I enjoy the chemistry you docs have together, and I think we are intellectually challenged best by colleagues like you who have disagreements and can debate each other. I am personally most aligned with Dr. Cifu (I had the great honor of meeting him when he visited our medical center a few weeks ago), but I have come to really love the p…
I enjoy the chemistry you docs have together, and I think we are intellectually challenged best by colleagues like you who have disagreements and can debate each other. I am personally most aligned with Dr. Cifu (I had the great honor of meeting him when he visited our medical center a few weeks ago), but I have come to really love the passion and courage of Dr. Prasad, who reminds me of my family members, and Dr. Mandrola's brilliant deep dives into major studies. I suppose you have all helped me gain more critical understanding of some big weak spots in high-profile studies.
In other words, there is a lot of brainpower among you docs. Unfortunately, there is nothing that RFK Jr. has to teach any of you, or us- he is not our friend. Remember, this is a guy who has a number of great lifelong passions: orgies, cocaine, fame-seeking, money, and the mutilation of animals. I'm no psychiatrist, but I am concerned he might score high on a psychopathology test. I suspect his foray into humiliating the FDA is not about efficiency or reducing waste- it's more likely to be settling personal vendettas. Any drug company willing to seduce RFK Jr. with cash or private jet flights will probably do just fine. He is not a medical conservative. And I have read your article "The Case for Being a Medical Conservative" at least a dozen times.
That being said, I think we can all agree that there is no such thing as "evidence-based" medicine when it comes to oncology. Screening for most cancers is probably not cost effective, and has not be shown in quality studies to reduce overall mortality (I'm repeating what I've learned on Sensible Medicine here). The major new therapeutic agents in oncology are approved by the FDA based on studies showing benefit in surrogate endpoints, not the endpoints that matter. Quite a bit of oncology seems to be based on burning huge amounts of cash to kill cancer patients a little faster than their malignancies would, left unattended. There are dramatic exceptions to this, of course; but too much money is spent approving and utilizing agents that simply don't work on hard outcomes. Will RFK Jr's crusade against the FDA improve this situation? I would like to be optimistic about this, but it's difficult to see how he could pull this off.
Cynically speaking, however, I might posit that primary care practices like my own might become more interesting. Other than teaching, most of what I do is data entry and the ordering of medications and tests to meet institutional metrics, so that the bean-counters will leave me in peace. It will be much more stimulating to my students and I when we have the opportunity to diagnose and treat mumps, diptheria, polio, tetanus, and hepatitis A again. A case of lockjaw in clinic will be a fantastic teachable moment. Perhaps I will even be able to leverage new outbreaks of old diseases into mentoring a student that chooses to go into outpatient internal medicine! That, certainly, is an event even more rare than finding a "brain worm." And I'd love to see more worms escape RFK Jr's CNS and get out into the general population...then we can finally start prescribing ivemectin in good faith!
I enjoy the chemistry you docs have together, and I think we are intellectually challenged best by colleagues like you who have disagreements and can debate each other. I am personally most aligned with Dr. Cifu (I had the great honor of meeting him when he visited our medical center a few weeks ago), but I have come to really love the passion and courage of Dr. Prasad, who reminds me of my family members, and Dr. Mandrola's brilliant deep dives into major studies. I suppose you have all helped me gain more critical understanding of some big weak spots in high-profile studies.
In other words, there is a lot of brainpower among you docs. Unfortunately, there is nothing that RFK Jr. has to teach any of you, or us- he is not our friend. Remember, this is a guy who has a number of great lifelong passions: orgies, cocaine, fame-seeking, money, and the mutilation of animals. I'm no psychiatrist, but I am concerned he might score high on a psychopathology test. I suspect his foray into humiliating the FDA is not about efficiency or reducing waste- it's more likely to be settling personal vendettas. Any drug company willing to seduce RFK Jr. with cash or private jet flights will probably do just fine. He is not a medical conservative. And I have read your article "The Case for Being a Medical Conservative" at least a dozen times.
That being said, I think we can all agree that there is no such thing as "evidence-based" medicine when it comes to oncology. Screening for most cancers is probably not cost effective, and has not be shown in quality studies to reduce overall mortality (I'm repeating what I've learned on Sensible Medicine here). The major new therapeutic agents in oncology are approved by the FDA based on studies showing benefit in surrogate endpoints, not the endpoints that matter. Quite a bit of oncology seems to be based on burning huge amounts of cash to kill cancer patients a little faster than their malignancies would, left unattended. There are dramatic exceptions to this, of course; but too much money is spent approving and utilizing agents that simply don't work on hard outcomes. Will RFK Jr's crusade against the FDA improve this situation? I would like to be optimistic about this, but it's difficult to see how he could pull this off.
Cynically speaking, however, I might posit that primary care practices like my own might become more interesting. Other than teaching, most of what I do is data entry and the ordering of medications and tests to meet institutional metrics, so that the bean-counters will leave me in peace. It will be much more stimulating to my students and I when we have the opportunity to diagnose and treat mumps, diptheria, polio, tetanus, and hepatitis A again. A case of lockjaw in clinic will be a fantastic teachable moment. Perhaps I will even be able to leverage new outbreaks of old diseases into mentoring a student that chooses to go into outpatient internal medicine! That, certainly, is an event even more rare than finding a "brain worm." And I'd love to see more worms escape RFK Jr's CNS and get out into the general population...then we can finally start prescribing ivemectin in good faith!