Logan Corey

@Hragy Obs then weren’t doctors? You ordered a c section for someone else to do?

The husband/father showed up later, when I told him his wife had died he was allover the place,then I told him that the baby was still alive so that I had ordered C section & handed him the boy,he instantly hugged him and laughed and cried, 40 years later I remember the emotion.

I started watching The Pitt, found it amazing, in 1984/85 I was the sole cardiology resident in Sohag teaching hospital in southern Egypt, I actually lived in a room in the hospital on the 4th floor for a year, I wish there was a way to write my story there, it was unbelievable.

@GIMedOnc @OncoAlert Ovarian cancer discovered this long ago. All visible disease or not at all. Do you think this applies here?

The intuition makes sense. Reduce tumor burden, let systemic therapy finish the job. But intuition has a poor track record in oncology. ORCHESTRA just published in JAMA. Phase 3 RCT, 382 patients, multiorgan mCRC. The bar for entry was high. You had to be able to take out more than 80% of disease burden across all sites before randomization. These are the best-case patients. Response or stable disease after 3-4 cycles of CAPOX or FOLFOX, then chemotherapy alone versus chemo plus debulking. Median OS: 27.5 months versus 30.0 months. HR 0.88, 95% CI 0.70-1.10. p = 0.26. PFS essentially identical, 10.4 versus 10.5 months. Serious adverse events significantly higher in the debulking arm, 53% versus 39%. That said, this isn’t the whole story. Symptomatic Krukenberg tumors, oligometastatic disease with curative intent, isolated liver-only disease. Those conversations should still be had. The cytoreductive surgery literature gave us hints this was coming, but the use cases that make biological sense still stand. What changes now? At minimum, “we can get more than 80% of it” is not a sufficient reason on its own. Except in NETs, NETs are weird. jamanetwork.com/journals/jama/… @gutonclab @oncoalert

“Is it still ‘Fuck Duke?” -@BarstoolBigCat “Forever. Duke sucks and they will always suck. Yeah fuck em” -@THANS50

@charlesornstein @AmyYurkanin You think the ob wanted to do a c section on that patient? You’re an idiot and this story is like saying “woman who wants to drive twice the speed limit forced to slow down against her will”

Jaw-dropping story: They Didn’t Want to Have C-Sections. A Judge Would Decide How They Gave Birth. propublica.org/article/florid… @AmyYurkanin

@rbarbosa91 @nickmmark Article please!

@nickmmark Not to get too pedantic, but that is an 11 blade, it’s just not on the usual No. 3 handle. (Handles use “No. X” and are 1-9; blades use “# X” and are 10 and above. This is all arbitrary, I have an article if anyone’s interested).

I like the Wayne chest tube kit but I don’t understood why it has this little prison shiv of a scalpel. Was it too expensive to put an actual 11 blade in a $500 tray?

Not being able to watch Caleb Wilson hoop in March Madness should be a crime 😭

@AbbasHassanMD @CMSGov @NEJM no link to the article?

Should residents & fellows bill? A single resident can provide >$300k/yr in uncompensated care due to outdated @CMSGov rules. Our @NEJM paper proposes a competency-based framework to capture this revenue, improve trainee pay, and offset massive debt. #MedTwitter #MedEd #GME

@rbarbosa91 @SkyNews Either the surgery is complicated enough to not need a super specialist or one needs to be there. Either way this is performative and idiotic

@SkyNews Always with the long distance robot surgery. You still have to have someone there that can salvage the situation if things go bad. Meaning a specialist. or: You have to be OK with not having such a person on-site. In which case, if things go wrong then it’s too bad I guess. 🤷‍♂️

A surgeon in London has performed the UK's first long‑distance robotic operation on a patient located 1,500 miles away in Gibraltar. Urological surgeon Professor Prokar Dasgupta says this moment is 'good news for patients' in remote areas.

my father in law asked why i wasn't cooking dinner for the family sorry dave i’m currently locked in on 2012 reggie bullock north carolina highlights get with the program its march

@DrMakaryFDA Very smart to avoid teaching what AI can. Don’t want kids to learn what’s in those textbooks!

