@janethooton_ @ErinInTheMorn @fifi_EY 1/ The 🏴󠁧󠁢󠁥󠁮󠁧󠁿 government decided pediatric gender care in England would be a monopoly contract (a Labour minister, in 2008), despite all other NHS patients officially being entitled to a choice of providers, & second opinions on diagnoses & treatment, & gave it to GIDS, which has…

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I'm thinking about Tim Keller's influence.

There is the curious fact that Keller is well-regarded among the culture elite (or at least has not suffered the sort of vilification one might expect given his influence). How can we explain this?

Looking at Prodigal God and other writings, you see that his approach to urban ministry is deeply political in a way that appeals to Democrat-heavy cities. It involves two moves:

1) equalizing sins: elevating the sin of hypocrisy, "moralism," and "religion" (the sins of "conservatives") and equating these with the sins tolerated among liberal (e.g., homosexuality)
&
2) emphasizing "self-righteousness" as a sort of chief sin (the sin of "red states").

Keller effectively downplays the sins that liberals tolerate while elevating the sins of their political enemies, the red state conservatives.

But the greatest appeal to liberals is that critiquing the "self-righteous" vilifies political action, particularly the action of social conservatives (e.g., anti-gay marriage). And the equalization of sins eases concerns over changes in social policy (e.g., gay marriage).

Anxiety resides in 4 spaces:

1. The space inside you
2. The space between you and another
3. The space between others
4. The space inside another.

A powerful de escalation tools is to first locate the anxiety. Where is it?

Often the answer is 'all 4.' Yikes!

1/

Anxiety is contagious, we spread it and escalate it unless we know how to manage it.

This was perhaps my biggest lesson as a trauma chaplain - the very hard work of not catching someone's anxiety.

2/

When I caught it, I was no good to them. I no longer saw what was going on, I was now 'infected' by my own triggers, assumptions, the story I tell myself. I was all wrapped up in myself.

But when I managed my anxiety, I was able to be calm, aware and fully present to them.

3/

Even in the very worst moment of their lives, even if they had me by the shoulders screaming, 'how could God allow this to happen?'

4/

Incidentally, early in chaplaincy, I thought this was an actual question. Because I was anxious, I was more infected by my need to answer than I was to simply be calm and present with them in their pain.

5/

It's Monday AM post-@ASCO #GU21 & clinic starts in a couple of hours! Lots to process - I'll try to tackle optimal 1L tx for #kidneycancer. I'll make a case for cabo/nivo, leaning on the beautiful (& timely) tables below from @lalaniMD, @SoaresAndrey & @brian_rini (1/15)

What about IO/IO? We have long f/u w #CM214 data w nivo/ipi, no doubt (@AlbigesL et al in @myESMO Open). And treatment-free interval discussed by McDermott @BIDMChealth is no doubt impt. But we've known data not as impressive for favorable risk (2/15)

And furthermore, as @ERPlimackMD points out in another tweet, impt to look at primary PD rates (seen in @lalaniMD's table) - nivo/ipi at 19%!!! CR rate used to be something we highlighted w nivo/ipi, but now comparable across studies (3/15)

Okay now to the really tough stuff - comparing TKI/IO regimens. Something interesting I will add to @brian_rini @uromigos table above is the HR for PFS by INVESTIGATOR review. If the diff in HR for PFS by IND review caught your eye, this is even more striking (4/15)

I think INV-assessed PFS is impt, but if you're a skeptic, forget that argument. Turn instead to #QOL with axi/pembro. Kudos to @brian_rini @tompowles1 @ERPlimackMD et al for advocating for QOL in KN-426. @crisbergerot et al have taughts us the importance of these metrics. (5/15)