? This is ... uh ... a suboptimal line of reasoning. I cannot imagine using this survey to change anything. Places that encourage this (as they should) will continue to do so - this type of mentorship program has existed across campuses for decades. I don't think anyone is against the idea that it is beneficial for a young _____(identity / racial group) trainee having a senior _____ mentor. Those that don't believe this concept are not going to change because of the article. This is listed under "Research Article". I know many of the authors. This would have made an excellent substack and discussion post and they are to be commended on the project, but as a far as a publication ... well, it will be referenced by other authors and the R J loves swinging around it's impact factor.

"Europe joins the party" - this is an organizational culture article that one would see in sociology journals. In essence, 26 people representing 4 countries in Europe + UK take a survey about personal values and conflicts with DEI principles. There is nothing cancer related. You could have surveyed the non-MD people, or non-hospital environments and then presented this, as well. A very odd choice as a "Research Article". I learned absolutely nothing reading this article about how this would help my practice, my hospital. It didn't change my mind or strengthen my resolve. I still wholeheartedly believe that D E and I (the words themselves, not DEI, Inc) are integral to a functional society. Those that don't believe this won't be swayed and they will ignore this. Those that believe - this does not even provide a hypothesis to test.

(Oh, dear, I am now the Dare You To Reply guy??)

---

Members don't see this ad.

 

[grenz]

"Mentorship seems to work, maybe kinda" - no hypothesis tested. No cancer related outcomes. Very low numbers in certain domains. One very odd statement - saying one of the hypotheses was that certain groups were more likely to not complete survey and this is in line with "attrition" in medical school. WTF? Quitting medical school is in line with not doing a survey? This is ... uh ... a suboptimal line of reasoning. I cannot imagine using this survey to change anything. Places that encourage this (as they should) will continue to do so - this type of mentorship program has existed across campuses for decades. I don't think anyone is against the idea that it is beneficial for a young _____(identity / racial group) trainee having a senior _____ mentor. Those that don't believe this concept are not going to change because of the article. This is listed under "Research Article". I know many of the authors. This would have made an excellent substack and discussion post and they are to be commended on the project, but as a far as a publication ... well, it will be referenced by other authors and the R J loves swinging around it's impact factor.

"Europe joins the party" - this is an organizational culture article that one would see in sociology journals. In essence, 26 people representing 4 countries in Europe + UK take a survey about personal values and conflicts with DEI principles. There is nothing cancer related. You could have surveyed the non-MD people, or non-hospital environments and then presented this, as well. A very odd choice as a "Research Article". I learned absolutely nothing reading this article about how this would help my practice, my hospital. It didn't change my mind or strengthen my resolve. I still wholeheartedly believe that D E and I (the words themselves, not DEI, Inc) are integral to a functional society. Those that don't believe this won't be swayed and they will ignore this. Those that believe - this does not even provide a hypothesis to test.

(Oh, dear, I am now the Dare You To Reply guy??)

These articles just prove that journals chase eyeballs, not good science. I have always thought this about NEJM

 

[Ray D. Ayshun]

What's an ally meant to be? A white person who acts a certain way?

 

[Fpg1245]

These articles just prove that journals chase eyeballs, not good science. I have always thought this about NEJM

But to be fair, they still have good articles just at least I read this more often than RJ.

 

[medgator]

These articles just prove that journals chase eyeballs, not good science. I have always thought this about NEJM

Nejm still publishes actual scientific articles and studies though. RJ has gone straight agenda at this point

 

[temujim]

These articles just prove that journals chase eyeballs, not good science. I have always thought this about NEJM

Current leadership at RJ are ideologues.

 

[RadOncDoc21]

What's an ally meant to be? A white person who acts a certain way?

Definitely one who can’t be acting the other way!

 

[grenz]

Nejm still publishes actual scientific articles and studies though. RJ has gone straight agenda at this point

Yea I don’t mean they’re publishing DEI. they’ll publish case series or phase 1 trials that are bound to get splashy headlines in the lay press. It’s research that is far beneath their impact factor but they know it’ll drive eyeballs and hence advertising revenue

 

[Palex80]

I have always thought this about NEJM

A colleague referred to NEJM as "The Journal of Positive Trials".
Looking at what NEJM publishes, it's always the trial with a positive outcome.
If you fail to meet your endpoint you can forget about getting your trial published there.

