Health News Review

A physician who is a frequent reader of this blog – and of other media – wrote the following note to me:

“This one from WSJ just left me speechless.  And I mean speechless.  Wow.

Can you clip the ACA, device tax, Medicare cuts, AHRQ, IPAB and pump up proton beam therapy in one shot–the latter being center of story? Yup. “

Let me explain his acronyms:

  • ACA = Affordable Care Act (or Obamacare)
  • AHRQ = US Agency for Healthcare Research & Quality
  • IPAB = Independent Payment Advisory Board

He saw an editorial in the Wall Street Journal, “A Parable of Health-Care Rationing.”

Read it and judge for yourself.  Excerpts:

When a provision of ObamaCare takes effect in January, IBA (a Belgian manufacturer of proton beam therapy devices) will face a fresh challenge: a 2.3% tax on medical-device sales. But the new tax still won’t pay for the millions of Americans who will gain or switch to publicly funded insurance. That’s why the government needs $716 billion in Medicare cuts, and why the health-care law creates an Independent Payment Advisory Board to help decide which treatments are worth what for whom.

A recent slew of government-funded studies helpfully suggest that Americans don’t need nearly so much health care. In April, research contracted by the federal Agency for Healthcare Research and Quality found that “proton therapy does not appear to provide additional benefit” against prostate cancer, which accounts for about half of all proton treatment.

Other studies disagree, as do online testimonials from men who have received the treatment. At any rate, (3 execs from 2 proton device manufacturers) all say they’re not scared of rationers or more studies, to which their companies are contributing.

“I sleep well at night knowing protons are fundamentally better to treat cancer than X-rays—substantially better, when anyone takes the time and effort to study it,” said (one proton device manufacturer exec).

But while he praises the “good intentions” behind ObamaCare, “the countervailing factor is that it’s pretty expensive for everyone to be covered, and it’s going to put a lot of pressure on the government to look for ways to cut costs. Down the line, someone’s going to have to pay the piper.”

For their part, (IBA execs) are excited about IBA’s latest offering, which will make cost-cutting somewhat more feasible: the ProteusONE, powered by a cyclotron weighing 35 tons versus the previous 220-ton model. The system will run about $30 million; the older version starts at $45 million.

I’m on the road today and can’t devote much more time to this myself for now.

Talk amongst yourselves.



Harold DeMonaco posted on November 2, 2012 at 11:43 am

“Other studies disagree, as do online testimonials from men who have received the treatment.” “I sleep well at night knowing protons are fundamentally better to treat cancer than X-rays—substantially better, when anyone takes the time and effort to study it,” said (one proton device manufacturer exec). Testimonials? That’s the best the proponents can offer? A couple of anecdotes and reference to unnamed studies?

The reality is that while there is great promise to this presumably more targeted form of therapy, that promise has yet to be demonstrated. Shame on the Wall Street Journal for publishing this infomercial. Rationale use of technology that provides a clear advantage over existing technologies is not rationing. Demanding demonstration of improved outcomes is what I would hope anyone paying for services would insist on. It is not the cost that is the critical issue but whether or not IBA’s technology offers any substantive improvement in survival in late stage prostate cancer and/or has a better side effect profile than existing forms of treatment. Suggesting that folks are not going to have access to this technology so that others can be covered is balderdash. Proton beam therapy for prostate cancer is not covered because it has not been demonstrated to be any better in terms of outcomes or side effects.

Gene Field posted on November 3, 2012 at 9:05 am

I am 74, have prostate cancer and completed Proton Therapy at MD Anderson. Admittedly, there is no difference in “Quantity of Life” with Proton. Virtually all treatment protocols kill cancer.
The difference is my “Quality of Life”. I am not a statistic, I am a real person with a life.

I interviewed approximately 40 + prostate cancer patients, in my age range, to get the “the patients view of side effects experienced”. They were remarkable in terms of real outcomes vs the statistics of Doctors providing competing treatment programs.
Proton Therapy is more precise and effective…that is why it is used for many in-operable cancers, includung pediatric brain cancers, etc.
We should be focused on making this superior technology more cost effective to improve our lives.
Being critical of a new technology is very easy. …and often self-serving..

    Harold DeMonaco posted on November 5, 2012 at 8:09 am

    I am happy to hear that your experience went well and hope that the cancer is behind you. I agree that quality of life is a very important aspect of the decision making process when thinking about cancer treatments. While I appreciate your comments about your poll of other men, it is in fact, a collection of anecdotes. And the plural of anecdote is not data.

    Yes, proton beam therapy has been shown to be life saving in what otherwise would be inoperable and untreatable brain tumors. It has not been shown to be an improvement over other forms of radiation therapy for prostate cancer. Proton beam therapy is an effective form of treatment. But it has yet to be shown to be better. That’s not my view but the view of the American Society of Radiation Oncology and others. The experts at the Massachusetts General Hospital recently launched a 5 year study to answer the question.

    Infomercials such as the recent WSJ editorial, are impressions and not the answer

Brad F posted on November 3, 2012 at 6:49 pm

How did you choose the 40 folks you spoke with and in considering effectiveness, what were your most helpful resources?

Also, what recommendations would you make to reduce the expense of this costly treatment? Does it matter?

kgapo posted on November 5, 2012 at 10:37 am

Until the certainty of the efficacy of proton beam over other types of radiation, why healthcare systems should bear the cost of this very very expensive therapy? Unless of course, manufacturers offer better prices and healthcare providers more reasonable price tags for therapy. Till that time I don’t see why debt ridden or financially unstable Europe feels the urge to jump into the proton wagon. Even we, in Greece, will get one, (it obtained financing from sources outside gov.) even though we miss plain linear accelerators in most major cities making cancer patients travel long distances to get their therapy or not getting it at all due to shut downs for maintenance…

keithmarton posted on November 5, 2012 at 4:14 pm

As someone who has been in health care for over 45 years and has been involved in technology assessment for more than half that time, I see the proton beam story as emblematic of what is wrong with American medicine.

1. As noted above, there is little to no evidence that proton beam therapy is better–either in terms of life expectancy or quality of life–than the more modern forms of radiation treatments, especially IMRT and other forms of targeted radiation.

2. While the newer forms of proton beam therapy are less expensive than the original forms, they are still many multiples of the cost of a standard radiation vault (usually around $2 million) . The proton beam device also takes up much more room than than a typical linear acceleration–and this is important in many landlocked health care facilities.

3. proton beam therapy, instead of being subjected to rigorous randomized controlled trials, is being sold via theoretical advantages and sophisticated marketing.

The result is that the American public is seeing yet another example of why our health care costs are so much higher than in other parts of the world without any accompanying rise in value. Expensive new technologies are introduced and sold to the market on a hope and a prayer rather than real evidence that they make a difference.