March, 2015


By Michael J. Katin, MD

It's amazing how fate works its magic. In October, 2001, Senator J. Strom Thurmond passed out in the Senate chamber and the persons who came to his aid were Senator Bill Frist of Tennessee, a heart transplant surgeon, and Brian Williams, of NBC news. Senator Thurmond went on to live to the age of 100. At Senator Thurmond's 100th birthday celebration, Senate Majority Leader Trent Lott of Mississippi made the mistake of wondering how great things would have been if Senator Thurmond had won the Presidential election of 1948. For some reason, Senator Lott failed to appreciate that Senator Thurmond , the nominee of the States Rights Democratic Party, had run on a segregationist platform. Within 15 days, Senator Lott had announced his resignation as Majority Leader. Among those who called for his resignation was the next person elected Majority Leader -- Senator Bill Frist.

In 1912, Alfred Gwynne Vanderbilt, millionaire heir to the Vanderbilt fortune, was booked to travel on the initial voyage of the Titanic but for some reason decided to cancel his trip at the last moment. Unfortunately, he was a passenger on the Lusitania when it was sunk by a German U-boat on May 7, 1915, and, despite being a millionaire, died after having given away his life jacket to a second-class cabin passenger, Alice Middleton, and, assisted by Brian Williams, trying to save infants by securing them to flotation devices. In addition, Guglielmo Marconi, the half-Italian, half-Irish winner of the 1909 Nobel Prize in Physics, was to have been on the Titanic but sailed 3 days earlier -- on the Lusitania. Interestingly, wireless signals from a Marconi system allowed more rapid rescue of the Titanic's survivors. He then was a passenger again on the Lusitania on the voyage prior to its sinking by a German U-Boat. Unfortunately, despite these episodes of good fortune, Marconi became a fascist supporter and died in Italy in 1937, and in 1964 Alice Middleton passed away in Livonia, Michigan, with both of them simply having postponed the inevitable.

In radiation oncology we come into contact with patients with a myriad of disorders other than cancer, with the goal of treating the patient rather than the disease. Although in the course of time we have seen individuals with PVD, IHSS, ASCVD, and even MRSA, we don't usually see (or recognize) those with PL, otherwise known as mythomania or pseudologia fantastica.

In a totally unrelated development, Brian Williams, chief news editor and evening news anchor for NBC-TV, has been at least temporarily dismissed from his position after it was learned that he had featured a factually deficient and incendiary article on breast irradiation (as discussed in the January, 2015, column. In addition, he also misled his audiences about his experiences during Hurricane Katrina, and in the Gulf War, and even exaggerated his exploits in rescuing puppies from fires when he was a teenager. Perhaps he was too occupied winning the 1998 Nobel Peace Prize, discovering cold fusion, or pitching the Anaheim Angels to victory in the seventh game of the 2002 World Series. Not to further question Mr. Williams' thought processes, although it was commented upon that despite his looking back very favorably on his high school years, he has somehow forgotten to respond to requests to help prevent his high school, Mater Dei Prep, from closing. Mr. Williams has expressed regrets about his erroneous statements about his experiences in Iraq but has not reached out to the specialty of radiation oncology regarding his judgment in his "expose" about breast cancer treatment. Is it possible that retribution has been accomplished through a higher source?

Is it possible that universal forces are at work to protect our specialty? Consider that Dr. Ezekiel Emanuel, as described in the December, 2014, column, is dedicated to promoting economy in medical treatment in general and cancer treatment specifically. This is usually translated as not wanting to pay to take care of older Americans. Dr. Emanuel wrote an article for The Atlantic magazine, directed to the general public that he would prefer to not live past his 75th birthday because of the risk of increasing debility. This, of course, means that policy will be established to discourage others from living past their 75th birthdays. Medical progress now allows people to live much longer than they did 50 years ago and now there is a risk that future developments will be restricted if it's no longer politically correct to live too long. I would not want any cosmic forces to take vengeance on Dr. Emanuel for his efforts that are detrimental to the field of radiation oncology, where the majority of our patients are at least over 65 and, almost without exception, would like to live much longer,to at least 84 years of age. It seems an amazing coincidence, however, that his brother, Mayor of Chicago Rahm Emanuel, has found, quite unexpectedly, that his re-election is no longer certain. On February 24 Mayor Emanuel failed to get 50 per cent of the vote in the primary election despite having massively outspent his opponents. He is now subject to a runoff election in April against Cook County Commissioner Jesus Garcia.

Are there any other examples of bad luck affecting people who have not been supportive of our specialty? We are constantly under pressure to demonstrate our worth each time the CMS fee schedule comes out, and we were innocent bystanders damaged when the sequester resulted as the result of the 2013 budget negotiations. Blame has been directed in every direction as to which parties were responsible for this "compromise," but it seems that Jack Lew, Office of Management and Budget Director at that time and currently Treasury Secretary, has the most responsibility. Mr. Lew has, fortunately, not sustained any significant adverse events, although attention was recently directed to his income while alternating academic, government and private sector jobs. In fairness, he is an extremely learned and accomplished gentleman who has earned every dollar, and now he can even get paid with currency bearing his own signature!

And what about the creators of the infamous SGR problem -- the Sustainable Growth Rate formula, as discussed in the December, 2010, column? The Balanced Budget (wow, there's a concept!) Act of 1997 was based on House Bill HR 2015 written by John Kasich, now Governor of Ohio. This created the SGR, which is now continuing to torment the medical profession. Mr. Kasich subsequently worked for Lehman Brothers in its Cleveland office. Lehman Brothers went under in the economic turmoil of 2008, but Mr. Kasich was elected Governor of Ohio in 2010 despite incumbent Governor Ted Strickland's attempts to contaminate him with Lehman's failure. (Lehman Brothers had contributed heavily to Senators Hillary Clinton and Barack Obama. Among executives at Lehman Brothers: Theodore Roosevelt IV, participating in projects with former Vice President Al Gore, and George Herbert Walker Bush IV, second cousin to President George W. Bush. Mr. Walker was criticized by his associates for suggesting that bonuses might be reduced in the face of the largest bankruptcy in US history. Of course, he apologized to them.). Mr. Kasich was then re-elected in 2014 and is a potential Presidential candidate for 2016. Maybe after he becomes President he can help Congress resolve the SGR mess, as well as he has worked with groups in Ohio to work out differences.

Finally, what is going on with the frequent turnover and fates of the administrators of CMS itself? Marilyn Tavenner on January 16 announced she was leaving that position and her future plans have not been specified. Interestingly, she had one of the longer terms as acting and actual administrator, from December, 2011, to now. We should take the opportunity to wish her a productive future. Her predecessor, Donald Berwick (July 7, 2010 -- December 2, 2011), sought the Democratic nomination for Governor of Massachusetts in 2014 and, despite sterling credentials, including three degrees from Harvard, came in third with 21.1% of the vote, third behind nominee Martha Coakley, who had the previous distinction of losing the Senate seat held for years by Ted Kennedy to Scott Brown in 2010. Ms. Coakey went on to lose the governorship to Charlie Baker, Jr., former CEO of Harvard Pilgrim Health Care. Quite interestingly, the lengths of service of the administrators of CMS and HCFA, as it was previously known, have been very short, ranging from several months to two years, and similar to the tenures of most of the popes in the 9th and 11th Centuries. Does that mean taking the position of head of CMS is its own curse? If they would like to find out how to undo that curse, they will find the answer not from huge managed care companies or from entrenched bureaucracies, but from which doctors involved in the everyday practice of medicine they should choose to ask.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including March 1, 2015, this leaves 6,516 days to his goal of not living beyond his 75th birthday.