My Twitter journey so far

It is an honest confession about what I have been able to achieve and put it in perspective. Is the social microblogging website, beneficial?

  1. I have been lucky to come across many excellent individuals! Medical Physicists, Radiation Oncologists and the fraternity which gets together and deliberates on matters of mutual interest.
  2. I had to use a lot of muted words because most people don’t realise that Twitter is meant for “manufactured outrage”. It is lazy person’s means of “activism”.
  3. I follow many accounts, but some of them are muted because their tweets add no value to the discourse here.
  4. Some Twitter users are great. They read whats on their platter, but Twitter sorts out interaction based on algorithms. It means you are likely to miss out on a lot of important things. Your likes, re-tweets or other signals are factored in what you ultimately see. It isn’t educative nor informative.
  5. I participated in my first virtual conference for ESTRO. It was an enjoyable experience, and I have written and shared my ideas extensively. If you wish to factor in Twitter as part of an interactive platform, you need to have a coherent strategy. A generic hashtag adds little value to the overwhelming noise. I would, on any given day, have a Telegram channel, instead.
  6. I am dismayed by the constant barrage of advertisements by many organisations. It is good to promote diversity of thought; however, it is clear that these accounts have been outsourced to different agencies. It appears phoney; as if they are drunk of kool-aid. My bullshit filters typically go up at the very thought. I am not naming them, of course, but it gets my goat. Likewise, for a respected “physician-scientist”. It may be acceptable to make political statements, but it is like mixing wine with water. The result- academics+politics doesn’t make any sense.
  7. Gender politics on Twitter is too stupefying; I am gender neutral (if that is the term) and I prefer to see individuals as such. There is no meaning of gender for me (as far as academics is concerned). Using your Twitter account to wash your dirty linen in public (because you have a specific gender) is labelling your back with the tag of “stupid”. Ultimately, it is your choice as to what you wish to achieve with social media. I usually prefer to stick to a personal account on Twitter or better still; I prefer Telegram.
  8. The click-through rate for articles is abysmal. If you wish to see an improved version of click-throughs for the posted links, you will need to have a large number of followers.

Has there been any luck with getting people to switch over to Telegram? Nope. Nada. Zilch. It is because of my tacit understanding as follows- Twitter as a medium for beginners is intimidating. Many users prefer to stick with the known than to start with something new. It is not laziness, but everyone has a motive to be online using Twitter. Some wish to have a more significant exposure; some users want to interact with peers, some want to express outrage or crib about life’s not fair. There is no one reason. Telegram is much more personal compared to Twitter. I have a couple of groups and channels with me on Telegram. It is good to spend time by consuming content passively. Groups allow more fine-grained control and better-nuanced interaction. And the recent moves by Twitter to force users to access it through web-alone is a stupid move.

Twitter is a bitter-sweet experience. Yes, the constant stream can be tiring and distract you cognitively but it is fun in parts. On the flip side, you end up meeting amazing individuals and people from different departments across the world.

The myth about tissue donation

 

Many organisations are involved in raising awareness about brain tumours. It is essential because of the relative rarity of these diseases. One also requires in-depth research for finding the elusive “cure”.

A diagnosis of brain tumours often lurches sufferers from anxiety to nearly suicidal ideation that often makes them do desperate things. Alternative therapies, herbal remedies etc. become the order of the day, often aided and abetted by the Internet. The practitioners make tall claims which have no scientific logic.

The worst off are the snake oil businessmen, often under the guise of taking your tumour samples. Now, this is a very contentious issue, and I will try to make it as simple as possible.

Research involves tumour tissue to do molecular experimentation. It would unravel the molecular pathways that are involved in the final clinical presentation. Once you sign away the tumour tissue, you also sign away the rights for any “commercial exploitation”. The devil lies in the details. I feel you are unlikely to get your money’s worth for the tumour tissue you have donated. Any “blockbuster” drug that might come off it will be the sole property of the organisation that took the tissue in the first place.

Things, of course, are not so simple. It is a very generic statement, and I am sure exceptions to the rule apply.

So should you give away the tumour samples? Yes, by all means necessary. However, not to the organisations but to respectable Government institutions where the public funds’ research.

What will be the benefit of this move? Whatever new research yields the outcomes, it has to be placed in the public domain which would make it easier for scrutiny and more importantly, for reproducibility in other geographical regions. There is no point in locking up the innovation. If the organisation pledges to do the same, then all the better!

There’s one more major concern- data privacy. What would happen to the data if the organisation and the company behind it go bust? In case of Government organisations, the ultimate control will remain in public hands.

I strongly feel that calls for tissue donation need to be understood in the right context; before you sign away your rights for a great common good.

