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I want to thank you for joining us on today’s episode of The Cancer Project Podcast. We’re very privileged to have Dr. Mark Story back with us today, radiation oncologist extraordinaire. Um and also a publisher of one of the better substacks uh on the Substack platform. Um so Dr. Story, thank you for coming back and joining us. Absolutely. It’s great to be here. So uh two things have changed since the last time we spoke. One, we have a new studio. Uh what are your thoughts? I love it. It’s nice. Yeah. Yeah. Great setting. I’m happy with it. I think it turned out I think it turned out great.

It’s a good setting. Uh and then two, you’ve retired. Or or maybe I should use the phrase transitioned. Yeah. I don’t know if that’s the right word. How are you telling How are you describing it to people? Probably more of a sabbatical. Sabbatical, there you go. At least take a break. Um Yeah, it’s kind of crazy. Time flies. Uh this was uh 30 years ago got medical license and 25 years in the clinic and uh just been busy and uh my mom’s back in Arkansas by herself. She lives on a big property, lot to take care of. I’m the closest child. Um seemed like a nice round number, 25 years in the clinic.

Um and uh so I was going to at least take a moment and assess. Um I still consider myself in ways young. Again, been doing it for 30 years, but it’s time. I still probably have more years if something just right fell into place. Yeah. Um but um So, yeah, sabbatical and a break and I’ll reassess and I’ll probably know a lot more in the next 6 months to a year, maybe 2 years as to what the game plan is. And I should say, so just to kind of rehash for people that are listening. So, you’ve been working here in Oklahoma City at the Proton Center since 2019.

Yep. Um you moved here from Arkansas. Yeah. Uh and then um you are even though you’re not bringing in new patients right now, there are still some patients that you’re finishing up some follow-up on. Yep. We’re sitting here at the Proton Center. Right. Um and so uh as you mentioned, you’re not It’s not like you’re completely stepping away from everything. It’s just what’s the next phase. So, let’s let’s do talk about uh your time here at the Proton Center over the last 7 years. Like big picture, how do you kind of think about what the last 7 years have meant to you? Uh again, that’s We’re We’re going big existential questions today.

a huge question. Yeah. I think um a midlife crisis gone well. Okay. Um you know, I I I loved my time in Arkansas. I’d been there for 18 years. I thought protons were really the next step forward in helping to take care of people, reducing toxicity, helping cure more patients, get them through the treatment easier, focus more on quality of life. Back in Arkansas, I had a big head and neck program and uh that was really the driving force is I thought we could do better with better technology for those patients with protons than we could even with really good IMRT treatment. And uh traditional radiation, one of the big You mentioned the Substack.

Uh one of the big themes on the Substack is just how much of value I think radiation oncology in general, holds within the field of of oncology. Uh I think we are under-appreciated. I think we under-appreciate ourselves. I don’t think we’re great advocates for our own field. And uh so, one of the points of the Substack was to write on our value. Even within that, I think protons are particularly helpful in some of the hardest-to-treat, highest-risk cases. Uh traditionally, those have been pediatrics. I think more and more we’re using it for head and neck cancer. We’re using it for lung, esophageal, breast, uh some difficult-to-treat cases.

And um I think that’s where it has the most value. And so, um that was really the reason I started looking into into the career change, whatever that was, like 2017 or so. Uh took about 2 years to kind of kind of come full circle, find the align with you guys here at the proton center, and then um fall into this in I think was March 1st of 2019, started here. And so, it’s been Yeah, like you said, a little over 7 years. Yeah. And um it has been a wonderful arc. Well, I will say, I mean, you took a big risk because we were and I say we cuz I I was moving from Knoxville, Tennessee, you were moving from Little Rock, Arkansas.

We took a big risk because we were buying a proton center that had shut down. Now, when we started looking at the deal, it hadn’t shut down yet, but it did shut down. So, December 31st, uh we found out through that purchase process that there were some major components of the proton system that had to be replaced. And so, we weren’t going to be able to reopen immediately. We ended up closing on the acquisition of this proton center from ProCure in January, didn’t reopen until April. So, you had 4 months there where we we own this very expensive asset. We kept everybody on payroll. Uh but we have no revenue coming in.

