Trust...in the Wind
By Michael J. Katin, MD
"We of the Kennedy and Johnson administrations who participated in
the decisions on Vietnam acted in accordance with what we thought were the
principles and traditions of this nation. We made our decisions in light
of those values. Yet we were wrong, terribly wrong. We owe it to future
generations to explain why." -- Robert McNamara, In
Trust is a valuable commodity at all times, especially now, when cynicism
is rampant and conspiracy theories are running wild. Probably many polls
would show that more people believe that Iraq's weapons of mass destruction
are being hidden in EuroDisney than believe that the budget can be balanced
by having tax cuts rather than increases (similar to steering in the direction
of the skid).
This being the case it is comforting to know that the field
of oncology has tended to be a bastion
of credibility, as long as you forget that hundreds of people spent
thousands of hours trying to document the value of misonidazole.
"I say to you here, as Minister of Health, that the epidemic has come
under effective control. It is safe to work, tour, or live in China."
-- Chinese Health Minister Zhang
Wenkang, April 4, 2003. He was fired April 20.
Maybe he was talking about West Nile virus; obviously SARS
was a concept foreign to him. With all this subterfuge going on in the world,
it is critical for the field of medicine to stay as pure as possible. Since
some publications also suffer from SARS (seldom accurate renderings of science),
maybe this is easier imagined than done.
I won't presume to speak about other specialties, but in the reporting
of radiation oncology alone there are can easily be found three recent examples
of fluctuations in the truth.
The first example is from a popular magazine, which will remain unidentified,
which is published in Pleasantville, New York, and can be found at supermarket
check-out aisles. No, not National Review. In the May issue there's a section
on "new cures" for breast cancer, describing radiofrequency ablation, sentinel
node biopsy technique, brachytherapy, and anastrozole. None of these is
particularly new, but it would be nice if the article didn't have the obligatory
negative reference to radiation therapy. The adjective "grueling" is used
not once, but twice, describing the "grueling marathon" and the "grueling
six-week regimen" as well as the "typical pain and fatigue." "Tedious,"
yes, "stressful," yes, but "grueling" may be overdoing it, especially twice
on the same page, and I'm not sure what the "typical pain" is supposed to
be. Ironically, this magazine "typically" has a monthly feature on "Word
Power," devoted to the accurate definition of words.
The second example is from another publication from New York, the New
York Txxxx, with an article on April 29 announcing that "Brain Surgery,
Without Knife and Blood, Gains Favor." Why exactly this is news in April,
2003, is unclear, but it describes a patient treated for a tumor that had
grown to "nearly the size of a Ping-Pong ball." There is more than a half
page extolling the wonders of stereotactic radiosurgery, which has already
been in use in nearly every community for over 10 years. I checked to make
sure there wasn't another article in this section discovering the existence
of personal computers or CD players or indoor plumbing. The scientific accuracy
of the radiosurgery article, however, is called into question when it then
downplays the use of this technique versus craniotomy, stating that it "cannot
be used to treat tumors larger than three centimeters." The updated September
1, 2002, official
rules of Table Tennis clearly state, "The ball shall be spherical, with
a diameter of 40 mm." So much for internal consistency.
The third example is less disconcerting, except that it incriminates the
IJROBP, commonly known as the Red Journal to most and as the Green Journal
to those with trichromacy.
It recently published papers from the Third S. Takahashi Memorial Workshop
on 3-Dimensional Conformal Radiotherapy. This included "Rotational 3D-
Conformal Radiation Therapy Combined with Hormone Therapy for the Treatment
of Stage B2/C Prostate Cancer in Japanese Men" and "High
Dose-Rate Brachytherapy as Monotherapy for Localized Prostate Cancer: A
Retrospective Analysis With Special Focus on Tolerance and Chronic Toxicity".
These are worthy articles, but in desperate need of commentary by Dr. Bob
Arnot, NBC's medical correspondent, who in 2000 published the Prostate Cancer
Plan, the premise of which was the Asian diet could prevent prostate
cancer. In that case, why did any Japanese men require treatment for this
I think the only solution is to set up an independent arbiter to help resolve
these paradoxes in medically-related publications, especially radiation
oncology (since we really don't care about the other specialties), to coach
the writers of scientific articles and to make sure that the facts are presented
as accurately and truthfully as possible. I think we all know the
person who is not only immediately available but already trained for