September 2011

Clockwork Homage

By Michael J. Katin, MD

Time keeps on slipping, slipping, slipping, into the future. (St. Thomas Aquinas, 1270)

Time is a great teacher, but unfortunately it kills all its pupils (Louis-Hector Berlioz, 1860)

One of the problems of having been around long enough is that one can see developments that were predicted year ago come to fruition. In August, Great Britain was disrupted by rioting based not on any specific causes, but just on the general discontent of a generation that feels alienated from society. This was one of the premises of Anthony Burgess' A Clockwork Orange. Written in 1962, it is not set in a defined year but it can be inferred to be in at least 1995. Burgess may have been off by 10 or 15 years but the vision of Alex and his droogies participating in a bit of the old ultra-violence was now coming alive in London and Birmingham.

One target of the looters involved complicated electronics equipment which was expensive and for which the average person would have to wait a long time under the current system. Actually, they did not have the opportunity to break into radiation therapy facilities, but instead were temporarily satisfied with computers and mobile telephones

The clock continues to move forward, and the future becomes the present. Some other examples of foresight were probably more predictable . We have seen that the National Debt of the United States has reached a crisis level, just as had been predicted by Ross Perot in 1992. One of the ASTRO Gold Medal winners for this year, Dr. K. Kian Ang, had, in 2002, brought attention to the role of EGFR expression in head and neck tumors, and now most of therapeutic advances in systemic therapy and for prognostic determination is based on molecular profiling . The Gray Lecture in 2001 predicted that proton beam therapy would replace photon beam therapy, and, now that that has happened, the emphasis is on a practical way to deliver carbon ion therapy. Segways have pretty much replaced automobiles as transportation in urban areas, and sales of New Coke and Zima have never been better. Well, maybe some prognostications aren't as good as others .

In general, predictions about the future of radiation therapy, systemic therapy, and immunotherapy have been favorable, with anticipation of even higher cure rates for cancer in the next few decades. It is therefore of some concern that the greatest of all seers, Dr. Michel de Nostradame, over 400 years ago wrote this worrisome quatrain:

Those who were in the realm for knowledge
Will become impoverished at the change of King:
Some exiled without support, having no gold,
The lettered and letters will not be at a high premium (Century VI, Quatrain 8).
Does that foretell the end of research in the face of recession and cutbacks of reimbursement and grants? It's too soon to know. Eventually we will know who had insight or even clairvoyance and who was just wrong. It's just a matter of time.

Just try not to look at what time did to little Alex.