We’re not seeing any patients. It’s a big risk in the sense that we’re going to have new doctors here. It’s a new brand. Uh there’s a lot of um other facility other other good cancer centers in the marketplace other good options for patients. And so, we’re having to reposition ourselves as an option for patients. So, it all could have gone I don’t want to say horribly wrong, but it all it it may not have all worked out as well as it did in terms of like even just practically the facility staying open and you having a livelihood. And you had moved, right? So, like if you think back on that just the risk that you took from that standpoint, I mean, does that resonate with you?

Like it was a big a leap of faith. You were going to go work with new people. Yeah. Yeah. No, I think again, it was a midlife crisis gone gone well. So, you were ready to take a big risk. I had uh Again, I think I don’t know. I I think in life there are there arcs to things. And sometimes things have beginnings and ends and trying to recognize those and and move forward part of the part of the path that you follow. Um Arkansas had been really really good. Uh that had gone well. We had built a big cancer center, turned it into a multi-specialty group.

I’d actually worked really hard in the months right before I left to sign my eight-person group I was president of that group to sign my eight-person group to a 5-year deal. So, when I moved here, there was 4 and 1/2 years left kind of guaranteed income at a 75th percentile great contract for 4 and 1/2 years. So, I left clear visibility from that standpoint to come here and do something different. Um but I’ve been I’ve been really fortunate. I’ve been I I enjoy the clinic the and and I’ve trained with great people. And just doing the clinic work a lot of times I I I need to find something else a little bit beyond that.

Right. Whether that’s business, whether that’s Substack, whether that’s more recently in the last couple of years working a little less and making sure to spend the extra time to at least try to make all the right steps to call the patients to contact, communicate them. World is a busy place. Sometimes you don’t always get the ability to do all those things when you’re seeing a full clinical load. When you’re seeing less, hopefully I’ve made the most of those opportunities to be able to call the patients to communicate and do things and answer phone calls and and help them through the process because from the patient standpoint um it’s got to be a chaotic ride.

Yeah. You know, once you get the diagnosis anything you can do I think to help personalize the the process and smooth the path, that’s really the goal. And that’s uh like you said, there’s not a firm stop date to me being here. Again, because that’s part of the goal is to smooth the path for the people who are under treatment. Yeah. And uh if that means coming back for next month or two and seeing a few or extra people and helping to transition care from myself to the rest of the team here who I think it’s going to be excellent. Um that’s that’s easy. That’s just part of the process.

What what has proven to be over the last seven years that transition Oklahoma, what is what has proven to be the hardest part of that transition or maybe something that was unexpected? I was just um everybody has life stories and the life story was we packed up and we moved, and the kids our youngest kid went off to college. Yeah. And uh my wife lost both of her parents in the prior couple of years before the move, or one a year before we moved, and one the first year we moved. Uh and then you’re here, and it’s COVID. And as an oncologist, there were two of us, and like you said, we didn’t have infinite money in the bank.

And so, if um if we were out, and the center closed, um that was the end of it. And so, for probably the first 9 months of COVID, I went from my house to here, and that was it. Trying to be extra cautious, trying to do everything I could in an unknown world to try and batten down the hatches, do everything to not have an exposure, be able to show up here Monday through Friday, do what I do. And so, um From my wife and I’s standpoint, it wasn’t it you isolated. You moved and Right. So, you just moved, and now you feel super isolated because you moved in March.

COVID hits Oklahoma basically the next March, and really things are shutting down in April. Um and I it’s we’ve we’ve had enough time now from COVID, especially the 2020, 2021 time period, where it’s not as fresh. You kind of forget about it. You don’t it’s not like top of mind. But when I think back on what just the day-to-day was like, I mean, it was wild. Uh being here at the Proton Center, and you mentioned just as an example, we had two oncologists. Yeah. And we basically had to tell the two of you don’t be in the same room at the same time. Yeah. Because if one of you has COVID, we can’t have you both have COVID, so that you’re out.

So, like, you guys don’t be around each other. Even exposures. Yeah. And and and Yeah. like we have these like this single point of failure, but there’s like single points of failure around the facility. We’re trying to keep our therapists who are treating patients, we can’t stop treating patients. Cancer doesn’t stop because of COVID. Right. So, they’re trying not to get exposed, and we’re trying to be super cautious because you’re treating people that have compromised immune systems. So, we’re trying to be super cautious even if someone has minor symptoms, well, don’t come into work. Okay, well, how do you have enough staff to keep coming in?

