December 2002

Collateral Damage

By Michael J. Katin, MD

Previously we have had the luxury of addressing a wide range of topics of interest to radiation oncologists, therapists, physicists, dosimeters, nurses, and administrators, as well as to the occasional fetishist who accidentally surfed onto this site. Times have changed (not just daylight savings) and for the next few months it may be necessary to concentrate on techniques to help preserve the very existence of our specialty.

At the time of this writing the Middle East is still in turmoil and it would take only one incident to make the situation more dangerous than going shopping with Winona Ryder. At the same time, the world economy is in the doldrums with minimal prospect of improvement. United Airlines is on the brink of declaring bankruptcy (Once I built an airline, made it run, Made it race against time, Once I built an airline, now it's done, Brother, what's the paradigm?). When the proverbial fan is impacted by excrement, a lot of people are going to be affected, and we may be prime targets for collateral damage.

Most of you are familiar with the concept of collateral damage, not to be confused with the film by Arnold Schwarzenegger. The term is derived from the prefix "col-," meaning cost-of-living, and the term "lateral," indicating a pass to or toward a player on the same team who is no closer to the goal. The result is that not only is our reimbursement not going in the desired direction, it's probably going to be transferred to somebody else. Would this be the Department of Homeland Security? They didn't even exist a few weeks ago and they're going to need financing. The longer there's a possibility of open hostility, the less likely that Congress is going to address correcting the relative value scale changes or implementing funding for new technology.

It's been said that in the past we've been able to survive by staying under the radar screen as well as by requiring incredibly complex and expensive equipment to carry out treatments. What's changed? First, we're no longer under the radar screen. The radar has gotten better, and most of what we do is now readily accessible instead of tucked away in basements in large urban hospital buildings that nobody visited because of nychtophobia, claustrophobia, and zemmiphobia. The equipment that we use is no longer impressive compared to the X-50A CRW Dragonfly.

Before we get too righteous about this, recall that years ago there were also concerns about having paying for both "guns" and "butter," referring not to two necessities in upstate Wisconsin but rather to the dilemma of trying to pay for security as well as fulfilling basic human needs. This conflict was usually resolved by the observation that, when the enemy is advancing toward your home, it probably wouldn't be practical to try to drop a day care center on them.

I'm confident our specialty can survive this challenge, but we may need to set up contingency plans in case things go bad. If there is a column next month, it will address two approaches. If there is not a column next month, it will mean that it was too late.

email: mkatin@radiotherapy.com