How Twitter enriched me professionally as a radiation oncologist

I am a recent convert to Twitter but have flirted with it in its earlier days of inception when 140 characters were the norm. It wasn’t apparent as to why this service came into existence in the first place. Facebook started off with a similar pretence of “connecting dorm mates”, and it grew viral pretty fast from an invite-only platform to connect a majority of the online population.

I will not go in its politics or how toxic it has become. Its algorithms are an opaque science, and Facebook is a platform for social and psychological manipulation (despite public claims to the contrary). For this write-up, I’ll focus only on Twitter since I am engaging with it on a daily basis.

Twitter offers a place for discussion, sharing links, some media (pictures) and a medium to reach out to other users for marketing. Advertisers see some value in it (because Twitter offers granular options for targeting users). Beyond that, most scientists and doctors have discovered this as a platform to articulate their viewpoints. There’s life beyond academia as well, and most events affect us collectively. However, it blurs lines between personal and professional lives, often. This has prompted several professional organisations coming in with their “recommendations”, but social media is like any other platform which is public.

There is no inherent privacy if you get online. Period. Likewise, all this serves as a construct to showcase or to interact (like presenting a paper in conference or hanging out with colleagues post lunch). This also leads to a considerable scope for confusion because of the inherent limitation of characters. Like any written word, it cannot offer tone, tenor and contextual meanings which leaves things open to interpretation. However, Twitter provides only a limited scope of interaction via “re-tweet” or “like” which signals the intent. Beyond this engagement, it is a very limited platform.

With these caveats, Twitter offers a rich experience in professional interaction. I chanced on pathology colleagues, for example, who could reach out others in the world for a rapid “second opinion”. Pathological inferences usually require objective criteria, and it is not possible to be swayed by “wisdom of the crowd”. It makes it easier to nail the diagnosis for anything that’s obscure. Likewise, I interacted with a radiation oncologist, who advocated “shining the light in the basement”- exhorting fellow oncologists to embrace this medium. Another instance wherein I interacted with someone from the US to discuss the QA for a newer gamma knife machine. The follow-up comments were interesting, and I learned a lot in the process.

Similarly, it was fun to interact with professionals from down under! They are using social media in a very positive way (by dancing!) to target cancer and bring about an attitudinal change for radiation oncology (unstated and underused, like anywhere else in the world). I love their imaginative use of “targeting cancer” pin-ups with the backdrop of landmarks. Cats and dogs are also a part of it, for good measure! The idea is to get the word out to patients, who shouldn’t ever feel that they are alone. We are all a part of the team to take care of them.

These advocacy efforts on behalf of professionals are in addition to a lot of other patient advocates- one who has gone through the trauma of diagnosis and treatment and have lived to tell their stories.It is instructive for us to learn, as doctors, to understand and be empathic to their fears, concerns and how cancer diagnosis fundamentally changes their lives. A prominent patient advocate, for example, even suggested having “lego based models” to show what patients would be going through (radiation therapy mockups). A brilliant idea indeed!

Scientists have also joined in this chorus and have added their might to it. I follow their efforts to bring science to the public domain, how they navigate through government bureaucracy and how translational science can become the cornerstone of “cure”.

So yes, there are multiple positive attributes to being here on social media! For those who are starting out, a quick re-cap. You can follow specific “hashtags” like #btsm (brain tumour social media) or #radonc which are widely used around. Topical conversation happens around these hashtags. If you suffix the character “@“ before anyone’s username, it is like a “shout-out” to draw their attention. (Similar technique works in Telegram).

Join in here for the conversation and enjoy! Remember, you have only one life to make a difference!

Scientific elitism, failure and research.

Dwight D. Eisenhower Source: Wikipedia

I was alerted to an interesting discussion on effects of federally funded research- the rise of scientific elite and “military-industrial complexes“. The thought process was initiated with a compelling article on what President Dwight D. Eisenhower had mentioned in his address about 50 years back.

