Premium Medicine: Proton Therapy
By Arnold Kling
From the New York Times.
The machines accelerate protons to nearly the speed of light and shoot them into tumors. Scientists say proton beams are more precise than the X-rays now typically used for radiation therapy, meaning fewer side effects from stray radiation and, possibly, a higher cure rate.
But a 222-ton accelerator — and a building the size of a football field with walls up to 18-feet thick in which to house it — can cost more than $100 million. That makes a proton center, in the words of one equipment vendor, “the world’s most expensive and complex medical device.”
…Some experts say there is a vast need for more proton centers. But others contend that an arms race mentality has taken hold, as medical centers try to be first to take advantage of the prestige — and the profits — a proton site could provide.
“I’m fascinated and horrified by the way it’s developing,” said Anthony L. Zietman, a radiation oncologist at Harvard and Massachusetts General Hospital, which operates a proton center. “This is the dark side of American medicine.”
The stray radiation, though, from the newest form of X-rays, called intensity-modulated radiation therapy, is already low, diminishing any advantages from proton therapy.
My father was diagnosed with esophageal cancer, one of the most difficult cancers to treat, in part because the surrounding tissue that might be damaged by stray radiation includes the heart and lungs, as well as healthy esophageal tissue. So the issue of being able to target radiation is something I can relate to.
But the Times article does not give us enough information to make cost-benefit estimates about proton therapy. If intensity-modulated radiation therapy costs less and is roughly equivalent, then these proton therapy centers are indeed a case of our health care system run amuck. In this case, you cannot blame private health insurance–the article says that it is Medicare, i.e., you and me, footing the bill.
Articles like this make me want to plug my book even harder. The use of what I dub “premium medicine” is, in my telling, the central facet of the U.S. health care story.