So, like I mean, what was that like for you just day-to-day? What are some of the things that you remember of, man, we really did that? It probably probably everybody has their own stories as to how chaotic it was. I mean, it was uh it was unknown. It was unknown for the country. Um we had different perspective. I mean, as as a big large proton center, um I was on that weekly call with New York, California, MD Anderson, Mayo, Seattle, and you were hearing the worst of the worst from the really densely populated cities. We were trying to make Then I was medical director trying to make judgment calls for like what was appropriate here.

Um it was it was a crazy time. Uh um you know, I think it we we everybody tried to navigate it the best we could. We we had a lot of unknowns. I think radiation oncology were were relatively lucky cuz generally our facilities are pretty big and open. Mhm. Um not much contact. Um uh patients are spread out easily. So, I think we have a lot of advantages in hindsight. Um and uh like you said, we operated throughout it all. Did very well, kept the doors open, kept treating patients. Um but yeah, truly a truly a crazy time to try and be leading a multi-room proton center.

Trying to trying to make appropriate medical direction or or yeah, advice through that was was um hundreds of hours each week reading trying to figure out where we are. Yeah, and having to make like daily decisions, yep, critical decisions. One of the things too uh that I remember was I mean we just like most healthcare institutions we ran into the whole PPE uh craze and shortage and are we going to have masks and do we need to have hazmat suits and like what masks work and what don’t work and you know, you got patients showing up and with all kinds of things strapped over their face and is that going to work?

I mean that I just yeah, you were trying to buy stuff on eBay and uh it’s yeah. Again, I think in the big picture my answer would be uh hopefully the legacy is all the that we got through it and that uh we’ve we’re taking care of so many patients this Yeah. Now, like what? 700 a year or so? Is what we’re up to, new patients and uh I think that’s really the what I’ll remember long term was being able to save a facility that potentially could have closed. Yeah. That is a large capital investment for the initial investors and for the city of Oklahoma uh Oklahoma City and for the state of Oklahoma and for the even this region of the country.

This is a anchor for proton therapy. It’s got the history to England and the and the pediatric patients from from that part of the world. Um this has tremendous history and to be able to be a part of keeping it open and now providing that care to hundreds of patients annually moving forward. I really think that’s the that’s the story hopefully that in the long term we can look back on and and continue to be proud of because I think these are incredible assets. I think with time we’re proving areas to where um we’re more and more certain that they offer benefit to patients. Um you can debate exactly where that line should be because of cost versus quality of life issues.

But I think to have it available as choices with improving technology, we’re going to be able to better define who needs protons, who benefits from protons, what what type of role these facilities should play, and I really see them as as re- regional resources. Um that serve Too often I think in America we side all this is a Um too often is an aside. yeah, exactly. So So too often I think we see these things as as institutional or single building structures. Yeah. And I I think they’re best viewed as expensive as they are to build, as resource intensive as they are to run. Um we need to be pulling the best patients from a region to be able to successfully use these.

And I think over the next 10 years hopefully the the model in the health care landscape evolves to where we do a better job nationally of utilizing the resources more broadly for the patients who were most certain achieve the most benefit from them. So from your standpoint, who who are those patients? Like who are the patients that you would say you live in Tulsa, you live in Northwest Arkansas, you live in Wichita, and I you you would really benefit from. I would encourage you to think about traveling to get proton therapy. Traditional list, I think is uh I I think almost everybody agrees that pediatric cases um at least need to be considered um almost uniformly considered having a have a review or have somebody look at it and say yes or no and and consider that as a resource.

Uh I personally still think the head and neck data is incredibly strong. There are two trials. There’s one in the US that showed an improvement in overall survival. There’s one that was done in the UK to where they took a 6-month metric and decided that it showed, in their words, no benefit. But if you look at it from a patient standpoint it helped patients to swallow better. It helped patients to eat foods, normal foods at the end of treatment more regularly. It decreased the chance of feeding tubes Mhm. needing to be placed in patients by about 10 to 15%. So 10 to 15% less feeding tubes.

So instead of it being, say, 45% it was 30%. Um those are huge gains from a quality of life standpoint. Uh and the US data has a little bit longer follow-up and shows a survival benefit. And so um even the negative data shows these large reductions um in feeding tube placement, significant short-term improvements in like can you eat solid foods? Can you drink anything? Um those are big patient issues and improving those by 15, 20, 30% are significant. So I think head and neck cases are very important. And then I think um I personally think the data long-term will have to wait until 2030 for like true data for left-sided advanced breast cancer.

