Educational Content and some sarcasm. Does not reflect any opinions other than the author's.
Joined June 2025
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Joseph (Joe) Maakaron retweeted
It’s 2075. There is only one hospital in the entire country. It is 8 square miles in the middle of Kansas and owned by United Healthcare. Premiums are $47,000 per month. The only medications left are Ozempic and boner pills. Life expectancy is 38.
Government: “I can’t believe doctors did this to us.”
Joseph (Joe) Maakaron retweeted
“You don't build psychological resilience by feeling good all the time. You build psychological resilience by getting better at feeling bad”—via @Markmanson
Joseph (Joe) Maakaron retweeted
Certificate of need laws are one of those things that should be a 90/10 issue.
You aren’t allowed to build extra healthcare capacity unless you get permission from the existing hospitals.
Like if you couldn’t build a new hamburger stand without McDonalds permission.
Rural states without “certificate of need" laws average 21.5 hospitals per 100,000 people.
States with CON laws? Just 7.4 hospitals per 100,000 people.
These laws hurt rural and underserved communities the most, according to a new Cato briefing paper by @sslivinski and @Matt_d_Mitchell.
ow.ly/V1lY50Zz6KF
Joseph (Joe) Maakaron retweeted
And I'll add, reviewing FDA announcement:
✅ Iberdomide approved in myeloma #MMsm after 1 prior line
✅ MRD-neg CR as basis for accel approval, woohoo!
✅ 41% MRD-neg CR with Iber-Dd in RRMM. Both DVd here and DKd in final CANDOR was ~20% MRD-neg CR, so essentially doubled.
🚨 VTE PPx still needed; I've moved to DOACs for most.
📋 REMS still needed... brand name ZENBEXUS so maybe I'll start saying Dara-Zd ?*
*No, I'll still say Iber-Dd...
CELMoDs - from the subject of podcasts to the subject of 🇺🇸 clinic discussions!
.... but we'll still need podcasts :)
1️⃣ Be ready to give G-CSF during Cycle 1 and push through... neutropenia will often improve with time.
2️⃣ VTE PPx still imperative from what we know.
#MMsm
Joseph (Joe) Maakaron retweeted
Scientists have created one of the most detailed 3D reconstructions of a human cell (eukaryotic cell) ever produced.
This groundbreaking model, often termed a "Cellular Landscape Cross-Section Through a Eukaryotic Cell," combines data from X-ray tomography, nuclear magnetic resonance (NMR), and cryo-electron microscopy to map molecular structures in extreme detail.
Joseph (Joe) Maakaron retweeted
I’m all for transparency and clear pricing, but as professionals, our skill scales with experience and talent. Same as lawyers or CEOs.
There are $500/hr lawyers and $2000/hr lawyers. Do we think skill in medicine is different somehow, and that we can flatten services into priceable elements?
Where does the value of true skill come into play?
Same question for CEOs. Why don’t we have price transparency and guardrails for all CEO comp?
I am saying this as an independent acute care doc who is publishing all of his prices transparently on our website.
But as a medical expert witness for legal matters, my rate has gone up over the last decade and is now far beyond any hourly rate I could earn practicing medicine.
Medicine as a profession has been skill-gutted. There’s no real economic incentive to be the best like there is for CEOs, lawyers, athletes etc.
If you had infinite money, and needed brain surgery, would you rather have a doctor who was the absolute best and most skilled and cost $100k for the surgery? Or not have that choice because the system is designed to make mostly just-good-enough neurosurgeons who will do it for $10k all day.
“Luckily,” ego in medicine fills that gap a bit—we want to be the best—but there are still skill gaps based on raw talent, hard work and experience…
Right now, if you are a 20+ yr seasoned ER doc, you get paid the exact same as a first year attending. The skill part doesn’t get priced.
Every profession has elite earners based on elite skill. Except medicine.
That’s weird.
Joseph (Joe) Maakaron retweeted
#ASCO26 #mmsm Oral sessions myeloma
@AjaiChari discussion
Nice summary slides on studies with some imp findings that limit cross disease comparison
Joseph (Joe) Maakaron retweeted
.@hopkinskimmel physicians achieve 95% cure rate for sickle cell disease with bone marrow transplant
cancerletter.com/clinical-ro…
Joseph (Joe) Maakaron retweeted
Systemic steroid treatment of grade I acute GVHD increases steroid-ref... sciencedirect.com/science/ar…
James Ferrara, MD, John Levine, MD, and colleagues
@IcahnMountSinai #GVHD
Joseph (Joe) Maakaron retweeted
Transplant-eligible myeloma - whether patients proceed with transplant or not, it's important to get stem cells collected.
We recommend quad therapy, stem cell collection after 4-6 months of therapy, followed by post-ASCT therapy.
Don't wait too long to get patients in for stem cell transplant evaluation - it makes it harder to collect enough stem cells.
Joseph (Joe) Maakaron retweeted
Everyone at the @OSUCCC_James is excited about the opening of Dr. Sameek Roychowdhury’s groundbreaking telemedicine clinical trial, which has the potential to change the treatment of cancers of the pancreas, and much more. cancer.osu.edu/news/first-of…
Joseph (Joe) Maakaron retweeted
Brilliantly said 🙏🏽
"We don’t understand why some centers keep giving Induction to achieve CR before heading to ASCT. The patients not responding well are the ones who need the early transplant more."
Trials of transplant in #MMsm did not require ≥PR, and neither should we!
Couple of historical studies which are important to know about.
1) We showed primary refractory myeloma has good outcomes with transplant better than relapsed or relapsed refractory and hypothesized that the main benefit of transplant in myeloma is actually in patients not responding to initial therapy. This was in 1999! nature.com/articles/1701805
@MorieGertz
Which is why we don’t understand why some centers keep giving Induction to achieve CR before heading to ASCT. The patients not responding well are the ones who need the early transplant more.
2. This forgotten RCT in @BloodPortfolio in 2005 by the Spanish group which showed no benefit of frontline ASCT in partial responders to induction, suggesting that the prior reports by Attal and Child that showed benefit with transplant may be mainly because of a pronounced beneficial effect of ASCT in non responders. This is the only study that has randomized responders to ASCT vs no ASCT and even with quite mediocre conventional therapy no benefit was seen. ashpublications.org/blood/ar…
History! #IMS25
Joseph (Joe) Maakaron retweeted
This newly published study reveals that EZH2 inhibitors effectively induce apoptosis in MDS/AML cells with inv(3)/t(3;3) and -7 by activating the GADD45γ-p38-p53 axis. This finding highlights a potential therapeutic vulnerability in these high-risk myeloid cancers.
👉 bit.ly/3TDDb6A
