Idi Come, Idi Go
By Michael J. Katin, MD
Is it true that all things must come to an end? Eventually it's party over,
out of time for everything from the Roman
Empire to the dot-com economy, with the possible exception of Geraldo
Rivera's career. The three regular readers of this column will be relieved
that their vigil is over, since several events have coincided to finally
bring fulfillment of the January 2003 column. And as for the concluding
half of the January 2000 column -- don't push your luck.
Remarkable advances in medical science are occurring at a speed straining
the ability of managed care organizations to disallow them, and one of the
major recent breakthroughs is in the use of growth factor manipulation.
An excellent example is the work of Yang, Haworth, Sherry et al. from the
N.I.H. on the use of an
anti-vascular endothelial growth factor antibody, bevacizumab, to treat
metastatic renal cancer. This led many of us to search out the July 31,
2003, issue of The New England Journal of Medicine to obtain this article,
while the more pragmatic were buying Genentech stock. As often happens,
looking through the whole issue can help reorient us to the field of medicine
as a whole, reminding us that humans can get a lot of things wrong with
them other than cancer.
One of these conditions is dramatically illustrated by an x-ray of extensive
soft tissue calcification related to pseudohypoparathyroidism. Granted,
this condition is typically found only on board examinations and has virtually
no recognition by the general public ("I'll take obscure endocrine diseases
for $200, Alex"), but, come on, how many diseases have you ever discovered?
Do I hear, "none?" Probably. This is then a very long segue to the resumption
of the topic of the January, 2003, column.
The year 2002 saw the passing of Dr. William Parson, whose life story could
be the next Tom Hanks vehicle.
Possibly the most famous product of the Bronx prior to J.Lo, Billy from
the Block went to medical school at Columbia
and then moved on to Massachusetts General Hospital. In those days there
were no antibiotics, no CT scans, no PET scans, no echocardiograms, no immunohistochemical
studies, and no fiberoptic endoscopy. The blood pressure cuff had come into
use only recently, and the rectal thermometer just behind that. For all
practical purposes, a resident at MGH could only sit around and watch people
bleed and get infected.
This free time,
however, allowed meditation on the nature of being, and one day, while approaching
Dr. Parson was able to imagine a person who gave the impression of not producing
parathyroid hormone, but, in fact, was. He was immediately struck speechless
and wandered the basements of the Baker and White Buildings for days, tearing
at his clothing and avoiding other people, until one morning he announced
his discovery in the Ether Dome in front of five janitors who were hiding
out trying to avoid work. Not one of them understood the concept of pseudohypoparathyroidism,
a foreshadowing of the reaction of thousands of medical students over the
next 70 years.
Now that he had the distinction of having discovered a disease, Dr. Parson
was entitled to be named to the next available chairmanship of Internal
Medicine, and this happened to be at the University of Virginia.
This next segment of his life took up 18 years, including the first three,
which, due to a misunderstanding were spent in Richmond rather than Charlottesville.
He failed to discover any more diseases and sought to make up for this by
disseminating the subject of Internal Medicine throughout the world, including
working in Uganda, where he became the personal physician of Idi Amin Dada.
Having anything to do with Idi Amin showed fairly poor survival instinct,
and, in fact, Dr. Parson narrowly escaped becoming a statistic when he and
his wife broke out of a poorly-maintained prison and were able to get out
of the country. He taught medicine extensively throughout the world for
many more years, finally passing
away on November 25, 2002, having never developed pseudohypoparathyroidism.
The irony is that Dr. Parson, who began his career in the golden era of
medicine in which treatment techniques were carefully analyzed and standardized
and pharmaceutical and technical breakthroughs were beginning to come through
to revolutionize the practice of medicine, is now participating in celestial
CPCs with Cushing, Graves,
and Addison, having to put up with their trenchant remarks about having
the diseases they discovered named after them while his wasn't. In contrast,
these advances in medical science have dramatically benefited Idi Amin,
who this past month was at death's door in an ICU in Jiddah, Saudi Arabia.
Joel was right, that only the good die young, and sooner or later it
comes down to fate. This hideous tyrant (Idi Amin, not Billy Joel) murdered
tens of thousands of people in his own and neighboring countries but managed
to get out in one piece and is living and not yet dying in luxury. It was
said he never met a man he didn't like, as demonstrated by his habit of
his eating pieces of his enemies. He was known for saving the heads of his
executed cabinet ministers and officers and placing them out on the conference
table to prove to himself that they no longer expressed any disagreement
to his decisions. Yet here he is, benefitting from decades of progress in
medical science, without worrying about either justice or DRGs.
Will he eventually come to his end? Presumably. In the meantime, when you're
next in an annual hospital medical staff meeting, wondering if it will ever
come to an end, just imagine that you're there with the heads of the hospital
departments. That should help get you