Um today I think it’s going to be a is going to show benefit in reducing cardiac toxicity, especially for younger patients. Uh so, younger women with multiple lymph node positive breast cancer, I think it’s going to be a win. Um I think there’s really good data for esophageal cancer. Uh esophageal cancer has kind of changed since that that whole trial came out. And esophageal cancer now is sometimes we don’t use radiation, but when we use radiation, the trial said 99. 9% of the time we think protons are going to be better. Okay. So, it wasn’t 100% sure, but it was 99. 9% sure Yeah. the protons were better.

Uh I think hospitalizations in that trial dropped from like 13 days to 8 days. Yeah. So, like 5 days less in the hospital if you needed to have surgery after traditional radiation or surgery after protons. Yeah. And so, you know, at 3 years out, they may be doing the same, but 5 days less in the hospital and being significantly less sick for let’s say 3 months is a significant pa- patient-oriented metric. Yeah. And so, um complex cases like re-treatments, I think those benefit. I think we do great for liver. I think we do Here, uh I’m really proud of our prostate treatment. I mean, I think we do really well.

Our results are um I think you can get really good results with IMRT. I think you can also get really good results with protons. I uh It’s kind of what I tell everybody is I can’t guarantee an outcome, but I can guarantee, I think, that we’re in the like top 5%. Yeah. And push into the top 5% outcome. Um and I think we work really hard to do that. Yeah. Um I think you can get really good outcomes. Um You know, I wish they were all available everywhere. And the ease of access and referral lanes were open so that we got the patients most likely to benefit most here consistently.

So, uh I don’t know if you know this, but we have a live stream going uh with questions coming in from the audience. Oh, excellent. And so, uh these are some questions that have come in from the audience as we’ve been sitting here. Excellent. Um The first one, uh this is this is a good one. What song would perfectly soundtrack your career? What song? Yeah. I don’t know. I have no idea. Um Beautiful Day. Oh. Yes. That is a fantastic answer. I and I put you on the spot with that. That’s really good. It’s a beautiful day. Uh and so this this next one is that or Back Loser.

And I decided to be optimistic. Glass half full or glass half empty, you know? Which What’s it going to be? Um Okay, so then the uh another question, this is sort of related to this cuz you you said Beautiful Day. So, a beautiful day for you, what are you most proud of that no one really sees? Uh um I mean, I family. Uh and I guess from a from a career standpoint, that would be helping me take care of the people who take care of me. Um in the clinic and uh taking care of the staff, taking care of the patients, and trying to do go the extra mile to put them in the loop of how you would treat your family.

Mhm. And so I I think broadly family. Personal life is I we I’m I’m I don’t bring a lot of that to work. So that’s private in a way. Um but I I think the goal of of the job and something as important as oncology is to try and bring the people you see either at work staff who help care for the patients um or the patients bring them in closer and at least try to replicate what you would want done for your family. Yeah. What so uh let’s talk about Krista. Because she’s been a presence up here at the facility. She’s served on the board of the Proton Pals Foundation.

So she’s done a lot to give back and volunteer. What What would What has she meant to you in your career? And just life in general. No, she’s been great. I mean, partner. Um married in ’93. Yeah. So uh it’s been wonderful. And uh I was trying to do the math on that. She She’s the good part. What 50 50 years 60 years? Yeah. Yeah. Like I’m at 78 years. Yeah. Yeah. Yeah. So the uh Yeah, what is that? 34 33? Um in July of this year. Okay. So um Yeah, it’s been a blessing. Uh she’s the she’s the good force that steers me in the right direction.

So. Yeah. Yeah. Well, we’ve loved getting to know Krista. Uh and again, it’s always it’s always great to see her up here and uh see her like when she’s serving lunch for the patients and patient graduations and so um you’re you it it’s it’s neat to see you guys just interact with each other and I think you’re right it does kind of set an example for just the way that you the way that you guys interact with each other is also I see that and how you interact with patients as well and there’s like a respect and a compassion and uh but also just a friendliness.

Like I think and I and maybe talk about that because so we do these patient graduation ceremonies every 2 weeks um and the the patients that are finishing treatment get this opportunity to stand up and talk about their time here and I I’m going to give you the uh credit for being the most frequently mentioned physician at the I don’t know if that’s a good thing or a bad thing but you are the most frequently mentioned physician. But no seriously it’s a good thing because these patients obviously develop a rapport with you so describe if you were if you were talking to a younger doctor coming out of residency and and you were to just tell them what their relationship should be like with their patients.

