My friend, your last post makes no sense whatsoever, and I say this respectfully.
You talk about elitism thinking. I have to say that your posts have been elitist in the opposite way. You continually voice criticism of doctors who have "another gold star" on an academic diploma. You have constantly been elitist in a different way, glorifying local doctors. I am not talking about YOUR doctor, I am talking about local doctors versus the so-called top ones.
Well, David, a gold star means there is some accomplishment. A "cum laude" on a degree means something. My daughter graduated with a "cum laude" degree from Umich. She worked her tail off in high school and college, putting in a ton of hours, to earn that. These doctors -- the top ones -- are not getting mail order gold stars.
You said "So what would be different in this supposed higher level opinion? If there is something different out there, then why isnt any one talking about it?"
David, there are research papers and new ideas coming out every day. It takes a long time before they pass muster and become new standards of care. I told you my past situation about being dx. with Crohn's Disease via colonoscopies, but not being quite "sick enough" to fit the usual profile. It took an expert to remark about the latest research suggesting that it was the prep I was using (Fleets Phospha Soda). In a small cadre of patients, it caused temporary inflammation indicative of Crohn's Disease. How come my local doctors didn't know this key fact?
In fact, speaking of Umich, I think that's where they discovered there are 24 PC varieties. Maybe they can test which kind a person has and do something about specific kinds. Now, probably they cannot at this stage,, but when they can it will happen first at Umich or Mayo or Hopkins or... It will not happen in my neck of the woods or yours and it will take time -- possibly a year or two or three -- before that new useful information filters to our local medicos.
I don't know if anything would be different for you. But, frankly, your continued insistence that there is no difference between top doctors and world class centers versus local doctors is specious, especially when dealing with advanced cancers.
There are no guarantees for any of us. As you've pointed out many times, I sought one of the top surgeons in the world and I am still in a failed tx. situation. But to make the quantum leap that therefore we shouldn't bother to seek out the best people is ridiculous.