 

[Fpg1245]

A colleague referred to NEJM as "The Journal of Positive Trials".
Looking at what NEJM publishes, it's always the trial with a positive outcome.
If you fail to meet your endpoint you can forget about getting your trial published there.

Could always try the lancet

 

[grenz]

A colleague referred to NEJM as "The Journal of Positive Trials".
Looking at what NEJM publishes, it's always the trial with a positive outcome.
If you fail to meet your endpoint you can forget about getting your trial published there.

UNLESS it’s a negative RT (control) vs no RT (experimental) trial, whereby the conclusion is inevitably noRT is not that bad so it should become the standard

 

[Fpg1245]

UNLESS it’s a negative RT (control) vs no RT (experimental) trial, whereby the conclusion is inevitably noRT is not that bad so it should become the standard

NEJM clear messege

Down with RT up with systemic

 

[Gfunk6]

and hence advertising revenue

When was the last time anyone actually "read" the Red Journal - I mean a physical copy? I've not done it in 10 years I think. Sure I read a lot of PDFs but that misses all the wonderful ads.

I tried to get ASTRO to stop sending me physical copies because they just wind up in the recycling bin but they tell me they are contractually obligated to do so.

 

[medgator]

When was the last time anyone actually "read" the Red Journal - I mean a physical copy? I've not done it in 10 years I think. Sure I read a lot of PDFs but that misses all the wonderful ads.

I tried to get ASTRO to stop sending me physical copies because they just wind up in the recycling bin but they tell me they are contractually obligated to do so.

Could just cancel your membership? 🤷‍♂️

 

[evilbooyaa]

Need to rename IJROBP to:

International Journal of Diversity, Inclusion and Trainee Support

"IJDITS"

Buncha Ijdits...

 

[Gfunk6]

Could just cancel your membership? 🤷‍♂️

That's the plan but I pre-paid for three years

 

[sirspamalot]

Several years ago did just that. Got some plaintive emails begging for money. Never a call. After 18 (? at least) years of faithful dues paying, I voted with my checkbook. That, and seeing one of the purest d-bags I have ever known rise to leadership via stagnant academic position (ie hang around long enough, publishing nonsense and having ensured the departure of so many quality peers from the department)..

 

[RadOncMegatron]

(Oh, dear, I am now the Dare You To Reply guy??)

Welcome to the club! haha

 

[medgator]

Along the same vein... Surprised this ended up in advances rather than RJ

Challenges and Solutions for Establishing Robust Diversity, Equity, and Inclusion Efforts in US Academic Radiation Oncology Departments

Hospitals, medical schools, graduate medical education programs, and National Cancer Institute–designated cancer centers have accreditation standards for diversity, equity, and inclusion (DEI) that aim to address the unique challenges arising from each of these structures. Despite this...

www.advancesradonc.org

 

[BobbyHeenan]

DEI and "green" mission creep into red journal/ASTRO....sigh.

I actually have less of a problem with DEI stuff than I do carbon emissions stuff entering astro/red journal.

We would be better off donating that money to nuclear power lobby than wasting space and research dollars on how much carbon a trip for breast xrt emits or how much the linac takes to run. Those considerations are dwarfed by the carbon to get a third world country into the second world (emerging economies) or where carbon emissions are on the ledger of important priorities for China or India. What are the carbon implications of printing a "green" article on rad onc on literal paper then shipping it across the world?

I know I sound like a hater but I just roll my eyes....maybe I'm entering boomer territory?!?! I can just feel my margins on my GTV's growing.

 

[deleted1111261]

This is from this morning.

It’s a critical review of the DEI literature. I tried reading it, but couldn’t figure out how it 1) improved cancer cure 2) decreased toxicity 3) improved cost effectiveness 4) improved delivery of care 5) improved QOL.

It did suggest that more research is needed.

Not a bad article by any means and authors should be congratulated. Just don’t get why it is in this journal.

 

[medgator]

 

[RO28]

DEI and "green" mission creep into red journal/ASTRO....sigh.

