Published on the Dec. 6, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Decades ago, radiology and radiation oncology decided to separate, giving rise to two distinct specialties. But times and technologies have changed, and it is, perhaps, time for two branches of radiology to consider a close relationship, said one industry expert.
During this year’s RSNA annual meeting last month in Chicago, William Shipley, MD, a radiation oncology professor at Harvard Medical School and chair of the Massachusetts General Hospital Genitourinary Oncology unit, proposed a partnership between radiation oncology (RO) and interventional radiology (IR).
“With all our new training and new societies, perhaps we’ve gone too far away from each other,” he said. “To survive as a specialty, we must adapt and look at which areas could marry.”
But is such a pairing necessary? According to Shipley, yes. Both RO and IR are facing challenges that they could better weather together. A paradox exists in RO, he said. As the specialty has become for technologically advanced, it has ceded many of its duties to other types of providers. For example, medical oncologists and surgeons frequently conduct patient evaluations, ablation, and brachytherapy procedures. IR faces a similar concern — unless these providers assume clinical responsibility for patients, they will lose ground to physicians who can acquire and learn to use the same imaging equipment.
“There are remarkable parallels between interventional radiology and radiation oncology,” he said. “I believe they’re running on the same track and at the same gauge. It’s time for their train tracks to merge.”
RO and IR would still continue as separate specialties. The goal, he said, would be to create a new certification — image-targeted oncology — for those residents interested in mastering skills in both areas. There’s already a great deal of overlap. RO has already become more imaging based, mirroring IR with its use of 3D, 4D, and stereotactic imaging. In addition, both types of providers use the same technologies, such as needles and ultrasound equipment. And, both still hold to continuing the oral exam.
In order for this merger to work, RO and IR must both bring attributes to the table. According to Shipley, RO would bring model of training that includes cancer biology, staging, chemotherapy strategy, and a process of care that incorporates medical and surgical oncology. Conversely, IR would offer a broad portfolio of therapies, including an ablative therapy that is complementary to radiation therapy.
“Radiation oncology is very good at irradiating the microbes of small-volume disease. And, most ablative technologies handle larger tumors, but they don’t address microscopic disease,” Shipley said. “Imagine how powerful it could be if we put them together.”
The advantages of combining these two branches of radiology would extend beyond offering a new training track to medical students and residents, he said. Patients who need these services would also benefit.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2118473
Published in the Sept. 17, 2012 Raleigh News & Observer and Charlotte Observer
By Whitney L.J. Howell
We asked Alex Roland, professor emeritus of history at Duke University, to put the current Mars Curiosity mission in a perspective. Roland is a former NASA historian.
Q: What are the benefits of unmanned space exploration, such as the Mars Curiosity?
One question has driven all current space exploration: Was there ever, or is there now, life on Mars? It’s likely if there were, it’s disappeared, but we might find evidence. That would have enormous implications for the space program and for the human race and condition. It would suggest we’re not unique in the universe.
Such a discovery would increase NASA’s emphasis on getting the country to agree to a manned Mars mission. NASA sees itself as having had a golden age with the Apollo program. Ever since, it has tried to find something else to capture public imagination to justify a large increase in our space activity spending. Curiosity plays an interesting role because if it finds evidence, NASA can increase its manned mission push. But Curiosity is such a capable exploration vehicle, and it’s so much cheaper and less dangerous than a manned mission, that many of us believe we should invest in more Curiosities.
Q: What’s the advantage of unmanned missions?
Whenever you send people to space, the expedition’s purpose changes. To explore Mars, we can send up as many remotely controlled vehicles as necessary. They’re uniquely designed for exploration. A manned mission must get people there and back safely. That trumps all else, and it limits exploration. Humans can only do safe exploration. Their exploration time is limited because they must return to Earth soon. It also limits the equipment sent up because astronauts need a lot of life support. For exploration, we’re better off sending custom-designed, remotely controlled, automated spacecraft. There’s nothing humans can do on Mars that a machine can’t. Sending people increases risk and diverts the mission’s goal.
Q: Are there potential technological gains from the Curiosity mission?
Investing in science and technology, especially research and development,
always produces spinoff. Second-order consequences and unanticipated technological applications can be useful in other fields. But that comes from any R&D. NASA’s spinoff record isn’t great. It has claimed the dollars it has invested produced more spinoff technology, but that mostly isn’t true. There’s nothing specific NASA does that makes R&D any more productive.
Q: Could this Mars mission be seen as a relaunch of space exploration?
Whenever I hear of manned Mars missions, my first question is, “Why?” What will we do? Will it be like Apollo where we send humans there and bring them home safely, and that’s the end?
NASA maintains manned Mars missions will be part of a permanent space colonization program. That begs the question of why colonize Mars? Sending humans there to take pictures, scoop soil, and return safely will cost hundreds of billions of dollars. An initial colonization mission would cost probably around $1 trillion just to get started.
So, it’s reasonable to ask the purpose and benefit of having people on Mars. A good comparison is the International Space Station. We paid more than $100 billion to put it up there and never found a good use for it. Within a decade, we’ll likely abandon it, let it decay in orbit, and burn up in the atmosphere. If we can’t find a good use for the space station that’s comparatively close and safe – even though we’ve lost two space shuttles and crews going there and back – how do we think we’ll find a good use for humans on Mars?
Q: What continues to drive NASA toward manned exploration? Are we still searching for our place or role in the universe?
That’s exactly it. When NASA sent the first crew to the space station, it stressed this reflected both the agency’s and our country’s place in history. It emphasized this was the beginning of permanent human space habitation. It believed from then on humans would be in space and people would look back and remember America, NASA, and the space program.
