February 2000

You Say You Want a Resolution

By Michael J. Katin, MD

Anyone who claims to be an iconoclast shouldn't write about following up on New Year's resolutions but for at least two weeks I kept up with the promise to myself to look at each journal as it came by and avoid the alternative pathway directly to the pile. In truth, this hasn't usually been a problem since in 1978 I found a check for $2.00 in a throwaway journal, a clever technique to find out how many people were actually ever looking inside. I haven't found another check since then but I think I'm due. Anyway, it paid off in terms of generating a topic for another column, which is definitely worth more to me than $2.00, although I'm not sure how much.

In the January, 2000, issue of the Journal of Clinical Oncology is an editorial by Daniel Haller addressing the need for determining the appropriate techniques and indications for hepatic arterial chemotherapy for colorectal cancer. Yogi Berra would have referred to this as "Deja vu all over again." I was transported mentally, although not physically, unfortunately, back to my early days in oncology training, in which some of the hot topics included hepatic arterial chemotherapy. Why, then, after all these years, should this be an editorial in a January, 2000, journal?

The answer is answered by the story of the two guys whose flight from Chicago to Cleveland got cancelled and they needed to get there within three hours for an important meeting. "No problem," one of them said, "we'll just drive." "What do you mean?" said the other, "That's at least a six hour drive." "I know that," said the first. "We'll take two cars."

The message from this pointless story is that for years oncologists, whether in surgical, radiation, or medical oncology, have been trying to get to conclusions working in parallel. Now there's an article from the German Cooperative Group on Liver Metastases (not amenable to a pronounceable acronym) (except perhaps in Klingon) which serves as the stimulus for the editorial by Dr. Haller. It's with embarrassment that we find that this topic is still being reworked after more than 20 years without having been definitively settled.

I wish there were a solution to this. But don't get too depressed. Several will be proposed in the April, 2000, column.