What would you tell that person? We’re going big picture, huh? Yes. Yeah. We’re going Mark the Mentor. Yeah. Um I don’t know I think they just need to be themselves. I think everybody’s going to have a little bit different path and a little bit different vision for how they they are going to integrate and care for their patients. I don’t know that there’s one formula. I think um everybody needs to kind of lean into who they are. Um you’ve got to obviously pair that with with good education and science background and knowing the literature and knowing the the guidelines. Um but I think everybody’s going to have to figure out their communication skills and patterns as to how to help patients make reasonable decisions?

I’ve always been relatively um informal even in the most formal board meetings or whatever kind of situation. Um I’m not overly technical. And I think that’s helped. I think um it’s super easy for patients to be overwhelmed. Mhm. Um the more you talk to them later, the more you realize just how little even people with a lot of context can take in. It’s really quite limited, I think, in the room. And so I think to try to simplify things down and tell a complex story in a simple way that’s um reasonably accurate but relatable um is important. And then how those how they do it um Again, my my my simple guiding principle’s pretty easy.

Just try to do what I do for family. And if I hit that mark, then everything else kind of falls into place. And nobody’s perfect, so I’m sure I I I don’t hit it all the time, but um you know, if there’s an opportunity to make a phone call that that you think the patient would like to do, pick up the phone and make the phone call. Um and part of that’s structuring for me it has been limiting the volume of the clinic at times in order to be able to prioritize the care aspect. Um when people get so busy doing so many procedures, it comes with two things.

It probably comes with a lot of skill, a lot of expertise, a lot of excellence, but sometimes the personal touch, I think, slides a little bit. So it’s a fine-tuned balance. Um I just encourage everybody to have high standards and do what you’d want done for somebody who you would want the best in class care for. Um And then going back to the foundation, I mean that’s another thing that we did when we came is we restarted the foundation. Mhm. Um when I’d worked in Arkansas, we had a foundation and it did wonderful charitable work for the oncology patients there. And talked to you about starting something up here to like support cuz like you have these organizations and we’re blessed to be in such a wealthy country and people are amazingly generous and and if you ask for something that affects so many people like cancer has such a broad touch and broad impact, um people are amazingly generous.

And uh you were able to find the Proton Pals Foundation that had kind of at least gone into remission for a moment and uh wasn’t active. The nice thing there though was that that foundation even though they weren’t actively out raising money, uh You didn’t have to do the paperwork. They’d already done the paperwork with the IRS, so that was an added bonus, yeah. We were able to get going Yeah. And then surrounded by the team and the work we’ve done, that foundation has raised a ton of money. And uh that foundation then sends that back to the oncology patients, so again, that’s one of the things I look back again and you like look back at the the seven years here and you’re like, wow, we’ve we’ve done we’ve done a lot of really good stuff.

What um are there any patient stories that stand out to you or as much as you can potentially share, is there a a particular patient that uh or particular situation that resonates with you? Um There’s certainly, yeah. I mean, there’re obviously probably, I don’t know, 20, 30. Yeah. Um the uh they stand out for different reasons. Um obviously, you can’t be too specific, and then like ones that come up that are super specific, you I don’t I’m not going to go into. But, I think it’s more you know, there are two sides there. They’re They’re the very kind of from a radiation oncologist who’s done this for 30 years, and this may sound bad, but they’re they’re relatively routine cases.

They’re They’re the things that you see all the time. And then, within that subset, there’s there’s still people who go in and handle that situation with an amazing amount of grace, strength. They’re still faced even though it’s routine from this side, it’s not routine from that side. Right. And they still handle it amazingly well. And and then and then there are the other side away from routine are these um true outliers that you just never want to see happen. Younger cases, children, those kind of cases that all of those are unique. And um you and so they they stand out and those stories stand out for different reasons, different ways.

I think back to um As an this As an as an aside, again, continuing with the whole thing as an aside. Yeah. When we moved here, um the contractor who picked up picked up our house when we bought it, um it’s the husband of the lady who started Project 31. Hm. And so, she’s had an amazing story. She’s been a been a been a leader for the community, raised up uh a whole support group for young women affected with breast cancer and uh so we’re we’re blessed to have the opportunity to be in spots to where you see people at important life moments. And those life moments then affect everybody Mhm.

along that arc. So, uh on that note speaking of life moments and legacy what kind of legacy This is from the audience. This is another question from the audience, yes. What kind of legacy actually matters to you now? Um And maybe how has that evolved from when you first started your career to this point? Uh again, it’s a when we first start, you just want to kind of be able to do it. Like be out on your own and like I remember one of the original patients I’d just first shown up and you have to go through all these regulatory steps and I didn’t have my DEA license.

