July 1999

Codependence Day

By Michael J. Katin, MD

This column has now been in existence for nearly three years and despite the fact that readership has been soaring and even that multiple fan sites have been generated dedicated to this column (even I have problems with some of the trivia questions that have been posted) it has come time for a reassessment. I have been accused of writing in hope of having my material discovered by a reader outside our profession (William Safire? ET?) whereas in fact I have probably been moving further off the subject only because of the difficulty of addressing some of the more important issues in Radiation Oncology without offending those who can make life miserable for us. Inspired by recent developments in Kosovo and (potentially) in Northern Ireland, I have decided to resume dealing with more controversial topics. I am again posponing the long-awaited second installment regarding dealing with department inspections (begun sometime in the distant past, earlier this year) to address the topic of cooperation.

At the beginning of the 20th century, the only non-surgical treatment for cancer was radiation therapy. That is, of course, not including aromatherapy, massage therapy, acupuncture, homeopathy, and other techniques (politically correct addendum). When chemotherapy first came into use, the radiation therapist still remained the primary practitioner of cancer treatment after the surgeon. It is estimated that in 1964 a catastrophic event must have occurred, resulting in a dramatic increase in breeeding of medical oncologists and decreasing prominence of radiation oncologists, with the latter surviving partially because of an influx of new genetic material from overseas. The nature of this event is uncertain and only partial understanding can be inferred from available records. Further analysis of this is warranted.

The truth is that both sides need to recognize that ultimately they must join for the sake of oncology in general. The diseases that we treat have potential to do damage both locally and systemically, and excessive concentration on one aspect to the exclusion of the other is not conducive to maximizing good results. Will this coming together take the form of the interaction between the tickbird and the elephant, or between the hagfish and the trout? (Warning: don't try to visualize these)

I hope that we can resolve to work out these differences before the next castrophic event occurs. According to paleontologists, this would have the potential to replace both the radiation oncologist and medical oncologist with another species: the accountant.

email: mkatin@radiotherapy.com