Twitter: Towards a slow spiral of death

Twitter is getting desperate after an increased focus and scrutiny of its actual number of users. While they use metrics like users who were online in the past month, Twitter knows that it is a sinking ship.

There was a lot of hoopla about Twitter making its first profit after consecutive losses. However, it seemed like a flash in the pan. It is yanking off the API’s (third party services which connect via desktop applications). It wants web-only services so that it can serve up “personalised” advertisements. The daily engagement with the service is declining.

It is a worrying trend. While the BTSM practitioners have linked and bonded over this microblogging service, it is easier to get lost in the din of rapid tweets which makes it impossible for any coherent discourse. I have seen posts from institutions- pictures shot from the OT about the cases that they have done. Why this kind of marketing?

The impact of social media ought to be real- like reaching out to potential donors, for example. However, that individual tweet is decidedly less likely to be seen by a specific person. Re-Tweets or Symplur impressions hardly have any bearing on the impact of “tweet”. It only states how many people could have possibly seen. Were they the correct target audience?

A vast majority of the population isn’t aware of nuances of Twitter which can be overwhelming. Mobile interface, like Telegram, needs to be explored in earnest. It should be linked to all the Telegram links (like URL’s). That is also a safe, secure service which doesn’t track you, unlike Twitter.

My rejection for PhD

I have been applying to get into academia for quite some time. I have been rejected for all offers on board without assigning any reason to me!

I am not naming the “latest rejection”, but I feel that documenting my failure would help me to keep things in perspective. It is amply clear that the selection committee had not looked into this blog, social media presence, my publications, present acceptances for international conferences and the like.

While they want a “team player”, it is apparent that socio-cultural contexts and issues would play out in adapting to the new scenario. If I were in their shoes, it would be more comforting to deal with the knowns than the unknown. Letters of recommendation hardly capture the interest and motivation of a candidate. Those letters are stuck in a time-warp. They were a reflection of how I was a student or a professional then. How I am now, is a different story altogether.

It is usually the professional networks that lead to word of mouth recommendation and hence landing the required fellowship or job.

I wouldn’t consider this as a loss under any reasonable set of circumstances, but I was sure that I fulfilled their requirements in more abundant measure than they had bargained for. Since this was a call from international prospects as well, I am sure they must have been able to zero down to a more competent candidate than myself.

I genuinely wish them good luck.

I had earlier spoken out Twitter as well- it is persistence that is required to push for a career in neuro-oncology. It is not easy to deal with shortened life spans, familial expectations and their anxieties. However, the work remains incredibly exciting with vast potential for translational research. Many drug combinations with radiation therapy are being tried out with rapid accruals- yet I stay circumspect because alternative radiation sensitisers and fractionations still need to find their ground on stronger footing.

Failure is only temporary, and I am sure I am going to land in academia, someday because I crave for an intellectual challenge.

Whole Brain Radiotherapy: Is it valid?

The debate between whole brain radiation therapy and stereotactic radiation is spurious. One thumb rule that determines the “success” of stereotactic radiotherapy is the presence of extracranial disease. If it is still present, whatever lesions are being treated, are all likely to recur.

I strongly feel that motivation for stereotactic came in from higher billable for this modality. It isn’t valid and practical for most scenarios across the world. I am not going in for all defence of whole brain radiation which does have its drawbacks, like affecting the quality of life- but any robust psychometric testing hasn’t reliably quantified this. Likewise, the advantages touted for stereotactic don’t always hold water.

The “researchers” have pushed for statistical mumbo-jumbo with the “expert” committees that jump in to “bring order” to the mess of “confusion”. There is no uniform consensus, still, but it is slowly becoming the norm to push for stereotactic XRT (even for multiple mets) when a whole brain radiation therapy may suffice. I believe that the well was poisoned earlier on by papers pushing for many lesions to be treated via Gamma Knife. Cyberknife has only made things worse.

To top it all, multiple “universities” have overactive public relations department to push for “cutting edge treatment”. I was appalled to note that someone was pushing VMAT, for head and neck, as the “standard”. No Sir. Modulation is still not established on substantial evidence but is being only used for its perceived benefits.

This post was triggered because I had a lengthy discussion with a patient’s family about the use of stereotactic radiation for a solitary lesion versus the whole brain, even though she has an extensive extra-cranial disease. She was arguing from half-baked knowledge because she was concerned about the quality of life. Someone told her that the patient might not be able to do mental calculations. Well, is this reason valid in the socio-cultural context? Nope. Only if people are keen to promote “hippocampal sparing” (which adds to unnecessary complexity to treatment), which ultimately, in my opinion, offers no robust advantage. Likewise, scalp sparing again is fancy vanity metric which I call as intellectual masturbation. Good for the conferences to blow your trumpets but the poor practical application or impacting outcomes.