I actually have less of a problem with DEI stuff than I do carbon emissions stuff entering astro/red journal.

We would be better off donating that money to nuclear power lobby than wasting space and research dollars on how much carbon a trip for breast xrt emits or how much the linac takes to run. Those considerations are dwarfed by the carbon to get a third world country into the second world (emerging economies) or where carbon emissions are on the ledger of important priorities for China or India. What are the carbon implications of printing a "green" article on rad onc on literal paper then shipping it across the world?

I know I sound like a hater but I just roll my eyes....maybe I'm entering boomer territory?!?! I can just feel my margins on my GTV's growing.

Ok so I'm going to play devils advocate here...what if these are just personal interests of people? For instance the intersection of climate impacts on cancer therapy and public health? Ok maybe it doesn't belong in the RJ, but I don't see anything wrong with trying to meld different interests (though maybe not at the expense of science that accelerates our field grows our footprint) but I do think both can exist.

In the vein of "do what excites you" maybe its okay to have some climate/public health/population health discussion if a certain subpopulation of rad oncs find it more interesting than trying to navigate our exit from breast cancer radiotherapy altogether.

 

[medgator]

Ok maybe it doesn't belong in the RJ

I think that's the crux of what a lot of us have a problem with and what the OP was getting at

 

[deleted1111261]

Ok so I'm going to play devils advocate here...what if these are just personal interests of people? For instance the intersection of climate impacts on cancer therapy and public health? Ok maybe it doesn't belong in the RJ, but I don't see anything wrong with trying to meld different interests (though maybe not at the expense of science that accelerates our field grows our footprint) but I do think both can exist.

In the vein of "do what excites you" maybe its okay to have some climate/public health/population health discussion if a certain subpopulation of rad oncs find it more interesting than trying to navigate our exit from breast cancer radiotherapy altogether.

Very recently -

DEFINE_ME

There are some legit big names on here! Read it fully and tell me how this is science. It’s lovely and pretty well written. It should be a blog post.

If you have interesting ideas:

Publish a substack and discuss these interesting things!

Come on our show to talk about your personal interests! I am happy to have these conversations.

Make your own show/podcast! Even better - add to the ecosystem.

Submit to journals where it makes sense!

The academic rigor of vast majority of these articles would not stand up to peer review in a non-cancer journal. The stats are never great, the conclusions are never actionable and all we get is “more studies are needed”.

I’m okay with a sociology / climate offshoot, but this stuff is just not benefiting patients or the specialty in a meaningful way. And you’ll note that they basically reference each other. There is a careerist aspect to some (not all) of this work.

I’m open to having my mind changed, but there is very little out there that is good science in our book. Once in a while something interesting/useful is published. Then, it’s back to counting types of people again.

 

[RickyScott]

Who would have thought that Canadian Eskimos and aborgines in the outback are highly underserved by linacs.

 

[BobbyHeenan]

Ok so I'm going to play devils advocate here...what if these are just personal interests of people? For instance the intersection of climate impacts on cancer therapy and public health? Ok maybe it doesn't belong in the RJ, but I don't see anything wrong with trying to meld different interests (though maybe not at the expense of science that accelerates our field grows our footprint) but I do think both can exist.

In the vein of "do what excites you" maybe its okay to have some climate/public health/population health discussion if a certain subpopulation of rad oncs find it more interesting than trying to navigate our exit from breast cancer radiotherapy altogether.

I get it. I think that's perfectly reasonable.

I just feel like all that brain power and journal space isn't going to move the needle on global carbon emissions and it doesn't seem to be advancing the field...so I know I'm just kind of a hater here. But if someone is interested in it ok, sure.

But I see what you're saying.

 

[RO28]

Very recently -

DEFINE_ME

There are some legit big names on here! Read it fully and tell me how this is science. It’s lovely and pretty well written. It should be a blog post.

If you have interesting ideas:

Publish a substack and discuss these interesting things!

Come on our show to talk about your personal interests! I am happy to have these conversations.

Make your own show/podcast! Even better - add to the ecosystem.

Submit to journals where it makes sense!

The academic rigor of vast majority of these articles would not stand up to peer review in a non-cancer journal. The stats are never great, the conclusions are never actionable and all we get is “more studies are needed”.