And that came back as a rather negative comment on a on a patient form. So, you go from that early on. that can’t even prescribe drugs. What kind of doctor is this? had to call in. So, um there are all these kind of stories along the way and then you uh you try to grow up and expand and become really good and and see certain cases and read on those cases and then expand it into the business stuff. Um I think as far again as legacy goes I don’t know what’s important What’s important is to know that I I I tried really hard to take care of people and hopefully that that landed.

Um I um hopefully did really good work. Um I encourage all the residents, for example, um on my Substack to uh to measure their results. Like, pick an area to where you treat a lot of cancer. And don’t just take for granted that you’re going to hit the number that the experts hit in the paper. Right. Right. Um take your patients, follow them, measure your results. Um we don’t do that enough in medicine. I think people like to to think that maybe if their results aren’t good, it’s because of something else. It’s because of the doctor who sent them to. But ultimately, you’re responsible, and you need to measure your your own results, and know that you’re hitting a high mark because if you if you got eight people and you’re not the best one, you ought to be trying to be the best one.

And And if you’re the best one, then you ought to be trying to teach the next person how to do better. Because at the end of the game, um it’s not a competition between the physicians. It’s competition between the patient and trying to get rid of the cancer. Yeah. And so focusing on that. Give me an example. So, when you say So, measure your results. I’ve measured my head and neck outcomes, followed them all for like 3 years. I’ve measured my lung cancer outcome, followed them for 3 years. Here, I’ve measured my prostate cancer outcomes. I’ve got a database that I update daily that’s got about I don’t know, 450 patients in now.

And outcomes meaning Um I was following their PSA and labs and data points. Um for lung cancer, it was different. Following the CT scans and keeping a record of who I thought the cancer was gone in and who it wasn’t. Uh or how it came back or where it came back. Trying to look and see if my fields were right and if I was treating what I needed to and trying to minimize normal tissues. Cuz there are there are levels to this. Uh meaning you know, we like to think of things being binary, like I Well, I either got radiation or I didn’t, and all radiation’s created equal or all protons are created equal or even all radiation oncologists are created equal, but that’s not actually the case.

Just like with any profession, you can spend the extra time and care about the details and study the literature and assess if there’s issues that have arisen and make adjustments or you can ignore all of that and maybe have different results. That all of that’s true and I try to do very good. The reality is, um, if you turn on CNBC, everybody there thinks it’s a stock picker’s market and they have to be the stock picker. Yeah, all right. Probably in medicine, everybody thinks they are all doing top 5% work. Right. And they are all probably 99% of them are actively working to do that.

And so, the reality is everybody’s not at the top of that tier. Um, the reality is, I think if we measured more across the board, we’d have better outcomes and we’d be able to move the needle higher. I think more than one person trying to move their own needle, I think the the larger goal is to collectively move the needle higher. I think you see that in the data. I think we cure more people now than we ever have before. Cures for breast cancer continue to climb. Cures for the head and neck cancer I think are going to increase. They are The treatments today are much less toxic than they were 30 years ago.

There’s really no comparison. Um, so I think we continue to make advances, continue to do better. Uh, I think everybody gets there through small individual efforts and then trying to have bright people at big institutions try to shift the general trends in the right direction. What has has the the, uh, practice of oncology gotten harder? Absolutely. I mean, it’s gotten so much more complicated, especially on the drug side. Drug side, it seems like every day there’s a new drug coming out. Um my joke is even the staging system’s gotten more and more complicated. Every time we move it more complicated, we’re just going to force it to be an AI answer.

Cuz you can’t There’s like 42 different ways you can do It used to be four, and now it’s like 3A 3B, and there are all these little different subtypes. And um Yeah, there’s something to be said for simplicity. There’s something to be said for a lot of a lot of depth and knowledge. Um and I think again, from the physician role, translating the complexity into something that’s simpler for the patient. That’s one of our main goals, right now. Where do you think the balance is between just doing what the physician tells you to do versus well, be your own advocate and make the decision that you feel is best for you.

