Bloomberg story: “Proton beam therapy like the death star of American medical technology”

Bloomberg reports,”Prostate Cancer Therapy Too Good to Be True Explodes Health Cost.”

It was Harvard health economist Amitabh Chandra who used the “death star” analogy in the story. He also said, “It’s a metaphor for all the problems we have in American medicine.” Further excerpts:

Yet even though the machines are breathtakingly expensive, hospitals and for-profit clinics are in a race to build proton- beam facilities for their prestige, perceived benefits, and potential revenue. One machine can generate as much as $50 million in annual revenue and new facilities are sprouting up around the country.

“It’s like a nuclear arms race now, everyone wants one,” said Anthony Zietman, a radiation oncologist at Boston’s Massachusetts General Hospital, which has had a proton-beam accelerator since 2001.

Proponents of the technology say it can zap cancerous tumors without damage to surrounding tissue. That’s a major benefit for the relatively small number of people who suffer from tumors of the spine, brain and eyes, where stray radiation may blind or paralyze, or in children who are more sensitive to radiation.

The therapy has even wider appeal for treating prostate cancer, a much more common disease, since existing treatment often causes rectal bleeding as well as impotence. More than 240,000 American men were diagnosed with prostate cancer in 2011, making it the nation’s most-diagnosed tumor, according to the American Cancer Society. Most of those men are potential candidates for proton-beam therapy.

“The easiest group to market to in the country is a group of men worrying about the functioning of their penis,” said Paul Levy, former head of Beth Israel Deaconess Medical Center in Boston.

The problem is that despite the push to build proton-beam facilities and the groundswell of enthusiasm for the treatments, it remains unclear whether the therapy does a better job of shrinking tumors or avoiding side effects than the far less costly traditional therapy. Clinical trials haven’t yet provided a clear picture proving the treatment’s worth for common tumors such as prostate cancer.

Lower rates of impotence, for one, are unlikely from the use of proton therapy because proton and traditional treatments deliver high doses of radiation to the nerves to the penis, Zietman said. So whether the pricey treatments will do a better job managing prostate cancer while also preserving sexual function is an open question.

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