December 2003

Duty Now for the Future

By Michael J. Katin, MD

2003 is rapidly passing into oblivion, joining the Concorde and the Seychelles fresh water terrapin, and although there is still one month left it is probably reasonable to assume that this will have turned out to have been one of the better years for the field of oncology. Systemic therapy made substantial progress, with approval of gefitinib, the first EGFR-TK inhibitor to get through the FDA, and and other agents
were advancing through clinical trials such as bevacizumab, erlotinib, and ecteinascidin, and also providing a crisis among transcriptionists. Other systemic agents, such as oxaliplatin, had been approved last year and are now finding their way extensively into use. Diagnostic advances are continuing to allow cancer to be detected at an earlier stage. Most importantly, radiation oncology techniques are becoming more sophisticated and being brought into clinical use more rapidly than anticipated.

Regardless of technological advances, implementation of techniques in the community cancer program would not be possible without financial support, and the final version of the Medicare bill voted out by Congress included continued reimbursement for sophisticated procedures in our field and for this we need to be grateful. We know that this situation may not last indefinitely, especially when there is no shortage of special interest lobbyists to divert federal funds into less critical venues. It would therefore seem appropriate and proactive to take measures now to thank our country for recognizing the value of our work.

Our President is currently under criticism for not rapidly resolving the problems in the Middle East. Although this may be a Sisyphean task, there may be a contribution that our specialty can make.

One of the most striking differences between our country and much of the rest of the world is that we take for granted security, food, and shelter, and can indulge ourselves in other interests. A survey of any newsstand will find the majority of articles dedicated to health issues, Michael Jackson, and Paris Hilton, not necessarily in that order. Is it possible that type of orientation can be created elsewhere in the world?

All of us could spend the next several years anticipating the collision of Asteroid 2002 NT7 with Earth on February 7, 2019, or else go on with our lives, looking forward to our next PSA measurement, mammograms, or colonoscopy, as well as to the next reality series or NFL Monday night game. Can this mentality be transplanted elsewhere?

Granted, if you're killed before you're 35 it probably doesn't matter if you ever get a screening whole body spiral CT, but it might be that the availability of modern medical services could lead to increased demand and utilization. One way to accomplish this would be to extend Medicare and Medicaid benefits to the residents of any areas occupied by our forces. This would then stimulate establishment of medical facilities throughout these areas faster than Starbucks colonizing a new suburb. It would be only a matter of months before the population was too busy getting CT, MRI, and PET correlations, downloading information from the internet, and seeking second opinions to worry about who is a Shiite and who is a Sunni. Add to this the need to agnonize over HDL and C-reactive protein levels and scheduling Holter monitors and stress tests. It would be only a few months more before aromatherapy, biofeedback, chelation therapy, and plaintiffs' attorneys arrived. By the time of the 2004 election, it is possible that this Administration may have come up with an accomplishment that has defied the best efforts of the past two generations.

I believe the Nobel Peace Prize is now worth about $1,000,000 tax-free. I'll take it in $20 bills, please.

email: mkatin@radiotherapy.com