But there’s no commitment to fund the space station very far into the future. It’s too expensive to maintain, and it’s not doing anything useful.
NASA will argue strenuously to maintain a space presence. We all love NASA. We love what they do and think they’re good and capable. But the public has a right to ask what we’re getting for our investments, especially when budgets are stressed.
Q: In the last decade, space exploration has shifted from government-funded enterprise to the private sector. Will this continue?
I’ve long been skeptical that private companies without government subsidy can make money flying in space. There isn’t that much money to be made. It’s a big business, but it’s not what most private venture firms are motivated by. Often, it’s idealistic, very wealthy people with lots of money to invest.
They grew up in the space age. They want the same permanent space presence NASA wants, and they’re going to help make it happen. I think we’re seeing evidence they can build launch vehicles and operate them more cheaply than NASA. But do they have a business model for sustainable programs and making money?
None will reveal how much they’ve spent, and without long-term, sustainable business models, venture capital isn’t attracted. It’s unclear how many companies will make money.
NASA’s trying to help them because if companies assume routine activities, like launching satellites or resupplying the space station, then NASA can divert funding to futuristic enterprise, including manned Mars missions. Perhaps NASA has enough business to keep them going for a while, but not enough for long-term profit. One strange peculiarity of modern technology is the satellites we launch now are so big and powerful we don’t need as many of them as we used to.
Q: What can NASA do to reignite or reinvent itself?
What many at NASA only say privately is the public often doesn’t appreciate NASA’s unmanned spacecraft magnificence. It has transformed how we understand the universe and presented research possibilities, but NASA’s believed its public and congressional support and budget depend on manned space exploration.
NASA has believed people don’t care about space science, communication and weather satellites. But these technologies give us today’s world. Manned space flight has been little more than circus or stunt. Astronauts go up, float around, and return without accomplishing much.
Curiosity exemplifies how exciting unmanned space activity is, and how interested the public can be if NASA educates them.
Published in the June 2012 AAMC Reporter
By Whitney L.J. Howell
At Mississippi’s Jackson State University campus, roughly 160 undergraduate students gathered last February to learn about the ins and outs of medical school—applying, financing, and navigating the curricula. Most important however, they discovered that becoming a doctor is within reach.
The experience was part of a five-day campaign, known as the Tour for Diversity in Medicine (T4D), a bus tour that brings information about academic medicine and clinical practice to students attending historically black colleges and universities (HBCUs). The tour also includes information for students interested in dentistry.
“We wanted to make sure these events had a personal component to them. We, as physicians and medical students, go to campuses, sit with students, and have conversations about their personal and academic lives,” said Alden Landry, M.D., M.P.H., T4D co-founder. “It’s more personal than a webinar, Web site, or newsletter. We wanted to meet the students where they are comfortable so they could see us as examples in front of them.”
Landry is an emergency medicine instructor and associate director for the office of multicultural affairs at Beth Israel Deaconess Medical Center in Massachusetts. Along with Kameron Matthews, M.D., J.D., an attending physician at Cermak Health Services of Cook County in Chicago, Landry created the tour to introduce health and medical careers to minority students with the goal of increasing the number of doctors and dentists from groups that are underrepresented in medicine and other health professions.
Academic medicine continues to make progress toward growing a more diverse student body, but programs like T4D still are important, said Norma Poll-Hunter, Ph.D., director for diversity programs and policies at the AAMC.
“It’s critical to take this innovative approach to reach out to underserved communities. Despite concerted efforts from medical schools, associations, and foundations, the overall percentage of racial and ethnic minorities matriculating to M.D.-granting institutions hasn’t changed significantly in the past 10 years,” Poll-Hunter said.
T4D completed its first tour in February, visiting five HBCUs: Jackson State, Tuskegee University in Alabama, South Carolina State University, Johnson C. Smith University in North Carolina, and Hampton University in Virginia. All told, the tour reached approximately 500 students and provided information on how to prepare for and take the Medical College Admission Test®, which undergraduate courses to take to strengthen medical school applications, and how to finance medical education.
But the most significant information, according to Matthews, came from the nine mentors she and Landry recruited. The group of practicing physicians representing minority groups traveled with the tour and offered students first-hand experiences from both school and practice.
“They hammered home that there’s a sense of delayed gratification with medical school. It’s a marathon in terms of the steps from application to becoming a physician or dentist,” Matthews said. “You need to look at this as a long-term career and not be swayed so much by what it takes to get through school. The students got the hint that we did it, and they could persevere to do it, too.”
The information students gathered and the skills they learned through T4D undoubtedly will contribute to increasing the number of minority students who enter medicine, said Michael Druitt, who coordinates pre-health programs and a medical science master’s degree program at Hampton University. The mentors offered tips on how students can improve their interview performances and how they can build rapport with practicing health care professionals, he said. These relationships could lead to shadowing experiences that bolster medical school applications.
Bridget Rideau, M.D., Jackson State’s pre-med and pre-nursing coordinator, said the T4D inspired several of her students to begin actively taking the path toward medical school.
“Many of our students latched onto information about the National Health Service Scholarship. I’ve already filled out five recommendation letters to accompany applications,” Rideau said. “This is especially significant for our students coming from lower-income families who are fearful of how to pay for additional education.”
Student feedback from this year’s tour has been overwhelmingly positive, Landry said, and the program has already scheduled a Midwest tour for this fall and another tour across Texas in spring 2013. HBCUs will continue to be a focus, but upcoming tours also will concentrate on Hispanic-serving institutions, tribal colleges and universities, and regions that have few minority physicians and dentists.
To read the story at its original location: https://www.aamc.org/newsroom/reporter/june2012/285340/diversity.html