March 1999
Rivalry
By Michael J. Katin, MD
When I was in college at the University of Pennsylvania, I and most of my colleagues thought that Princeton had definitely lost a coin toss somewhere in having us as its traditional rival. At Princeton, everyone had clothes from Brooks Brothers and drove big cars and the women all looked like Thalia Menninger. At Penn, the clothes came from I. Goldberg's Army-Navy Store, we rode the subway, and the women looked like Zelda Gilroy. One year, just before the Penn-Princeton football game, someone finally came up with the one thing we had that was better than Princeton's. We had a better rival.
Recently there has been a great deal of propaganda about the next generation of radiation therapy hardware and software. A Florida physician not yet in our group called attention to a news release from the RSNA touting the glory of IMRT (Intensity Modulated Radiation Therapy, to civilians who have surfed onto this site from elsewhere on the net). No one would argue that increasing technical sophistication is undesirable, except for the impracticality of having rising overhead with falling reimbursement, but the unintentional (it is hoped) implication can be that if you don't have IMRT you're trying to kill the patient. The patient's family should kidnap him or her to go to a facility that uses IMRT. The only recourse is for you to buy IMRT 2.0.
In fact, a difference in outcome can be extraordinarily difficult to demonstrate regardless of what we want to believe (if the truth belies the legend, print the legend). It used to be ironically said that the penumbra of cobalt-60 saved more people than it harmed. The concept of "pinpointing" the cancer may be applicable only if one is treating with pins.
But this propaganda has spread to the popular media. There is a PSA (public service announcement, not you-know-what) circulating now on AM radio as one of a series of "Energy Minutes," sponsored by the Department of Energy, undoubtedly in a desperate attempt to use up those disgusting surplus dollars before they have to be given back to us. This features Secretary Bill Richardson describing the Peregrine system, developed as a project funded by the Department of Energy. This system pinpoints treatment to cancer cells and spares all normal cells. In his narrative, he is particularly impressed that this system can help select the right kind of radiation (Varian vs Siemens vs Philips?), which is important since radiation is absorbed differently by bone than soft tissue. It's been a while since I looked at this, but I thought this didn't make much difference once you got to megavoltage levels.
I think we need to give Secretary Richardson the benefit of the doubt since probably somebody else wrote this for him; he only read it personally. Since we don't expect Secretary Albright to know about Kosovo and we don't expect Attorney General Reno to know about independent counsels, we shouldn't expect Secretary Richardson to know about radiation therapy.
I just hope he knows something about nuclear power plants.
email: mkatin@radiotherapy.com
