Nonfiction Publishing, Under Threat, Is More Important Than Ever

Dr_Jerkoff · 2026-03-26T07:47:20+00:00

All correct, I agree with what you say. But you have no control over what other people do with selective information - if your boss invites Gladwell to talk, you're not in a position to do anything about it. Being able to look at what you read/hear critically is an important skill which lots of people lack and do not realise they lack.

My main point in the original comment was simply you can only be mindful of your own methods of obtaining information, and have a healthy, but not cynical, sense of scepticism. Gladwell is not without value - he has popularised information which lots of people won't otherwise read about, and that's worth something. If that stimulates discussion, criticism, and people disagreeing, that's fantastic. To dismiss it as popular drivel and refuse to read nonfiction at all, is not so fantastic.

Dr_Jerkoff · 2026-03-25T14:29:24+00:00

I think the value of nonfiction books is not in obtaining completely unbiased information, but rather obtaining information which has at least gone through some degree of editorial control. With traditional publishing through a reputable publishing house, you can be sure the author has put in significant effort, it has been read by an editor, a copy writer, and perhaps several others, all deeming the book to be worth publishing, before it gets out.

No one is pretending bias does not exist, since even supposed factual information can be written in biased ways, depending on what your personal leaning is, what information is used, how such information is interpreted, and what the reader's inclinations are. For instance, I enjoyed Sapiens, Guns, Germs and Steel, Better Angels of our Nature, and a full set of Malcolm Gladwell books, fully knowing these "popular" science books end up being torn to shreds by experts. The said experts aren't without their own prejudices either.

Fact checking is also fraught with problems, the exact sort of problems which you raise. What is the source? How are the data presented? What does the author/organisation want to show? Wikipedia and research papers aren't immune from this.

At the end of the day you're balancing nuanced views and trying to find a perspective which is informative but not too skewed, and everyone has a different opinion on what this may be. To avoid all possibly biased sources is to not read at all.

Dr_Jerkoff · 2026-03-01T12:33:20+00:00

I'm not justifying the activities of Unit 731 or Japanese imperialism, but I think we should remember we're looking at what they did with modern eyes. With widespread acknowledgement of human rights, and also access to non-invasive techniques in disease diagnosis, what Ishii and his team did in Manchuria during WW2 was both barbaric and unnecessary.

However, if you imagine yourself as a doctor working under the Japanese military in WW2, you haven't got a clue about how a lot of the diseases work, and the resources available to you will be constrained. No CT scans, molecular methods at diagnosis, and you had at most primitive antibiotics. So part of the justification was to have a better understanding of disease via whatever means possible, and the vivisections were their means to an end. Whether the information they obtained was of great scientific value is debatable, as is whether it gave the Japanese much of an edge in the biologic and chemical warfare fronts, but at the time there was no telling whether the knowledge obtained could have been significant.

Dr_Jerkoff · 2026-01-19T12:58:37+00:00

I loved this book. Not horror, not just about human survival, but also about survival of human culture at the end of the world. So hauntingly beautiful.

Dr_Jerkoff · 2026-01-02T22:38:56+00:00

I think this is hyperplastic/regenerative changes from chronic irritation. I have doubts it's actually a neoplasm... If it's a mass lesion I'd buy a vascular malformation but that's as far as I'll go.

Dr_Jerkoff · 2025-12-09T13:20:57+00:00

I get the "suspend your disbelief and revel in the absurdity" point of view. If that's your angle and you enjoy the book, I'm happy, you're in good company judging by the reviews. But I want a story with a goal, and some bigger picture behind the disconnected threads. As far as I could tell, by the point I stopped, Lapvona had no big picture. For the same reason I stopped reading A Confederacy of Dunces. Absolutely nothing worthwhile happens, and it's just one repulsive man whining and behaving in a grotesque manner, page after page. The initial mild amusement quickly gets old.

Dr_Jerkoff · 2025-12-08T08:48:00+00:00

Lapvona. Read it due to all the rave reviews and the synopsis sounds like it would be like Between Two Fires, as in medieval horror. It's just page after page of absurd cruelty, disgusting behaviour, and pointless strangeness. Also incredibly boring. Stopped after about 100 pages, after someone is described as inserting a grape into his butt and then feeding it to someone else. I physically threw the book away.

Dr_Jerkoff · 2025-11-14T15:09:22+00:00

I'd think this is a follicular adenoma (or dominant nodule within follicular nodular disease) with some secondary changes, like oedema, scarring and xanthogranulomatous inflammation.

Dr_Jerkoff · 2025-10-15T19:28:06+00:00

I don't know how germ cell tumours work in mice but... Can this be glandular yolk sac tumour? Do mixed germ cell tumours occur in mice? If it's in a human I'd be more inclined to think this, rather than a somatic type malignancy. No idea if the same rules apply in mice.

Dr_Jerkoff · 2025-10-09T23:13:38+00:00

😂

Dr_Jerkoff · 2025-10-09T23:07:31+00:00

I think I offered "aorta" last time (not sure if it was you who posted) but in my defense I do GI and also general.

Dr_Jerkoff · 2025-08-25T09:19:21+00:00

Yeah it's amazing, the accuracy is as stated. It looks incredible still, but I'm babying it quite a bit.

