December 1997

Sea You Next Year

By Michael J. Katin, MD

Q: What is the major difference between the Titanic and the U.S. Health Care system?
A: On the Titanic, not everybody died.
Alternative A: (only part credit) The food was better on the Titanic.

I can surely not be the first but I didn't want to be the last person to make the comparison between the Titanic and our beloved medical-industrial-governmental complex. This may be unfair to the Titanic, since at least it was being steered in a general direction, as opposed to the haphazard wanderings of our system. Perhaps comparison to the Exxon Valdez would be more appropriate. In any event, since the new film version of the Titanic tragedy apparently turned out all right despite expectations, and constant references to "Waterworld," and since we will be barraged by Titanic tie-ins (action figures? Happy Meals?) we should assume it will be around for a while and take the opportunity for reflection.

The Titanic was the largest movable structure ever built, up to that point in history. The decorations were extravagantly expensive, as if to cover up the fact that this was just a means of transportation. Those passengers who were wealthy were able to participate in the full experience, but the passengers who were willing to put up with the indignity of being in the steerage area nonetheless would have still gotten to New York just the same. Unfortunately, when the Titanic went down, it took both groups with it.

The principle that there are only two types of organisms in the sea, either sharks or shark food, also seems appropriate in assessing today's medical care environment.

Perhaps we should be encouraged that evolving technology and innovative thinking may eventually get us out of this mess. Years after the Titanic, we don't cross the Atlantic in larger and more crush-resistant ocean liners since we can cross on an airplane more safely in less than 5% of the time (forgetting TWA 800}. Unfortunately, while we're waiting, the icebergs are getting bigger.

email: mkatin@radiotherapy.com