October, 2012

Last Tango in Boston

The Horror, The Horror

By Michael J. Katin, MD

Perhaps it's fitting that the 54th Annual Meeting of the American Society for Radiation Oncology is held in the area in which the American War of Independence began on April 19, 1775 . Without a rebellion, is it possible that this is the end of the era in which highly-technical and, unfortunately, expensive, therapies can be used at the discretion of the physician and the patient?

The similarities are interesting. By 1775, the colonies were increasingly oppressed by restrictions and taxes imposed at a distance by the British Crown . The Americans considered that they were being unfairly burdened to financially offset the losses that Britain was accumulating due to military expenditures . It was being taken for granted that wealth could be drained from the colonies out of proportion to any benefits received. In fact, in previous years, Americans had profited from the investment made in the French and Indian War, and were now adjusting to a lowered standard of living. Are there any relationships to the fact that medical practices, initially able to flourish due to Medicare reimbursement, are now being constricted as allowances are cut back and restrictions increased? Can a comparison be made to penalizing the medical care system because of decreasing resources due to having to pay for Iraq , Afghanistan , GM , Chrysler , Fannie , Freddie and Solyndra ? Could this be construed as taxation without representation ? Of course, not.

It took only until 1781, 6 years later, for the British to be placed in the position to relinquish their rule of the colonies, HHS may turn out to be a much more tenacious master .

There are two approaches. The first would be to accept that we are not in control of our fate, and start adjusting appropriately. For example, with it probable that reimbursement will go down markedly, regardless of what happens with the current fee schedules, and that panels will start restricting who can receive radiation therapy (especially with competition from more economical systemic treatments and from supportive care ). Those attending the ASTRO Annual Meeting have the choice of one last fling when booking their hotels and other activities, versus starting to cut back in recognition of times to come.

For example, the State Suite at the Four Seasons Hotel https://secure.fourseasons.com/content/fourseasons/en/booking/choose_room.htm l on Boylston Street can be had for $1495 a night, providing a view of the State House (Why? Whatever). Amenities include "bottled water, refreshed daily." In contrast, a queen bed room at the Motel 6 on Commercial Road in Leominster, is available for $49.99 a night. It is also specified that the State Suite has a 3-person maximum, whereas there would probably be less surveillance at the Motel 6 in Leominster, thus raising the possibility of even further savings. However, there is no mention of bottled water .

Dining can also be an opportunity for saving money. The L'Espalier restaurant offers "sophisticated and modern New England-French cuisine" and was the "first independent restaurant to bring haute cuisine to Boston." Ninety dollars will buy the Autumn prix fixe dinner, including a choice of such specialties as warm Wellfleet oysters, faux gnocchi , charred leek, Cape Ann samphire , and vermouth, as well as Spanish sea bass with Apple Street Farm aubergine , white sesame puree, almond milk, braised cardoons , and crispy artichokes. An additional $210 will buy an ounce of Galilee Osetra caviar, and six wine pairings will be available for $85. Seekers of Boston cuisine who want to conserve resources would be better served to take meals at Mul's Diner on West Broadway in South Boston, listed as "one of Boston's hidden treasures," at which entrees are available for less than $10 each and with a 91% positive rating (let's see L'Espalier match that!). Don't miss the fluffy pancakes and the corned beef hash. For those seeking variety, there are no fewer than 23 Dunkin' Donuts (world headquarters in Canton , Massachusetts) within 10 miles of Leominster.

One more expense can be reduced. A taxi from the Four Seasons to the Boston Convention and Exhibition Center will cost $9.33, plus tip . Going to lunches and dinners and other venues will probably run up a daily cost of at least $50. A weekly pass on the MBTA will cost $18.00, without tip.

As you can see, we would be able to adjust to changing times, but there is an alternative. Over 200 years ago patriots in Boston provoked the start of the Revolutionary War and freed us from British domination, in order that now we can be dominated by OPEC and China. Is it not appropriate to take the initiative as radiation oncologists to become the heirs of Samuel Adams , Crispus Attucks , Paul Revere , J. Geils , and John Hancock to represent all of the medical profession by striking the first blow against government oppression?

I'm not advocating violence , but wouldn't it be a major media event if the members of ASTRO were motivated to rebel against government restrictions by symbolically dumping linear accelerators into Boston Harbor, which is only three blocks away from the Convention Center? This could be the next "shot heard 'round the world."

The Boston IMRT Party .