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Hospitals Look to a Nuclear Tool to Fight Cancer
The feed points us to a NYTimes article about hospitals using particle accelerators to treat cancer. While expensive, proponents say that the proton beams generated by the accelerators are more precise than conventional X-ray radiation therapy. This results in fewer side effects and reduced irradiation of surrounding tissue. The technology's critics say that the cost is not justified by a measurable increase in the level of care given to the patients. Nevertheless, this is an excellent example of "pure scientific research" leading to a useful, unrelated technique. From the NYTimes:
"Tumors in or near the eye, for instance, can be eradicated by protons without destroying vision or irradiating the brain. Protons are also valuable for treating tumors in brains, necks and spines, and tumors in children, who are especially sensitive to the side effects of radiation."
critics is just a shorthand for "Insurance Companies" right?
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although 'modern' medicine offers some benefit, a lot of it is still 'guess your best' & experiment on the rest.
Some benefit? May I remind you that "Life expectancy at birth in the United States in 1900 was 47 years" (http://en.wikipedia.org/wiki/Life_expectancy)?
Compare that to the 77 years we enjoy today... But yeah, the fact that we live on average 30 years longer is just a detail.
Personally, who cares how expensive it is. I mean, we're not rich people and we are pretty close to that sarcastic "upper lower middle class" line.. but watching my wife go through chemo and surgery (no radiation, thank God) hurt me more than I can ever explain. If there was a way to make sure that radiation was a little "cleaner" and crisp around the edges, I'd say go for it. Chemo and surgery are hell enough.
Plus, x-rays are so last century. Everyone knows the new thing is protons.
Insurance companies frequently follow Medicare's lead, so we may find in a few years that we're paying gobs of money for proton beam treatments that do not offer better outcomes than alternatives. Once it gains acceptance as a standard treatment for cancers on which it offers no better outcome, we'll be paying a huge collective sum in taxes and insurance rates with no discernable benefit.
The article is mostly about the cost/benefit. The treatment has been around since 1990. Each center costs over $100M to build, so probably $10M/year to run. It can only treat a few thousand patients per year. At 2000/year and amortizing over 10 years, that's at least $10,000/patient just in facility cost. They say Medicare pays $50,000 per treatment so I can see why there is a rush to build these.
Intron: the portion of DNA which expresses nothing useful.
There's nothing new about using a "nuclear tool" in medicine.
http://outcampaign.org/
Now, for me, personally, every single procedure that has a reasonable chance of giving me a normal lifespan (I'm under 30, so figure another 40-60 years) is worth it. I want to live - who doesn't? But reality is that I have an incredibly rare (synovial sarcoma, 800-1000 new cases per year in the US), which is functionally much different than carcinomas (all the big killers, lung/breast/colon, are carcinomas) there isn't much research being done and drugs that are developed for carcinomas don't work for sarcomas. The best drugs they have are decades old. Once my cancer recurred, statistics said I had a 5-8% chance of surviving 10 years.
Now, let's estimate that treating me over the last three years has cost half a million dollars. Was it worth it? For me, my family, my friends, yes, anything the doctors can do is worth it. (I should note that I have insurance, good insurance, because I happen to live in a state with a high-risk pool http://www.mchamn.com/) But was I overtreated, given the probability of a cure? Probably. But it's a lot easier for me to say that now that I don't have any good options left. This article is essentially about the fact that in order to control health care costs, we need to make the decision about how much money to spend on people like me before we treat them. I just read a NYT review of Overtreated http://www.nytimes.com/2007/12/19/business/19leonhardt.html?, which speaks to this very issue. There was one line I particularly liked:
because most Americans think it's the other guy who's getting unnecessary treatment How do you choose who to treat, and who not to treat, and when to stop treatment even though there are more procedures the doctors could do? Yes, proton therapy is better than LinAc-based radiation, but how much, and for whom, and are we willing to pay a lot more for a marginally better outcome? Each of us as individuals will always be willing to pay more, because the added cost is spread over the whole insurance pool. Of course this cost- and risk-spreading is the entire point and benefit of insurance, so we can't throw the baby out with the bathwater. But we need to find a way to decide what is good enough, and how much treatment is enough.
It isn't so much a question of how much we can afford, but how much we are willing to spend, how many other things we are willing to give up as health care spending displaces other spending. Given the urgency of the debate in the US over the rising cost of health care, we are close to or even already past what we prefer to spend on health care. Slowing and stopping the growth in cost ultimately means slowing and stopping the growth (relative to GDP, at least) the growth in care. The politicians won't say it, but that's reality.
How are you going to solve it? Not the NHS way; not the Medicare/Medicaid way. But somehow. And no matter what you choose, someone isn't going to get all the treatment they possibly could, and they might (probably will) be upset. You can see the result of NOT choosing. Time to decide.