May 2005

The Meaning of Life, Part I

By Michael J. Katin, MD

Whether you're trying to win the title of Miss America or you've gone through the less-likely-to-be successful effort to obtain a radiation oncology residency, one question is invariably asked. The words may differ slightly, but the summary is: "If you achieve the title of Miss America/acceptance to your 12th-choice radiation oncology residency, what will you want to accomplish?"

The answer will undoubtedly revolve around helping children, promoting world peace, and curing cancer, not necessarily in that order. Would prospects be different if an honest answer were given: to get prizes, to get a chance to sign a television or movie contract, and to meet Nick Lachey? Probably this would torpedo a shot at a residency, but maybe it's what the Miss America pageant could use, considering that it's on the ropes and may not even be televised on a major network this year. In fact, most people going into radiation oncology are probably truly interested in helping to relieve suffering and to pushing back the frontiers of medical knowledge. This attitude may even persist for years after the residency, despite discouragement because of bureaucratic burdens, liability concerns, and the futility that many patients with advanced disease still can't get cured.

Unfortunately, many of the Miss Americas (Misses America?) fade off into obscurity without having solved problems of domestic violence or homelessness. After a few years most radiation oncologists have relegated their knowledge-expanding tendencies to limbo and are trying their best to stay the course.

Years pass, and despite improvement in diagnosis and treatment techniques, progress is never as rapid as we would like and it's easy to start wondering about the ultimate goals we should be trying to accomplish. Is it to delay suffering and death with the realization that everything, even Dick Clark's New Year's Rockin'Eve, must eventually come to an end?

Obviously people have differing ideas of accomplishment. Getting the lead article in the red journal might be enormously important to a junior faculty member, whereas getting access to water without fecal contamination would be very desirable to a resident of the slums of Cartagena, Colombia (although it would also be a goal for a passenger on a U.S. commercial airliner). If everyone had the same opinions, there would be only one religion , one fast-food franchise, and one musical genre. Obviously this isn't the case, but despite our differences we all need motivation beyond basic needs.

What then should be the reason for us in radiation oncology to go on? Is it best to dedicate one's career to perfecting the use of heavy particle therapy, the use of radiation sensitizers and protectors, advances in targeting, or innovations in treatment delivery schedules? Is it discouraging that the lives that might be saved by any of these techniques is far fewer than would be lost if North Korea lobs even one nuclear warhead anywhere in the world? Fortunately, just as it seems as if there's nothing left to work toward, the answer appears in an unlikely source: the April 25, 2005, issue of AutoWeek magazine.

email: mkatin@radiotherapy.com