October 2010

San Diego Cadres

By Michael J. Katin, MD

It's that time of year again. Before we know it, we'll be celebrating a festival of ghosts, witches , gamma goblins, and other creepy   characters. Yes, the ASTRO annual meeting will be starting on October 31 which, coincidentally, is the same day as Halloween. Remarkably, in another frightening coincidence, Election Day 2010 will be on the third day of the meeting. At the same time, there are deep political differences to be worked out within ASTRO which seem to be a reflection of the situation in our country as a whole .

Ordinarily this column would deal with the attractions of the host city. Not only is San Diego the birthplace of such luminaries as Ted Williams, Cameron Diaz, RuPaul , and Scott Peterson , but it also provided support during the formative years of Adam Lambert and Raquel Welch. . Usually there would be a description of landmarks devoted to these and other personalities, as well as outstanding attractions in the greater San Diego area, but due to the urgent circumstances of our time attention should rather be directed to the decisions that will need to be made within ASTRO itself. There will be no time for extra-curricular activities despite the outstanding ambience of the host city.

Although it may not be known to most of the membership, there is a deep division in political philosophy in ASTRO which remarkably parallels the situation nationally. There are two camps with widely disparate views of the best way to advance our specialty.

As in prior years, there has tended to be leadership by those who envision radiation oncology as a pure science rather than a business. This was admirable as long as the economy allowed practitioners to be able to make a living. Despite the fact that this situation has changed markedly, this idealistic faction may try to dominate. It will be important to recognize the details in what is being presented for voting by the members to avoid being committed to policies that might unintentionally bring down the specialty as a whole. One example is the proposed 'Cap and Treat' policy, in which centers which treat more than 250 patients a year will have to pay for the right to exceed that number. This money will be used to fund research for environmentally-friendly treatment alternatives to radiation therapy. It is also rumored that a second plan is for the Thousand Accelerators Radiating the Public (TARP) project. Under TARP, massive expenditures will be made to place a thousand treatment units throughout the United States in places usually not easily accessed by patients. In order to provided synergy with the government's stimulus program, these can be located close to other shovel-ready sites, such as near new toilet construction in the Mark Twain National Forest, or next to factories for manufacturing clean energy products that don't work well enough . This is supposed to be supported by ASTRO and not intended to deplete its endowment but a new analysis indicates this will actually produce a deficit of at least $5 billion for 2010-2011. The impact of this is being downplayed using techniques learned from Washington, such as not publishing a budget at all , but ultimately there will be a tremendous burden on current and future members, as well as children and grandchildren of future members. The argument is that the TARP plan will require training of thousands of radiation oncologists, therapists, physicists, and nurses, without realizing that these people will all be out of a job once the total of three patients in DeSmet South Dakota, and Ehrenberg , Arizona have completed their treatments. A new funding plan is to balance the budget by raising membership dues, but only on those making more than $250,000 per year.

Unfortunately, this faction is based on the premise that the specialty of Radiation Oncology has been successful by a combination of luck and exploitation of other specialties -- that we have profited at the expense of Family Practice and Internal Medicine, for example. . There is a feeling that we should be apologetic about our success and take the opportunity to pay back what is not rightfully ours.

On your way to San Diego, please take the opportunity to decide if you want to participate in this culture or whether it is time to start asserting ourselves as a profession of exceptionalism. This may be our last opportunity to rededicate ourselves to the principles of the Founders (Washington, Hamilton, Brady) of individualism, entrepreneurship , and creativity. Finally, it is time to stop having to constantly defend our use of increasingly sophisticated techniques to treat patients.

The time has come for the IMR and IGR Tea Party .