March, 2020

Dread, Wrath, and Begone

By Michael J. Katin, MD

Humankind has survived innumerable catastrophes over nearly six million years (if one counts Ardipithecus ) or six thousand years (according to Bishop James Ussher). We have been through the bubonic plague, Krakatoa (actually west of Java), and Disco. Everything seemed relatively under control toward the end of last year, with conversation dealing with the Houston Astros' sign-stealing techniques and whether the 2017 World Series championship needed to be voided, or whether Arthur Fleck was imaging all the bizarre events around him, although even his imagination could not have created "Cats" Those were the days. Was there any way to know that someone eating a batsicle in Wuhan (theoretically) would set off a chain of events that has resulted in a level of anxiety in this country that hasn't been seen in years? Where can we find some rationale for what's happening? Were we forewarned? Ironically, Nostradamus was a physician whose practice included taking care of patients stricken by the Black Death, and he generated a fairly obvious prediction about that's going on:

III - 75
Pau, Verona, Vicenza, Saragossa,
From distant swords lands wet with blood:
Very great plague will come with the great shell,
Relief near, and the remedies very far.

The country with the most rapidly rising incidence right now is Italy, and "the great shell " obviously refers to the recent drop in oil prices, Undoubtedly a vaccine will be available (not for oil prices, for the virus) but not for at least six to eighteen months.

Of course, there are multiple good scientific explanations for why this is happening at this time, most of which dealing with the vengeance of the Almighty. Rick Wiles of the Flowing Water Church in Florida has called for China to convert to Christianity to save itself from the illness but also blames it on society "transgendering" little children. Sort of two for one. Fortunately, this is a non-denominational issue. Rabbi Meier Mazuz is blaming Pride Parades, and an Iraqi Muslim scholar, Hadi Al-Modarresi, stated that the virus was punishment for China for its treatment of its Muslilm minority --and also eating weird food. Everyone else seems to blame it on Donald Trump.

As long as blame is being assigned, we should take this opportunity to offer our own theory. In 2019, CMS presented its plan to bundle radiation oncology services in an alternative payment system (the Radiation Oncology Model). This would pay a fixed amount for treatment of any of 19 malignant conditions, rather than the traditional system of paying based on the specific components of treatment. In other words, whether one treated a patient with breast cancer with IMRT, special breath-hold techniques to minimize lung dose, standard fractionation or accelerated hypofractionation, or any sophisticated localization techniques, the payment would be the same as if the absolute minimum standards were met. In addition, percentages would be withheld pending evaluation of patient satisfaction and other parameters. This would apply to 40% of practice sites, to be selected randomly and with assurance that practices in the same geographic areas would be treated the same, whereas 60% of practice sites would continue to bill the standard way. There was anticipation this would be adopted in the final rule in December, 2019, with the complication that billing systems would have a very short time to be adapted. Concern was expressed by multiple professional organizations that implementation would be an extreme hardship on the 40% of practices selected for the new system, and CMS decided to postpone implementation. Now there are reports that this new system will again be revived and there is mystery as to how this might have been made more fair to allow the 40% to stay in operation. It appears there may be forces in the universe that dislike uncertainty. Is that why our lives were relatively carefree several months ago and now heading into despair?

COVID-19 may turn out to be no worse than the common cold but maybe that's what they said in 1918, when the inappropriately-named Spanish flu killed between 50 and 100 million people worldwide, including such notables as Sir William Osler, Gustav Klimt, , Edmond Rostand, Egon Schiele (horrible year for Austrian painters), Friedrich Trump (father of award-winning physicist John G. Trump and grandfather of President Donald J. Trump), and Henry Ginaca, inventor of the Ginaca Machine.

In any event, rather than take such a chance it might be reasonable for CMS to again table proposals for alternative payment models for radiation therapy. If this should occur, we can guarantee that eight weeks from now COVID-19 will have run its course and been barely an inconvenience. I would prefer not to think what might happen next if this correction is not made.

Asteroid JF1 Countdown: Asteroid JF1 will be impacting with or passing by Earth May 6, 2022, which, counting May 6, is 797 days from now. Plenty of time left to stock up on batteries and plywood.