May 2002
The Wayne Rogers Effect
By Michael J. Katin, MD
Recently the world was diminished by the loss of Thor Heyerdahl but I soon realized that the outpouring of grief was controlled by the fact that the vast majority of the population under age 40 didn't have any idea who he was. I thought it was a nice gesture that, despite this, our employees were willing to go along with shutting the office down for the day in his memory. That turned out to be a bad precedent since within only a few days of each other it was curtains for multiple other cultural icons including Reginald Rose and Justice Byron "Whizzer" White. The treatment days were eventually caught up, but it became obvious that David Bowie was right (Fame....what you get is no tomorrow). Public recognition is ephemeral, which is certainly worth remembering the next time you're asked to head a committee for ASTRO
I then realized that it was probably time to update some of the popular cultural references that we take for granted every day, or at least explore whether they need to be changed. Very recently in tumor board someone spoke about the "Will Rogers effect" and it wasn't until later that we found out that most of the people in the room thought we were talking about the kid from "Lost in Space." I would not need to explain this to the regular readers of this column, but for the benefit of those who have accidentally surfed in, Will Rogers (1879-1935) is considered one of the greatest American humorists, ranking with Mark Twain, Bob Hope, and Andrew "Dice" Clay. He may be most famous for the expression, "I never met a man I didn't like," which, unfortunately, more recently has been attributed to Jeffrey Dahmer. Will Rogers made the observation that when many natives of Oklahoma moved to California in the 1930's, the IQ of both states went up. This has subsequently been adapted to refer to changes in treatment outcomes seen when staging is done more rigorously, so that patients with lower staging truly are more likely to have early disease and therefore will probably have better results with a given treatment, and similarly those patients upstaged with minimal amounts of cancer make it more likely that patients in those stages will also do better compared to previous results.
This phenomenon can therefore make interpretation of results more complicated, since staging studies continue to get more sophisticated, with PET scanning particularly effective at finding sites of disease that might otherwise not be detected. Maybe there's not a newer reference that can be used to label this phenomenon, even if Will Rogers is no longer as famous as he should be. But maybe it's worth confusing everything by creating the "Wayne Rogers effect" to describe another phenomenon in clinical research.
I would not need to explain this to regular readers of this column, but to those who have accidentally surfed in, Wayne Rogers (1933- ) may be considered one of the foremost personalities in television, along with James Komack, Jerry Van Dyke, and Dustin "Screech" Diamond. He is, however, more importantly to be noted as always winding up with the best of every situation. It was Wayne Rogers who happened to be in the U.S. Navy on a ship in drydock who wandered over to a theater rehearsal and realized his life's calling, who then rapidly got roles on the stage, landed a continuing part on "Edge of Night," and then was cast as Trapper John McIntyre on "M*A*S*H," a television series that wasn't expected to do well. During this time he was successfully managing his own finances and his ability to do this became so well known in the entertainment community that he was constantly asked to help other actors with their investments. He finally turned this into a full-time profession. Presumably if he had wandered over to a massage parlor instead none of this would have happened, but the point is, each time he encountered a favorable situation he made the most of it.
Some years ago the patients most likely to be solicited for clinical research were those who had nothing to lose and everything to gain, those unfortunates with advanced stages of resistant types of cancer that had nothing else to try. Needless to say, most of these patients didn't do well with the investigational treatment, either. It was only a matter of time before someone realized that a patient with a good performance status was more likely to live longer regardless of the treatment that one with a poor performance status, and then the clinical protocols started to specify Karnofsky or Zubrod score requirements. There was then further fine-tuning, in terms of selecting out histologic types and subtypes, let along excluding anyone with other medical problems. It finally has gotten to the point that for Phase I and II studies, the results of which are often prematurely compared to historical results, most of the subjects are healthier than most of the researchers.
I would therefore propose that the expression, "Wayne Rogers effect" be immediately brought into use in tumor boards and other discussions to refer to the selection out of the very best patients for clinical trials. I will also be suspending my professional responsibilities for the next three weeks working out the significance of the "Roy Rogers effect," the "Wayne Campbell effect," and the "John Wayne Gacy effect." Or at least until my dose of lithium is adjusted.
email: mkatin@radiotherapy.com
