Sunday, March 14, 2010

Dr. Thomas Origitano - Brain Surgeon Demands Smart and Ethical Choices Over Trumpeted Technology

The most horrific words that I have heard in my fifty seven years on earth were said to me by one of the most wonderful men I have met in that same time. "It's a glioblastoma."

In June of 1995, my young wife, mother of my three children, Mary had a brain tumor operated on by Loyola University Neurosurgeon Dr. Tom Origitano,M.D. - he sent a piece of the tumor to various labs and had gotten the fatal summary from many quarters.

"Mary has a glioblastoma tumor*." This savagely aggressive tumor is more prevalent in males. To my understanding, it is a death sentence. The tumor was massive! The pressure on my poor Girl must have been unbearable, but she was a beautiful, tall, skinny, redheaded, Kankakee Irish/French hardass - who else could put up with south side Irish knucklehead?

Dr. Origitano used a state of the art laser procedure, but warned me that the brain was God's domain and that he would only do as much - actually it was more - as he could do. This was Ali versus Mickey Rooney.

Dr. Origitano looked like Tom Selleck at the time that he treated Mary and they bonded immediately. The fact that I look like Barney Rubble on a good day had no impact on my relationship with this tall, dark, handsome and commanding surgeon had no impact whatsoever - " Oh yeah, Honey,He is almost a cute as you, . . .even without the soup stains all over his shirt. You didn't wear your drop-cloth at lunch again. Now, trot along and get me some ice cream, we have brain surgery stuff to do."

DR. Origitano gave Mary more time with me and the kids than should have been acceptable according to rules of science and technology. Mary kicked at the glioblastoma for the better part of two years before the Divine Ref called the Fight on January 17th, 1998. From that time on, I got periodic phone calls from Dr. Origitano about "how's things going for you?" Dr. Origitano gave me Mary's hair from the last surgery, which I store and treasure.

Today in the Chicago Sun Times, this soft eyed, humorous and very compassionate man of science and skill warns us of taking technology much too seriously - the human brain was built by God.

In the U.S., industry aggressively promotes the rapid adoption of new technology. Manufacturers spend heavily on studies, medical meetings and ads in medical journals and sign up influential physicians as well-paid consultants. This raises the possibility that money, rather than data, is driving the use of new technology. When a surgeon uses a particular brand of clip to seal off a brain aneurysm, is it because the product is truly the best clip on the market or because the surgeon is being paid by the manufacturer? (Loyola University Medical Center, like most other academic centers, has policies to pro- tect against such conflicts.)

Industry has been, and will continue to be, a partner in developing innovative technologies to prevent, diagnose and treat disease. But we need to protect against the possible corrupting influence of industry. And with health-care costs exploding, we also must make sure new technology is worth the cost. Intraoperative navigation may very well prove to be an effective way for surgeons to safely remove larger portions of tumors. But if this extends patients' lives only by two or three months, can we afford it?

Among the most-expensive new technologies are computer-assisted systems that deliver precisely targeted doses of cancer radiation therapy. Studies have found that each of these systems is effective in treating specific types of tumors and other disorders. But in many cases, they are being used to treat tumors or disorders that haven't been studied definitively.

Medical technology also has risks. CT scans and other medical imaging procedures are the greatest contributors to total radiation exposure in the U.S. population. But some CT scans may not be necessary.

This was demonstrated in a recent study at Loyola University Chicago Stritch School of Medicine. Our study, published in the Journal of Neurosurgery, examined the routine use of CT scans in patients after brain surgery. We found low-tech bedside exams by a skilled physician did a far better job than CT scans in predicting which patients would need to return to the operating room to treat complications. We eliminated about one-third of the post-operative CT scans because they weren't telling us anything useful.

Thanks Doctor! Thanks for everything.

* It is very difficult to treat glioblastoma due to several complicating factors:[20]
The tumor cells are very resistant to other conventional therapies
The brain is susceptible to damage due to conventional therapy
The brain has a very limited capacity to repair itself
Many drugs cannot cross the blood-brain barrier to act on the tumor
Treatment of primary brain tumors and brain metastases consists of both symptomatic and palliative therapies.

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