March 1997

Medical Recycling

By Michael J. Katin, MD

One of my concessions to eccentricity is maintaining at least some degree of sideburn growth consistently over the years despite changes in fashion. By my estimate, I have now gone through three separate cycles of acceptance and rejection of sideburns with the most recent being brought to me attention by the fact that Beck had a prominent role in several recent recording industry awards shows.

At the same time I realize that I have succeeded in living through probably at least one full cycle of innovations in radiation oncology.

It was before my time that radiation therapy was used locally in treating benign diseases and by the time I was involved in oncology the use of radiation therapy for a benign problem was avoided with a few exceptions. At the Massachusetts General Hospital it was renowned that Dr. Milford Schulz had published a compilation of the use of radiation therapy for benign problems but it was very difficult to locate this book. Now there has been an entire volume of the International Journal of Radiation Oncology, Biology, and Physics devoted to benign diseases and nearly every month there is a new conference on one of these topics.

One can only wonder which will be the next rediscovery. While I was still in medical oncology, before going into radiation oncology, it was thought the use of hyperbaric oxygen would be a major breakthrough in terms of maximizing the benefits of radiation therapy. The next innovation was the use of misonidazole. Now this compound is used only as an answer to a trivia question. When I was first going into this field aggressive brachytherapy was being used only by very selected practitioners who had the ego strength to recognize that the greatest potential complication of radiation therapy is the growth of the cancer. Now the implementation of brachytherapy is continuing to expand. The readers can probably come up with multiple other examples. There are several centers now that are increasing their potential applications for neutron beam therapy after the initial large study in the 1970's that did not indicate a value for the wide spread of this modality, for example.

My greatest fear is that in this era of managed care and cost containment, that other treatments previously in vogue will return. It might not be a bad idea to invest in companies that manufacture orthovoltage equipment since that might be the only treatment method left with low enough overhead to be profitable. Most importantly, it is necessary to guard against the ultimate rediscovery, namely that for 99% of man's time on earth, observation rather than treatment, whether with surgery, radiation therapy, or chemotherapy, was the preferred method of dealing with cancer.

email: mkatin@radiotherapy.com