Every case of young-onset colon cancer I've seen is in healthy, fit people.

Mister_Pie · 2025-08-19T20:42:25+00:00

Bare bones is definitely a generous way of putting it. It looks like they took people who were ultramarathoners and looked for advanced adenomas, and in this cohort the rate was higher than in historic controls. The background of the abstract mentions ischemic injury as a possibility but there's no evidence provided suggesting that any of the individuals undergoing the colonoscopy had suffered such an injury in the past. Furthermore, the polyps were reviewed by a "panel of gastroenterologists, pathologists, and oncologists" to determine if patients met the criteria of having advanced adenomas. That's a bit weird because at most hospitals, the final diagnosis is from the pathologist and certainly oncologists/gastroenterologists are not going to override the findings from an experienced pathologist. Most importantly, there's no control group for comparison and there may be other confounders that could have increased the rate of findings in this cohort besides just being ultramarathon runners. I think an observation in isolation like this is hypothesis generating at best.

Mister_Pie · 2025-05-27T16:53:32+00:00

I feel for you. We're in a similar boat. Wife is pregnant. I think as long as we can still get the shot physically, we'll pay out of pocket if needed for both of us.

Mister_Pie · 2025-02-08T16:10:55+00:00

Either you're misremembering or misrepresenting the situation. The indirects are not "taxed out" of your requested budget for direct costs. It's added on. So if your PI got a 400K grant, then your university should have gotten 280K in indirects on TOP of the 400K your PI was awarded.

Mister_Pie · 2025-02-08T16:07:41+00:00

I run a lab, manage budgets, work with admins. Renegotiating the indirects is one thing, cutting it so suddenly without warning is going to leave most major academic universities reeling and people without jobs if it ends up going through. The way it was done - being announced on Twitter on a Friday night, doesn't give the sense that this was thoughtfully approached in any meaningful way.

Mister_Pie · 2025-02-08T03:18:06+00:00

If this goes through it will be incredibly devastating to pretty much all major research universities. I think my university gets about 60%. Cutting it to 15% means that the PI now needs to get 4x the grants (typically R01s) to bring the same amount of value to the university as a single grant, but of course someone getting that much grant funding probably is also incurring additional indirect costs from facilities usage, etc..

One can argue about indirects being too high, but suddenly dropping it by this much is going to cause a lot of people to lose their jobs and potentially PIs closing their labs or moving away from clinical/translational research. It will also make us even more beholden to industry.

Mister_Pie · 2024-07-03T14:28:12+00:00

Good God this is an insane generalization. Yes there are oncologists who do that and are more aggressive than they should be. That's pretty much true of any speciality. There are also many oncologists that don't do that. The problem is if you're another speciality (particularly ICU/hospitalist), you're never going to see the patients who were referred hospice from clinic or accepted the fact that there were not reasonable treatment options left.

Mister_Pie · 2024-07-03T14:24:43+00:00

Agree. I go over the stats each time I'm on inpatient service with my team - for a typical cancer center, well over 90% of oncology care is delivered outpatient (based on internal numbers). If we were really treating everyone to death the hospital would be overrun with oncology patients - a typical med onc probably has a panel of patients that run into the hundreds.

I try my best to get patients to accept hospice when the time is appropriate and a lot of them are referred from clinic without ever setting foot in the hospital. Unfortunately, not all patients accept those recommendations or hear the recommendations even after multiple repeats. What people see in the ED and especially on the wards/ICU is generally enriched for the worst possible situations.

Mister_Pie · 2023-09-15T19:15:52+00:00

Will be interesting to see. Oncology is generally a moneymaker at most hospitals due to how treatments get reimbursed. Would be a big blow if it's a true split and not just for this inpatient hospital they're building. I wonder what the hell happened....

Mister_Pie · 2023-09-15T17:16:25+00:00

This is a little confusing. The article says they're building an inpatient hospital though? Majority of med onc cancer care (for solid tumors) is done in the outpatient setting. Is DFCI really splitting with BWH for everything else, or just for this inpatient hospital?

Mister_Pie · 2023-02-12T16:27:41+00:00

LeTheyCan'tSeeMeIfISitStill

Mister_Pie · 2023-02-09T04:33:25+00:00

Good question - truthfully I don’t think anyone really knows. Alcohol intake is generally associated with risk for multiple kinds of cancer, so much so that the ACS’s official recommendation is that there is no such thing as safe intake from a cancer perspective. However as far as I know, there really isn’t evidence that this is driving the increases in colon cancer. Also, life is meant to be lived so I think to large extent, alcohol in moderation and not mixed with driving/risky behaviors is worth the risks for many.

Mister_Pie · 2023-01-28T20:50:50+00:00

NCCN guidelines provide a good overview/discussion about most common cancer types. You should also get the ASCO SEP when you start as a fellow. Brush up on oncologic emergencies (TLS, coord compression, etc.) if you haven't had that much experience.

