August 2003

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 to know
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 Nirvana, 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. Maybe Billy 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 through

email: mkatin@radiotherapy.com