No, whole brain radiation isn’t out of “fashion”. It has more utility in the face of progressive extracranial disease. Stereotactic radiotherapy may be kept in reserve for recurrence or local failure. Whole brain with concomitant boost might serve the same purpose. I prefer SIB, to be honest, which for me, hasn’t shown any sign of failure.

Always keep some steroids handy, taper them down and patients do well to go to receive definitive chemotherapy. I believe, whole brain XRT will hold more importance in the setting of oligometastatic disease that is likely to impact survival. It is an anecdotal observation- liver Mets have a profound impact on survival. Lung Mets or bone Mets end up with a relatively prolonged course.

Twitter for oncologists: More reflections.

One thing is apparent. Twitter as a service, is for sharing links alone. The original premise was to get the overall perspective of how users discuss issues in “real time” and function as a “real-time” search engine. Google, at some point, listed Twitter results but it ended for reasons best known to them.

The more the people on any platform leads to an excessive banter. Separating the signal from the noise becomes even more difficult as informational deluge overwhelms us. While it is fanciful to have more Twitter (or Instagram) followers and show off as “influencers”, it doesn’t help much because of abysmal rates of engagement. While I may consistently get a large number of “Tweet impressions” (mumbo-jumbo of acronyms that Twitter is marketing), this is useless as it doesn’t translate to real life behavioural change.

It is evident from the fact that engagement with my shared links is abysmally poor. My idea of being on the social network is an academic exchange. Suppose I share in a link which is opened and read by another- it would foster a dialogue of information.

On the other extreme, I have come across “verified” accounts of “star-influencers” in Oncology community who push out links with annotations, pictures, survival curves and proper attribution to the authors. How do those “star-influencers” manage it?

I have a strong reason to believe that these links are pushed by dedicated teams using enterprise accounts. A lot of window dressing takes place and after “approval” is “tweeted” out. You have to see the pattern to understand it. It is impossible to juggle professional commitments with tweeting links all the time. There has to be a team involved.

The race for “followers” has polluted the ecosystem. Automated bots propel the specific “likes” making it impossible to differentiate legitimate traffic from bot sponsored and propagated traffic.

I am not cynical. I use Twitter for ideas to write on this blog here. I observe trends. I interact with virtual selves of humans, genteel people scattered all over the planet. It is fun to learn from there, to ping them and understand their perspectives. The trick is to moderate, turning off retweets which don’t concern you, muting specific words and staying focused on what you wish to gain. As a result, I have whittled down to less than half off my previous unread tweets on the timeline. It took time to cull away the deadwood and the fresh perspectives soak in. In the end, it was worth it.

Research in radiation oncology: Break the logjam

I came across this on Twitter (where else!) Despite the “weirdness” (pun intended), it was apparent that it raised substantial issues. I had responded to it, but it merited a blog post.

There has been an institutional push to observe and record in western countries. Higher disposable incomes with specific segments of society helped them to get a better education and as a result, better opportunities. It is not getting into a nuanced debate about the racial differences or affirmative action. Inequalities have always played a part but so is the ability to capitalise on opportunities that present itself.

A lot of research happens because of institutionalised mechanisms. The children have exposure to ideas from the school and paid internships, scholarships and grant opportunities. In India, the approach is entirely insular and works in silos. Medical science has grown incredibly complicated, and it is beyond the purview of anyone to grasp nuances of differentials.

As a result of those initiatives, a few developed economies have led and broken ground in “research” (whether it is transformational or applicable to real-world solutions is immaterial). It has spurred on the likes of China (an aspirational economy) to ape the same system led by the US, but rigid hierarchies stymie them. It is indeed laughable when Government of India decides to set up a “scientific officer for innovation” because it cannot happen in silos. Throwing money at central “research institutes” isn’t going to help because lack of real-world application has hardly moved the needle in any meaningful direction. Likewise, the research is mostly divorced from socio-cultural contexts.

We can only break the log-jam if we first identify the cause of the problem. Outsourced research to understand molecular pathways and then to apply developmental molecules for “blocking them” only perpetuates, what I call a scientific fraud of “monumental proportions” because of perverse incentives associated with “pharmaceuticals”.

(Radiation Therapy needs love- not in delivery methods but radiobiology and fractionation). It is sad that radiation oncologists have more faith and belief in “combination regimes”- altered fractionation schemes have been beneficial too. But progress is excruciatingly slow here.

It would be difficult to think beyond patent protections and intellectual property if someone else controls the purse strings.