I quote:

“Today, the solitary inventor, tinkering in his shop, has been overshadowed by task forces of scientists in laboratories and testing fields… ,” Eisenhower warned. “Partly because of the huge costs involved, a government contract becomes a substitute for intellectual curiosity virtually.”

While continuing to respect discovery and scientific research, he said, “We must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.”

There’s been enough debate in the knowledge circles about the exact import of this. But these words ring real as the years have passed. “Military-Industrial” complex has grown in stature, causing havoc, while the new upstarts in the scientific research world are increasingly elbowing their way in this cosy club from China.

This isn’t a geopolitically nuanced post. It only serves to reflect my concerns about wastage of research efforts and how much it is held hostage to scientific committees. It is a good thing to keep a rein on how the dollars are being invested, but this also comes with the riders on how difficult it is to fail.

All of this has come at the cost of progress and reward to the scientific thought and tinkering.

It is true that the advent of “atomic bomb” spurred on research in the US, but there was defined anxiety to achieve the goals. In Asia, we grapple with the income inequalities and access to equitable healthcare, while in western democracies, they are floundering to create the next breakthrough. Hence, the likes of “project moonshot” because it is recognised that something is required.

It leads us to another question: Has the scientific process and the research methodology gone too bureaucratic in its approach?

Likewise, the cost of publishing the research has become beholden to the established interests. The scientific cabal controls access to literature pushing vanity metrics (which in turn determines means to get further funding). It transpires that if the research isn’t published in a “high impact journal”, it isn’t meritorious enough. The unstated pressure to achieve publications in high impact journals breaks most people resolve to push through them. It only leads to either cronyism, cooking lab results to dress them up and an established PR machinery to impress the charities backing the research efforts.

Who loses out?

The patients. It is because the bulk of published research can neither be reproduced nor translated in clinical domains efficiently.

The spinoff from this has also led to an arms race to find the next big molecular target. The idea is to of course, “sell” it to the pharma company to patent it. While not inherently evil but it feeds the same demon wherein we know how equitable access worsens.

Rinse and repeat.

What are the implications for developing countries?

Herein, lies the rub. It is sad that bulk of doctors have turned away from scientific research because what they see in the patients is not meaningfully communicated in the lab. Dr Ronald Ross discovered the malarial parasite while actively practising medicine. Leannec invented the stethoscope because he needed an efficient way to auscultate the patients presenting to him. He went stumbling from various kind of tubes to something resembling a stethoscope that we now know as- universally ubiquitous.

Ideally, we should be researching the hows and whys of radiation effects on cells, the way it breaks DNA, the downstream effects, minimising the impact on healthy tissues, exploiting the fractionation schedules and a better mathematical modelling. Instead, we are going agog about Amazon and JP Morgan’s of the world stepping in healthcare, ferreting away the precious human health data to their data centres, feeding algorithms and fuelling the hype cycle about AI in healthcare as the next breakthrough. It only reflects how faith in the system has broken down.

Clinician-scientist is a moniker. What we lack is a comprehensive roadmap to what we want to achieve- not concerning survival but a meaningful continuation. As the world celebrates cancer day, it is a call for the radiation oncology community (and the medical profession) to evaluate its priorities and work towards alleviating what we are supposed to do.

What is the way forward?

The way out, forward, is to break shackles of our minds and allow ideas to fail. If I were to have my lab (someday!), I would dedicate a portion of funding only to tinker with the possibilities. Involve people from different fields to brainstorm on what all possible directions the idea can go. Involve mathematics, for example, with probabilities on what can go wrong or right. These are not the core competencies of clinicians but opening up dialogue and communicating with teams looking at the same problem with a different perspective can help enlarge the idea.

“Cure” will not be hope but a purpose and an end all.

Is research wasted?

How far is this true?

I would dispute the numbers but the questions raised here are extremely pertinent.

  • As always, we need to ask the right question. Design appropriate methodology.
  • Put it out in public domain.
  • And make the research accessible.

These are desirable goals but not the end points that we see in practise. Things have to change for meaningful outcomes.