Cancer as parasite is an analogy I’ve been aware of, but I’ve never seen a cancer spreading between animals as a direct parasite (generally contagious spread is a result of viral hijacking causing changes in DNA that then leads to cancer).

Interesting — and potentially a disruptive way to think about cancer biology.

Scientists Report Findings on Origin of a Cancer in Tasmanian Devils – NYTimes.com.

The Tasmanian devil, the spaniel-size marsupial found on the Australian island of Tasmania, has been hurtling toward extinction in recent years, the victim of a bizarre and mysterious facial cancer that spreads like a plague.

Now Australian scientists say they have discovered how the cancer originated. The finding, being reported Friday in the journal Science, sheds light on how cancer cells can sometimes liberate themselves from the hosts where they first emerged. On a more practical level, it also opens the door to devising vaccines that could save the Tasmanian devils.

The cancer, devil’s facial tumor disease, is transmitted when the animals bite one another’s faces during fights. It grows rapidly, choking off the animal’s mouth and spreading to other organs. The disease has wiped out 60 percent of all Tasmanian devils since it was first observed in 1996, and some ecologists predict that it could obliterate the entire wild population within 35 years.

When the tumor disease was discovered, many scientists assumed that it was caused by a rapidly spreading virus. Viruses cause 15 percent of all cancers in humans and are also widespread in animals.

But subsequent studies failed to turn up a virus. Instead, Anne-Maree Pearse and Kate Swift, of the Department of Primary Industries, Water and Environment in Tasmania, discovered something strange about the tumor cells. The chromosomes looked less like those in the animal’s normal cells and more like those in the tumors growing in other Tasmanian devils.

In 2007, Dr. Belov and her colleagues compared DNA from 26 sick and healthy Tasmanian devils with DNA from the tumors. They found that cancer cells from different animals shared distinctive genetic markers not found in the animals themselves.

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.