Code-switching and Revolutions in Communications
By Brian Kavanagh, MD, MPH, FASTROThis year’s meeting theme, Data to Dialogue
This year’s meeting theme, Data to Dialogue..., covers lessons in code-switching, defined as adapting speech and behavior to a situational context. Radiation oncologists talk among themselves in their own argot replete with clinical trial name acronyms and long medical words. But patients often want to know in simple terms what are their chances of living a long time, how likely will they need treatment for side effects, and what will happen if the cancer comes back. And so we all need to know how and when to switch codes to communicate clearly with individual patients or the lay public in general.
The city of Boston, our host for the meeting, was the epicenter of the American Revolution, that little skirmish 250 years ago with our on-again, off-again national BFF, England. Wartime espionage calls for codes and other secretive forms of communication, and there was much cleverness giving the colonists advantages over the Lobsterbacks. But progress in communications technology achieved in and around Boston did not stop in 1776... And so, this high-speed jaunt through history to look at major milestones in messaging that happened in and around The City by the Bay…
18th Century Spyware
18th Century Spyware
The most famous moment of communication in U.S. history is the “one if by land, two if by sea” lantern signal sent to Paul Revere, who then stormed off on his wild midnight ride through Massachusetts to warn the New England Minuteman of the direction of imminent attack by British soldiers. Not exactly a complicated semaphore, but quite useful.
The brothers Jay, John and James, appreciated the importance of not letting the enemy gain intel about military operations. The more famous John, future co-author of “The Federalist Papers” and Chief Justice of the United States, served as commander of the Second Regiment of the New York City militia and exchanged letters with high-ranking fellow Patriots1 written in an odd cipher based on pages and line numbers of a popular dictionary. Alphanumeric symbols mapped to individual words. James, a physician, invented an invisible ink called the “sympathetic stain” that was favored by George Washington, who thought it would “not only render...communications less exposed to detection, but relieve the fears of such persons as may be entrusted in its conveyance.”2
19th Century Acoustics
19th Century Acoustics
A century later the Professor of Vocal Physiology and Elocution at the Boston University School of Oratory, Alexander Graham Bell, patented “the method of, and apparatus for, transmitting vocal or other sounds telegraphically ... by causing electrical undulations, similar in form to the vibrations of the air accompanying the said vocal or other sound.”3 It is hard to imagine modern life without the telephone, and Bell’s invention is among the most valuable patents in history.4
20th Century Digital Communication
20th Century Digital Communication
MIT grad Ray Tomlinson is credited/blamed for inventing the first email program in the early 1970s. To be fair, the guy who gave the @ symbol eternal life as a celebrity glyph didn’t intend for email to be a nonstop phishing rodeo or wearying cause of mental fatigue. As he once noted, “I’m often asked, did I know what I was doing? And the answer is, yes, I knew exactly what I was doing. I just had no notion whatsoever of what the ultimate impact would be. What I was doing was providing a way for people to communicate with other people.”5 At least some of the 400 billion emails sent daily6 are “Happy Birthday” wishes, so it has that going for it.
21st Century Virtual Communities
21st Century Virtual Communities
Early 2000s. Zuckerberg. Facebook.
Uluru in the Northern Territory of Australia is considered the world’s biggest rock. It is still not large enough for anyone over the age of 12 to hide under in a way that would prevent them from knowing that last name or that social networking service, which since its inception has grown to engage over 3 billion frequent users worldwide and spawned numerous competitors in the social media space.
Oh, by the way, when posting about the meeting on Instagram or LinkedIn or whatever online platform you prefer, don’t forget to add #ASTRO26 so the team can share your comments even more widely around cyberspace.
References
- Nowhere in this essay will I touch on the New England Patriots’ Spygate scandal of 2007, in which the team was found to have been surreptitiously videotaping. Sorry, I just won’t go there. You’ll have to read about it yourself. It isn’t exactly hard to find info, since it has its own Wikipedia page. https://en.wikipedia.org/wiki/Spygate_(NFL).
- https://www.mountvernon.org/george-washington/the-revolutionary-war/spying-and-espionage/spy-techniques-of-the-revolutionary-war. Accessed August 5, 2026.
- https://patents.google.com/patent/US174465A/en, accessed August 5, 2026.
- https://isitpatented.ai/guides/most-valuable-patents, accessed August 5, 2026.
- Grimes W. Raymond Tomlinson, Who Put the @ Sign in Email, Is Dead at 74. New York Times. March 7, 2016.
- Workplace Email Statistics 2025: Usage, Productivity, Trends. https://blog.cloudhq.net/workplace-email-statistics/. Accessed August 5, 2026.
