James Good

Oncologist | Husband, father | Englishman | Civilisation enjoyer

[James Good @drjamesgood]

🧠 This chart popped up in my feed via @balajis

It shows the exponential growth in human brain size and complexity over evolutionary time.

It got me thinking about oncology.

Cancer medicine now sits at the convergence of:

🧬 Biological complexity
🙏 Moral gravity
🚀 Technological acceleration

No other specialty demands this much cognitive and ethical bandwidth.

Are we nearing a new inflection point?🧵

[James Good @drjamesgood]

@mikepat711 And a negroni with it? Good skills

[James Good @drjamesgood]

@AJWLight @thetimes @5_utr

[Anirban Maitra @Aiims1742]

Cool preclinical study by @ACKoongMDPhD @Vince_BernPag that’s basis for a pending clinical trial in #PancreaticCancer 👉🏽
Concurrent Stereotactic Body Radiation Therapy & KRAS Inhibition Synergistically Improve Pre-clinical Pancreatic Cancer Treatment
https://t.co/42BHXHMOwb

[James Good @drjamesgood]

@jryckman3 @HHammersMD ‘Medonc is uneasy’ 😑

[NonsparseOncologist @5_utr]

Just read the new Light et al. focal therapy paper in European Urology. In short: beyond fatally flawed marketing brochure with a DOI. Here's the autopsy 🧵

[James Good @drjamesgood]

@signulll can’t tell you how much they diminish my every day qol

[James Good @drjamesgood]

@cremieuxrecueil It’s much much better. Like it used to be, or closer to it.

[James Good @drjamesgood]

@NikoMcCarty @AsimovPress I must have one!

[James Good @drjamesgood]

@bradwouters And yet people still go to see live music

[Kurt Harris MD 🇺🇦🇮🇱 @radfugee]

One thing breaking my brain in this “let’s screen the whole body” duscussion Is Silicon Valley acting like the human body is a giant black box full of data and we don’t have 1000 years of learning about anatomy physiology, and 100 years of what things look like on images

[James Good @drjamesgood]

@DrMichaelBonner ai slop

[James Good @drjamesgood]

@aeronlaffere @tomough Why is he now vocal frying so badly

[NonsparseOncologist @5_utr]

AI scaling is not exponential. It never was. I fit a logistic model to general capability vs compute across every major model generation — AlexNet to GPT-4. R² = 0.98. The asymptote is not infinity. Never was or will be. Thread 🧵

[James Good @drjamesgood]

@doodlestein Top signal

[James Good @drjamesgood]

@Jameswise The bottleneck in diagnostic imaging is staff rather than machines @RCRadiologists

[James Good @drjamesgood]

Correct take

[CoffeeBlackMD @CoffeeBlackMD]

Doctors all report we wouldn’t do chemotherapy, right?

No. We’d all try the chemo. The radiation. The immunotherapies. The surgery if available.

What we won’t do is flog ourselves at the half dead spot or point of futility. Or pursue heroics that will leave large disability.

[James Good @drjamesgood]

Burgers are a superfood btw

[Achilles @mralexthomas]

Burgers are a superfood btw

[James Good @drjamesgood]

@EMostaque I’d say it’s more homoiousios

[James Good @drjamesgood]

@DrDiGiorgio It’s relentless and counter productive

[James Good @drjamesgood]

10,000x this

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Imagine if every passenger on an airplane had a direct line to the pilot.

That’s what medicine has become.

We have embraced frictionless communication and that not a good thing.

With things like Epic Chat, every member of the healthcare team has immediate access to the physician.

Now there’s a constant stream of minor questions. It’s discouraged people from thinking critically. “Just ask the doctor,” has replaced any sort of clinical reasoning.

When I was a resident, we had an answering service. Anyone who wanted to reach the doctor needed to go through a third party. This provided triage and accountability. If we were getting called in the middle of the night for stool softener orders, there was a record of that.

A little friction in communication is a good thing.