September, 2016

Lost in Boston

By Michael J. Katin, MD

The 58th Annual Meeting of the American Society for Radiation Oncology will be held September 25 through 28 in a city with many facets: Boston, Massachusetts, labeled by Oliver Wendell Holmes as the Hub of the Solar System, the Hub of the Universe, or just "the Hub."

The future of the specialty of Radiation Oncology has probably never been in more jeopardy. It seems ironic, then, that this year's meeting is in Boston, a city that is notorious for two career paths that appear, at least superficially, totally dissimilar. Not only is this city well known for individuals who were outstanding leaders in understanding human anatomy, biochemistry, and physiology, but it is also very well known for generations of persons who were experts in making human avarice, envy, and carnal desires work to their advantage.

The list of outstanding medical pioneers correlates very well with the even longer list of entrepreneurs who found success working just outside the system:

  1. Zabadiel Boylston, with the support of Cotton Mather, established smallpox inoculation as an acceptable technique and controlled the disease, saving hundreds of lives Samuel Swift and Ebeneezer Mackintosh, heads of the North End and South End Gangs, respectively, controlled the mobs in Boston just before the Revolutionary War, terrorizing hundreds of lives.
  2. Oliver Wendell Holmes was not only a distinguished author but also contributed significantly to improvements in medical practice. by supporting the ideas of the infectious cause of puerperal fever and also helping to finally end the belief of the benefit of bloodletting. Jesse Pomeroy was a convicted mass murderer at the age of fourteen, with a prodigious history of bloodletting
  3. Although Crawford Long may have been the first surgeon to use ether and nitrous oxide for procedures, it was William T. G. Morton, a dentist, and John Collins Warren, Professor of Anatomy and Surgery at Harvard Medical School, who performed surgery on a patient under anesthesia that was publicized and led to its general usage. Interestingly, it was Oliver Wendell Holmes (again!) who invented the term, "anesthesia." The Patriarca Crime Family of New England was blamed for the assassination of Albert "The Mad Hatter" Anastasia.
  4. John Martyn Harlow was the first physician to describe a connection between brain trauma and personality change, from his observations of Phineas Gage, who was the unfortunate recipient of a 43-inch-long tamping iron blown through his head from an accidental explosion while building a railroad bed. Mr. Gage's skull currently resides in the Warren Anatomical Museum at Harvard Medical School. Head trauma was the common result of disagreements within the crime families of Boston. Most resulted in quite permanent personality changes (multiple examples, including Raymond (Baby) Curcio, Richard J. Castucci, and Robert Candos )
  5. Pioneering in public health, in 1785, Massachusetts enacted the first pure food legislation in America. In 2015, Carmine "The Cheeseman" DiNunzio became acting boss of the New England Mafia.
  6. Medical practitioners have been active in politics in Massachusetts. John Brooks, a Revolutionary War hero, was the 11th governor of Massachusetts (1816-1823) and was succeeded by William Eustis (1823-1825), who also was distinguished in the Revolutionary War. Dr. Eustis was present at the Bunker Hill/Breeds Hill battle, at which Joseph Warren, under whom he had studied medicine, was killed. Joseph Warren's younger brother, John Warren, founded Harvard Medical School and was the father of John Collins Warren (see #3 above). Samuel Abbott Green, who served in the Civil War, was Mayor of Boston in 1882. More recently, Jill Stein, Harvard Medical School graduate, ran for Governor of Massachusetts in 2002 and 2010 and for President in 2012 and 2016. Unlike most physicians, persons with a compromised sense of responsibility have in the past successfully infiltrated the government in Massachusetts in general and Boston particularly in order to carry out policies beneficial to themselves. Daniel "Dapper Dan" Coakley has been given the title of "America's Most Corrupt Politician," quite an honor considering the competition. James M. Curley, member of the U. S House of Representatives, Governor of Massachusetts and three-time Mayor of Boston, was convicted and served time twice for fraud, in 1904 and 1947 (pardoned by Harry S Truman in 1950). That was in the past, though, and it has now been over two months since anyone in the Boston political administration has been arrested.
  7. Paul Dudley White was a superstar in cardiology, with his efforts resulting in widespread use of the electrocardiogram, recognition of dysrhythmias (WPW -- obviously), and epidemiology of heart disease. His input was wanted by medical centers and organizations throughout the world. James "Whitey" Bulger was a dominant figure in the New England (Winter Hill Gang) crime scene and had influence throughout the United States. He was wanted for 16 years. In an illustration of the close relationship between politics and organized crime, "Whitey" Bulger's younger brother, William, was the longest-serving President of the Massachusetts State Senate.

This year ASTRO is in need of making a decision on how to stand up for our specialty and perhaps the example of the "other" category of accomplished professionals in Massachusetts may be worth emulating. Logic and recognition of fairness may not be the motivations for CMS and other agencies to recognize our accomplishments and our needs. It is estimated that Medicare payments for Radiation Oncology will be $1.72 billion for 2017. In Italy, a country with a population less than one-fifth that of the United States, the four major Mafia gangs take in $33 billion per year (granted, not all earned in Italy). Where are we going wrong? We need to come out of the Boston meeting with a new sense of empowerment and a feeling that we deserve better than we're getting. This would be taken for granted by those New England entrepreneurs such as Anthony "Spucky" Spagnolo, William "Billly the Wild Man" Grasso, James "Buddy" McLean, Charles "King" Solomon, and Francis "Cadillac Frank" Salemme, Maybe it's time for the factions in Radiation Oncology to come together to push for greater influence and, certainly, greater name recognition under the leadership of Bruce "Mad Man" Minsky, David "Beware" Beyer, Brian "the Hammer" Kavenaugh, Jeff "Mick" Michalski, Bruce "Bagman" Haffty, and, particularly, spiritual leader Anthony "Ay-Z" Zietman.

We can make CMS an offer it can't refuse.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including Septemben 1, 2016, this leaves 5,966 days to his goal.