Small town newspapers and the medical arms race

OK, it’s “only” a small town newspaper.

But a lot of people live in small towns.

And a small town newspaper may be the biggest source of news about your local health care facilities.

So when The Tribune of Ames, Iowa published a story not about the University of Iowa’s longterm experience with proton beam therapy, not even about the University’s acquisition of a proton beam facility, but merely about the University requesting funding for a proton beam facility, it catches our attention.

And once you get into the story, you see how the locals are being set up to be dazzled by the latest and greatest in cancer treatment. Excerpts:

“The bottom line is that it is absolutely undeniable that protons theoretically are better,” said Dr. John Buatti, director of the UIHC Center for Excellence in Radiation Oncology, “therefore, technically, they are preferable.”

You don’t need to dust off your college logic textbook in order to see the incongruities in that quote. “Absolutely undeniable” it’s “theoretically better”??? Followed by, “Therefore, technically, they are preferable.”???

Another quote:

“I think this is the proper place to have protons available for the state,” Buatti said. “I don’t want to be in a position where we do not have that.”

I can understand why Dr. Buatti feels that way. Most doctors want to practice in a setting where they have the latest technology. But journalism – even at this hyperlocal level – needs to ask questions such as, “Does every state NEED a proton beam facility? Is Iowa racing to get one before Chicago has its in place? Before Minneapolis gets one?”

Instead, the story seems to try to put any doubts to rest with a concluding sentence:

“The UIHC expects to see a $37 million return on their investment over the first 10 years of the center’s operation, Buatti said.”

You bet they will. But a good story would crunch the numbers on how they expect to do that. What will the per-patient per-treatment charges be?

We’ve written about proton beam therapy before.

• We blogged about Merrill Goozner’s article in the Journal of the National Cancer Institute, “The Proton Beam Debate: Are Facilities Outstripping the Evidence?”

• We blogged about Dr. Michael Barry’s editorial in the Archives of Internal Medicine,
“The Prostate Cancer Treatment Bazaar.”

• We blogged about a story on some staggering numbers that show how “expensive prostate cancer treatments are winning out over the old standards, driving up the cost of treatment before there’s clear evidence that they improve outcomes.”

This is the kind of scrutiny, the kind of analysis, the kind of perspective that the citizens of the state of Iowa, the Board of Regents of the University, and that journalists must apply to these claims.

There are reasons why we spend a greater percentage of the GDP on health care than any other country, without the outcomes to match that spending, and we don’t have enough of a public discussion often enough about what those reasons might be. Starting with “the medical arms race” might not be a bad place to start.

Addendum 3 hours after original post: For a better perspective on this story, see what the Des Moines Register reported – better largely because they got the cautious perspective of Dr. Len Lichtenfeld of the American Cancer Society. Excerpt:

“This is one more escalation in a medical arms race,” said Dr. Len Lichtenfeld, an Atlanta oncologist who is deputy chief medical officer for the American Cancer Society.

Lichtenfeld said prostate cancers account for a large portion of the cases being treated with proton-beam therapy. He said there’s no proof that the new, expensive machines are better at treating prostate cancer.

But he said patients too often insist on treatment with “gee-whiz technology.”

Lichtenfeld said the new devices probably are better than standard treatments for a few, rarer kinds of tumors, including some types affecting brains and spines.

“I think what you need to do with these technologies is prove them safe, effective and useful,” which has not been done, he said. He said if a university decides to install one, it should pledge to use it mainly for research.

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Dave, RN

June 10, 2010 at 11:16 am

What’s more amazing (or maybe not)is that this article was read by it’s subscribers and most of them probably noded their heads in agreement.
We don’t think enough about what we read. Thanks for being the voice of reason.