Strategic Defense Initiative
By Michael J. Katin, MD
The concern that is most frequently expressed by our colleagues through this site does not involve the optimal
treatment plan for esthesioneuroblastoma, believe it or not (that was number 3), but, rather, how to hang on to
one's practice share in these threatening times. As has been frequently discussed previously, each practitioner's
territory is under constant attack
by other modalities (chemotherapy, immunotherapy, radical surgery, etc.), the alternative of supportive care, limitations
by 3rd party payers, and competitors within our same specialty. Constant vigilance may be the price of freedom
but sometimes you can still watch your security circling the drain. Maybe it's not as hopeless as watching asteroid
XF11 collide with Earth (proposed date October 26, 2028) without much to do about it except sell short, but maybe
it's time to look to a different model for promoting our specialty.
Not all good ideas have turned out to be able to be successfully implemented ( Iridium
global telephones? New Coke?) but maybe this one could work. I had to go to a 24-hour pharmacy to pick up photographs
that I had left for developing. Their charge for 1-hour developing is now the same as for overnight, so I can get
the pictures back the same day before they go into the drawer never to be seen again for 20 years. Upon leaving
the store, I had become the new owner of four boxes of Jell-O, two bags of potting soil, and 15 Pepcid, all of
which were on sale and none of which I had any intention of buying when I went in. I successfully resisted the
clock with the 12 different bird songs, but it's a matter of time. If I had not gone in to pick up the photographs
I would have been deprived of these items, and my life would have been none the worse.
The message is that when someone comes into the radiation oncology office, that person has a fairly good idea
that he or she is there to find out about radiation therapy. Maybe it's the sign outside, the thick walls, the
film badges, but something gives that away. People who don't want to think about getting radiation therapy never
make it in. People whose primary physicians don't think about radiation therapy never make it in. In other words,
we're being deprived of a substantial number of potential patients from the outset.
The solution is obvious. The logical location for our facilities in not in the hospital, not in the medical
complex, not in the health park (shouldn't it be disease park?) but in the malls and convenience stores. Give people
a chance to browse radiation oncology options the same way they might look at a Hammond organ they'd never in a
million years go out intending to buy. We'll leave out whether there'd be any benefit to go into discount stores
(maybe for people who don't really want 3-D planning, for example) but the details will sort themselves out.
And we'll know we've really made it when the person at the checkout register is able to ask, "Would you
like bolus with that?"