July, 2015

The I's Have It

By Michael J. Katin, MD

Egocentrism has always been a factor in most professions, and not least of all in the medical field. This year, the letter "I" was prominently featured in several national venues. Most impressive is the theme of the 2015 Annual Meeting of the American Society of Clinical Oncology, May 29-June 2, "Illuminations & Innovation." The April 9-11 Annual Meeting of the American Brachytherapy Society headlined "Brachytherapy for the Future: Innovative, Precise, Effective, and Affordable." The 97th Annual Meeting of the American Radium Society, May 2-5, presented the slogan, "Integrating High-Tech with High-Touch in Radiation Oncology." The theme of the 2015 American College of Surgeons Clinical Congress , October 4-8, is "Achieving Improvement." The 101st Scientific Assembly and Annual Meeting of the Radiological Society of North America, November 29-December 4, states "Innovation Is the Key to Our Future." Among organizations that did not choose to use "I" words in their 2015 meetings, the classiest was probably that of the May 17-21 meeting in Washington, D.C., of the American College of Radiology, "Educate-Advocate-Elevate," (notwithstanding that this is also the motto of the Greater Elkhart, Indiana, Chamber of Commerce), and the most mundane that of the American Society for Radiation Oncology, coming up October 18-21 in San Antonio, Texas, "Technology Meets Patient Care." Interestingly, this is not used as the description for the Best of ASTRO 2015 meeting in November in San Diego, when it will have morphed into "Science of Today/Hope for Tomorrow." If ASTRO keep using up two slogans in a year, it may soon be necessary to recycle famous sayings of the past to promote radiation oncology: "Change We Can Believe In," "Progress Is Our Most Important Product," and "It's Finger-Lickin' Good."

It would seem coincidental that the fairly ubiquitous use of "I" terms in medical conferences this year was reflected in the Supreme Court's decision on June 25. On that date, the justices decided on a matter that can have a major impact on medical care for the rest of time.

"Impact" may turn out to be the most important "I" word this year. On June 25, SCOTUS voted 5-4 that the Inclusive Communities Project in Texas was correct in claiming that the Texas Department of Housing and Community Affairs was incorrect in allotting too many tax credits for housing in inner-city areas and not enough in suburban neighborhoods, resulting in continued segregation even though that was not the intention. The term "Disparate Impact" is used to indicate that there is an unfair effect on a group even if the intention to discriminate is not obvious.

Could this be the salvation of freestanding cancer centers? Over the past 40 years there has been a struggle between the philosophies of concentrating medical care in urban medical centers versus making medical advances accessible to as many people as possible, even in less-populated areas. In the recent past, the emphasis was on making treatments available to everyone regardless of location. Unfortunately, as funding for medical care became more restricted, turf considerations arose. Money to pay for health care needed to be distributed "fairly," with the definition of "fairly" up to those with the ability to distribute it.

It would be possible to supply thousands of references dealing with the value of making cancer care more accessible to less affluent rural and suburban populations. What good is the administration's Precision Medicine Initiative (another "I" word!!) , to design individualized treatment for cancer (and certain other diseases) if the individuals have to live in downtown Detroit, Cleveland or San Francisco? Is the plan to use high-tech high-speed transportation to allow patients to access these centers, thus increasing the value of another Initiative?

Now that the Supreme Court has emphasized the supremacy of "Disparate Impact" we can take for granted that everything will be done to make sure that cancer treatment can be available to everyone in the United States, regardless of race, religion, sexual orientation, financial status, height, eye color, or Twilight preference. It now becomes mandatory for the United States Government and all private (academic!!) facilities to avoid doing anything that disparately impacts any of these groups, no matter how isolated. (another "I" word!). This essentially ends the dominance that large hospitals and academic centers have had in their influence on CMS and other agencies and eliminate any number of future columns complaining about CMS proposed and final rules for fee schedules -- a trade-off that I will happily accept.

Oh, yes....on June 25, 2015, SCOTUS also ruled that "established by the state " was a typographical error in the Affordable Care Act and gave immorality to Obamacare. I knew there was something memorable about that day.

Emanuel Countdown: The Emanuel Countdown will be suspended for several months, to be replaced by a tribute to each of the 37 persons currently seeking the position of President of the United States. The Emanuel Countdown will resume after the nominees of both parties have been selected. The clock, however, will still be running.

The Ballad of Jeb Bush (to the tune of The Ballad of Jed Clampett )

Want to tell you folks a story 'bout a man named Jeb
A multimillionaire, with a family that you've met
He had a lot of businesses but wanted to do more
So he made a run for governor in 1994

Florida, that is.......golf courses ..beaches...lost!

The second time around old Jeb was voted in
But W ran for president in 2000 'stead of him
He helped his brother out and gave it everything he had
And made for sure he got a vote from every hanging chad

Ballots, that is....recounts, David Boies....sorry, Al!

So W went to Washington, and Jeb was left behind
He ran his state so very well he won a second time
But the country was in trouble so that no one could tell when
It would be safe for any Bush to ever run again

Recession, that is....Iraq War...Katrina...where's Bin Laden?

Now Jeb was making money and was lying kinda low
And every day he checked which way the wind would seem to blow.
He looked at what was going on in this Obama nation
And thought this was the perfect time to get the nomination

For President that is....Benghazi.....Affordable Care Act....Eric Holder

So now it's time to welcome back old Jeb and all his kin
Karl Rove and all the RINOS will be signing up again
They all think that the White House is the place he ought to be
So they're loading up the donors and they're moving to DC

Washington, that is....Columba and the kids....Bar and 41....que tal, Hillary?!