October 2002

Double Blonde Study

By Michael J. Katin, MD

It was the best of times, it was the worst of times,
It was the age of wisdom, it was the age of foolishness,
It was the epoch of belief, it was the epoch of incredulity,
It was the season of Light, it was the season of Darkness.
It was the Spring of hope, it was the winter of despair...

How would Charles Dickens describe today's world? Probably not audibly, considering that he's been dead for 132 years, but otherwise would he have to lop off the first portion of each of those lines? Things haven't been so great over the past year. The economy is going to Gehenna in a Gehennabasket, the situation in the Middle East hasn't been worse in years, and David Caruso is back on television.

The problems of the radiation oncology community don't amount to much in comparison except for the fact that it's our community. Actions have consequences, and the ripple effect can have a profound influence on our specialty. World turmoil can drive up the price of oil and make it too expensive for mobile mammography units and prostate screening vans to operate. An increasing Federal deficit will lead to hard decisions regarding allocation of assets. If there needs to be a choice between moving the remaining two government agencies not already in West Virginia into that state before Senator Robert C. Byrd retires versus funding expansion of Medicaid coverage for IMRT, I don't think we'd come out on top.

With these depressing developments it didn't seem possible to generate a column this month that wouldn't further diminish our fortitude, and I was planning to emulate Garry Trudeau, who has made a very good living over the past 25 years writing a comic strip, "Doonesbury," that inexplicably detours from current events at the most inappropriate times. As war is getting ready to erupt and as the political climate domestically is getting more vicious every day, Zonker is involved in a squabble with David Geffen over beach privileges. I thought that with the ASTRO meeting starting in a few days that I should avoid any disheartening messages and finally get around to writing the "Top Ten List of Reasons Not To Be a Medical Oncologist" when a news item surfaced that proved once and for all that we can't insulate ourself from the rest of the world.

The United Nations already has its proverbial hands full with dealing with global warming, inspections for weapons of mass destruction, and AIDS but we now learn that one of its agencies, the World Health Organization, has invested time in a project that concludes that blondes will be extinct in 200 years. We have to assume this involved multiple research junkets to Sweden, but the fact that WHO was able to run this project with all the other health problems going on is admirable. Aside from wondering what else they could have been working on instead, we need to deal with the fact that even this has an impact on our specialty, let alone on the elimination of an entire category of jokes. People who are pigmentally challenged supply an exceptional number of malignant problems that are treated by radiation onclogists. There are specific categories with immune impairment that predispose to malignancy (Chediak- Higashi syndrome, Hermansky Pudlak syndrome, xeroderma pigmentosa, etc.). Even garden variety blondes are virtual breeding grounds for skin cancers of every type, providing a dependable source of business for dermatologists and plastic surgeons, and, when these specialists have tired of them, radiation oncologists. Several other malignancies have been thought to be slightly more prevalent in blondes, ranging from gastric cancer to lump jaw. Predictions of depletion of petroleum products have often proven incorrect, but this prediction of 200 years to nonblondom seems conclusive.

Rising prices for blondes are already being seen. Reese Witherspoon will be receiving $15,000,000 to star in the sequel to "Legally Blonde," receiving enough money to pay for IMRT for the population of Ohio, as long as microdosimetry isn't included.

We need to conclude that even if world events impact us eventually we might as well go on with our work and hope for the best. Let the diplomats, politicians, generals, and WHO officials do their jobs and let's go to New Orleans and get the most out of ASTRO in terms of upgrading our technical and patient management skills.

Until, of course, Hurricane Lili impacts the Louisiana coast on October 3. Then we can upgrade our ability to tread water.

email: mkatin@radiotherapy.com