Order in the Court

In the courtroom, truth rarely wins. Performance does. The lawyer with the best delivery, arched eyebrow, sonorous voice, and well-timed pause takes the prize. Now enter oncology, where justice wears a white coat and carries a laminated copy of the Standard of Care, 2023 Edition. Here, innovation is radioactive, curiosity is subversive, and protocol is the gospel. Your life becomes a case file. Your treatment plan? A recitation. And like any good courtroom drama, facts are optional, especially if they make things... complicated.

Exhibit A: The Estradiol Patch
You show up with evidence: real studies, international trials, lower risks, fewer side effects. The estradiol patch works. It’s effective. It’s affordable. It doesn’t melt your bones or detonate your libido. But it’s not in the sacred script. It doesn’t spawn side-effect industries. No labs, no co-pay symphonies, no cardiology referrals. Worst of all? It works too quietly. So the court responds with professional skepticism and quiet dismissal. Not because the science is bad, but because it’s not profitable, not familiar, and definitely not laminated.

Exhibit B: The Invisible Judge
You think your oncologist runs the courtroom? Think again. The real judge is The Protocol, an anonymous, ever-updating document written by a conclave of experts with biotech lanyards and shrimp-stained PowerPoints. It doesn’t know your name. It doesn’t care about your side effects. It cares about one thing: defensibility. Deviate from it, and your doctor risks audit, litigation, or worse, being labeled “noncompliant.” So your doctor sticks to the script. Not because they’re heartless, but because the system is.

Exhibit C: The System Was Not Designed for You
Let’s stop pretending this is about the best care. This is about what’s billable. The estradiol patch? It works, sure. But it doesn’t generate profit, churn, or professional turf wars. It doesn’t need five follow-ups and a cardiac clearance form in triplicate. In a rational world, this patch would be standard. In ours, it’s an orphan. It’s too logical. Too humane. So it gets quietly erased, not because it fails, but because it doesn’t serve The Machine.

Cross-Examination: I Brought My Wife
She’s a psychiatrist. Calm, informed, dangerous. She asked a logical question about alternatives. The temperature dropped five degrees. Charts were gripped like shields. You could almost hear: “Patient accompanied by highly educated threat. Monitor closely.”

Closing Argument
My client, guilty of curiosity, of bringing data, of wanting to understand, stood trial for his prostate but was sentenced for his questions. The punishment? 18 months of chemical neutering, bone loss, fatigue, and existential erosion.

Not because that was best. But because it was safe. Standard. Legally defensible. The real crime wasn’t cancer. It was a deviation. It was thinking. It was hope.