I’m okay with a sociology / climate offshoot, but this stuff is just not benefiting patients or the specialty in a meaningful way. And you’ll note that they basically reference each other. There is a careerist aspect to some (not all) of this work.

I’m open to having my mind changed, but there is very little out there that is good science in our book. Once in a while something interesting/useful is published. Then, it’s back to counting types of people again.

Yep, I agree with all of this.

I think there are certain situations within these tangential topics where we can link it directly to patient care and in that arena could be a way to grow the impact that radiation oncologists have on the big picture (rather than being just a technician in the basement...which we are NOT).

But again, to your point, it shouldn't come as an ALTERNATIVE to publishing science to further our field.

 

[deleted1111261]

I should separate the environmental articles from the rest.

This is low hanging fruit and can easily reduce carbon emissions.

This is a worthy goal, IMO.

 

[NotMattSpraker]

Yep, I agree with all of this.

I think there are certain situations within these tangential topics where we can link it directly to patient care and in that arena could be a way to grow the impact that radiation oncologists have on the big picture (rather than being just a technician in the basement...which we are NOT).

But again, to your point, it shouldn't come as an ALTERNATIVE to publishing science to further our field.

They have a published scope that they no longer follow because they... Im guessing... are chasing clicks. There is no other explanation I can think of to explain these papers.

Honestly, I do not mind the topics. I like the environmental stuff. Its just the scientific rigor is poor. The discussions are way over stated. I had high hopes for some innovation with the EIC change, very disappointed the way its gone.

 

[medgator]

He's on a roll...

 

[sirspamalot]

And that role? Shining light on the silliness of RJ.

ASTRO is the new AMA....

 

[medgator]

And that role? Shining light on the silliness of RJ.

ASTRO is the new AMA....

Far more malignant than the AMA imo. Junk mail for life insurance and membership renewal has nothing on actively promoting policies to hurt non academic practitioners in a specialty

 

[Fpg1245]

Far more malignant than the AMA imo. Junk mail for life insurance and membership renewal has nothing on actively promoting policies to hurt non academic practitioners in a specialty

Definitely not a comparison worth making. ASTRO has ****ed me and my future more than the AMA could even dream of accomplishing. Isn’t the AMA considering dumping rad onc from its delegation anyway?

 

[medgator]

https://www.redjournal.org/article/S0360-3016(23)00450-9/fulltext?s=09

Neha trying to up the unemployment rate for new grads going forward. The only thing more effective than switching everything to 0-5fx is just replacing the damn RO.

The kind of thing that's perfectly at home getting published in the IJROBP in 2023

 

[BobbyHeenan]

https://www.redjournal.org/article/S0360-3016(23)00450-9/fulltext?s=09

Neha trying to up the unemployment rate for new grads going forward. The only thing more effective than switching everything to 0-5fx is just replacing the damn RO.

The kind of thing that's perfectly at home in the IJROBP

And unless I missed it, nary a whiff of this type of thing (or utilization of NP's/PA's) in the ASTRO workforce study. We can just ignore a huge existential threat...

 

[Fpg1245]

And unless I missed it, nary a whiff of this type of thing (or utilization of NP's/PA's) in the ASTRO workforce study. We can just ignore a huge existential threat...

Should be nipped in the bud but really this is just so the RO depts at mega health Corp can push wages down further.

 

[medgator]

Should be nipped in the bud but really this is just so the RO depts at mega health Corp can push wages down further.

ROs version of HCA expanding EM training programs and pushing APPs in the ED

 

[Gfunk6]

I think it would be more relevant to talk about cross training of Rad Onc residents into Therapy, Dosimetry and Physics. Talking about APPs replacing physicians is a “problem” that doesn’t need solving.

 

[Fpg1245]

I think it would be more relevant to talk about cross training of Rad Onc residents into Therapy, Dosimetry and Physics. Talking about APPs replacing physicians is a “problem” that doesn’t need solving.

Gonna solve it for you anyway

 

[sirspamalot]

LOL. The admins would love us ALL to be replaced..

 

[RadOncDoc21]

LOL. The admins would love us ALL to be replaced..

