ASTRO: Breakthrough Technology and the True Meaning of Contracts
From tissue engineering to words so moving they required tissues, highlights of today's ASTRO meeting centered on a mix of awe-inspiring technical updates and heartfelt reminders of why docs enter the rad onc field to begin with.
In Keynote Address 1, "Advances in Drug Delivery and Tissue Engineering," the highly renowned Robert S. Langer, ScD, a David H. Koch Institute Professor at MIT, discussed treatment possibilities with new drug delivery technologies including novel polymers and intelligent microchips to target cancer, heart disease and other illnesses. He also highlighted new approaches under development that combine mammalian cells with synthetic polymers to help repair tissues for patients with burns, damaged cartilage, paralysis and vascular disease.
Among advances, he described a dime-sized microchip designed to remain in the body for years. The technology, used in animal research, could potentially serve as a pharmacy-on-a-chip device through which different drugs could be released at different times via telemetry. He also discussed the marvels of tissue engineering-using patient's own cells (bone, cartilage, stem cells) to create virtually any tissue.
His slides wowed, evident through random midlecture applause and occasional whoops normally reserved for concerts and sporting events. We saw the creation of a human ear later sported by a rabbit, a young boy with a new chest, a toddler whose severe burns were replaced with new skin, and a rat whose previously paralyzed leg regained a good amount of function. Never mind the economy and World Series woes (if you're a nervous Phillies fan, that is); we need to bask in the brightness of these amazing treatment possibilities.
Also wowing attendees, Tim R. Williams, MD, outlined the many facets of physician responsibility in his ASTRO Presidential Address, "The Contract."
"Patients want us to be there for them when they get sick," said Dr. Williams, a radiation oncologist at Boca Raton (Fla.) Community Hospital, "and that's not asking too much."
Such care involves compassion, to be sure, but it also requires something more-experience and acumen. Recalling a patient who hauled in a shopping bag full of literature, including 50 pages of hand-written notes on prostate cancer, Dr. Williams shared: "Data is not necessarily information, and information is not necessarily understanding, and understanding is not necessarily knowledge, and knowledge is not necessarily wisdom."
He also added that while every doctor must be part businessman-after all, they live in the real world, too-the unwritten physician-patient contract stipulates that patients come first.
"We have to be very careful about the Faustian bargain that all doctors make with society," he warned. "As long we put the patients first and only care about their interests, everything else will take care of itself."
He closed with a story about a 6-year-old patient named Diana whom he treated as a resident more than 20 years ago; she had a terminal brain tumor. Shortly before she died, he made a house call to the trailer where she lived. She was lying on the sofa, surrounded by candles and religious ephemera.
"I didn't know what to tell her, but I did mumble a few words. I told her I was sorry I couldn't do anything more for her but that soon she wouldn't have to worry about the nausea any more, and her headaches would go away, and she'd find herself around a lot of really nice people," he recalled. "But that didn't seem to be enough for the moment. It was pathetically inadequate ... So I told her that if I ever amounted to anything in my life that I would never forget her. And that I would always do the best job I could for the patients that I took care of, and that going into the future I would always try to [honor] the Faustian bargain and make sure I kept the patients close to me and do everything I could to make them better."
"I think about Diana once in a while," he added, "and I've always wanted to be able to someday, in Valhalla, tell her that I've honored the contract."