Like how how how do you would you advise patients to balance those two things? So, we’re at a proton center. Context. be anywhere. So, you’re at a proton center. Ask me that question. Um largely here, like again, I think patients need to be their own advocates in a way. Yeah. Um I think you can go too far. I think it right now it’s really complicated online cuz it’s hard to find what you think is truth. Even in an area of expertise, it is hard to decide exactly where truth is. And so, um there’s a balance. You’ve got to trust experts. Um but I think you need to be your own advocate.

I tell people all the time, you got to find a person who you think is an expert who you can trust. Don’t trust the process. Mhm. I mean, the processes are pretty good. They can kind of get through stuff, but at the same time you need people at the end of the day who can help navigate the thing, get it as good as we can for that individual person. Um So, it’s a balance. Um largely for protons you’ve got to be an advocate to get here. Mhm. Uh if you don’t if you’re not aware and not asking about it, it probably falls into 1 or 2% chance that it will be discussed.

Yeah. If you’re an advocate, you can maybe push that to 20, depending upon what region you are of the country. Um so, How much do you consider yourself a scientist and how much do you consider yourself an artist? Artist, I’m not a good artist. Um so, I’d go with scientist. Okay. But, I do think um But, there’s an art to what you do. Absolutely. Absolutely. We’ve had a couple of residents come through and uh and and have have had the opportunity to work with them um as kind of a mentor. And so, they’ll leave their program and academic programs are a lot of times are very structured.

Here’s what we do. Here’s the exact steps. And I’ve had couple of them come in and go, “Wow, well, you changed this for this patient and you did this for this patient. ” Um especially as I’ve gotten older, I have um gone away from the exact prescription more. I think if you’re in a really high volume area and you really see a lot, you can appropriately deviate from the guidelines easier than you can if you’re only seeing 10 of them a year. If you’re seeing 200, it’s easier for you to know the details and to know like, these are just general guidelines, but in this specific case, then we need to be up here.

Um so, I guess but I’ve always been more of an artist. MD Anderson was uh very rigid. Mhm. Um today radiation oncology has a hundred times the flexibility. We used to treat prostate here for for what, 5 years? It was probably 100% of men were treated for 44 fractions. Right. Now, you can almost throw any number out on the dartboard and we’ve done it. Yep. Right. Right. Well, I mean literally from like 5 to 44 we’ve done 20, we’ve done 10, we’ve done 15 cases, we’ve done 28, 29, 30, 35 39, 40, yeah. Right. Yeah. And so today with knowledge and and the ability to target specific stuff, we’ve got a lot more flexibility to be able to customize the treatment towards that individual patient.

Yeah. So you have a Substack. Uh let me ask you first and I’m going to I’m going to pull this up too cuz I have a specific question from the Substack. But why did you why did you start writing the Substack? Um I was on Twitter. I thought Twitter was really good. It was back in the day when it was called Twitter. And um Some of us old people still call it Twitter, so yeah. So it was back in that time and it was a really good resource for figuring out the new science, figuring out what was being talked about at the uh at the meetings.

Um but I did not want my professional voice to be that truncated. Mhm. And you have to have it um anything online and social media sites it is really really difficult maybe to say. It’s really difficult to stay balanced on social media. Right. When if you add any zinger to it, it gets a hundred X the views. Right. And so it is it it was really I didn’t think it was the right format for me to write. And then Substack came along and it let me write these incredibly long, too long articles that were at least focused on radiation oncology that I thought would bring in a radiation oncologist oriented.

So it’s it’s mainly for like technical. Uh-huh. Uh the I the original idea was for radiation oncologist just to kind of say that I was reasonable and balanced and you could do protons and be reasonable and balanced. Um and that was uh that was one of the main driving features. And then over time I’ve enjoyed it. It helps organize my thoughts. Um and uh now it’s turning more into a uh hopefully more of a mentor the next generation of younger radiation oncologist try and pass along um knowledge. I think uh if I can make help speed up somebody’s progression through some disease site by just a little bit by giving a little bit more context then that’s good.

And uh I laughed the other day somebody posted something on desmoid and a friend of mine wrote one of the original desmoid papers like summarizing it from Andy Anderson. And I’m like, “Oh, Matt Ballo’s like somewhere wondering if you were going to link his old reference. ” And I looked up the reference and it was from 1998. Okay, yeah. And I thought, “Yep, I’m old. ” Yeah. That’s that that was the take home. Yeah. So uh you mentioned that your Substack started technical, but it’s now ventured into the philosophical to a certain extent. extent. Your last uh your last three posts, so there’s a this is a three-parter.

