November 2010

Cold Hard Truth

By Michael J. Katin, MD

In the 1970's and 1980's, hospitals and free-standing facilities proudly announced that they had installed linear accelerators to replace cobalt therapy for treatment of cancer. Suddenly, the use of cobalt was considered primitive, even though two decades earlier it had been praised as the greatest advance in the history of cancer treatment. It became inevitable that simply having a linear accelerator no longer was no longer adequate. Multiple companies developed competing models, each with slightly different design characteristics. In keeping with the high-tech image of this equipment, most units had names using letters and numbers (Clinac 18, Clinac 1800, Clinac 2100C, Clinac 21EX, Philips SL20, GE Saturne 43, etc.). This system still seems to work very well for some products but other companies decided to compete by coming up with more enticing names. This was not always successful. "Saturn" didn't seem to work too well for General Motors, just as it didn't seem to work for General Electric. Selection of names has become a specialized field thought not to be able to be left to amateurs. The name "Enteron" was selected by a naming consultant for a new energy company. Despite the effort that went into this choice, it was not realized until just before launch that this word meant "alimentary canal" in Greek. It was changed to "Enron," resulting, ironically, in policies that destroyed the digestive tracts of millions of employees and investors.

For whatever the reason, it seems that most radiation oncology product manufacturers have decided to go the route of meaningful and memorable names for their products. The pharmaceutical industry has always been masterful in this field. Whereas some medications (Lopressor, Flomax) have names that tell you exactly what the product does, others rely on more subjective connections. We can sort of figure out what "Levitra" is supposed to do, but it would be hard to know what are the uses for "Prozac" and "Cymbalta" although the names are much more memorable than their generic names, Vardenafil, Fluoxetine, and Duloxetine. Is Duloxetine twice as good as Fluoxetine? Is Cymbalta used by percussionists? There's no logic to this. In fact, the FDA has recently decided not to allow names of drugs to reflect medical claims , thus eliminating any future drug such as "Concentrex for ADD or Furosemin for anger management. In the radiation oncology community, the reasons for the names of products seem varied. Some of the names give the impression of power (Siemens Primus ) or superiority (Eleka Infinity ). Others seem much more dramatic and try to describe what the product does, such as Cyberknife or Gamma Knife , although it seems odd that the word "knife" is used when the goal is to avoid surgery. There have even been some patients who, quite reasonably, were convinced that "Cyberknife" is the name of the robotic prostatectomy device

Some names could be problematic, such as the Siemens Oncore system. Does that mean treatment has to be given a second time? Is it possible to be given excessive radiation with the Eleka Axesse? Sometimes a name change may make a difference . Sometimes names are changed for no reason at all .

Finally, sometimes products are changed so rapidly that it's hard to keep up with the names. It's easy enough dealing with the Apple I-Phone, going from 3GS to 4G, except that there may have been a little too much emphasis on rolling out the new model before it was ready. That bring us to the never-ending progression of linear accelerators produced by the Varian Corporation. Let it be emphasized that this is no means is to impede the success of this company, which is one of the few American products keeping up from absolute capitulation in terms of the trade deficit If not for the weapons industry , Boeing aircraft, and a few other companies , we would all be speaking Chinese now instead of ten years from now. In recent years Varian has marketed the Eclipse planning system, the Trilogy, and RapidArc. Presumably "eclipse" was defined as "overshadowing, or greater in significance" rather than named after the third segment of the Twilight series. The name Trilogy was sometimes interpreted, incorrectly, as a religious term, but was supposed to indicate the three ways that treatment can be administered. The RapidArc speaks for itself, although, as with the Trilogy, the name doesn't tell you it has anything to do with radiation therapy. Now that as many centers as possible have bought the Trilogy plus RapidArc systems, Varian has moved on to the TrueBeam. The inclusion of the word "beam" at least implies the nature of the product. It is disturbing, however, to think that this implies that all previous Varian products were faux beams and probably should not have been used to treat humans. Perhaps from now on medical equipment, as with pharmaceuticals, should be called by its generic name, although in that case "TrueBeam" sounds very much better than "linear accelerator which moves in a lot of directions and has bunches of computer screens around it."

In the next year Varian will unquestionably come out with a newer model to make the TrueBeam obsolete. What will it be called? In the 1950's, there was a product that was "truly new" and encompassed the latest in technical advances but still remained economical. Maybe that name would be available.