It’s funny how society can be ok with the CEO of a hospital or company making millions, going out to eat in the middle of day or playing golf to “network” but a doctor needs to be busy either seeing patients or documenting with a full schedule to be considered “valuable,” while reimbursements and respect for our roles continues to decline.

 

[sirspamalot]

Those who have money in power will continue to create and enforce rules ensuring things remain status quo.

Oh, you want eloquence in my protest you say.. not SirSpams drivel? Well then, I give you... Bastiat:

The law has been perverted, and the powers of the state have become perverted along with it. The law has not only been turned from its proper function, but made to follow an entirely contrary purpose. The law has become a tool for every kind of greed. Instead of preventing crime, the law itself is guilty of the abuses it is supposed to punish. If this is true, it is a serious matter, and moral duty requires me to call the attention of my fellow-citizens to it.

He knew back then what to do. We ain't doing it.

 

[temujim]

LOL. The admins would love us ALL to be replaced..

Aware of admin who thinks that physicists/dosi/RTTs can do everything so why do we need rad oncs? Posits why not the neurosurgery SRS model -- just have some other specialty sign off on the plans (still need someone to blame if things go sideways!).

 

[Fpg1245]

It’s funny how society can be ok with the CEO of a hospital or company making millions, going out to eat in the middle of day or playing golf to “network” but a doctor needs to be busy either seeing patients or documenting with a full schedule to be considered “valuable,” while reimbursements and respect for our roles continues to decline.

Because the choice was simple

1. Nationalize healthcare
2. Corporatize healthcare

Either way there would be admin

 

[temujim]

https://www.redjournal.org/article/S0360-3016(23)00450-9/fulltext?s=09

Neha trying to up the unemployment rate for new grads going forward. The only thing more effective than switching everything to 0-5fx is just replacing the damn RO.

The kind of thing that's perfectly at home getting published in the IJROBP in 2023

Impression is this is attractive in countries with "clinical oncologists" and/or those who get paid half or less the US rate and don't have time for the mundane stuff like simulation, contouring, plan evaluation, etc.

 

[OTN]

Impression is this is attractive in countries with "clinical oncologists" and/or those who get paid half or less the US rate and don't have time for the mundane stuff like simulation, contouring, plan evaluation, etc.

It's also attractive for those of us in private practice who realize that, in order to maintain our income in the face of declining cuts, we will need to continue to increase the number of patients treated per radonc moving forward. I welcome both technological and regulatory changes which will allow us to do so.

The effect this could have on the job market for new grads is not my problem.

 

[sirspamalot]

RTT's can just expand their 'practice role'' along with the physics, dosim and hell throw in the front office person. Yep. Good idea.

 

[sirspamalot]

It's also attractive for those of us in private practice who realize that, in order to maintain our income in the face of declining cuts, we will need to continue to increase the number of patients treated per radonc moving forward. I welcome both technological and regulatory changes which will allow us to do so.

The effect this could have on the job market for new grads is not my problem.

 

[communitydoc13]

It’s funny how society can be ok with the CEO of a hospital or company making millions, going out to eat in the middle of day or playing golf to “network” but a doctor needs to be busy either seeing patients or documenting with a full schedule to be considered “valuable,” while reimbursements and respect for our roles continues to decline.

It's worse than this and it is not specific to any particular culture.

It's the diminution of the value of personal expertise. It is obvious for clinicians, but will also start impacting the scientists. (More data scientists, less scientist scientists). It is a product of our technological revolution, as well as our emphasis on "evidence" over the past 5 decades.

The people in power believe that big data will give us the answers without insight. It believes that our statistical tools tell us the truth at the level of personal interaction and individual cases (they do not). They have also become very "metaverse-y" (see @TheWallnerus post on protons). What matters to them is what they want to matter or particularly what they can convince their customers/patients/investors to believe matters. They grotesquely believe in data even when they have no understanding of it's origin.

Big data meets end stage capitalism meets postmodernism meets evidence based medicine.......there is absolutely no need for people smart enough to understand physiology anymore.

And the people who still believe that there is some magic to knowing details, to thinking through things from first principles, to treating each patient as an individual? Maybe at the social worker niche/pay grade are these people valued.

The CEO? They have vision.