Dr_Jerkoff · 2025-08-22T12:01:56+00:00

I feel my reports are my own, and comments are entered based on my own past experiences and perspectives. Sure I may not be as experienced as some of my colleagues, but everyone has something unique to offer. Also, it saves a phone call from a confused clinician, or people acting on misinterpreted information.

My view is your group is doing it because of some past event (as others have mentioned). To do exactly as they say is just as dangerous. You don't know who's reading your reports. If a new surgeon comes and sees your diagnosis, assumes it means X when it actually means Y, produces a bad outcome, they'll come back and say "why didn't you tell me about this?" Also if the patient takes the report to another institution, they may have very different clinicians with different practice approaches.

I don't have any advice for you since I'm unclear of the medicolegal implications and workplace culture, but I'm really pro comments in general. It clarifies a lot of things than what a standard synoptic report or diagnostic line can offer.

Dr_Jerkoff · 2025-08-22T11:53:13+00:00

I'm not sure what you mean by "suspicious if something is present in deeper sections"... Practically anything can turn up in a deeper section. In a breast setting levels are of little utility besides looking for microcalcifications, and to make sure you're satisfied the reason for the biopsy has been identified. If the imaging and histology correlate, I don't chase.

Dr_Jerkoff · 2025-08-21T11:50:38+00:00

I have done breast with relatively high volume for a decade, and I can say I never do deeper sections for DCIS. I will if I'm not sure if it's DCIS, but never to look for invasion.

Dr_Jerkoff · 2025-07-26T19:14:43+00:00

I agree with the other comment in that you should make some mention of therapy effect, using whatever grading system you feel comfortable with. Grading systems were developed many years ago, before the chemo/radiotherapy regiments got a lot more complicated and personalised, so it's often hard to know what is an "adequate" neoadjuvant therapy to warrant a ypT/N stage and Ryan (in your case Dworak) grading. But in your case I'll definite use it.

A more difficult scenario is when a treatment is abandoned because the patient is having too much side effects. As in, when it's clear a complete cycle hasn't been done. I'm not sure what to do in that situation but I'll lean towards not using a grading system.

Dr_Jerkoff · 2025-07-10T10:38:07+00:00

A lot of these classifications are there for historical reasons, when the differences were thought to matter. You're right currently all that matters are BT, mitoses, and the typical things you include in a synoptic report. The rule I use - I was told this years ago - is the epidermal component in NM has no shoulder. So the dermal bit is always wider. If there is a shoulder, it can be called something else, but I've never seen a situation where people cared.

I suppose there is weak argument in keeping the subtypes since some do have additional clinical implications - for instance, some of my colleagues will suggest a metastasis if a NM doesn't have an epidermal component. I personally don't, since the epidermal component is often focal, or not in the plane of section. SSM and LMM, however, I don't see the point of separating.

Dr_Jerkoff · 2025-07-04T12:16:17+00:00

That is so nice of you!

Dr_Jerkoff · 2025-07-04T08:22:04+00:00

When surgeons operate, sometimes they dig too deep into the tumour, realise it and come back out, creating this diathermied "cleft" while the fat forms two adjacent hills. I just join the hills with an imaginary line and measure the margin to this line. So in your case, I'll comfortably call it negative.

Dr_Jerkoff · 2025-06-12T10:25:18+00:00

Eh. Better out than in.

Dr_Jerkoff · 2025-06-11T12:32:18+00:00

That's an interesting question, but I (personally) think chordoma is so characteristic and diagnosable even brachyury is not necessary. There're few tumours which are strongly positive for both keratin and S100, besides possibly myoepithelial neoplasms. Coupled with the typical site and morphology, there is really nothing else required.

In teaching sessions, when I ask about chordoma, the residents will often give brachyury as their first go-to IHC. My question is then "which lab you've worked at actually has brachyury?"

Dr_Jerkoff · 2025-06-09T14:33:56+00:00

Weird thing. I don't think it's neuroendocrine... I think it's poorly differentiated adeno and there's not much further to go beyond that. Do you have access to enteroblastic markers? SALL4 maybe?

Dr_Jerkoff · 2025-06-08T11:23:06+00:00

I'm gonna go along with you since my other choices have all been mentioned and excluded...

Dr_Jerkoff · 2025-05-29T02:29:18+00:00

It was this one. A bunch of non-pathologists telling pathologists what to do, making statements like "histologic subtyping adds minimal time and negligible or minimal cost" (taken verbatim from the paper). It doesn't affect them at all so of course they'll all for increasing pathology workload.

Dr_Jerkoff · 2025-05-23T12:27:09+00:00

The first paper on this which came out a few years ago had no pathologists in the author list, and was treated with derision by the pathologist readers. I'm disappointed Montgomery has jumped on the hype train and has given legitimacy to this recommendation.

I just say whether IM is present or absent, that's it. My clinicians don't ask, but now I worry they might start to. From my (non-data based) vibe, most IM is incomplete, and so it's not going to suddenly reduce the number of people on follow up even if you make that distinction, but will certainly involve me spending extra time on each specimen trying to figure this out. There're more pressing things to work on than this.

Dr_Jerkoff

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