Milestone day! Medical schools agreed to teach nutrition with a new strong curriculum. Far more relevant & useful than the minutiae i had memorize and regurgitate—stuff that AI can recall in seconds anyway.

North Carolina lost Seth Trimble for over a month. It’s been without Caleb Wilson for multiple weeks. 23-6 with wins over Duke, Kansas, Kentucky, and Virginia, with the latter two coming on the road. A heck of a job by Hubert Davis and his staff in Chapel Hill.

देश की बेटियां स्वस्थ और समृद्ध हों, इसके लिए हम कोई कोर-कसर नहीं छोड़ रहे हैं। इसी दिशा में आज सुबह करीब 11:30 बजे राजस्थान के अजमेर में एचपीवी टीकाकरण के देशव्यापी अभियान का शुभारंभ करूंगा। इस पहल का उद्देश्य सर्वाइकल कैंसर की रोकथाम है। इस दौरान कई परियोजनाओं के शिलान्यास और उद्घाटन के साथ ही अपने युवा साथियों को नियुक्ति पत्र देने का भी सुअवसर मिलेगा। pib.gov.in/PressReleasePa…

Squad!!!!!!!

@5_utr ? But they are effective? I dunno if you’re upset that radiation is clearly archaic and being usurped or just mad at the world

@LoganCoreyMD Well my entire point is Personalized/Precision Medicine is based largely on false premises. I’m not sure I can be clearer than Senn lshtm.ac.uk/media/30901

While I’m at it on PARP inhibitors: these are sold as “precision”: targeted, gentle, non-cytotoxic. Reality? They are systemic genotoxic agents inflicting catastrophic DNA damage on normal cells 🧵

@5_utr I’ve lost the point of your rants. Precision medicine to me is treating tumors based on their biology and histology and other custom factors. Tailoring the treatment. Your argument is there isn’t a way to treat just the cancer without any side effects? Or something like that?

@LoganCoreyMD Your radiation strawman is another misunderstanding that can be added to the others including cancer biology Radiation is localized; PARP inhibitors have a high volume of distribution, hitting everything from bone marrow to the gut. Systemic therapy vs local therapy 🤦‍♂️

@5_utr I think you live in a fantasy land. Your definition of precision oncology will never be achieved but it’s light years better than radiation. Which has all the features you’re upset about

@LoganCoreyMD Both are false. It’s toxic, and tailored to the tumor biology implies static, identifiable, sparse targets

@5_utr @jbdotdotdot Ok then a parp inhibitor for HRD ovarian cancer. Half the patients will have this. Wouldn’t call that sparse but still would call it precision medicine

@LoganCoreyMD @jbdotdotdot Precision oncology assumes sparsity. A small number of dominant, clonal dependencies. Inhibit the sparse driver → collapse the system.

surgery out here deleting tumors at the filesystem level. radiation running rm -rf on mutant and wild-type alike. your precision drug needs Y220C, a full moon, and $18k/month for 20% ORR 😅 necessary? no. sufficient? also no. Biotech valuation-maxxing, response-minning 🗑️

@leitaomd Is Pelvic MRI really necessary? pubmed.ncbi.nlm.nih.gov/40130299/

Pelvic MRI is all that is needed for cervical SCC and adneoca that are clinically and radiologically stage IB2 or less... Time to stop over-imaging these aptients which actually leads to unnecessary false positives sciencedirect.com/science/articl…

@5_utr @jbdotdotdot Pembro in MMRd endometrial tumors? Huge benefit

@jbdotdotdot “Precision Medicine”: targeting a heterogeneous and evolving and molecularly redundant tumor with ungodly expensive, highly specific, drugs that benefit almost nobody, the main apparent benefit apparently being grants, publications and pharma/biotech valuations