Uh the title is the approaching singularity. Um so first of all, and then I do have a specific question about uh some of what you’ve written, but that title, the approaching Singularity, what did you mean by that? Uh it’s inside joke for me. It’s AI based. Let us in. Let us in on the joke. uh it’s commonly used in AI as we uh continue to improve with artificial intelligence, the the answer is that we’re approaching singularity to where we singularity is around the black hole. Mhm. Light can’t escape, rules of physics change, you can’t predict what’s going to happen in there. And I think AI is approaching this loop to where it improves itself and is going to rapidly change the world.

And I I really think that’s going to happen over the next 10 years or so. I don’t know exactly the timeline, but I’ve always been technical, computer-oriented. Um I think we’re on the verge of something really pretty different for the next decade, maybe 20 years. Um and so I see those changes, and then on the radiation oncology side, we have a lot of changes to our field that are fundamental as we move towards fewer and fewer fractions. [snorts] We’ve had reimbursement changes over the decades that have put incredible pressure on our field now, and I think leadership in our field, I hope reads them and starts to realize how important it is for us to be strong advocates for our specialty.

Mhm. We are going to compete at a um faster and faster pace with large-scale pharmaceutical companies that have literal trillions of dollars of capital. And um not that it I mean the ultimate goal is progress, right? Like I don’t I don’t care who does it, but like um if we don’t fight for our value proven roles for radiation have potential to just be overlooked and substituted for drugs that maybe almost as good but may cost 10x as much, may cost 20x as much may not be as good for the cancer, may actually come with more toxicity. Um but that’s the real potential. Um and so it was kind of more for leadership of our field to to pay attention to the reimbursement issues, to look at the trends for our field, and to start to try and guide people as to things to consider.

Things to watch for that I think are again, you never know if you’re right or wrong, uh but 30 years in at least I have opinions. So, I wrote them down. Well, uh and some great opinions. Proton’s 101 is the Substack. Um so, this is my last question for you. So, part three uh which just recently published um advice approaching singularity advice I’d give my younger self. Yeah. What uh without giving away too much uh cuz people can read the entire Substack, but give us the highlights of advice I’d give my younger self. Um the summary was back in the day I I I I was really able to focus only on IMRT and run an external beam practice very simply.

And that worked and that was profitable at the time, and it cured patients, and it was top-tier state-of-the-art. And we but it allowed me to simplify the clinic work and then focus on the running the eight-person practice and business and reimbursement and other things along the way. Um now I think with the amount of change that we’re going to see in the field, uh you need to diversify. Mhm. Uh you need to look at things like we do Pluvicto here. Uh it’s a targeted drug for prostate cancer. It’s a radioactive targeted drug. We’re going to have more targets in cancers. We’re going to find them through AI.

We’re going to be able to build the protein on the computer chip rather than in spending a year and a half in the lab. And we’re going to have more and more of these types of treatments. So, you need to do a handful of procedures and not just be traditional IMRT focused. We need to work on the short fast high dose treatments like SBRT. You can work on protons. You can work on treatment for benign disease like arthritis. You can branch out and do more of the drugs, which we did 20 years ago, but we don’t do as much now. You can do more procedures.

You can do things that diversify because again the the po- point of the Substack is um uh there are trends in place, long-term trends, but I think our field is still great. And it again, I wouldn’t I still encourage young people who ask me who are in medicine like is radiation Yeah, it’s been great. Mhm. Wonderful. It has been the best career choice I could have made for myself and I’d do it again 100 times in a row. Um I just approach it slightly differently and I was just trying to pass along some of that information. I think um to hopefully help the next generation be a little bit more successful and continue to be um great representatives of what is a tremendously valuable treatment within the oncology space and that’s radiation for cancer.

That is a great way to close us out today. Thank you, Dr. Story. Absolutely. your time. We’re going to get you back on because we didn’t really cover approaching singularity part one or part two. And so that we’re going to save that for a whole separate episode and then maybe some future substacks as well. So thank you for joining us today. Absolutely. Great to be here. Thanks again. The Cancer Project podcast is made possible by the Oklahoma Proton Center. A state-of-the-art cancer center where precision and treatment meets real compassion in care. We’re grateful for their support and for you for spending this time with us.

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