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
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
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.