Consumer Focused Health

The NYtimes details the newest weapon in the fight against cancer– a $100M+ particle accelerator straight out of Star Trek, which appears to have gargantuan impact– but more to hospital bottom lines than cancer patient survival (to date, the evidence appears, well, as theoretical as the focus of this equipment to date).

Some experts say the push reflects the best and worst of the nation’s market-based health care system, which tends to pursue the latest, most expensive treatments — without much evidence of improved health — even as soaring costs add to the nation’s economic burden.

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.

The payment system of today is part of the reason why hospitals can make such a large investment in a technology with unproven impact on mortality– Medicare payments for proton therapy runs about twice as high as payments for the existing X-ray technology. Why? Medicare continues to set prices in a top-down fashion and suffers from its legacy of cost-plus (at the time of initial pricing) reimbursement. This means that as procedures could get cheaper over time due to the experience curve, pricing doesn’t adjust, benefiting specialists performing procedures (and incenting them to do more for marginal patients). It also means that Medicare is more focused on paying for things “on sale” than they are making sure that its something the patient really wants/ needs (think about all those advertisements for “free” wheelchairs paid for by Medicare).

“There are no solid clinical data that protons are better” said Dr. Theodore S. Lawrence, the chairman of radiation oncology at the University of Michigan. “If you are going to spend a lot more money, you want to make sure the patient can detect an improvement, not just a theoretical improvement.”

Lack of data aside, men are flocking to proton treatment.

“I’m 67 years old, and the last thing I want to do is wear a diaper for the rest of my life,” said Pete Freeman of Spokane, Wash., who was undergoing treatment at Loma Linda.

Some men hear about proton therapy from the Brotherhood of the Balloon, a group of 3,000 men who have had the treatment. (A balloon is inserted into the rectum and filled with water to immobilize the prostate during treatment.)

The organization, which now gets some financial support from Loma Linda, was founded by Robert J. Marckini, a former Loma Linda patient who calls himself Proton Bob.

And herein lies the rub– if our government is paying twice the price, we should see twice the benefit– and today we don’t. Whereas, if individuals are driving demand for an unproven therapy, they should see the difference in cost– and they don’t.

I believe we need to move toward the consumer view of the world– but that also means that decisions need to happen because average Americans decide to open up their pocketbooks for the latest treatments, not because some random committee being lobbied by hospitals and device companies decides to open up our tax coffers for something that will yield zero return to society (many prostate cancers don’t even need to be treated aggressively to have limited impact prior to the end of normal lifespan).

The building of palaces to modern medicine shouldn’t come directly from taxpayer pockets, with no strings attached. But then again, arbitrary decisionmaking to spend our money comes with very low administrative cost.