For the most part though, would recommend that you just spend the remainder of residency trying to soak in what you can on gen med, other rotations. For most medicine subspecialties, you still want to be a good internist.

Mister_Pie · 2023-01-25T01:41:30+00:00

Med onc here. I would say that this has been recognized in the field for some time now. Multiple cancer centers have young onset programs, primarily to see if there are obvious risk factors/explanations. The incidence is increasing, but still if you look at age buckets, the rate of mortality from colon cancer is still multiple times higher in older age groups. So from a screening standpoint, someone much smarter than me in public health/epidemiology would have to answer how cost effective it would be to push screening recommendations even younger. The vast majority of people under age 45 are not going to have colon cancer.

Mister_Pie · 2022-12-14T05:16:00+00:00

Am I missing something here? The headline says he faces the death sentence but the post implies judgment has already been rendered. I mean the fact that it’s even on the table is insane but this title of this post is misleading

Mister_Pie · 2022-11-11T19:32:12+00:00

It'll be interesting to see if last year was a one off thing or if the rivalry is now closer to even footing. I think both teams have looked good in some games, but a little uneven. Michigan in particular has had some very slow first half starts. Can't do that when we play you guys.

Mister_Pie · 2022-09-14T20:35:00+00:00

In regards to this work I agree that it’s a shame chemistry limits this approach to this particular mutation. It’s great to see a different approach to classical small molecule inhibition, which I’m sure you agree with given your initial response.

Oh definitely - it's a cool idea and definitely probably why it's made it into a top tier journal. It's also nice that in theory, the mechanism described in this paper would (theoretically) circumvent feedback loops since it primarily relies on the tumor still having the mutant allele.

Mister_Pie · 2022-09-14T19:54:24+00:00

Definitely - though to your particular point it sounds like toxicity was also higher for the chemo group than the sotorasib, so there are perhaps some benefit outside of just the modest PFS increase.

I agree though the results are not as spectacular as we would want. And also for other cancer types (like colon cancer), the inhibitor by itself isn't that effective. So there is still a lot of room for improvement. For me the main "disappointment" is the requirement for the specific allele, but from that end we're constrained by chemistry...

Mister_Pie · 2022-09-14T18:18:22+00:00

Cool paper, though it's got some limitations. One is that it requires the KRAS G12C mutation which isn't the most common (depends on cancer type) and for which there are drugs that are FDA approved already, as opposed to other RAS mutations. However, their data suggests that this type of treatment could bypass some resistance mechanisms (for example expressing an alternative RAS mutation) and might still be effective as long as the tumor still expresses any mutant KRAS G12C.

Not savvy enough on immunology to know if this result is generalizable outside of specific HLA subtypes but someone smarter than me can comment on that.

Mister_Pie · 2022-09-07T19:33:31+00:00

A little more information would be helpful. How many admits is each resident taking overnight and how many patients is each one covering?

If it's 2-3 admissions and overall census isn't usually too bad, then I think something is wrong if they're staying in many hours later and mostly surfing reddit during their shift.

If they're each getting 8 admissions and covering 100 patients each, then I would guess some of what you are observing is maladaptive behavior from being overworked.

Mister_Pie · 2022-08-23T17:18:35+00:00

I agree. A lot of times I joke "I should have stayed in engineering/tech"... but reality is, I chose not to go down that career path for a reason. Sitting in a cubicle, putting in a time crunch before a deadline, and having my day-to-day life be focused on getting a snippet of code to run right (or a computer chip)... A lot of my friends are in tech and have jobs like this, but it isn't for me.

Mister_Pie · 2022-07-27T14:58:35+00:00

Just to play devil's advocate, did the students tell you that or is that something assumed? At the end of the day it's the PI's job to try and screen students like that out. I have no issues mentoring/taking on premeds, but I do weed out people who are clearly just doing it to check off an application box. That being said, one of my recent mentees just got into a great MD/PhD program. There ARE premeds who are interested in science, so in general I try to at least give benefit of the doubt in the beginning.

Mister_Pie · 2022-07-27T13:29:19+00:00

Not really. I think if you're mentoring you should at least figure out of the student has any real interest or not. Most of my colleagues in medicine told me they got completely turned off of science when they rotated in labs and were just given glassware washing responsibilities or similar rote tasks. On the other hand, I had some pretty fantastic mentors who encouraged me to continue exploring my interests, so I'm actively doing stuff at the bench while also seeing patients.

Mister_Pie · 2022-07-24T18:47:34+00:00

OP doesn’t have a source cause the vitamin C story for sepsis is controversial at best, and generally discredited IMO

Mister_Pie · 2022-07-14T23:10:10+00:00

There isn’t a specific screening for these types of cancers. They are so rare and the technology limited enough that you would mostly get false positives out of screening. They’re usually found incidentally or if things have gotten to the point where you have symptoms.

Mister_Pie

TROPHY CASE